Subcortical, thalamic and cortical somatosensory evoked potentials to median nerve stimulation

Somatosensory evoked potentials recorded from DBS electrodes: the origin of subcortical N18

The different peaks of somatosensory-evoked potentials (SEP) originate from a variety of anatomical sites in the central nervous system. The origin of the median nerve subcortical N18 SEP has been studied under various conditions, but the exact site of its generation is still unclear. While it has been claimed to be located in the thalamic region, other studies indicated its possible origin below the pontomedullary junction. Here, we scrutinized and compared SEP recordings from median nerve stimulation through deep brain stimulation (DBS) electrodes implanted in various subcortical targets. We studied 24 patients with dystonia, Parkinson's disease, and chronic pain who underwent quadripolar electrode implantation for chronic DBS and recorded median nerve SEPs from globus pallidus internus (GPi), subthalamic nucleus (STN), thalamic ventral intermediate nucleus (Vim), and ventral posterolateral nucleus (VPL) and the centromedian-parafascicular complex (CM-Pf). The largest amplitude of the triphasic potential of the N18 complex was recorded in Vim. Bipolar recordings confirmed the origin to be close to Vim electrodes (and VPL/CM-Pf) and less close to STN electrodes. GPi recorded only far-field potentials in unipolar derivation. Recordings from DBS electrodes located in different subcortical areas allow determining the origin of certain subcortical SEP waves more precisely. The subcortical N18 of the median nerve SEP-to its largest extent-is generated ventral to the Vim in the region of the prelemniscal radiation/ zona incerta.

Skin type and nerve effects on cortical tactile processing: a somatosensory evoked potentials study

Somatosensory evoked potential (SEP) studies typically characterize short-latency components following median nerve stimulations of the wrist. However, these studies rarely considered 1) skin type (glabrous/hairy) at the stimulation site, 2) nerve being stimulated, and 3) middle-latency (>30 ms) components. Our aim was to investigate middle-latency SEPs following simple mechanical stimulation of two skin types innervated by two different nerves. Eighteen adults received 400 mechanical stimulations over four territories of the right hand (two nerves: radial/median; two skin types: hairy/glabrous skin) while their EEG was recorded. Four middle-latency components were identified: P50, N80, N130, and P200. As expected, significantly shorter latencies and larger amplitudes were found over the contralateral hemisphere for all components. A skin type effect was found for the N80; glabrous skin stimulations induced larger amplitude than hairy skin stimulations. Regarding nerve effects, median stimulations induced larger P50 and N80. Latency of the N80 was longer after median nerve stimulation compared with radial nerve stimulation. This study showed that skin type and stimulated nerve influence middle-latency SEPs, highlighting the importance of considering these parameters in future studies. These modulations could reflect differences in cutaneous receptors and somatotopy. Middle-latency SEPs can be used to evaluate the different steps of tactile information cortical processing. Modulation of SEP components before 100 ms possibly reflects somatotopy and differential processing in primary somatosensory cortex.NEW & NOTEWORTHY The current paper highlights the influences of stimulated skin type (glabrous/hairy) and nerve (median/radial) on cortical somatosensory evoked potentials. Mechanical stimulations were applied over four territories of the right hand in 18 adults. Four middle-latency components were identified: P50, N80, N130, and P200. A larger N80 was found after glabrous skin stimulations than after hairy skin ones, regardless of the nerve being stimulated. P50 and N80 were larger after median than radial nerve stimulations.

Reconstructing subcortical and cortical somatosensory activity via the RAMUS inverse source analysis technique using median nerve SEP data

This study concerns reconstructing brain activity at various depths based on non-invasive EEG (electroencephalography) scalp measurements. We aimed at demonstrating the potential of the RAMUS (randomized multiresolution scanning) technique in localizing weakly distinguishable far-field sources in combination with coinciding cortical activity. As we have shown earlier theoretically and through simulations, RAMUS is a novel mathematical method that by employing the multigrid concept, allows marginalizing noise and depth bias effects and thus enables the recovery of both cortical and subcortical brain activity. To show this capability with experimental data, we examined the 14-30 ms post-stimulus somatosensory evoked potential (SEP) responses of human median nerve stimulation in three healthy adult subjects. We aim at reconstructing the different response components by evaluating a RAMUS-based estimate for the primary current density in the nervous tissue. We present source reconstructions obtained with RAMUS and compare them with the literature knowledge of the SEP components and the outcome of the unit-noise gain beamformer (UGNB) and standardized low-resolution brain electromagnetic tomography (sLORETA). We also analyzed the effect of the iterative alternating sequential technique, the optimization technique of RAMUS, compared to the classical minimum norm estimation (MNE) technique. Matching with our previous numerical studies, the current results suggest that RAMUS could have the potential to enhance the detection of simultaneous deep and cortical components and the distinction between the evoked sulcal and gyral activity.

Evoked Potentials During Peripheral Stimulation Confirm Electrode Location in Thalamic Subnuclei in Children With Secondary Dystonia

Deep brain stimulation is an elective surgical intervention that improves the function and quality of life in children with dystonia and other movement disorders. Both basal ganglia and thalamic nuclei have been found to be relevant targets for treatment of dystonia in children, including the ventral intermediate nucleus of the thalamus, in which stimulation can control dystonic spasms. Electrophysiological confirmation of correct electrode location within the ventralis intermediate nucleus is thus important for the success of the surgical outcome. The present work shows the evoked potentials response during contralateral median-nerve stimulation at the wrist at low frequency (9 Hz) provides physiological evidence of the electrode's localization within the thalamus. We show the correlation between evoked potentials and magnetic resonance imaging (MRI) and computed tomography (CT) in 14 children undergoing implantation of deep brain stimulation electrodes for secondary dystonia. High fidelity and reproducibility of our results provides a new approach to ensure the electrode localization in the thalamic subnuclei.

High test-retest-reliability of pain-related evoked potentials (PREP) in healthy subjects

Pain-related evoked potentials (PREP) is an established electrophysiological method to evaluate the signal transmission of electrically stimulated A-delta fibres. Although prerequisite for its clinical use, test-retest-reliability and side-to-side differences of bilateral stimulation in healthy subjects have not been examined yet. We performed PREP twice within 3-14days in 33 healthy subjects bilaterally by stimulating the dorsal hand. Detection (DT) and pain thresholds (PT) after electrical stimulation, the corresponding pain ratings, latencies of P0, N1, P1 and N2 components and the corresponding amplitudes were assessed. Impact of electrically induced pain intensity, age, sex, and arm length on PREP was analysed. MANOVA, t-Test, interclass correlation coefficient (ICC), standard error of measurement (SEM), smallest real difference (SRD), Bland-Altmann-Analysis as well as ANCOVA were used for statistical analysis. Measurement from both sides on both days resulted in mean N1-latencies from 142.39±18.12ms to 144.03±16.62ms and in mean N1P1-amplitudes from 39.04±12.26μV to 40.53±12.9μV. Analysis of a side-to-side effect showed for the N1-latency a F-value of 0.038 and for the N1P1-amplitude of 0.004 (p>0.8). We found intraclass correlation coefficients (ICC) from 0.88 to 0.93 and a standard error of measurement (SEM)<10% of mean values for all measurements concerning the N1-Latency and N1P1-amplitude. Intraclass correlation coefficients, standard error of measurement and Bland-Altman-Analyses revealed excellent test-retest-reliability for N1-latency and N1P1-amplitude without systematic error and there was no side-to-side effect on PREP. N1-latency (r=0.35, p<0.05) and N1P1-amplitude (r=-0.45, p<0.05) correlated with age and additionally N1-latency correlated with arm length (r=0.45, p<0.001). In contrast, pain intensity during the stimulation had no effect on both N1-latency and N1P1-amplitude. In summary, PREP showed high test-retest-reliability and negligible side-to-side differences concerning the commonly used parameters N1-latency and N1P1-amplitude.

Central motor and sensory conduction in patients with hepatic myelopathy

STUDY DESIGN

Experimental neurophysiological study.

OBJECTIVES

The hepatic myelopathy (HM) is characterized by progressive weakness and spasticity of the lower extremities, while there are only a few reports of sensory impairment. However, sensory function has been poorly explored in HM. We believe that an electrophysiological assessment of dorsal columns by somatosensory evoked potentials (SEPs) and of cortico-spinal lateral tracts by motor evoked potentials (MEPs) should be of considerable value in the functional evaluation of the spinal cord involvement in patients with HM.

SETTING

Salzburg (Austria) and Merano (Italy).

METHODS

Eight patients diagnosed with HM were studied with MEPs and SEPs. Neurological examination revealed different degrees of cortico-spinal tract involvement in all patients and sensory abnormalities in three patients.

RESULTS

Central motor conduction to lower limb muscles was abnormal in all patients, while central sensory conduction was abnormal in seven out of the eight patients. Both central motor and sensory conduction to upper limbs are normal in all patients.

CONCLUSION

The main finding is that electrophysiological evidence of central sensory involvement is present in a very high percentage of patients with HM, and that the threshold for electrophysiological abnormalities is below that for clinical manifestations. Therefore, central sensory and motor conduction studies are sensitive methods for detecting, localizing and monitoring spinal cord damage in HM.

Laser evoked potential recording from intracerebral deep electrodes

OBJECTIVE

To investigate whether recording from deep intracerebral (IC) electrodes can disclose laser evoked potential (LEP) components generated under the cerebral cortex.

METHODS

LEPs were recorded to hand and/or perioral region stimulation from 7 patients suffering from Parkinson's disease, who underwent implant of IC electrodes in the globus pallidum pars interna (GPi), in the subthalamic nucleus (STN) and in the pedunculopontine nucleus (PPN). LEPs were obtained from the IC electrode contacts and from the Cz vertex, referred to the nose.

RESULTS

The scalp traces showed a triphasic response (P1-N2-P2). The IC electrodes recorded two main components (ICP2 and ICN2), showing the same latencies as the scalp N2 and P2 potentials, respectively. The ICP2-ICN2 complex was sometimes preceded by a ICP1 wave at the same latency of the scalp P1 response.

CONCLUSIONS

The LEP components recorded from the IC electrodes mirrored the ones picked up from the Cz lead, thus suggesting that they are probably generated by the opposite pole of the same cortical sources producing the scalp responses.

SIGNIFICANCE

In the IC traces, there was no evidence of earlier potentials possibly generated within the thalamus or of subcortical far-field responses. This means that the nociceptive signal amplification occurring within the cerebral cortex is necessary to produce identifiable LEP components.

Is it possible to generate cerebral evoked potentials with a mechanical stimulus from the duodenum in rats?

The study aim was to develop a model to generate cerebral evoked potentials (CEPs) by mechanical distention of the duodenum in rats. Twenty Sprague-Dawley rats were anaesthetized and the EEG recorded from the left and right somatosensory cortices (S1L, S1R). A balloon catheter was implanted into the duodenum. A pneumatic device, triggered by data acquisition software, inflated the balloon for 200 ms every 3s to deliver a repeatable noxious stimulus. EEG was recorded for 100 ms before and 500 ms after onset of inflation and the response to 512 stimuli averaged to generate a CEP. Two CEPs were generated in each animal and data summed to calculate a single CEP for each channel. Data were excluded when the signal to noise ratio was < 2, therefore data are presented from 11 animals. A repeatable CEP was identified in waveforms recorded from S1L. The mean (S.D.) CEP comprised a triphasic waveform (P1, N1, P2) with latencies of 246.0 (24.7), 289.3 (12.8) and 321.5 (13.2)ms, respectively. We are the first group to have generated and characterized a CEP following mechanical stimulation of the duodenum. This model can be applied to further elucidate the mechanisms leading to visceral pain perception.

Fundamental principles of somatosensory evoked potentials

Studies of SSEP provide unique opportunities for investigating physioanatomic substrates of sensory pathway and cognitive functions of the sensory system. Progress of clinical investigation and application of SSEP have been stalled in more recent years, although SSEP still remain a useful tool for diagnosis of various neurologic disorders and for the monitoring of spinal cord function during surgery. Reflecting complex sensory system in human, scalp-recorded SSEP consists of multiple waves, having different distribution, amplitude, and latencies among different electrodes. The physioanatomic significance of these multiple waves, especially the late components, is largely unknown. These should be explored further, especially in relation to cognitive function.

Reduction in amplitude of the subcortical low- and high-frequency somatosensory evoked potentials during voluntary movement: an intracerebral recording study

OBJECTIVE

To investigate whether the reduction of amplitude of the scalp somatosensory evoked potentials (SEPs) during movement (gating) is due to an attenuation of the afferent volley at subcortical level.

METHODS

Median nerve SEPs were recorded from 9 patients suffering from Parkinson's disease, who underwent implant of intracerebral (IC) electrodes in the subthalamic nucleus or in the globus pallidum. SEPs were recorded from Erb's point ipsilateral to stimulation, from the scalp surface and from the IC leads, at rest and during a voluntary flexo-extension movement of the stimulated wrist. The recorded IC traces were submitted to an off-line filtering by a 300-1500 bandpass to obtain the high-frequency SEP bursts.

RESULTS

IC leads recorded a triphasic component (P1-N1-P2) from 14 to 22 ms of latency. The amplitudes of the scalp N20, P20 and N30 potentials and of the IC triphasic component were significantly decreased during movement, while the peripheral N9 amplitude remained unchanged. Also the IC bursts, whose frequency was around 1000 Hz, were reduced in amplitude by the voluntary movement.

CONCLUSIONS

Since the IC triphasic component is probably generated by neurons of the thalamic ventro-postero-lateral nucleus, which receive the somatosensory afferent volley, the P1-N1 amplitude reduction during movement suggests that the gating phenomenon involves also the subcortical structures.

Topographical relationships between the brainstem auditory and somatosensory evoked potentials and the location of lesions in posterior fossa stroke

The topographical relationships between the location of brainstem lesions detected by magnetic resonance imaging and abnormality of brainstem auditory evoked potentials (BAEPs) and short-latency somatosensory evoked potentials (SSEPs) were studied in 57 patients with stroke in the posterior fossa. Abnormal BAEPs or SSEPs were associated with lesions involving the pontine tegmentum, and abnormal BAEPs also with lesions at the cerebellar peduncle. Absence of the V wave in BAEPs and N20 in SSEPs was associated with a localized overlapping area in the pontine tegmentum contralateral to stimulation. The overlapping area associated with loss of N20 coincided with the location of the medial lemniscus. Lesions widely involving the pontine tegmentum caused the disappearance of multiple waves in the BAEPs and SSEPs. Patients who entered prolonged coma or died had total loss of the III, IV, and V waves, bilateral absence to the contralateral response in BAEPs, or loss of N18 in SSEPs. The loss of N18 in SSEPs had a statistically significant correlation with bad outcome, which suggests the superiority of SSEPs for predicting the outcome of stroke and indicates the involvement of some system excluding the medial lemniscus in the generation of N18.

Neuromagnetic somatosensory responses to natural moving tactile stimulation

OBJECTIVE

To explore the somatosensory cortical responses to natural moving tactile stimulation in adult subjects using magnetoencephalography.

METHODS

We measured cortical somatosensory magnetic evoked fields (SEFs) to moving tactile stimuli by a brush over the right thumb once every 1.5 s in seven subjects. Electric SEFs with various intensity or simulated jitter were used for comparison.

RESULTS

Tactile SEFs in primary somatosensory cortex (SI) consisted of two deflections: N24mT and P55mT. Electric SEFs consisted of N24mE, P30mE, P40mE, and P55mE. The amplitude of N24mT was only 34% +/- 12% of N24mE, whereas P55mT and P55mE were of about the same size. With increased jitter or decreased intensity, attenuation of electric SEFs was more clearly found in early deflection than late deflection.

CONCLUSIONS

Natural moving tactile stimulation produced simpler cortical somatosensory waveforms in comparison with electric SEFs, partly related to less sharp intensity and stimulation jitter with moving tactile stimulation. We propose that of all the afferent fibers conveying the early deflection, the low threshold components participate the generation of the late deflection.

Source generators of the early somatosensory evoked potentials to tibial nerve stimulation: an intracerebral and scalp recording study

OBJECTIVE

To investigate the location of the cerebral generators of the early scalp somatosensory evoked potentials (SEPs) after tibial nerve stimulation.

METHODS

Tibial nerve SEPs were recorded in 15 patients, suffering from Parkinson's disease, who underwent implantation of intracerebral (IC) electrodes in the subthalamic nucleus, in the globus pallidum or in the thalamic ventralis intermediate nucleus. SEPs were recorded both from the scalp surface and from the IC leads.

RESULTS

The lemniscal P30 response was recorded by all the electrodes. The IC waveforms included a negative N40IC response, followed by a positive (P50IC) and a negative (N60IC) potential. The N40IC, the P50IC and the N60IC potentials did not differ in latency from the P40, the N50 and the P60 responses recorded by the Cz electrode. In 6 patients, in which SEPs were recorded also during the voluntary movement of the stimulated foot (active gating), an amplitude reduction of the SEP components following the P30 potential was observed during movement at the vertex and in the IC traces. Instead, in the contralateral temporal traces the SEP components (N40temp and P50temp) were not modified by active gating, and in the ipsilateral parietal traces only the positive potentials at about 60ms of latency was decreased.

CONCLUSIONS

Two differently oriented generators are active in the contralateral hemisphere at both 40 and 50ms of latency after tibial nerve stimulation. One source is oriented perpendicularly to the mesial hemispheric surface and generates the potentials recorded by the contralateral temporal and the ipsilateral parietal leads; the other dipolar source is radial to the hemispheric convexity, and generates the potentials at the vertex and those recorded by the IC electrodes.

Median nerve somatosensory evoked potentials recorded with cephalic and noncephalic references in central and peripheral nervous system lesions

Somatosensory evoked potentials (SSEP) to electrical stimulation of the median nerve by using cephalic and noncephalic references were studied to detect the generator sources of short latency evoked potentials in 29 patients with cerebral, brainstem, spinal and peripheral nerve lesions. Patients were divided into six groups according to the localization of their lesions: group 1: cortical and subcortical lesions, group 2: basal ganglion lesions, group 3: pons and mesencephalon lesions, group 4: diffuse cerebral lesions, group 5: cervical cord lesions, group 6: brachial plexus lesions. Potentials were recorded using cephalic and noncephalic references after median nerve stimulation. Evidence obtained from patients suggested the following origins for these short latency SSEPs: P9 may arise in brachial plexus, P11 in dorsal basal ganglions or dorsal column, P13 and P14 in the nucleus cuneatus and lemniscal pathways, N16 in subthalamic structures and most likely mid and lower pons, N18 from the thalamus and thalamocortical tract, and N20 from primary somatosensory cortex.

Linking 600-Hz "spikelike" EEG/MEG wavelets ("sigma-bursts") to cellular substrates: concepts and caveats

Somatosensory evoked human EEG and magnetoencephalographic (MEG) responses comprise a brief burst of low-amplitude, high-frequency (approximately 600 Hz) spikelike wavelets ("sigma-bursts") superimposed on the primary cortical response (e.g., the N20 to electrical median nerve stimulation). The recent surge of interest in these macroscopic sigma-burst responses is energized by the prospect of monitoring noninvasively, highly synchronized and rapidly repeating population spikes generated in the human thalamic and cortical somatosensory system. Thus, analyses of spike-related sigma-bursts could uniquely complement conventional low-frequency EEG/MEG, reflecting mass excitatory and inhibitory postsynaptic potentials that potentially also incorporate subthreshold activities of undetermined functional relevance. Recent studies using spatiotemporal source analysis of multichannel recordings identified regional burst sources subcortically (near-thalamic) as well as cortically. At the primary somatosensory cortex, sigma-burst generators showed the well-established homuncular somatotopic ordering. Functionally, the 600-Hz burst appears to comprise multiple subcomponents with differential sensitivity to stimulus rate, intensity, sleep-wake cycle, tactile interference, subject age, and certain movement disorders. A plenitude of cellular candidates contributing to burst generation at different levels can already now be envisaged, including cuneothalamic and thalamocortical relay cells, as well as cortical bursting pyramidal cells and fast-spiking inhibitory interneurons. Although cellular burst coding might serve to relay information with high efficiency, concepts to link macroscopic sigma-bursts and cellular substrates call for additional study.

Differential effects of muscle contraction from various body parts on neuromagnetic somatosensory responses

We studied eight healthy subjects with a whole-scalp 306-channel neuromagnetometer to explore the effect of motor activity from different body parts on somatosensory responses to left median nerve stimulation. The stimuli produced clear tactile sensation without any motor movement. In the rest condition, the subject had no task. During contraction conditions, the subject had to maintain submaximal isometric contraction in masseter, left deltoid, left thenar, or left tibialis muscles. Short-latency responses from the primary somatosensory cortex did not change during contraction. Responses from both the right (contralateral) and left second somatosensory cortices (SII) were significantly enhanced during contraction of the left thenar muscles. Responses from the left SII were significantly enhanced also during contraction of the left deltoid muscles, but they were decreased during contraction of the masseter and left tibialis anterior muscles. This study implies that SII activation is modulated by motor activity and that the effect depends on the topographical proximity of the stimulated and contracted body parts.

Parallel processing of sensory inputs: an evoked potentials study in Parkinsonian patients implanted with thalamic stimulators

In two drug-resistant Parkinsonian subjects, who underwent thalamic chronic stimulation for extrapyramidal symptoms relief, median nerve somatosensory evoked potentials (SEPs) were recorded before and at different times following the thalamic lead implant. In both subjects, a transient obliteration of post-rolandic SEPs components was detected; pre-rolandic waves' amplitude was preserved or showed a tendency to increase after the beginning of chronic stimulation. Parietal waves' amplitude totally recovered pre-surgical values after 1 month. Latency of both pre- and post-central components remained stable. The 'dissociate behaviour' of the examined waves following the thalamic implant reinforces the hypothesis that short-latency sensory inputs are processed by separate and independent routes which are functionally segregated at subcortical level.

Sensorimotor integration in human primary and secondary somatosensory cortices

We measured somatosensory evoked fields (SEFs) to electric median nerve stimuli from eight healthy subjects with a whole-scalp 122-channel neuromagnetometer in two different conditions: (i) 'rest', with stimuli producing clear tactile sensation without any motor movement, and (ii) 'contraction' with exactly the same stimuli as in 'rest', but with the subjects maintaining sub-maximal isometric contraction in thenar muscles of the stimulated hand. The aim was to study the role of the primary (SI) and secondary somatosensory (SII) cortices in sensorimotor integration. The amplitude of the SI response N20m did not change with coincident isometric contraction, whereas P35m was significantly reduced. On the contrary, activation of contra- and ipsilateral SII cortices was significantly enhanced during the contraction. We suggest that isometric contraction facilitates activation of SII cortices to tactile stimuli, possibly by decreasing inhibition from the SI cortex. The enhanced SII activation may be related to tuning of SII neurons towards relevant tactile input arising from the region of the body where the muscle activation occurs.

Functional involvement of central nervous system in mitochondrial disorders

Thirty-nine patients with mitochondrial diseases were studied with somatosensory and motor evoked potentials. Sixteen patients (41%) had clinical and 12 (31%) had neuroradiological evidence of central nervous system involvement. The overall incidence of electrophysiological abnormalities was 64%. Abnormal evoked potentials were also found in a significant percentage (33%) of patients with pure myopathic forms of mitochondrial diseases and in an asymptomatic carrier of MERRF mutation. Of the individual tests, somatosensory evoked potentials were abnormal in 49% of the patients and motor evoked potentials were abnormal in 46% of the patients. The outcome is that electrophysiological evidence of central nervous system involvement is present in a high percentage of patients with mitochondrial disorders, and that the threshold for central nervous system electrophysiological abnormalities is well below that for clinical and/or radiological manifestations.

Ipsilateral median somatosensory evoked potentials recorded from human somatosensory cortex

Somatosensory evoked potentials (SEP) to ipsilateral and contralateral median nerve stimulations were recorded from subdural electrode grids over the perirolandic areas in 41 patients with medically refractory focal epilepsies who underwent evaluation for epilepsy surgery. All patients showed clearly defined, high-amplitude contralateral median SEPs. In addition, four patients showed ipsilateral SEPs. Compared with the contralateral SEPs, ipsilateral SEPs were very localized, had a different spatial distribution, were of considerably lower amplitude, had a longer latency (1.2-17.8 ms), did not show an initial negativity, and were markedly attenuated during sleep. Stimulation of the subdural electrodes overlying the sensory hand area was associated with contralateral hand paresthesias, but no ipsilateral hand paresthesias, occurred. It was concluded that subdurally recorded cortical SEPs to ipsilateral stimulation of the median nerve (M) reflect unconscious sensory input from the hand possibly serving fast bimanual hand control. The anatomical pathway of these ipsilateral short-latency MSEPs is not yet known. Transcallosal transmission seems unlikely because of the short delay between the ipsilateral and contralateral responses in selected cases. The infrequent occurrence of ipsilateral subdurally recorded SEPs and their low amplitude and limited distribution suggest that they contribute very little to the short-latency ipsilateral median SEPs recorded on the scalp.

Somatosensory evoked potentials to median nerve stimulation in meningomyelocele: what is occurring in the hindbrain and its connections during growth?

Twenty patients with meningomyelocele (MMC) and shunted hydrocephalus, ranging in age from 3 to 23 years old, underwent serial recording of short-latency somatosensory evoked potentials (SEPs) to median nerve stimulation, on the basis of which to assess the evolution of dysfunction in the brainstem and its connections (cervical spinal cord, cervical nerve roots, lower cranial nerves). Eighteen patients had Chiari type II malformations, none of which was symptomatic. In all 20 patients, serial SEP recordings were obtained repeatedly after periods ranging from 2 to 7 years. The results were as follows: (1) the ratio of EP-N13 interpeak latencies (IPLs) to body height (BH) tended to lengthen gradually after starting in the normal range with growth. (2) In contrast, the ratio N13-N20 IPLs/BH decreased continuously to the normal range with growth, after initial prolongation. These findings and our earlier studies of brainstem auditory evoked potentials suggest that compression and traction result in strangulation of the cervical spinal cord and kinked medulla as well as stretching of the cervical nerve roots and lower cranial nerves. However, primary intrinsic functional disorders of the brainstem appeared to improve gradually during growth. The natural history of Chiari type II malformations involves these opposing dynamic phenomena in the hindbrain and its connections.

Frontal intermittent rhythmic delta activity (FIRDA) in pituitary adenoma

We report a case of FIRDA in the EEG of a patient diagnosed as major depression with pituitary adenoma and hyponatremic encephalopathy. The pituitary adenoma appeared to be a major factor responsible for FIRDA in this case. Although other factors associated with this case, i.e., diffuse encephalopathy and administration of antipsychotic drugs, have been reported to be causative, FIRDA remained in the EEG after these other factors diminished. Although size of the pituitary adenoma that might be associated with FIRDA in the EEG recording was not identified in this study, FIRDA may be associated with a small pituitary adenoma less than 10 mm in diameter. We think a diligent search for additional pathology is recommended if FIRDA is seen in the EEG of an otherwise normal patient.

Sympathetic skin responses evoked by magnetic stimulation of the neck

We studied sympathetic skin responses (SSRs) following magnetic stimulation of the neck in 40 normal subjects and 54 patients with neurological diseases and active sweat gland densities (ASGDs) at the foot induced by pilocarpine in 39 patients. SSRs at the hand following magnetic stimulation showed the lowest coefficients of variability of the latencies and amplitudes in eight consecutive responses compared with SSRs following other types of stimuli (electrical and auditory stimulation, and deep inspiration) in 12 normal subjects. Fourteen of 38 patients with neuropathies (37%) showed the presence of SSRs after magnetic stimulation, but not after median nerve stimulation, although SSRs to magnetic stimulation corresponded with those to nerve stimulation in all patients with multiple sclerosis or multiple system atrophy. These results suggest that the absence of SSRs after nerve stimulation in patients with neuropathies may be due to abnormalities of the peripheral sensory afferent fibers. ASGDs significantly correlated with SSRs at the foot following magnetic stimulation, but not with those following nerve stimulation in patients with neuropathies. Magnetic stimulation of the neck is the highly reproducible method of evoking SSRs because this technique is able to produce strong sensory afferent inputs proximally. Furthermore, SSRs following magnetic stimulation, little influenced by sensory afferent fiber involvement, are very useful for evaluating the postganglionic sympathetic function in patients with neuropathies.

Effect of manipulation and fractionated finger movements on subcortical sensory activity in man

Previous studies have shown that the somatosensory evoked potentials (SEPs) recorded from the scalp are modified or gated during motor activity in man. Animal studies show corticospinal tract terminals in afferent relays, viz. dorsal horn of spinal cord, dorsal column nuclei and thalamus. Is the attenuation of the SEP during movement the result of gating in subcortical nuclei? This study has investigated the effect of manipulation and fractionated finger movements of the hand on the subcortically generated short latency SEPs in 9 healthy subjects. Left median nerve SEPs were recorded with electrodes optimally placed to record subcortical activity with the least degree of contamination. There was no statistically significant change in amplitude or latency of the P9, N11, N13, P14, N18 and N20 potentials during rest or voluntary movement of the fingers of the left hand or manipulation of objects placed in the hand. The shape of the N13 wave form was not modified during these 3 conditions. It is concluded that in man attenuation of cortical waves during manipulation is not due to an effect of gating in the subcortical sensory relay nuclei.

[Evoked potentials by median nerve stimulation (SSEP): subcortical components]

Este estudo constitui uma revisão de literatura realizada com a finalidade de se relacionar a designação, as características dos campos de potencial e os geradores implicados, para os componentes subcorticais do potencial evocado somatossensorial por estimulação do nervo mediano no punho.

Central sensory and motor conduction in vitamin B12 deficiency

Four patients with subacute combined degeneration were studied through upper and lower limb SEPs recorded with a non-cephalic reference montage and through cortical and spinal magnetic stimulation. Clinical signs were confined to the lower limbs in 3 patients; the remaining patient presented only paraesthesiae in 4 limbs. Median nerve SEPs showed a normal cervical N13 response with a significant increase of central conduction time concerning exclusively the P9-P14 interpeak interval. Central motor conduction to upper and lower limb muscles was abnormal. Nerve conduction studies provided no evidence of peripheral nerve involvement. These electrophysiological findings suggest that in vitamin B12 deficiency the higher segments of the cervical cord are usually affected first and that central sensory and motor conduction studies are sensitive methods for detecting such damage.

Epilepsy in schizencephaly: abnormal cortical organization studied by somatosensory evoked potentials

Median nerve short-latency somatosensory evoked potentials (MN-SSEP) are recorded from the scalp to assess parietal lobe function and from the cortex to identify primary sensory and motor areas before epilepsy surgery. Nevertheless, the origins of many of the MN-SSEP waveforms and the reliability of this technique for localizing the central sulcus are not definitively known. We studied a child with a unilateral, closed, right parietal schizencephalic cleft and frequent simple partial seizures before the child underwent cortical resection. The sensory examination, neuroimaging, and electrical brain stimulation findings indicated a normal thalamus and an abnormal parietal lobe. Scalp-recorded MN-SSEPs showed intact widespread N18 potentials bilaterally, but absent right, although normal left parietal N20 and P27 waveforms. Cortically recorded MN-SSEPs could not localize the central sulcus owing to an absence of the expected negative potential over the right postcentral gyrus and the presence of waves with abnormal latencies over the precentral cortex. These findings suggest that: (a) the N18 potential probably originates at or below the level of the thalamus, (b) the N20 and P27 peaks are most likely generated by parietal cortex or white matter, and (c) cortically recorded MN-SSEPs can fail to localize the central sulcus before epilepsy surgery when congenital anomalies exist in the parietal lobe.

Current source density mapping of somatosensory evoked responses following median and tibial nerve stimulation

Potential recording of brain activities always encounters the problem resulting from the activation of reference electrodes. Current source density (CSD) computation does not take reference sites into account and consequently may better localize the generator sources. In the past, several attempts have been made to record CSDs of the somatosensory evoked responses (SERs) following median nerve stimulation. In order to compare the generating mechanisms of SERs following median nerve and tibial nerve stimulation, the scalp CSD distributions of the median nerve SER and the tibial nerve SER were compared in 5 normal subjects. In the median nerve SER, far-field potentials such as P14 and N16 were abolished in the CSD records. N20, P25 and N35 showed almost identical CSD distributions, albeit P25 had a reversed polarity. By contrast, the tibial nerve SER showed similar distributions for P40 and P60 CSDs, but N50 had a different distribution from the others. In the potential records, P40 and P60 were distributed predominantly ipsilateral to the stimulus (paradoxical lateralization), whereas the P40 and P60 CSDs formed a dipole localized over the contralateral foot somatosensory area. N50 disclosed the same tendency, although it had a slightly different CSD pattern from that of P40 and P60. These findings suggest that the median nerve and tibial nerve SER components are not necessarily comparable and that under certain circumstances CSDs are better indicators of local electrical events than the corresponding potentials.

Morphological characteristics of the scalp far-field potentials evoked by median nerve stimulation in infants and children

We investigated the somatosensory evoked potentials (SEPs) produced by median nerve stimulation in normal infants, children and adults, focussing upon the wave forms of the scalp far-field potentials (FFPs). In adolescents and adults, 3 or 4 positive FFPs preceded the widespread N18 component on the scalp, corresponding to P9, P11, P13 and P14 (or P13-14). In infants and children, however, the scalp FFPs often included 5 positive waves, the initial three of which were characteristically sharp and brief. This distinctive wave form, with 5 positive FFPs, was correlated with an Erb's potential having a bipeaked negative phase. We studied the temporal relationship of the 5 positive FFPs to the Erb's potential and the cervical SEPs and concluded that the initial 3 brief positive waves were produced by overlapping of a bipeaked "P9" and bipeaked "P11." Both "P9" and "P11" are stationary waves that are thought to originate in the first-order afferents, so they probably reflect the bipeaked appearance of the compound nerve action potential.

The effect of hypercholesterolemia on SEPs recorded from rats

Twenty-four albino rats, weighing 180-200 g were studied. Twelve of them were fed with a diet containing 1% cholesterol for 12 weeks and the others were fed with a normal lab diet for the same period. As a result, plasma cholesterol level was found in the diet group 134.04 +/- 21.11 mg/dl with respect to control 72.72 +/- 10.5 mg/dl. In the two groups, following left posterior tibial nerve (PTN) stimulation, SEPs were recorded from central (Cz) referenced to frontal (Fz). In the hypercholesterolemic group, the first negative component (N24) was found to be prolonged (p less than .001) and the peak-to-peak amplitudes (N24P40, P40N80) were observed to be decreased (p less than .001). These results have shown that the latency and amplitude can be changed by hypercholesterolemia.

White matter lucencies in multi-infarct dementia: a somatosensory evoked potentials and CT study

White matter low attenuation (WMLA) on computed tomography (CT) and the central conduction time (CCT) measured by median nerve-somatosensory evoked potentials were examined in 12 multi-infarct dementia (MID) patients, 10 patients with multiple infarcts (MI) without dementia and 11 age-matched controls. Patients with deep vascular lesions without cortical infarcts on CT were included. In MID, prolongation of CCT and moderate to severe WMLA were observed. The CCT and WMLA in MI patients were intermediate. The CCT was longer when the WMLA was more extensive. The result suggests that white matter disease in MID is concerned to the occurrence of dementia by disturbing axonal conduction.

Origin of scalp far-field N18 of SSEPs in response to median nerve stimulation

To identify the origin of scalp-recorded far-field negativity of short-latency somatosensory evoked potentials to median nerve stimulation (designated N18), direct records were made from the thalamus and ventricular system during 4 stereotaxic and 3 posterior fossa operations. In the thalamus a negative potential with almost the same latency as the scalp N18 was restricted to the Vim nucleus, but there was a large positive potential in the VC nucleus and medial lemniscus. Vim negativity increased in amplitude when high frequency stimulation was given to the median nerve, indicative of a facilitation effect. In contrast, the amplitude of scalp N18 decreased at high frequency stimulus. Direct recordings made through the medulla oblongata to the mid-brain showed a negative potential with gradually increasing latency. Above the upper pons, there was stationary negativity with no latency shift. The similarity between this negative potential and N18 is shown by their having the same latency and same response to the amplitude reduction and latency prolongation produced by high frequency stimulus. Our data suggest that scalp N18 comes from brain-stem activity between the upper pons and the mid-brain rather than from the thalamus.

[Anomalies in early somatosensory evoked potentials in brain stem lesions (study of 64 cases)]

Short latency somatosensory evoked potentials (SEPs) have been recorded in 64 patients with brainstem lesions documented by neuroimaging techniques. Patients were classified in four groups according to the lesion topography: cervico-medullary junction and medulla (16 cases), pons (19 cases), mesencephalon (8 cases), extensive (21 cases). SEPs were abnormal in 57.8% of cases either bilaterally (17.2%), or unilaterally (40.6%). The different components were affected as follows, P14: 34.4%; N20: 56.9%; P22 and N30: 54.7%, peripheral and spinal responses were always spared: N18 and P14 abnormalities were highly correlated. In cervico-medullary lesions P14 and N20 were constantly abnormal, P14 was normal in strictly mesencephalic lesions but could be abnormal in cases of subthalamic lesions with mesencephalic extension; in pontic lesions, P14 could be normal or not, and N20 was always very reduced. These results confirm that P14 has a supra-spinal origin and may have two generators. SEPs detected a subclinical dysfunction of the lemniscal pathways in 18% of patients with normal somatosensory performances and, as BAEPs (abnormal in 54% of the 54 recordings performed in this series) deserve to be recorded for the routine investigation of brainstem function.

Neurophysiological study in chronic GM2 gangliosidosis (hexosaminidase A and B deficiency), with motor neuron disease phenotype

We report the electrophysiological investigation of two adult cases with GM 2 gangliosidosis with hexosaminidase A and B deficiency. Superficial peroneal biopsy was obtained from one patient. The electrophysiological alterations of the peripheral nervous system were fasciculations, signs of collateral reinnervation and loss of motor units, decrease in sensory potential amplitude and increase in distal motor latency. Increase in N9-N13 interpeak latency of the somatosensory evoked potentials and an increase I-V interpeak latency of the brain-stem auditory potentials were evident in both cases. Visual evoked potentials were normal. Nerve biopsy showed a severe loss of myelinated fibers, especially of those with the largest diameter, with no signs of segmental demyelination, or remyelination. A tentative interpretation of our findings is given.

Clinical utility of somatosensory evoked potentials in diabetes mellitus

The posterior tibial nerve and median nerve somatosensory evoked potentials (PTN-SEPs and MN-SEPs) were investigated in 34 patients with diabetes mellitus (DM). We measured the latency of the first positive cortical potential (the cortical P37) of PTN-SEPs and that of the first negative cortical potential (the cortical N18) and Erb's potential of MN-SEPs. In 18 patients (52.9%), the cortical P37 latency was more than 3 SD longer than normal in the tibial nerve. There were positive correlations between the latency of cortical P37 and the duration of DM and the motor nerve conduction velocity of the posterior tibial nerve. Sensory action potentials of the posterior tibial nerve were not detectable in 21 patients, though cortical P37 potential was unambiguously recorded by stimulating the posterior tibial nerve even in those subjects. Diabetic retinopathy and nephropathy also tended to rise with increasing latency of cortical P37. The latency of cortical P37 is an important parameter in assessing diabetic neuropathy.

Origin and distribution of thalamic somatosensory evoked potentials in humans

The distribution and generator sources of somatosensory evoked potentials (SEPs) in the thalamus and subthalamic area were studied, using a 'semi-microelectrode' during stereotaxic surgery on 34 patients with involuntary movements or intractable pain. Electrical stimulation was given to the median nerve at the wrist. Two distinct SEPs were evoked by contralateral stimulation. A high voltage (160 microV) positive SEP with a peak latency of 15.5 msec was strictly confined to the ventral part of the sensory relay nucleus (nucleus ventro-caudalis, V.c). A much lower voltage, positive-negative-positive triphasic SEP showed peak latencies of the initial positivity and the major negativity of 13.3 msec and 16.0 msec, respectively, and had maximal voltage (16 microV) in the ventralmost parts of the nucleus ventro-intermedius (V.im) and radiatio praelemniscalis (Ra.prl), and substantial potentials in the lemniscus medialis (L.m) and nucleus ventro-oralis posterior (V.o.p). The potential field of the triphasic SEP spread farther across the different thalamic nuclei and subthalamic region with identical configurations and peak latencies, but with decreasing amplitude. These findings suggest that the high voltage positive SEP reflects a postsynaptic potential generated by the V.c neurons, and the smaller triphasic SEP a presynaptic axonal potential generated in the rostral part of the lemniscal pathway, extending by means of volume conduction.

The use of somatosensory evoked potentials in infants and children

Somatosensory evoked potentials (SSEPs) are a useful, reliable means of assessing function of the somatosensory system. Complex maturational changes of the CNS such as synaptogenesis and myelination, as well as body growth, complicate interpretation of SSEPs. An understanding of these factors enhances clinical interpretation in infants and children.

Far field correlates of thalamic activity in cortical and cervical somatosensory evoked potentials

Median nerve cortical and cervical somatosensory evoked potentials (SEPs) were recorded from a group of normal adults in order to study far field reflections of thalamic activity. In the cortical SEP, the primary response (N20) was preceded by two inflections (N16 and N18). It is shown that these two potentials bear a close temporal relationship to a positive trough on the downward slope of the principal negativity (N13) in the cervical SEP. This potential, which is often bifurcated into two subcomponents, is labeled P17 and it has previously been suggested that it originates in or near the thalamus. The coincidence between the P17 complex and N16 and N18 inflections is consistent with the hypothesis that all three responses are generated in either the thalamic relay nucleus or the thalamo-cortical radiations. Possible clinical applications of recording far field thalamic potentials are discussed.

Topography of somatosensory evoked potentials to median nerve stimulation in patients with cerebral lesions

Scalp distributions and topographies of early cortical somatosensory evoked potentials (SEPs) to median nerve stimulation were studied in 22 patients with 5 different types of cerebral lesion due to cerebrovascular disease or tumor (thalamic, postcentral subcortical, precentral subcortical, diffuse subcortical and parieto-occipital lesions) in order to investigate the origins of frontal (P20, N24) and central-parietal SEPs (N20, P22, P23). In 2 patients with thalamic syndrome, N16 was delayed in latency and N20/P20 were not recorded. No early SEP except for N16 was recorded in 2 patients with pure hemisensory loss due to postcentral subcortical lesion. In all 11 patients with pure hemiparesis or hemiplegia due to precentral subcortical lesion N20/P20 and P22, P23/N24 components were of normal peak latencies. The amplitude of N24 was significantly decreased in all 3 patients with complete hemiplegia. These findings support the hypothesis that N20/P20 are generated as a horizontal dipole in the central sulcus (3b), whereas P23/N24 are a reflection of multiple generators in pre- and post-rolandic fissures. P22 was very localized in the central area contralateral to the stimulation.

Dipole-tracing of 'awareness' attenuating the cortical components of somatosensory evoked potentials

Using the dipole-tracing method, the source generators of N18, P22 and P40 of the somatosensory evoked potential (SEP) were estimated as the equivalent dipole. After voluntary action of the thumb flexion, no changes were observed in N18 or P40, but the amplitude of P22 was suppressed. The after-effects of intention accompanied by a voluntary action or the subject's awareness that electrical stimulation will be given after the voluntary action were treated as 'awareness'. By subtracting the pure SEP from SEP during 'awareness', it was found that the equivalent dipole of 'awareness' of P22 was located at the same region of pure P22, but the vector was of opposite orientation. 'Awareness' attenuated the perceptive potential of SEP like P22 generated in the cortex.

Topographical displays of somatosensory evoked potentials

The distribution of somatosensory evoked potentials (SEPs) after stimulation of the median nerve at the wrist was examined in 10 normal subjects using isopotential maps. The latencies of continuous negative and positive peaks were measured in each lead. The differences of the potentials at these latencies were measured in all the leads and the isopotential maps were constructed. The distribution of P0-NI was all similar. The latencies of P0 were almost the same in all the leads at about 13 msec. The distribution of NI-PI-NII was divided into three types--N16-P20-N28 localized in the frontal region, N17-P22-N30 localized in the central region and N19-P25-N33 distributed in the parieto-occipito-temporal regions. The distributions of NII-PII and PII-NIII were all similar, with high amplitudes in the central region. The latencies of PII and NIII were almost the same in all the leads at about 45 msec and 68 msec.

Latency and amplitude abnormalities of the scalp far-field P14 to median nerve stimulation in multiple sclerosis. A SEP study of 122 patients recorded with a non-cephalic reference montage

The frequency and characteristics of P14 abnormalities were investigated in 122 patients with probable (68), or definite (54) multiple sclerosis by recording SEPs to median nerve stimulation with a non-cephalic reference montage. The most frequent SEP abnormality found in our series (62% of abnormal results) combined latency increase and amplitude reduction of P14. Interindividual variability, inherent in absolute amplitude measurements, was by-passed by calculating the ratio between the amplitudes of far-field P9 and P14 components, which proved to be normally distributed in controls. In spite of the strong association (P much less than 0.001) between the P9-P14 interpeak interval (IPL) and the P9/P14 amplitude ratio in MS patients, the latter parameter was found to be the only abnormality in 12 patients whose P9-P14 and P14-N20 IPLs were normal. Also IPLs were increased in 12 patients with normal P14 amplitudes. These results suggest that adding the P9/P14 amplitude criterion to standard IPL data might be useful to detect conduction troubles in MS patients.

Origin of frontal N15 component of somatosensory evoked potential in man

Origin of the frontal somatosensory evoked potential (SEP) by median nerve stimulation was investigated in normal volunteers and in patients with localized cerebrovascular diseases, and the following results were obtained. (1) In normal subjects, SEPs recorded at F3 (or F4) contralateral to the stimulating median nerve were composed of P12, N15, P18.5 and N26. Similar components were recognized in SEP recorded at Fz. (2) In patients in whom putaminal or thalamic hemorrhages had destroyed the posterior limbs of the internal capsules, frontal N15 and parietal N18 (N20) disappeared. These components were also absent in patients with cortical (parietal) infarctions. Among these patients, the thalamus was not affected in cases with putaminal hemorrhages and cortical infarctions. These facts indicate that the generator of the frontal N15 does not exist in the thalamus but that it originates from the neural structure central to the internal capsule, which suggests a similarity to the generator of the parietal N18. Because N15 was recorded in the midline of the frontal region with shorter latency than parietal N18, the frontal N15 might represent a response to the sensory input of the frontal lobe via the non-specific sensory system.

Somatosensory evoked potentials from the thalamic sensory relay nucleus (VPL) in humans: correlations with short latency somatosensory evoked potentials recorded at the scalp

Somatosensory evoked potentials (SEPs) were recorded in humans from an electrode array which was implanted so that at least two electrodes were placed within the nucleus ventralis posterolateralis (VPL) of the thalamus and/or the medial lemniscus (ML) of the midbrain for therapeutic purposes. Several brief positive deflections (e.g., P11, P13, P14, P15, P16) followed by a slow negative component were recorded from the VPL. The sources of these components were differentiated on the basis of their latency, spatial gradient, and correlation with the sensory experience induced by the stimulation of each recording site. The results indicated that SEPs recorded from the VPL included activity volume-conducted from below the ML (P11), activity in ML fibers running through and terminating within the VPL (P13 and P14), activity in thalamocortical radiations originating in and running through the VPL (P15, P16 and following positive components) and postsynaptic local activity (the negative component). The sources of the scalp-recorded SEPs were also analyzed on the basis of the timing and spatial gradients of these components. The results suggested that the scalp P11 was a potential volume-conducted from below the ML, the scalp P13 and P14 were potentials reflecting the activity of ML fibers, the small notches on the ascending slope on N16 may potentially reflect the activity of thalamocortical radiations, and N16 may reflect the sum of local postsynaptic activity occurring in broad areas of the brain-stem and thalamus.

Comparison in man of short latency averaged evoked potentials recorded in thalamic and scalp hand zones of representation

Recordings were performed in the thalamus of 13 patients suffering from either abnormal movements or intractable pain, with the aim of delimiting the region to be destroyed or stimulated in order to diminish the syndrome. In 11 of these patients averaged evoked potentials were recorded simultaneously from the scalp and specific thalamus (VP) hand area levels following median nerve stimulation. These recordings were done during the operation or afterwards when an electrode was left in place for a program of stimulation. The latencies of onsets and peaks on the scalp 'P15' were compared with those of the VP wave; a clear correspondence was found. Moreover, when increased stimulation was used, both waves began to develop in parallel. Thus in the contralateral 'P15' a component exists due to the field produced by the thalamic response. To explain the presence of an ipsilateral scalp 'P15' wave, we propose that a second wave having the same latency and a slightly shorter peak exists on the scalp due to a field produced by a brain-stem response. This double origin of 'P15' is also shown by the different changes which the ipsilateral and contralateral waves present during changes in alertness. The scalp 'N18-N20' is also composed of at least 2 components. The first peak appears on the scalp with a latency shorter than that of the negativity which develops in the thalamus. The N wave, moreover, increases in latency with rapid stimulus repetition. We propose with others that 'N18' is a cortical event reflecting the arrival of the thalamo-cortical volley. The second component, 'N20,' has a peak latency closely correlated to that of the thalamic negativity. This component was present alone in 'N' when rapid stimulation (greater than 4/sec) was used, which did not change the thalamic response. It must be a field produced by the thalamic negativity.

Short latency somatosensory and spinal evoked potentials: power spectra and comparison between high pass analog and digital filter

Medium nerve somatosensory evoked potentials (SSEPs) and intraoperative spinal evoked potentials were analyzed using different analog and zero phase shift digital high pass filter and by power spectrum. Additionally, high pass analog and digital filtering was performed on various sine, triangular and rectangular waves manufactured by a wave form generator. Recordings were also transformed to the 1st and 2nd time derivatives. The great abundance of spectral energy for scalp recorded median nerve SSEPs was below 125 c/sec but lower energy fast frequency components consistently extended to 500 c/sec. Power spectrum of the Erb's point compound nerve action potential revealed a wide band of spectral energy commencing at about 50-100 c/sec, peaking at about 250-270 c/sec and extending to nearly 1000 c/sec. This suggests that synchronous axonal activity generates predominantly faster frequencies above 100 c/sec. High pass analog filter confers phase non-linearity which results in various distortions including latency shift and a morphological change which may be visually similar to the 1st or 2nd time derivatives. High pass zero phase shift digital filter removes selected low frequencies without accompanying phase distortion. This accentuates fast peaks seen at open bandpass as well as transition points between baseline and component ascent or descent. Zero phase shift digital filter may also generate peaks that are not visualized at open pass but which reflect the sum of frequencies which were not removed by filtering. These peaks do not necessarily correspond to discrete singular neuroanatomical structures. Although peaks observed in high pass analog and digital filter appear similar and comparable, their underlying activity may be of different origin. This is because high pass analog filter projects a considerable amount of overlap from earlier onto later waves. For clinical correlation it is important that restricted bandpass analog or digitally filtered recordings be compared with open pass data. Only those peaks visualized in both open and restricted bandpass can be considered authentic. Examples of spinal and scalp SSEPs indicate that selective filtering may, under certain circumstances, distinguish axonal or lemniscal from synaptic generators.