Separate generators with distinct orientations for N20 and P22 somatosensory evoked potentials to finger stimulation?

Neurophysiologic Mapping of Thalamocortical Tract in Asleep Craniotomies: Promising Results From an Early Experience

BACKGROUND

Subcortical mapping of the corticospinal tract has been extensively used during craniotomies under general anesthesia to achieve maximal resection while avoiding postoperative motor deficits. To our knowledge, similar methods to map the thalamocortical tract (TCT) have not yet been developed.

OBJECTIVE

To describe a neurophysiologic technique for TCT identification in 2 patients who underwent resection of frontoparietal lesions.

METHODS

The central sulcus (CS) was identified using the somatosensory evoked potentials (SSEP) phase reversal technique. Furthermore, monitoring of the cortical postcentral N20 and precentral P22 potentials was performed during resection. Subcortical electrical stimulation in the resection cavity was done using the multipulse train (case #1) and Penfield (case #2) techniques.

RESULTS

Subcortical stimulation within the postcentral gyrus (case #1) and in depth of the CS (case #2), resulted in a sudden drop in amplitudes in N20 (case #1) and P22 (case #2), respectively. In both patients, the potentials promptly recovered once the stimulation was stopped. These results led to redirection of the surgical plane with avoidance of damage of thalamocortical input to the primary somatosensory (case #1) and motor regions (case #2). At the end of the resection, there were no significant changes in the median SSEP. Both patients had no new long-term postoperative sensory or motor deficit.

CONCLUSION

This method allows identification of TCT in craniotomies under general anesthesia. Such input is essential not only for preservation of sensory function but also for feedback modulation of motor activity.

Intraoperative thalamocortical tract monitoring via direct cortical recordings during craniotomy

OBJECTIVE

Neuromonitoring of primary motor regions allows preservation of motor strength and is frequently employed during cranial procedures. Less is known about protection of sensory function and ability to modulate movements, both of which rely on integrity of thalamocortical afferents (TCA) to fronto-parietal regions. We describe our experience with TCA monitoring and their cortical relays during brain tumor surgery.

METHODOLOGY

To study its feasibility and usefulness, continuous somatosensory evoked potentials (SSEP) recording via a subdural electrode was attempted in 32 consecutive patients.

RESULTS

Median and posterior tibial SSEP were successfully monitored in 31 and 17 patients respectively. SSEP improved lesion localization and prevented unnecessary cortical stimulation in 9 and 16 cases respectively. A threshold of ≥30% SSEP amplitude decrease influenced management in 10 patients while a decrement of ≥50 % had a sensitivity of 0.89 and specificity of 1 in detecting worsening of sensory function. Simultaneous motor evoked potentials (MEP) and SSEP monitoring were performed in 10 cases, 9 of which showed short-lived fluctuations of the former.

CONCLUSION

Direct cortical SSEP monitoring is feasible, informs management and predicts outcome.

SIGNIFICANCE

Early intervention prevents sensory deficit. Concomitant MEP fluctuations may reflect modulation of motor activity by TCA.

Functional Semi-Blind Source Separation Identifies Primary Motor Area Without Active Motor Execution

High time resolution techniques are crucial for investigating the brain in action. Here, we propose a method to identify a section of the upper-limb motor area representation (FS_M1) by means of electroencephalographic (EEG) signals recorded during a completely passive condition (FS_M1bySS). We delivered a galvanic stimulation to the median nerve and we applied to EEG the semi-Blind Source Separation (s-BSS) algorithm named Functional Source Separation (FSS). In order to prove that FS_M1bySS is part of FS_M1, we also collected EEG in a motor condition, i.e. during a voluntary movement task (isometric handgrip) and in a rest condition, i.e. at rest with eyes open and closed. In motor condition, we show that the cortico-muscular coherence (CMC) of FS_M1bySS does not differ from FS_ M1 CMC (0.04 for both sources). Moreover, we show that the FS_M1bySS’s ongoing whole band activity during Motor and both rest conditions displays high mutual information and time correlation with FS_M1 (above 0.900 and 0.800, respectively) whereas much smaller ones with the primary somatosensory cortex [Formula: see text] (about 0.300 and 0.500, [Formula: see text]). FS_M1bySS as a marker of the upper-limb FS_M1 representation obtainable without the execution of an active motor task is a great achievement of the FSS algorithm, relevant in most experimental, neurological and psychiatric protocols.

Giant early components of somatosensory evoked potentials to tibial nerve stimulation in cortical myoclonus

Enlarged cortical components of somatosensory evoked potentials (giant SEPs) recorded by electroencephalography (EEG) and abnormal somatosensory evoked magnetic fields (SEFs) recorded by magnetoencephalography (MEG) are observed in the majority of patients with cortical myoclonus (CM). Studies on simultaneous recordings of SEPs and SEFs showed that generator mechanism of giant SEPs involves both primary sensory and motor cortices. However the generator sources of giant SEPs have not been fully understood as only one report describes clearly giant SEPs following lower limb stimulation. In our study we performed a combined EEG-MEG recording on responses elicited by electric median and tibial nerve stimulation in a patient who developed consequently to methyl bromide intoxication CM with giant SEPs to median and tibial nerve stimuli.

SEPs wave shapes were identified on the basis of polarity-latency components (e.g. P15-N20-P25) as defined by earlier studies and guidelines. At EEG recording, the SEP giant component did not appear in the latency range of the first cortical component for median nerve SEP (N20), but appeared instead in the range of the P37 tibial nerve SEP, which is currently identified as the first cortical component elicited by tibial nerve stimuli. Our MEG and EEG SEPs recordings also showed that components in the latency range of P37 were preceded by other cortical components. These findings suggest that lower limb P37 does not correspond to upper limb N20. MEG results confirmed that giant SEFs are the second component from both tibial (N43m-P43m) and median (N27m-P27m) nerve stimulation. MEG dipolar sources of these giant components were located in the primary sensory and motor area.

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Lower limb P37 is probably not the component corresponding to upper limb N20.

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Lower limb P37 was preceded by other cortical components.

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Giant SEPs and SEFs are the second component for both tibial and median nerve.

Dipole source analyses of early median nerve SEP components obtained from subdural grid recordings

The median nerve N20 and P22 SEP components constitute the initial response of the primary somatosensory cortex to somatosensory stimulation of the upper extremity. Knowledge of the underlying generators is important both for basic understanding of the initial sequence of cortical activation and to identify landmarks for eloquent areas to spare in resection planning of cortex in epilepsy surgery. We now set out to localize the N20 and P22 using subdural grid recording with special emphasis on the question of the origin of P22: Brodmann area 4 versus area 1. Electroencephalographic dipole source analysis of the N20 and P22 responses obtained from subdural grids over the primary somatosensory cortex after median nerve stimulation was performed in four patients undergoing epilepsy surgery. Based on anatomical landmarks, equivalent current dipoles of N20 and P22 were localized posterior to (n = 2) or on the central sulcus (n = 2). In three patients, the P22 dipole was located posterior to the N20 dipole, whereas in one patient, the P22 dipole was located on the same coordinate in anterior-posterior direction. On average, P22 sources were found to be 6.6 mm posterior [and 1 mm more superficial] compared with the N20 sources. These data strongly suggest a postcentral origin of the P22 SEP component in Brodmann area 1 and render a major precentral contribution to the earliest stages of processing from the primary motor cortex less likely.

Single-trial analysis of cortical oscillatory activities during voluntary movements using empirical mode decomposition (EMD)-based spatiotemporal approach

This study presents a method based on empirical mode decomposition (EMD) and a spatial template-based matching approach to extract sensorimotor oscillatory activities from multi-channel magnetoencephalographic (MEG) measurements during right index finger lifting. The longitudinal gradiometer of the sensor unit which presents most prominent SEF was selected on which each single-trial recording was decomposed into a set of intrinsic mode functions (IMFs). The correlation between each IMF of the selected channel and raw data on other channels were created and represented as a spatial map. The sensorimotor-related IMFs with corresponding correlational spatial map exhibiting large values on primary sensorimotor area (SMI) were selected via spatial-template matching process. Trial-specific alpha and beta bands were determined in sensorimotor-related oscillatory activities using a two-spectrum comparison between the spectra obtained from baseline period (-4 to -3 s) and movement-onset period (-0.5 to 0.5 s). Sensorimotor-related oscillatory activities were filtered within the trial-specific frequency bands to resolve task-related oscillatory activities. Results demonstrated that the optimal phase and amplitude information were preserved not only for alpha suppression (event-related desynchronization) and beta rebound (event-related synchronization) but also for profound analysis of subtle dynamics across trials. The retention of high SNR in the extracted oscillatory activities allow various methods of source estimation that can be applied to study the intricate brain dynamics of motor control mechanisms. The present study enables the possibility of investigating cortical pathophysiology of movement disorder on a trial-by-trial basis which also permits an effective alternative for participants or patients who can not endure lengthy procedures or are incapable of sustaining long experiments.

Detailed analysis of the latencies of median nerve somatosensory evoked potential components, 1: selection of the best standard parameters and the establishment of normal values

In order to objectively select the standard parameters best suited for the evaluation of somatosensory conduction in median nerve somatosensory evoked potentials (SEP), we performed a detailed statistical analysis of intersubject variability for the latencies of SEP components based on the recordings of 62 normal subjects. Multiple regression analyses for height, age, (age--20)2 and sex were performed for the latencies of 13 components and 78 intercomponent intervals, and the residual variance was used as an indicator of the stability of each parameter. As a result, N9 onset in EPi-NC lead, N11' onset in C6S-Fz lead, P13/14 onset in scalp-NC leads, for which N13' onset recorded in C6S-Fz lead may substitute, and N20 onset in CPc-Fz lead were the most stable time-points selected as standards. N11 onset in C6S-NC, which other authors have recommended as the standard point representing spinal entry, was not recorded consistently, and P11 onset in scalp-NC leads was also unstable. N20 peak and N13'-N20 interval (equivalent to conventional central conduction time) were extremely unstable. We presented the nomograms to find normal limits of the standard parameters corresponding to the given values of the predictor variables (height, age or sex). As the standard recording montage in routine clinical examinations, we recommended a simple method using Fz reference, for example (1) EPi-Fz, (2) C6S-Fz, (3) CPc-Fz, because this montage is sufficient to measure the stable standard parameters.

Differential generators for N20m and P35m responses to median nerve stimulation

To study the spatial and behavioral dynamics of cortical sources for N20m and P35m at varying stimulus intensities, we measured neuromagnetic cortical responses to left electric median nerve stimulation at the wrist in 17 male healthy adults. The stimulus intensity levels were individually determined according to sensory threshold (ST) for perceiving electric pulses. Using equivalent current dipole (ECD) modeling, we analyzed the peak latencies, amplitudes, and locations of ECDs from 14 subjects for N20m and P35m elicited at 2 ST, 3 ST, and 4 ST. Compared with N20m, P35m was localized 3.3 +/- 0.6 mm more superiorly at 2-4 ST, and 2.9 +/- 1.2 mm more medially at 3-4 ST. Superimposed over subjects' own MR images, N20m ECDs were localized in the area of 3b contralateral to stimulus side in all 17 subjects at 3 ST, whereas P35m ECDs were localized either in the postcentral (in 14 subjects) or in the precentral areas (in 3 subjects). We found no clear correlation between N20m and P35m in terms of peak latencies as well as the corresponding growth of activation strengths along with stepwise increase in stimulus intensity. Our results imply that the two early SEF components, N20m and P35m, have differential cortical generators, with distinctive neurophysiological behaviors in response to varying stimulus intensity levels.

Short-latency components of evoked potentials to median nerve stimulation recorded by intracerebral electrodes in the human pre- and postcentral areas

OBJECTIVE

To study whether sensory afferents of the hand projected directly to the primary motor cortex (M1) as they have been well electrophysiologically described in monkeys but not in humans.

METHODS

We recorded intracerebrally in the central areas (pre- and/or postcentral gyrus) somatosensory evoked potentials (SEPs) to median nerve stimulation in 5 (4 women, 1 man; age 14-37 years) epileptic patients during presurgical evaluation.

RESULTS

The primary somatosensory cortex (S1) showed negative-positive components peaking at about 20 and 30 ms, respectively. By contrast, M1 disclosed SEPs of two types of waveforms depending on the portion of the precentral gyrus explored by the different contacts of the electrode. Here, we demonstrated, for the first time, in the medial portion of M1, shaped like an omega in the axial plane, corresponding to the motor hand area, the occurrence of a primary negative component as in S1, but of higher amplitude and peaking at about 4 ms later. In other respects, the lateral portion of M1 disclosed positive-negative components peaking at about 21 and 31 ms, respectively.

CONCLUSIONS

These electrophysiological findings, based on accurate spatial and temporal resolution of intracerebral recordings, suggested that somatosensory inputs from the hand projected directly to M1 in its medial portion.

EEG minimum-norm estimation compared with MEG dipole fitting in the localization of somatosensory sources at S1

OBJECTIVE

Dipole models, which are frequently used in attempts to solve the electromagnetic inverse problem, require explicit a priori assumptions about the cerebral current sources. This is not the case for solutions based on minimum-norm estimates. In the present study, we evaluated the spatial accuracy of the L2 minimum-norm estimate (MNE) in realistic noise conditions by assessing its ability to localize sources of evoked responses at the primary somatosensory cortex (SI).

METHODS

Multichannel somatosensory evoked potentials (SEPs) and magnetic fields (SEFs) were recorded in 5 subjects while stimulating the median and ulnar nerves at the left wrist. A Tikhonov-regularized L2-MNE, constructed on a spherical surface from the SEP signals, was compared with an equivalent current dipole (ECD) solution obtained from the SEFs.

RESULTS

Primarily tangential current sources accounted for both SEP and SEF distributions at around 20 ms (N20/N20m) and 70 ms (P70/P70m), which deflections were chosen for comparative analysis. The distances between the locations of the maximum current densities obtained from MNE and the locations of ECDs were on the average 12-13 mm for both deflections and nerves stimulated. In accordance with the somatotopical order of SI, both the MNE and ECD tended to localize median nerve activation more laterally than ulnar nerve activation for the N20/N20m deflection. Simulation experiments further indicated that, with a proper estimate of the source depth and with a good fit of the head model, the MNE can reach a mean accuracy of 5 mm in 0.2-microV root-mean-square noise.

CONCLUSIONS

When compared with previously reported localizations based on dipole modelling of SEPs, it appears that equally accurate localization of S1 can be obtained with the MNE.

SIGNIFICANCE

MNE can be used to verify parametric source modelling results. Having a relatively good localization accuracy and requiring minimal assumptions, the MNE may be useful for the localization of poorly known activity distributions and for tracking activity changes between brain areas as a function of time.

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.

Sudomotor nerve conduction velocity and central processing time of the skin conductance response

OBJECTIVE

To estimate the sudomotor nerve conduction velocity (CV), the central processing time (CPT) and habituation of the skin conductance response (SCR).

METHODS

SCRs in response to a single deep inspiratory breath, an electrical stimulus and a sound click were obtained from the fingers and toes of 30 healthy adults. Sudomotor nerve conduction velocities were determined after measuring extremity length and latency differences. CPT was estimated by subtracting the efferent time and the known afferent times and neuroeffector times from the onset latency.

RESULTS

The inspiratory SCR habituated slower than the auditory or electrical SCRs. CVs of the 3 modalities did not differ statistically and their mean was 1.07 m s(-1) (95% CI: 1.01-1.13). The inspiratory SCR arrived at the fingers 1.26+/-0.09 s after the onset of chest wall movement. Electrical and auditory SCR onset latencies at the fingers were 1.60+/-0.03 and 1.75+/-0.04 s, respectively. Their CPTs were 140 and 160 ms, estimated from the electrical and auditory SCR onset latencies to the fingers. The CPT for inspiratory SCR was estimated to occur during the inspiratory CPT after the inspiratory decision and before chest movement.

CONCLUSIONS

In contrast to the SCR following an electrical or auditory stimulus, initiation of deep inspiratory SCR occurs before the inspiratory act, precluding any possible input from respiratory afferent receptors and implicating a central generator.

SIGNIFICANCE

This study provides new insights into the origin of the SCR following inspiration.

Asymmetry in the human primary somatosensory cortex and handedness

Brain asymmetry is a phenomenon well known for handedness and language specialization and has also been studied in motor cortex. Less is known about hemispheric asymmetries in the somatosensory cortex. In the present study, we systematically investigated the representation of somatosensory function analyzing early subcortical and cortical somatosensory-evoked potentials (SEP) after electrical stimulation of the right and left median nerve. In 16 subjects, we compared thresholds, the peripheral neurogram at Erb point, and, using MRI-based EEG source analysis, the P14 brainstem component as well as N20 and P22, the earliest cortical responses from the primary sensorimotor cortex. Handedness was documented using the Edinburgh Inventory and a dichotic listening test was performed as a measure for language dominance. Whereas thresholds, Erb potential, and P14 were symmetrical, amplitudes of the cortical N20 showed significant hemispheric asymmetry. In the left hemisphere, the N20 amplitude was higher, its generator was located further medial, and it had a stronger dipole moment. There was no difference in dipole orientation. As a possible morphological correlate, the size of the left postcentral gyrus exceeded that of the right. The cortical P22 component showed a lower amplitude and a trend toward weaker dipole strength in the left hemisphere. Across subjects, there were no significant correlations between laterality indices of N20, the size of the postcentral gyrus, handedness, or ear advantage. These data show that asymmetry of median nerve SEP occurs at the cortical level, only. However, both functional and morphological cortical asymmetry of somatosensory representation appears to vary independently of motor and language functions.

Ipsilateral area 3b responses to median nerve somatosensory stimulation

Magnetoencephalography investigation of the somatosensory evoked fields for median nerve stimulation detected ipsilateral area 3b responses in 18 hemispheres of 14 (1 normal subject and 13 patients with brain diseases) among 482 consecutive subjects. The major three peaks in the ipsilateral response were named iP50m, iN75m, and iP100m, based on the current orientation in the posterior, anterior, and posterior directions and the latency of 52.7 +/- 6.2, 74.1 +/- 9.4, and 100.2 +/- 15.8 ms (mean +/- standard deviation), respectively. The moment of the iP50m dipole (9.4 +/- 5.7 nAm) was significantly smaller than that of the N20m dipole of the contralateral response (cN20m, 27.5 +/- 10.5 nAm, P < 0.0001). Dipoles of iP50m and cN20m were similarly localized on the posterior bank of the central sulcus. iP50m in the present study had the same current orientation as and peak latency similar to that of the first ipsilateral primary somatosensory response to lip stimulation in our previous report. Therefore, the somatosensory afferent pathway from the hand may reach directly to the ipsilateral area 3b at least in part of the human population.

Abnormal gating of somatosensory inputs in essential tremor

OBJECTIVE

To study whether sensorimotor cortical areas are involved in Essential Tremor (ET) generation.

BACKGROUND

It has been suggested that sensorimotor cortical areas can play a role in ET generation. Therefore, we studied median nerve somatosensory evoked potentials (SEPs) in 10 patients with definite ET.

METHODS

To distinguish SEP changes due to hand movements from those specifically related to central mechanisms of tremor, SEPs were recorded at rest, during postural tremor and during active and passive movement of the hand. Moreover, we recorded SEPs from 5 volunteers who mimicked hand tremor. The traces were further submitted to dipolar source analysis.

RESULTS

Mimicked tremor in controls as well as active and passive hand movements in ET patients caused a marked attenuation of all scalp SEP components. These SEP changes can be explained by the interference between movement and somatosensory input ('gating' phenomenon). By contrast, SEPs during postural tremor in ET patients showed a reduction of N20, P22, N24 and P24 cortical SEP components, whereas the fronto-central N30 wave remained unaffected.

CONCLUSIONS

Our findings suggest that in ET patients the physiological interference between movement and somatosensory input to the cortex is not effective on the N30 response. This finding thus indicates that a dysfunction of the cortical generator of the N30 response may play a role in the pathogenesis of ET.

Modality-related scalp responses after electrical stimulation of cutaneous and muscular upper limb afferents in humans

To elucidate whether the selective electrical stimulation of muscle as well as cutaneous afferents evokes modality-specific responses in somatosensory evoked potentials (SEPs) recorded on the scalp of humans, we compared scalp SEPs to electrical stimuli applied to the median nerve and to the abductor pollicis brevis (APB) motor point. In three subjects, we also recorded SEPs after stimulation of the distal phalanx of the thumb, which selectively involved cutaneous afferents. Motor point and median nerve SEPs showed the same scalp distribution; moreover, very similar dipole models, showing the same dipolar time courses, explained well the SEPs after both types of stimulation. Since the non-natural stimulation of muscle afferents evokes responses also in areas specifically devoted to cutaneous input processing, it is conceivable that, in physiological conditions, muscle afferents are differentially gated in somatosensory cortex. The frontocentral N30 response was absent after purely cutaneous stimulation; by contrast, it was relatively more represented in motor point rather than in mixed nerve SEPs. These data suggest that the N30 response is specifically evoked by proprioceptive inputs.

Scalp distribution of the earliest cortical somatosensory evoked potential to tibial nerve stimulation: proposal of a new recording montage

OBJECTIVE

To investigate the most reliable method to record the earliest cortical somatosensory evoked potential (SEP) after tibial nerve stimulation. The 'gating' phenomenon was used to dissociate the overlapping cortical SEP components.

METHODS

In 11 subjects we recorded the scalp SEPs at rest, during the voluntary (active gating) and passive (passive gating) foot movement and during the isometric calf muscle contraction (isometric gating).

RESULTS

At the vertex the P40 amplitude was reduced in all the gating conditions. Instead, both the P40 response recorded in the parietal region ipsilateral to the stimulation (indicated as P40par) and the fronto-temporal N37 potential were reduced in amplitude only during the passive foot movement.

CONCLUSIONS

The same behaviour of the N37 and P40par potentials suggests that they can represent the opposite counterparts of the same dipolar generator. Instead, the real P40 amplitude, which is affected in all the gating conditions, is recorded at the vertex and might be generated by a different source. We conclude that the montage obtained by referring a temporal electrode contralateral to the stimulation to an ipsilateral parietal lead can reliably record the earliest cortical component (N37/P40par) after tibial nerve stimulation.

Differential interaction of somatosensory inputs in the human primary sensory cortex: a magnetoencephalographic study

OBJECTIVE

Somatosensory evoked magnetic fields (SEFs) were recorded to investigate the interaction of the somatosensory inputs using the modality of electrical finger stimulation in 6 normal subjects.

METHODS

Electrical stimuli were given to the index (II), middle (III) or little (V) fingers individually, and also to pairs of either the II and III simultaneously, or the II and V simultaneously. The interaction ratio (IR) was calculated as the ratio of the SEF amplitude by simultaneous two-finger stimulation to the arithmetically summed SEF amplitudes of two individual-finger stimulations.

RESULTS

SEFs showed 3 major components: N22m, P30m and P60m. The N22m and P60m revealed a clear somatotopic organization in the primary sensory cortex (S1) in the sequence of II, III and V, while the P30m showed a cluster with medial location compared with N22m and P60m in S1. The N22m had a significantly greater IR in II and III stimulation compared to that in II and V stimulation. The P60m also showed a similar trend in the IR but was greater than that of N22m. In contrast, the IR in P30m showed no such tendency.

CONCLUSION

The interaction of S1 was most influenced when adjacent receptive fields were activated in the modality of electrical finger stimulation. Our results were consistent with the concept that the Brodmann's areas in S1 which produce the 3 components of the SEFs have different functional organization.

Respiratory-related evoked potential elicited by expiratory occlusion

Respiratory-related evoked potentials (RREPs) have been elicited by inspiratory loads in adults and children. The RREP was recorded over the somatosensory region of the cerebral cortex. It was hypothesized that a RREP could be recorded by using expiratory occlusion. Electroencephalographic activity was recorded in adults from 14 scalp locations, referenced to the linked earlobes. The occlusion was presented as an interruption of expiration. Epochs of electroencephalographic activity and mouth pressure were recorded for each expiratory occlusion presentation. There were two occlusion trials and a control trial of 100 presentations each. The epochs in each trial were averaged and examined for the presence of short-latency, occlusion-related peaks. RREP peaks were observed bilaterally with expiratory occlusion and were absent in control unoccluded averages. A positive peak, P(34), was observed at central and postcentral sites. A negative peak, N(53), was observed at frontal and central sites. A second positive peak, P(95), was observed at frontal and central sites. These results demonstrate that expiratory occlusion elicits a RREP. This suggests that expiratory occlusion-related sensory information activates the cerebral cortex similar to that for inspiratory loads.

Different contribution of joint and cutaneous inputs to early scalp somatosensory evoked potentials

To elucidate whether the frontal components of scalp somatosensory evoked potentials (SEPs) depend on the type of peripheral input, we compared scalp SEPs in response to electrical stimuli applied to: (i) the proximal phalanx of the thumb, involving both deep and cutaneous afferents; and (ii) the distal phalanx of the thumb, involving cutaneous afferents, but excluding joint inputs coming from the interphalangeal articulation. We applied the same dipolar model that we built to explain the scalp SEP distribution to median nerve stimulation in previous investigations. Cortical SEPs after proximal stimulation were generated by three dipolar sources, one of which was likely to account for the frontal scalp N30. When we analyzed SEPs for distal (purely cutaneous) stimulation, the frontal and central recordings showed a clear reduction in amplitude of the negative responses having a latency of about 30 ms. Moreover, when applying the dipole model derived from analysis of responses to proximal stimulation to SEPs to distal stimulation, the source corresponding to the N30 distribution showed no activity, suggesting a strong relationship between joint and tendinous inputs and the activity of the N30 generator.

Functional MRI of human primary somatosensory and motor cortex during median nerve stimulation

OBJECTIVES

Somatosensory evoked potential (SEP) studies suggested that some early cortical SEP components may be generated in the primary motor cortex (M1) rather than the primary somatosensory cortex (S1).

METHODS

We now used functional magnetic resonance imaging (fMRI) to study activation of S1 and M1 by electrical median nerve stimulation in healthy volunteers.

RESULTS

The hand areas of both S1 and M1 showed significant activation (correlation coefficients >0.45) in 7 of 9 subjects (activated volume S1 > M1). For comparison, a sequential finger opposition task significantly activated S1 in 7 and M1 in all 9 subjects (activated volume M1 > S1).

CONCLUSIONS

These data show that the electrical stimuli used for SEP recording lead to a functional activation of S1 as well as M1.

Scalp topography and source analysis of interictal spontaneous spikes and evoked spikes by digital stimulation in benign rolandic epilepsy

OBJECTIVES

We report the analysis of scalp topography and dipole modeling of the rolandic spikes in 6 patients suffering of benign rolandic epilepsy of childhood with extremely high amplitude SEP by tapping stimulation of the finger of the hand.

METHODS

EEG and BESA analysis were performed for both rolandic spontaneous interictal spikes and high amplitude scalp activity evoked by tapping and electrical stimulation of the first finger of the right hand.

RESULTS

The evoked responses showed a morphology characterized by a rapid phase (spike) followed by a slow phase (slow wave). The spike presented an early small positive component followed by a main negative component. Similar morphology, dipole configuration and source localization were observed for both rolandic spikes and evoked high amplitude scalp responses. Dipole localization showed an overlap of spatial coordinates between rolandic and evoked spikes.

CONCLUSIONS

These findings suggest that the extremely high amplitude SEPs could be evoked spikes which probably had the same cortical generators of the spontaneous rolandic spikes.

Modulation of cerebral cortex in acupuncture stimulation: a study using sympathetic skin response and somatosensory evoked potentials

Although acupuncture has been widely used for treating disorders, its therapeutic mechanism remains unclear. In order to study the physiological mechanism of acupuncture stimulation, both palm recordings of sympathetic skin response (SSR) were evoked by electrical stimulation of the right median nerve on 13 normal adult volunteers. Median nerve evoked short-latency somatosensory evoked potential (SEPs) recordings were taken at least one week after SSR recording. The latencies and amplitudes were calculated. N13 component was obtained from Cv7, and N20 and P25 were from somatosensory cortex. The control did not receive acupuncture stimulation. Acupuncture needles were inserted into both Zusanli (St-36) acupoints as follows: 1) manual acupuncture (MA): using fingers to twist the acupuncture needle until so-called Der-Qi was obtained, 2) 2 Hz electroacupuncture (EA): 2 Hz square-wave electrical pulses were applied between the Zusanli needle and the Shangjuxu (St-37) needle bilaterally. Our results indicated that the mean latencies of SSR were largest during 2 Hz EA followed by MA stimulation, whereas the period of control exhibited the shortest mean latencies. In contrast, the mean amplitudes of SSR were smallest during the period of 2Hz EA, followed by the period of MA, and the period of control exhibited the largest mean amplitudes of SSR. The latencies of N13, N20 and P25 remained unchanged, but the amplitudes of P25 were largest during the period of 2Hz EA, followed by the period of MA; the period of control exhibited the smallest mean amplitudes of SEPs. The results suggest that acupuncture stimulation of both Zusanli acupoints inhibited SSR, which implies that the cerebral cortex contributed at least in part to this inhibition. The stimulation effect of 2Hz EA is stronger than MA.

Intra-operative localization of sensorimotor cortex by cortical somatosensory evoked potentials: from analysis of waveforms to dipole source modeling

Intra-operative localization of sensorimotor cortex is of increasing importance as neurosurgical techniques allow safe and accurate removal of lesions around the central sulcus. Although direct cortical recordings of somatosensory evoked potentials (SEPs) are known to be helpful for cortical localization, source localization models can provide more precise estimates than subjective visual analysis. In addition to intra-operative analysis of waveforms and amplitudes of SEPs to median nerve stimulation in 20 neurosurgical patients, we used a spatiotemporal dipole model to determine the location of the equivalent dipoles consistent with the cortical distribution of the SEPs. The early cortical SEPs were modeled by 2 equivalent dipoles located in the postcentral gyrus. The first dipole was primarily tangentially oriented and explained N20 and P20 peaks. The second dipole was primarily radially oriented and explained P25 activity. We found consistent localization of the first dipole in the postcentral gyrus, which was always located within 8 mm of the central sulcus, with an average distance of 3 mm. This finding provides an objective basis for using the SEP phase reversal method for cortical localization. We conclude that dipole source modeling of the cortical SEPs can be considered as an objective way of localizing the cortical hand sensory area.

Median and tibial nerve somatosensory evoked potentials: middle-latency components from the vicinity of the secondary somatosensory cortex in humans

The topography of the middle-latency N110 after radial nerve stimulation suggested a generator in SII. To support this hypothesis, we have tried to identify a homologous component in the tibial nerve SEP (somatosensory evoked potential). Evoked potentials following tibial nerve stimulation (motor + sensory threshold) were recorded with 29 electrodes (bandpass 0.5-500 Hz, sampling rate 1000 Hz). For comparison, the median nerve was stimulated at the wrist. Components were identified as peaks in the global field power (GFP). Map series were generated around GFP peaks and amplitudes were measured from electrodes near map maxima. With median nerve stimulation, we recorded a negativity with a maximum in temporal electrode positions and 106 +/- 12 ms peak latency (mean +/- SD), comparable to the N110 following radial nerve stimulation. After tibial nerve stimulation the latency of a component with the same topography was 131 +/- 11 ms (N130). Both N110 and N130 were present ipsi- as well as contralaterally. Amplitudes were significantly higher on the contralateral than the ipsilateral scalp for both median (3.1 +/- 2.4 microV vs. 1.7 +/- 1.6 microV) and tibial nerve (1.9 +/- 1.2 microV vs. 0.6 + 1 microV). The topography of the N130 can be explained by a generator in the vicinity of SII. The latency difference between median and tibial nerve stimulation is related to the longer conduction distance (cf. N20 and P40). The smaller ipsilateral N130 is consistent with the bilateral body representation in SII.

Somatosensory evoked potential identification of sensorimotor cortex in removal of intracranial neoplasms

OBJECTIVE

To assess the ease and reliability of routine use of somatosensory evoked potentials (SSEPs) for identification of sensorimotor cortex in brain tumour removal and to document its influence on the performance and outcome of surgery.

METHODS

SSEPs in response to contralateral median nerve stimulation were recorded from the cortical surface by means of a four lead electrode strip. Polarity reversal of short latency SSEP waves was used to identify the position of the central sulcus in 46 consecutive craniotomies for removal of metastases, gliomas, or meningiomas located in, near, or overlying sensorimotor cortex.

RESULTS

SSEPs were successfully recorded in 43/46 cases (94%) with demonstration of polarity reversal in 42/43 (98%). SSEP localization led to modification of 14/42 (33%) procedures, most frequently because of either displacement or involvement of sensorimotor cortex by tumour. Six patients (14%) developed new neurological deficits but none of these was attributable to incorrect identification of sensorimotor cortex.

CONCLUSIONS

SSEP polarity reversal is a simple, reliable, accurate, and inexpensive method of localizing sensorimotor cortex under general anaesthesia. Correct identification is possible when sensorimotor cortex is displaced or when surface anatomy is obscured by tumour. Routine use of this technique should be considered in all procedures for lesions located near the central sulcus.

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.

The pathophysiology of giant SEPs in cortical myoclonus: a scalp topography and dipolar source modelling study

Somatosensory evoked potential (SEP) recordings in patients suffering from cortical myoclonus (CM) are characterised by evidence of abnormally enhanced scalp components. Our aim was to verify whether enhanced activity in giant SEPs arises from the same generators as in healthy subjects. We used the brain electrical source analysis (BESA) to compare scalp SEP generators of healthy subjects to those calculated in 3 patients with CM of varying causes. Firstly, we built a 4-dipole model explaining scalp distribution of early SEPs in normal subjects and then applied it to traces recorded from CM patients. Our model, issued from the right median nerve grand average and applied also to recordings from single individuals, included a dipole at the base of the skull and three other perirolandic dipoles. The first of the latter dipoles was tangentially oriented and was active at the same latencies as the N20/P20 potentials and, with opposite polarity, the P24/ N24 responses; the second dipole explained the central P22 distribution and the third had a peak of activity corresponding to the N30 component. When we applied our 4-dipole model to CM recordings, the first perirolandic dipole had a third peak of activity in all patients at the same latency as a parietal negativity and a frontal positivity, both following giant P24/N24 components; on the other hand, in one patient the second perirolandic dipole showed a later activation corresponding to a high central negativity, following a giant P22 response. We suggest that only the initial giant SEPs correspond to physiological potentials evoked in healthy subjects. The occurrence of late giant SEPs could be explained by hyperpolarization, following the postsynaptic excitatory potentials responsible for the early giant components.

Giant central N20-P22 with normal area 3b N20-P20: an argument in favour of an area 3a generator of early median nerve cortical SEPs?

Generators of early cortical somatosensory evoked potentials (SEPs) still remain to be precisely localised. This gap in knowledge has often resulted in unclear and contrasting SEPs localisation in patients with focal hemispheric lesions. We recorded SEPs to median nerve stimulation in a patient with right frontal astrocytoma, using a 19-channel recording technique. After stimulation of the left median nerve, N20 amplitude was normal when recorded by the parietal electrode contralateral to the stimulation, while it was abnormally enhanced in traces obtained by the contralateral central electrode. The amplitude of the frontal P20 response was within normal limits. This finding suggests that two dipolar sources, tangential and radial to the scalp surface, respectively, contribute concomitantly to N20 generation. The possible location of the N20 radial source in area 3a is discussed. The P22 potential was also recorded with increased amplitude by the central electrode contralateral to the stimulation, while N30 amplitude was normal in frontal and central traces. We propose that the radial dipolar source of P22 response is independent from both N20 and N30 generators and can be located either in 3a or in area 4. This report illustrates the usefulness of multichannel recordings in diagnosing dysfunction of the sensorimotor cortex in focal cortical lesions.

Cortical sources of human short-latency somatosensory evoked fields to median and ulnar nerve stimuli

;;;;;õry evoked magnetic fields were measured with a 122-channel whole-scalp neuromagnetometer from seven healthy adults. Electric stimuli, with an intensity above the motor threshold, were delivered once every 0.5 s alternately to the median and ulnar nerves at the wrist; both wrists were stimulated successively within one session. In most subjects, two distinct neural sources were identified at the contralateral primary somatosensory cortex SI for both stimuli. The first source (M20) peaked at 21-22 ms and indicated activation of area 3b in the contralateral SI hand region. The same source peaked with opposite current direction at 32 ms. The second source (M40) was slightly medial to M20 and exhibited two peaks with the same current direction, first at 25 ms and most prominently at 42 ms. M20 was on average 7 mm more lateral along the central sulcus for median than ulnar nerve stimuli, in agreement with the somatotopic organization of the SI cortex; similar organization for M40 was less clear. These results suggest that M20 and M40 to upper limb stimulation represent activation of distinct neuronal populations in hand SI cortex, presumably in area 3b.

Scalp topography and dipolar source modelling of potentials evoked by CO2 laser stimulation of the hand

CO2 laser evoked potentials to hand stimulation recorded using a scalp 19-channel montage in 11 normal subjects consistently showed early N1/P1 dipolar field distribution peaking at a mean latency of 159 ms. The N1 negativity was distributed in the temporoparietal region contralateral to stimulation and the P1 positivity in the frontal region. The N1/P1 response was followed by 3 distinct components: (1) N2a reaching its maximal amplitude at the vertex and ipsilaterally to the stimulated hand, (2) N2b mostly distributed in the frontal region, and (3) P2 with a mid-central topography. Brain electrical source analysis showed that this sequence was explained, with a residual variance below 5%, by a model including two dipoles in the upper bank of the Sylvian fissure of each hemisphere, a frontal dipole close to the midline, and two anterior medial temporal dipoles, thus suggesting a sequential activation of the two second somatosensory areas, anterior cingulate gyrus and the amygdalar nuclei or the hippocampal formations, respectively. This model fitted well with the scalp field topography of grand average responses to stimulation of left and right hand obtained across all subjects as well as when applied to individual data. Our findings suggest that the second somatosensory area contralateral to the stimulation is the first involved in the building of pain-related responses, followed by ipsilateral second somatosensory area and limbic areas receiving noxious inputs from the periphery.

Topography and sources of electromagnetic cerebral responses to electrical and air-puff stimulation of the hand

SEPs and SEFs after air-puff stimulation of index and little fingers have been studied and compared to the responses following electrical stimulation of the same digits and of the median nerve at the wrist in 5 subjects. The differences in morphology of the evoked signals are described and the generator characteristics are analysed for SEFs by means of a moving dipole model inside a homogeneous sphere. In our measurements the magnetic fields following electrical finger stimulation show a 30 msec component, which was absent following air-puff stimulation. This could not be seen in the electric field activity. The generators of the first component of SEFs after air-puff finger stimulation proved to be deeper (8 mm on average across all subjects and for both fingers) than in the case of electrically evoked SEFs. A similar behaviour was also observed for the second component of SEFs for the 2 stimulus modalities.

The neural origin generating early cortical components of SEP: topographical analysis using temporal-second-order-differentiation of cortical SEPs

In order to identify dipole generators of the N20/P20 and P25, we employed second-order-differentiation in the temporal dimension (temporal-second-order-differentiation; TSOD) with delta t = 2 msec. The rate of variation in the voltage of cortical SEPs calculated by TSOD identified responses of each dipole, reflecting the density of neuronal firing. On topographic analysis, the distributions of N20/P20 and P25 conformed to the shape of gyrus better in the TSOD maps than in the isovoltage maps. The TSOD maps indicated that N20 and P25 were post-central components and that P20 was a pre-central one. Therefore, we concluded that the two dipoles generating N20/P20 and P25 were located in the posterior wall of the central sulcus (area 3b) and the crown (areas 1 and 2) of the post-central gyrus, respectively.

[Somatosensory evoked potentials: morphology and interareal S1-M1 relationships in the baboon (Papio papio)]

Primary somatosensory potentials (SEPs) were elicited by electrical stimulation of the medial sciatic (proprioceptive) or sural (cutaneous) nerves. They were detected by contacts on SI and MI dura on both cortical sides against a cephalic reference. SEPs were averaged (n = 20). Primary SI SEP consisted of positive, then negative, PI6/N30 waves. N30 was absent from MI records. Local electrocoagulation of the SI cortex on one side has entailed some reduction, but not suppression of together the homolateral MI and contralateral SI and MI SEP. The residual SEPs have increased in latencies by a few milliseconds. Additional coagulation of the MI area on the same side has resulted in loss of the SI and MI SEP on the opposite hemisphere when evoked by a stimulation ipsilateral to this intact cortex. Normal SEPs were elicited from the intact cortex by any of the used stimulation. No evoked signal could be evidence from the lesioned areas. It was concluded that negligible passive electrical diffusion from any SEP area was present onto any of the other SEP reception sites. From close comparison between the different records, we came to the following propositions: each of the SI and MI areas harbours a neural mass generator for SEPs elicited by contralateral nerve stimulation. SI and MI SEPs cannot be directly elicited by ipsilateral stimulus. SI and MI SEP ipsilateral to the nerve stimulation are due to some cortico-cortical trans-sagittal excitatory message arising from the contralateral SI/MI areas. Data stand for exteroceptive or proprioceptive stimulation as well. The absence of ipsilateral direct spino-cortical projection for SEP evidenced under barbiturate does also exist in the baboon after total recovery of surgery. A scheme is given which summarizes these active relationships between somesthetic areas.

Neuromagnetic evidence of pre- and post-central cortical sources of somatosensory evoked responses

Somatosensory evoked magnetic fields (SEFs), corresponding with electrical median nerve stimulation, were measured using an MRI-linked, whole-head MEG system. In total 184 hemispheres, SEFs were measured, involving 22 normal volunteers and 70 patients with intracranial lesions. The first SEF peak appeared 20.2 +/- 1.5 msec (mean +/- S.D.) after stimulation. The first peak was followed by a second and third peak, 7.7 +/- 3.2 msec and 14.6 +/- 5.4 msec respectively after the first. Corresponding isofield maps suggested a single current dipole oriented in the anterior direction for the first peak, posterior for the second and either anterior or posterior for the third. Using a spherical model and a single current dipole source, the localization of each peak was estimated and superimposed on individually determined MRI images. On a grand average basis, the first-peak dipole was localized on the posterior surface of the central sulcus, "area 3b." The second-peak dipole was localized 3.7 mm medial (P < 0.001) and 2.0 mm superior (P < 0.001) to the first-peak dipole, on the anterior wall of the central sulcus, "area 4." This study with a large number of subjects was able to statistically distinguish two adjacent cortical sources, located on opposite walls of the central sulcus, and within a few millimeters of each other.

[Somatosensory evoked potentials: interference and perceptual masking of cutaneous afferents in man]

Somatosensory evoked potentials (SEP) are attenuated following double electrical stimulation of the fingers (II + III). This effect is observed at cervical (N13), parietal (N20-P27) and frontal (P22-N30) levels. We simultaneously observed in the same subjects that cutaneous perception of the test-shock is completely suppressed with interstimulus intervals (ISI) within a 0-10 msec range. With 25-30 msec ISI, the perceptive function totally recovers, but SEP inhibition remains at 50 % of the control. The SEP reduction does not result in a perception deficit as long as the cortical-test response exceeds 50% of control. These results suggest that: SEP inhibition could be a local but durable phenomenon occurring at both cervical and cortical levels. Cutaneous perception does not necessitate a maximal SEP development. The perceptive process involves other associative areas (5,7...) and is activated when the primary cortical activation exceeds a certain threshold which was found at 50% of the unconditioned response voltage.

[Evoked somatosensory potentials in the baboon: intracortical localization and nature studies using pharmacology and analysis of sources of current]

SEPs were elicited by stimulation of the sciatic (proprioceptive) or sural (exteroceptive) nerves. SEPs were recorded through epidural chronic electrodes implanted in the related S1 cortical surface. They were studied after systemic or local cortical administration of subconvulsive doses of bicuculline (a specific GABAa antagonist). A powerful increase in the amplitude of the P16 component, along with an inhibition of the N30 component were observed. From a cortical Current Source Densities analysis, the P16 facilitation was shown to result from blockade of the GABAa inhibitory synapses on the somas of pyramidal cells that are responsible for the P16 wave. Reduction of the N30 wave was attributed to a bicuculline-induced reduction of an axo-dendritic depolarisation of the apical dendrites belonging to pyramidal cells. A neurophysiological model of the SEP primary waves elicited by the thalamocortical proprioceptive or cutaneous inputs is suggested.

Generators of somatosensory evoked potentials investigated by dipole tracing in the monkey

Generators of somatosensory evoked potentials, elicited by electrical stimulation of the median nerve in anaesthetized monkeys (Macaca fuscata), were investigated by submitting a three-dimensional reconstructed brain model to dipole tracing, which can equate surface potential distributions to an approximate corresponding equivalent dipole. The following components of the somatosensory evoked potentials were simultaneously recorded from 21-27 epidural electrodes: P7 (the letter indicates positive or negative polarity; the number indicates the approximate latency of the peak in ms) was recorded widely from various locations on both the left and right hemispheres, P10 was recorded near the anterior side of the central sulcus contralateral to the stimulation side, N10 was recorded near the posterior side of the contralateral central sulcus, P12 was recorded on both sides of the contralateral central sulcus, and P18 was recorded posterior to the contralateral central sulcus. Current source generators (dipoles) of each component of somatosensory evoked potentials were localized by dipole tracing: a dipole for P7 was located in the thalamus contralateral to the stimulation side; a dipole for P10 and N10 in the posterior wall of the contralateral central sulcus (area 3b); a dipole for P12 in the contralateral post central gyrus (areas 1 and 2); and a dipole for P18 in the anterior wall of the contralateral intraparietal sulcus (area 5). The locations and latencies of dipoles that generated cortical components of somatosensory evoked potentials, estimated by dipole tracing, were confirmed by direct cortical surface recording from a 16-25 electrode array placed directly on the cortical surface; and multiple unit recording from the anterior and posterior parietal cortices. After excision of area 5, P18 and N18 were abolished, whereas P10, N10, and P12 were not affected. The results suggest that dipoles for somatosensory evoked potentials progressed from the thalamus to area 5 via the primary somatosensory area. This progress is consistent with the hierarchical sequence of somatosensory information processing.

Peri-rolandic and fronto-parietal components of scalp-recorded giant SEPs in cortical myoclonus

Scalp topography of giant SEPs to median nerve stimulation was studied in 4 patients with cortical myoclonus of various etiology. The positive peak (P30) at the contralateral parietal area was simultaneously accompanied by a negative peak at the frontal area (N30), and at least one of these two peaks was enhanced in 2 patients. Another positive peak (P25) and a negative peak (N35) were also identified at the peri-rolandic area with different latency from P30 and N30, respectively, in all patients. N35 was enhanced in 3 patients, and P25 in 2 patients. It is concluded that, as seen in normal subjects, tangential (P30-N30) and radial (P25 and N35) components of SEPs are most likely distinguishable in giant SEPs, and that either one or both of those components is enhanced in different ways depending on the patients.

Neural generators of early cortical somatosensory evoked potentials in the awake monkey

Controversy continues to exist regarding the generators of the initial cortical components of the somatosensory evoked potential (SEP). This issue was explored by detailed epidural and intracortical mapping of somatosensory evoked activity in Old World monkeys. In depth recordings, 3 complementary procedures were utilized: (1) the intracortical and subcortical distribution of SEPs was determined from approximately 4000 locations; (2) concomitant profiles of multiple unit activity (MUA) were recorded as an estimate of local action potential profiles; (3) 1-dimensional calculations of current source density (CSD) were used to outline the timing and pattern of regional transmembrane current flow. Our analysis confirms the participation of multiple cortical areas, located on either side of the central sulcus, in the generation of the initial cortical SEP components. Earliest activity P10, was localized to area 3, followed within milliseconds by activation of areas 1, 2 (P12), and 4 (P13). In SI (Brodmann's areas 3, 1 and 2), the initial SEP components reflect the depolarization of lamina 4 stellate cells and the subsequent activation of adjacent pyramidal cells in laminae 3 and 5. The genesis of later cortical components (P20, N45) represents the composite of activity distributed across multiple cortical laminae and the interaction of overlapping excitatory and inhibitory events. These findings have direct implications for the clinical interpretation of SEP waveforms.

The interaction of the somatosensory evoked potentials to simultaneous finger stimuli in the human central nervous system. A study using direct recordings

In order to investigate the interaction of sensory electrophysiologic fields arising from the adjacent second (II) and third (III) fingers and the distant second and fifth (V) fingers, direct recordings of somatosensory evoked potentials (SEPs) were performed from the sensory and motor cortices, the sensory thalamic nucleus (nucleus ventralis caudalis, VC) and the cuneate nucleus in humans during neurosurgical operations. Electrical stimulation was given to the II, III or V fingers individually, and also to pairs of either the II and III fingers or the II and V fingers simultaneously. The interaction ratio (IR) was devised as the ratio of amplitude attenuation caused by the simultaneous stimulation to two fingers compared with the amplitude of the arithmetically summed SEPs to the individual stimulation of two fingers. The IRs were calculated on N20 and P25 from the sensory cortex, P22 from the motor cortex, P17thal from the VC, and N16cune and P35cune from the cuneate nucleus. With both stimulations to the II and III fingers and the II and V fingers, P25 showed the greatest IR, followed by P22, then by P17thal, with N16cune exhibited the smallest IR. N20 and P35cune showed similar IRs and significantly greater IRs with II and III finger stimulation compared with II and V finger stimulation. These results thus indicate that the interaction of somatosensory impulses occurs in several structures along the sensory pathway in CNS, including the cuneate nucleus, the sensory thalamic nucleus, as well as sensory and motor cortices, with the greatest IRs in the cerebral cortices and the weakest ones in the brain-stem.(ABSTRACT TRUNCATED AT 250 WORDS)

Temporal segmentation and multiple-source analysis of short-latency median nerve SEPs

Short-latency (10-50 ms) median nerve somatosensory evoked potentials (SEPs) from four normal subjects were analysed by means of temporal segmentation techniques and source derivation methods. In each case the responses were recorded using 32 electrodes. Dipolar optimization was carried out with a time-varying technique, using three different approaches: regional source estimation, spherical source estimation (one radial and one tangential component), and multiple dipolar approach. This was to assess the relative influence on the dipolar solution of the different optimization techniques. The effect of the different number of channels in the estimation procedures has been also investigated. The methods of optimization are crucial, particularly for the orientation of P22. In all cases the source location estimated with the 32-electrode montage was shifted towards the centre of the spheres.

Somatotopy of human hand somatosensory cortex revealed by dipole source analysis of early somatosensory evoked potentials and 3D-NMR tomography

Somatosensory evoked potentials (SEPs) to median nerve and finger stimulation were analyzed by means of spatio-temporal dipole modelling combined with 3D-NMR tomography in 8 normal subjects. The early SEPs were modelled by 3 equivalent dipoles located in the region of the brain-stem (B) and in the region of the contralateral somatosensory cortex (T and R). Dipole B explained peaks P14 and N18 at the scalp. Dipole T was tangentially oriented and explained the N20-P20, dipole R was radially oriented and modelled the P22. The tangential dipole sources T were located within a distance of 6 mm on the average and all were less than 9 mm from the posterior bank of the central sulcus. In 6 subjects the tangential sources related to finger stimulation arranged along the central sulcus according to the known somatotopy. The radial sources did not show a consistent somatotopic alignment across subjects. We conclude that the combination of dipole source analysis and 3D-NMR tomography is a useful tool for functional localization within the human hand somatosensory cortex.

The effects of stimulus rates upon median, ulnar and radial nerve somatosensory evoked potentials

We examined the effect of stimulus rates on the somatosensory evoked potential (SEP) amplitude following stimulation of the median nerve (MN) and the ulnar nerve (UN) at the elbow or wrist, and the radial nerve (RN) at the wrist in 12 normal subjects. We measured the amplitude of frontal (P14-N18-P22-N30) and parietal peaks (P14-N20-P26-N34) at a stimulus rate of 1.1, 3.5 and 5.7 Hz. The amplitude attenuation was found at frontal P22 and N30 and to a lesser degree at parietal N20 and P26 peaks with an increasing stimulus rate from 1.1 to 5.7 Hz. The amplitude attenuation was greatest at the elbow when compared to the wrist stimulation for both MN and UN. The attenuation was least for wrist stimulation for the RN. The UN block by local anesthesia just distal to the stimulus electrode at the elbow abolished the amplitude attenuation caused by the fast stimulus rate. The observed amplitude attenuation with the faster stimulus rate is probably due, in part, to interference from the "secondary" afferent inputs. The secondary afferent inputs arise from peripheral receptor stimulation (muscle, joint and/or cutaneous) as a subsequent effect of efferent volleys initiated from the point of stimulation. The greater number of peripheral receptors being activated as more proximal sites of stimulation in a mixed nerve would result in greater attenuation of the SEP recorded from scalp electrodes. We postulate that the attenuation of frontal peaks by the fast stimulus rate is due to the frontal projection of interfering "secondary" afferent inputs.

Prognostic value of frontal and parietal somatosensory evoked potentials in severe head injury: a long-term follow-up study

We have shown that the combined analysis of the frontal and parietal somatosensory evoked response (SEP) improves the global short-term outcome prediction in severe head injury (SHI) after 3-6 months. In the present study the same patients were reexamined 18 months after trauma and the prognostic value of the combined SEP parameters reassessed, in particular their value of predicting the exact Glasgow Outcome Scale (GOS) class reached (as opposed to a crude good or bad distinction). Frontal (P20/22, N30) and parietal (N20) SEP components were studied in 50 patients within 72 h after the injury and were related to the GOS after 3-6 months and again after 18 months. When both frontal and parietal components were used as predictors, discriminant analysis correctly classified 76% of the patients after 3-6 months and 82% after 18 months. Considering parietal SEP alone, classification was less accurate (74% after 3-6 months, and 68% after 18 months) and misclassifications were more severe. Our results show that (i) a combined analysis of frontal and parietal components of the SEP improves and refines the outcome prediction in SHI, (ii) the predictive power of the combined approach increases with time after trauma, while that of the parietal response alone decreases.

Somatosensory evoked potentials at rest and during movement in Parkinson's disease: evidence for a specific apomorphine effect on the frontal N30 wave

Studies attempting to relate the abnormalities of the frontal N30 components of the somatosensory evoked potentials (SEPs) to motor symptoms in Parkinson's disease (PD) have shown contradictory results. We recorded the frontal and parietal SEPs to median nerve stimulation in 2 groups of PD patients: a group of 17 patients presenting the wearing-off phenomenon, and a group of 10 untreated PD patients. The results were compared with a group of 13 healthy volunteers of the same age and with a group of 10 non-parkinsonian patients. All parkinsonian and non-parkinsonian patients were studied before ("off" condition) and after a subcutaneous injection of apomorphine ("on" condition). The gating effects of a voluntary movement (clenching of the hand) on the SEPs were also studied for the wearing-off group of PD patients (in states off and on) in comparison with the healthy subjects. At rest and in the off condition the amplitude of the frontal N30 was significantly reduced in the 2 groups of PD patients. We demonstrate that the movement gating ability of the PD patient is preserved in spite of the reduced amplitude of the frontal N30. This result suggests that the specific change in the frontal N30 in PD is not the consequence of a continuous gating of the sensory inflow by a motor corollary discharge. Clinical motor improvement induced by apomorphine was associated with a significant enhancement of the frontal N30 wave. In contrast, the subcortical P14 and N18 waves and the cortical N20, P22, P27 and N45 were not statistically modified by the drug. Apomorphine infusion did not change the absolute reduced voltage of the N30 reached during the movement gating. While the frontal N30 component of the non-parkinsonian patients was significantly lower in comparison to healthy subjects, this wave did not change after the apomorphine administration. In the wearing-off PD patient group the frontal N30 increment was positively correlated with the number of off hours per day. This specific apomorphine sensitivity of the frontal N30 was interpreted as a physiological index of the dopaminergic modulatory control exerted on the neuronal structures implicated in the generation of the frontal N30.