Motor cortex excitability after thalamic infarction

Subcortical atrophy correlates with the perturbational complexity index in patients with disorders of consciousness

BACKGROUND

The complexity of neurophysiological brain responses to direct cortical stimulation, referred to as the perturbational complexity index (PCI), has been shown able to discriminate between consciousness and unconsciousness in patients surviving severe brain injury as well as several other conditions (e.g., wake, dreamless sleep, sleep and ketamine dreaming, anesthesia).

OBJECTIVE

This study asks whether, in patients with a disorder of consciousness (DOC), the complexity of the neurophysiological response to cortical stimulation is preferentially associated with atrophy within specific brain structures.

METHODS

We perform a retrospective analysis of 40 DOC patients and correlate their maximal PCI to MR-based measurements of cortical thinning and subcortical atrophy.

RESULTS

PCI was systematically and inversely associated with the degree of local atrophy within the globus pallidus, a region previously linked to electrocortical and behavioral arousal. Conversely, we fail to detect any association between variance in cortical ribbon thickness and PCI.

CONCLUSION

These findings corroborate the previously reported association between pallidal atrophy and low behavioral arousal and suggest that this region's role in maintaining the overall balance of excitation and inhibition may critically affect the emergence of complex cortical interactions in chronic disorders of consciousness. This finding thus also suggests a target for potential neuromodulatory intervention in DOC patients.

Modulation of motoneuron firing by recurrent inhibition in the adult rat in vivo

Recent reports show that synaptic inhibition can modulate postsynaptic spike timing without having strong effects on firing rate. Thus synaptic inhibition can achieve multiplicity in neural circuit operation through variable modulation of postsynaptic firing rate vs. timing. We tested this possibility for recurrent inhibition (RI) of spinal motoneurons. In in vivo electrophysiological studies of adult Wistar rats anesthetized by isoflurane, we examined repetitive firing of individual lumbosacral motoneurons recorded in current clamp and modulated by synchronous antidromic electrical stimulation of multiple motor axons and their centrally projecting collateral branches. Antidromic stimulation produced recurrent inhibitory postsynaptic potentials (RIPSPs) having properties similar to those detailed in the cat. Although synchronous RI produced marked short-term modulation of motoneuron spike timing and instantaneous firing rate, there was little or no suppression of average firing rate. The bias in firing modulation of timing over average rate was observed even for high-frequency RI stimulation (100 Hz), perhaps because of the brevity of RIPSPs, which were more than twofold shorter during motoneuron firing compared with rest. These findings demonstrate that RI in the mammalian spinal cord has the capacity to support and not impede heightened motor pool activity, possibly during rapid, forceful movements.

The influence of correlated afferent input on motor cortical representations in humans

Animal models reveal that correlated afferent inputs are a powerful driver of sensorimotor cortex reorganisation. Recently we developed a stimulation paradigm, which evokes convergent afferent input from two hand muscles and induces reorganisation within human motor cortex. Here we investigated whether this reorganisation is characterised by expansion and greater overlap of muscle representation zones, as reported in animal models. Using transcranial magnetic stimulation, we mapped the motor representation of the right first dorsal interosseous (FDI), abductor digiti minimi (ADM) and abductor pollicis brevis (APB) in 24 healthy subjects before and after 1 h of (1) associative stimulation to FDI and ADM motor points, (2) associative stimulation to digits II and V (3) a control condition employing non-correlated stimulation of FDI and ADM motor points. Motor point associative stimulation induced a significant increase in the number of active sites in all three muscles and volume in FDI and ADM. Additionally, the centre of gravity of the FDI and ADM maps shifted closer together. Similar changes were not observed following digital associative stimulation or motor point non-associative stimulation. These novel findings provide evidence that convergent input induces reorganisation of the human motor cortex characterised by expansion and greater overlap of representational zones.