Brain stimulation revisited

Traumatic brain injury and frontal lobe plasticity

Over 1.4 million people in the United States experience traumatic brain injury (TBI) each year and approximately 52,000 people die annually due to complications related to TBI. Traditionally, TBI has been viewed as a static injury with significant consequences for frontal lobe functioning that plateaus after some window of recovery, remaining relatively stable thereafter. However, over the past decade there has been growing consensus that the consequences of TBI are dynamic, with unique characteristics expressed at the individual level and over the life span. This chapter first discusses the pathophysiology of TBI in order to understand its dynamic process and then describes the behavioral changes that are the result of injury with focus on frontal lobe functions. It integrates a historical perspective on structural and functional brain-imaging approaches used to understand how TBI impacts the frontal lobes, as well as more recent approaches to examine large-scale network changes after TBI. The factors most useful for outcome prediction are surveyed, along with how the theoretical frameworks used to predict recovery have developed over time. In this chapter, the authors argue for the need to understand outcome after TBI as a dynamic process with individual trajectories, taking a network theory perspective to understand the consequences of disrupting frontal systems in TBI. Within this framework, understanding frontal lobe dysfunction within a larger coordinated neural network to study TBI may provide a novel perspective in outcome prediction and in developing individualized treatments.

Asymmetric Activation of Motor Cortex Controlling Human Anterior Digastric Muscles During Speech and Target-Directed Jaw Movements

Like most of the cranial muscles involved in speech, the trigeminally innervated anterior digastric muscles are controlled by descending corticobulbar projections from the primary motor cortex (M1) of each hemisphere. We hypothesized that changes in corticobulbar M1 excitability during speech production would show a hemispheric asymmetry favoring the left side, which is the dominant hemisphere for language processing in most strongly right handed subjects. Fifteen volunteers aged 24.5 ± 5.3 (SD) yr participated. All subjects were strongly right handed as reported by questionnaire. A surface electromyograph (EMG) was recorded bilaterally from digastrics and jaw movement detected by an accelerometer attached to a lower incisor. Focal transcranial magnetic stimulation (TMS) was used to assess corticomotor excitability of the digastric representation in M1 of both hemispheres during four tasks: 1) static isometric contraction of digastrics; 2) speaking a single word; 3) visually guided, nonspeech jaw movement that matched the jaw kinematics recorded during task 2; and 4) reciting a sentence. Background EMG was well matched in all tasks and jaw kinematics were similar around the time of the TMS pulse for tasks 2–4. TMS resting thresholds and digastric muscle-evoked potential (MEP) size during isometric contraction did not differ for TMS over left versus right M1. MEPs elicited by TMS over left, but not right M1 increased in size during speech and nonspeech jaw movement compared with isometric contraction. We conclude that left corticobulbar M1 is preferentially engaged for descending control of digastric muscles during speech and the performance of a rapid jaw movement to match a target kinematic profile.

Central nervous system control of the laryngeal muscles in humans

Laryngeal muscle control may vary for different functions such as: voice for speech communication, emotional expression during laughter and cry, breathing, swallowing, and cough. This review discusses the control of the human laryngeal muscles for some of these different functions. Sensori-motor aspects of laryngeal control have been studied by eliciting various laryngeal reflexes. The role of audition in learning and monitoring ongoing voice production for speech is well known; while the role of somatosensory feedback is less well understood. Reflexive control systems involving central pattern generators may contribute to swallowing, breathing and cough with greater cortical control during volitional tasks such as voice production for speech. Volitional control is much less well understood for each of these functions and likely involves the integration of cortical and subcortical circuits. The new frontier is the study of the central control of the laryngeal musculature for voice, swallowing and breathing and how volitional and reflexive control systems may interact in humans.

Transcranial magnetic double stimulation: influence of the intensity of the conditioning stimulus

The influence of stimulus parameters on compound muscle potentials evoked by transcranial magnetic double stimulation was systematically investigated. Two magnetic stimulators were discharged via a figure-of-eight-shaped magnetic coil (outer diameter of each circular coil, 7 cm) over the left hemisphere, 6 cm lateral to Cz, using a Bistim interface. Recordings were made from the right first dorsal interosseus muscle. In experiment I, in 12 healthy volunteers the intensity of the conditioning subthreshold stimulus was varied from 0 to 100% of the relaxed motor threshold at an interstimulus interval of 1 ms. In experiment II, interstimulus intervals of 1, 3 and 5 ms were used to investigate the effect of conditioning stimuli of 3 fixed intensities. Maximal reduction of the amplitude of motor evoked potentials was found at a conditioning stimulus intensity of 65% of the relaxed motor threshold (and at an interstimulus interval of 1 ms). Because intensities of the conditioning stimulus higher than 65% reduced amplitudes of motor evoked potentials less effectively than at this intensity, refractoriness of pyramidal neurons can be ruled out as the main mechanism contributing to the observed inhibition. Activation of inhibitory interneurons by intensities lower than is necessary to activate pyramidal neurons is discussed as a possible mechanism for the inhibitory effects evoked by transcranial magnetic stimulation.

Transcranial magnetic stimulation in partial epilepsy: drug-induced changes of motor excitability

Single-pulse transcranial magnetic stimulation (s-TMS) with recording of motor evoked potentials (MEPs) from thenar muscles of both hands was performed on 84 patients with cryptogenic partial epilepsy and 50 healthy controls. We analyzed the cortical latency (CL), central conduction time (CCT), and threshold intensity (TI) required to elicit liminal MEPs at rest. In the patients, CL and CCT were normal, but TI was significantly higher than in the controls. Of the 84 patients, 65 were taking one or more antiepileptic drugs and 19 were untreated. The untreated patients had a significantly lower TI than the treated patients. In the treated patients, the TI increase paralleled the number of drugs taken. Additionally, in 2 subgroups of patients undergoing major modifications of antiepileptic treatment, TI dropped after partial withdrawal of medication and increased following the commencement of therapy. The results suggest that anticonvulsants depress the excitability of human motor pathways in epileptic subjects.

Magnetic coil suppression of extrafoveal visual perception using disappearance targets

We used magnetic brain stimulation with a butterfly coil over the occipital lobes to study extrafoveal visual field effects in six subjects. The visual test pattern was a grid of asterisks around a central fixation point, and the target was the disappearance of one asterisk for a single frame of the video monitor. Using single magnetic pulses at stimulator outputs of 55-95%, we noted robust interference effects at latencies < or = 100 ms, peaking at approximately 50-90 ms. Suppression of visual perception occurred with both transverse and sagittal alignments of the coil. When the coil was moved laterally over either occipital lobe, perception of target disappearance was consistently suppressed in the contralateral visual field. Movement of the coil rostrally produced consistent suppression in the lower and middle field, but preferential suppression of the upper field could not be obtained. This altitudinal asymmetry may be correlated with the anatomy of the occipital lobe in relation to the scalp surface.

Early and late motor evoked potentials reflect preset agonist-antagonist organization in lower limb muscles

A single transcranial magnetic stimulus can evoke two involuntary muscle responses in lower limb muscles of healthy humans. The purpose of the present study was to find out if these responses, when evoked during the processing period of a simple or choice reaction time task, such as ankle dorsiflexion, have specific characteristics related to the task. During the auditory reaction time, a transcranial magnetic stimulus was delivered to observe changes in the excitability of the central nervous system. A dual-cone coil was used, which effectively stimulated the fairly deep-lying lower limb motor cortex. Stimuli were delivered in a random order with 20-300-ms delays from the auditory go-signal. Motor evoked potentials (MEP) in right and left anterior tibial and soleus muscles were analyzed while early MEPs were observed invariably in both muscles; late MEPs occurred consistently only in soleus muscles. Both early and late MEP amplitudes were larger in simple reaction time trials than in choice reaction time trials. The late MEP appeared earlier in the simple reaction time task than in the choice reaction time task, reflecting faster central processing of simple reaction time tasks. The amplitude of the soleus late MEP in the simple reaction time task followed closely the amplitude of anterior tibial early MEP, suggesting a preset agonist-antagonist organization. This relationship was not present in the choice reaction time task.

Magnetic motor evoked potentials during methohexital anesthesia in the dog

Magnetic motor evoked potentials (MMEPs) were recorded from the right cranial tibial muscle after magnetic stimulation of the left motor cortex in six dogs sedated with oxymorphone. Anesthesia was induced with an intravenous bolus of 5.5 mg/kg of methohexital and maintained with a methohexital infusion. The dogs inspired 100% oxygen during anesthesia. Blood pressure, heart rate, respiratory rate, esophageal temperature, and end-tidal carbon dioxide tension were recorded. The depth of anesthesia was increased until the amplitude of the MMEP was less than 5% of the control value, and the dogs were then allowed to recover. Every 5 minutes during anesthesia, a blood sample was taken for methohexital assay and at the same time, four replicate MMEPs were recorded. Plasma methohexital levels were significantly (P < 0.05) correlated with heart rate (p = 0.38) and end-tidal carbon dioxide tension (p = 0.49) and negatively correlated with respiratory rate (p = 0.74). There was no significant correlation between blood pressure and methohexital levels. The dogs regained consciousness at a plasma methohexital level of 10.4 +/- 3.8 micrograms/ml (mean +/- SD). The amplitude of the MMEP decreased significantly with increasing methohexital levels. In four dogs, the relationship was reasonably linear. The MMEP disappeared at a plasma methohexital level of 23 +/- 6.6 micrograms/ml. The latency of onset of the MMEP increased significantly from its control value of 14.7 +/- 1.0 ms to 17.5 +/- 1.3 ms at the highest methohexital levels at which MMEPs were recordable. This study demonstrated that MMEPs can be reliably recorded under methohexital anesthesia.