Deficits and Recovery of First-Order and Second-Order Motion Perception in Patients with Unilateral Posterior Parietal Lesions

Our aim was to test whether unilateral posterior parietal lesions degrade first-order and second-order motion differentially, and to investigate the time course of any potential recovery. We tested ten patients with circumscribed parietal lesions.

Thresholds were measured for the discrimination of the direction of motion of stimuli presented 5.5° peripherally in the ipsilesional and contralesional visual hemifields. Subjects had to indicate whether a rectangular region (1.6 deg × 3 deg) embedded in dynamic random noise background moved up or down. The region contained moving (signal) and flickering (background) dots and moved for 1 s at 2.36 deg s−1. Signal dots were either (a) coherently moving in the same direction as the region (first-order), (b) stationary (second-order), or (c) coherently moving in the opposite direction (theta). Thresholds were defined as percentage of signal dots within the region yielding 75% correct responses.

All patients had higher thresholds for second-order than for first-order motion. When contralesional and ipsilesional thresholds were compared, three patients showed proportional threshold elevations for all three types of motion stimuli in the contralesional hemifield. Two of these three patients were tested again five months later. Both showed considerable recovery: in one patient, the contralesional deficit was no longer present; in the other, it was reduced by about half. None of our patients had lesions affecting first-order or second-order motion differentially; lesions always affected first-order and second-order motion similarly. Owing to recovery, these deficits might be detectable only for a short time.

Local administration of DFO-loaded lipid particles improves recovery after end-to-end reconstruction of rat median nerve

PURPOSE

The improvement of regeneration and functional recovery after peripheral nerve injury is a major challenge in neurosurgery. Although microsurgical techniques for nerve reconstruction have seen great advancements over the last years, the clinical outcome with patients is often unsatisfactory. The aim of the present study was to investigate if administration of the iron chelator Deferroxamine (DFO), can improve postoperative outcome in the rat median nerve reconstruction model.

METHODS

After complete transection, the right median nerve was repaired by end-to-end neurorrhaphy. The suture site was wrapped by a 1-cm-long external jugular vein segment, either empty or filled with DFO-loaded lipid particles (Perineurin or with a vehicle (unloaded lipid particles) alone. Functional testing was carried out weekly by means of the grasping test. At the time of withdrawal, 12 weeks post-operatively, muscle tropism recovery was assessed by weighing flexor digitorum sublimis muscle that is innervated by the median nerve only. Before harvesting of the nerve specimens electrophysiological analyses were performed with measuring the latency, the threshold and the conduction velocity. Finally, the repaired nerves were withdrawn for immunocytochemistry with a neurofilament antibody and axon quantitative morphology.

RESULTS

The comparison between the groups showed that intraoperative application of the DFO-loaded lipid particles at the neurorrhaphy site led to a significant increase in the density of regenerating axons as well as to an accelerated recovery of both muscle tropism and motor function. The electrophysiological results demonstrated a decrease of the threshold, a lower latency, and a higher conduction velocity in the Perineurin-treated animals.

CONCLUSIONS

The results of the present study suggest that local administration of Perineurin might have a therapeutic potential for improving the postoperative outcome after microsurgical nerve reconstruction in patients.

Selective color constancy deficits after circumscribed unilateral brain lesions

The color of an object, when part of a complex scene, is determined not only by its spectral reflectance but also by the colors of all other objects in the scene (von Helmholtz, 1886; Ives, 1912; Land, 1959). By taking global color information into account, the visual system is able to maintain constancy of the color appearance of the object, despite large variations in the light incident on the retina arising from changes in the spectral content of the illuminating light (Hurlbert, 1998; Maloney, 1999). The neural basis of this color constancy is, however, poorly understood. Although there seems to be a prominent role for retinal, cone-specific adaptation mechanisms (von Kries, 1902; Pöppel, 1986; Foster and Nascimento, 1994), the contribution of cortical mechanisms to color constancy is still unclear (Land et al., 1983; D'Zmura and Lennie, 1986). We examined the color perception of 27 patients with defined unilateral lesions mainly located in the parieto-temporo-occipital and fronto-parieto-temporal cortex. With a battery of clinical and specially designed color vision tests we tried to detect and differentiate between possible deficits in central color processing. Our results show that color constancy can be selectively impaired after circumscribed unilateral lesions in parieto-temporal cortex of the left or right hemisphere. Five of 27 patients exhibited significant deficits in a color constancy task, but all of the 5 performed well in color discrimination or higher-level visual tasks, such as the association of colors with familiar objects. These results indicate that the computations underlying color constancy are mediated by specialized cortical circuitry, which is independent of the neural substrate for color discrimination and for assigning colors to objects.

Deficits and recovery of first- and second-order motion perception in patients with unilateral cortical lesions

Unilateral lesions in the posterior parietal cortex can degrade motion perception in the contralesional visual hemifield. Our aim was to investigate whether deficits caused by cortical lesions may be different for first- and second-order motion perception, and to study the time scale of any potential recovery. In nine patients with circumscribed lesions mainly in the parietal and fronto-parietal cortex, thresholds for direction discrimination were measured for stimuli presented peripherally in their ipsi- and contralesional hemifield. Subjects had to identify the direction of a vertically moving object embedded in a background of dynamic random dot noise. The object consisted of various proportions of signal and noise dots. Signal dots were either (a) coherently moving in the same direction as the object (first-order), (b) stationary (second-order: drift-balanced), or (c) coherently moving in the opposite direction (second-order: theta). Noise dots were flickering. Two patients showed significant threshold elevations for all three types of motion stimuli presented in their contralesional hemifield, while thresholds for ipsilesional targets were unaffected. Neither showed any selective deficit of first- versus second-order motion perception, but second-order motion was more impaired. Their lesions probably included the motion area V5-MT, which was spared in the other seven patients. One of the patients, who was retested several times during a 27-month postlesional period, showed complete recovery for first- and second-order motion direction discrimination, as well as for the detection of speed differences.

[Assessment of motor cranial nerve functions using transcranial magnetic stimulation]

Transcranial magnetic stimulation applied over one cerebral hemisphere evokes bilateral responses in the muscles supplied by cranial nerves (masseter, mentalis, sternomastoid, genioglossus) (Tabl. 1). The relatively long latencies of these responses and the influence that preactivation of the muscle has on them, suggests that they are cortically evoked. Shorter latency and exclusively ipsilateral responses can be obtained if the position of the stimulating coil over the head is more lateral. These responses are uninfluenced by pre-activation of the muscle which suggests that they arise from stimulation of the peripheral nerve itself. By considering the conduction velocity of the nerve and the response latency such stimulation probably occurs in the proximal intracisternal segment (Fig. 2). The results obtained using magnetic stimulation of the cortex in patients with unilateral cerebral hemisphere lesions lend support to the idea of a bilateral projection from each cerebral hemisphere to the motor nuclei of the facial and hypoglossal nerves on both sides: stimulations over the intact hemisphere produces bilateral responses, whereas stimulations over the damaged hemisphere produce no responses (Fig. 1). In patients with idiopathic facial palsy no short latency responses were obtained on the affected side either during the acute (less than 10 days) or during the chronic phase (greater than 3 months) of the illness-despite clinical improvement during the chronic stage (Fig. 3, 4). However cortically evoked responses were obtainable in patients seen during the chronic phase indicating that facial motoneurones could be excited transsynaptically (Fig. 3).(ABSTRACT TRUNCATED AT 250 WORDS)

[Transcranial brain stimulation. Methods and results]

Since the end of last century direct electric brain stimulations have produced remarkable neurophysiological results. Unfortunately, this method can be used only during neurosurgical operations. With the introduction of transcranial electric brain stimulation in 1980, for the first time, it became possible to perform brain stimulations on non-anaesthetized subjects. Magnetic brain stimulation, available since 1985, allows brain stimulation without any discomfort of the subject. This paper is dealing with methodological aspects of both methods and presents first results of neurophysiological and clinical applications.

Transcranial magnetic stimulation of the human brain: responses in muscles supplied by cranial nerves

The present investigation demonstrates that time-varying magnetic fields induced over the skull elicit distinct types of responses in muscles supplied by the cranial nerves both on the ipsilateral and the contralateral side. When the center of the copper coil was positioned 4 cm lateral to the vertex on a line from the vertex to the external auditory meatus, bilateral responses in the masseter, orbicularis oculi, mentalis, and sternocleidomastoideus muscles with a delay of about 10 to 14 ms after the stimulus occurred. Similar to the transcranially evoked muscle responses in hand muscles, the responses in the cranial muscles can be influenced in latency and amplitude by background excitation. It is concluded that these responses are induced by excitation of the face-associated motor cortex followed by multiple I-waves in the corticonuclear tract with both ipsilateral and contralateral projections to the corresponding motoneurones. Additionally, at higher stimulation strengths "short-latency" ipsilateral responses in muscles supplied by the trigeminal, facial, and accessory nerves occurred which we suggest are induced by direct stimulation of the peripheral cranial nerves in their intracisternal course. The present study confirms the bilateral projection of corticonuclear tracts in awake unanesthetised human subjects which has been observed by electrical stimulation on the exposed cortex during surgical procedures already decades ago. The present investigation will serve as a basis for the assessment of pathophysiological mechanisms involving the corticonuclear system or the peripheral cranial nerves in their proximal parts in awake humans.

Speech and respiration

This investigation deals with the temporal aspects of air volume changes during speech. Speech respiration differs fundamentally from resting respiration. In resting respiration the duration and velocity of inspiration (air flow or lung volume change) are in a range similar to that of expiration. In speech respiration the duration of inspiration decreases and its velocity increases; conversely, the duration of expiration increases and the volume of air flow decreases dramatically. The following questions arise: are these two respiration types different entities, or do they represent the end points of a continuum from resting to speech respiration? How does articulation without the generation of speech sound affect breathing? Does (verbalized?) thinking without articulation or speech modify the breathing pattern? The main test battery included four tasks (spontaneous speech, reading, serial speech, arithmetic) performed under three conditions (speaking aloud, articulating subvocally, quiet performance by tryping to exclusively 'think' the tasks). Respiratory movements were measured with a chest pneumograph and evaluated in comparison with a phonogram and the identified spoken text. For quiet performance the resulting respiratory time ratio (relation of duration of inspiration versus expiration) showed a gradual shift in the direction of speech respiration--the least for reading, the most for arithmetic. This change was even more apparent for the subvocal tasks. It is concluded that (a) there is a gradual automatic change from resting to speech respiration and (b) the degree of internal verbalization (activation of motor speech areas) defines the degree of activation of the speech respiratory pattern.