In vivo human hippocampal cingulate connectivity: A corticocortical evoked potentials (CCEPs) study

ObjectiveTo investigate the human limbic system using cortico-cortical evoked potential (CCEP), which reveals the brain networks.MethodsFive patients with nonlesional medically intractable focal epilepsy with ictal onset outside the limbic system were enrolled. All patients underwent stereoelectroencephalogram electrode implantation in order to delineate the epileptogenic zone. Alternating 1 Hz electrical stimuli were delivered to the hippocampus and posterior cingulate gyrus. A total of sixty stimuli were averaged in each trial to obtain CCEP responses.ResultsHippocampal stimulation elicited prominent CCEP responses in the posterior cingulate gyrus. The latencies of early (N1) and late (N2) negative peak ranged 20–60 ms and 102–175 ms respectively. In addition, CCEP responses were observed in the posterior parahippocampal gyrus, medial superior frontal gyrus (SFG) and orbitofrontal cortex. Stimulation of posterior cingulate contacts induced CCEPs in the hippocampus with N1 and N2 latencies of 25–43 ms and 90–234 ms respectively in all five patients.ConclusionThis finding supports the assertion that the hippocampus is connected with the posterior cingulate gyrus, posterior parahippocampal gyrus, medial SFG and orbitofrontal cortex. The hippocampus and posterior cingulate gyrus have a bidirectional network through the cingulum.SignificanceThe present study provides new insight into the human limbic network.     

Influence of limb temperature on cutaneous silent periods

ObjectiveThe cutaneous silent period (CSP) is a spinal inhibitory reflex mediated by small-diameter afferents (A-delta fibers) and large-diameter efferents (alpha motoneurons). The effect of limb temperature on CSPs has so far not been assessed.MethodsIn 27 healthy volunteers (11 males; age 22–58 years) we recorded median nerve motor and sensory action potentials, median nerve F-wave and CSPs induced by noxious digit II stimulation in thenar muscles in a baseline condition at room temperature, and after randomly submersing the forearm in 42 °C warm or 15 °C cold water for 20 min each.ResultsIn cold limbs, distal and proximal motor and sensory latencies as well as F-wave latencies were prolonged. Motor and sensory nerve conduction velocities were reduced. Compound motor and sensory nerve action potential amplitudes did not differ significantly from baseline. CSP onset and end latencies were more delayed than distal and proximal median nerve motor and sensory latencies, whereas CSP duration was not affected. In warm limbs, opposite but smaller changes were seen in nerve conduction studies and CSPs.ConclusionThe observed CSP shift “en bloc” towards longer latencies without affecting CSP duration during limb cooling concurs with slower conduction velocity in both afferent and efferent fibers. Disparate conduction slowing in afferents and efferents, however, suggests that nociceptive EMG suppression is mediated by fibers of different size in the afferent than in the efferent arm, indirectly supporting the contribution of A-delta fibers as the main afferent input.SignificanceLimb temperature should be taken into account when testing CSPs in the clinical setting, as different limb temperatures affect CSP latencies more than large-diameter fiber conduction function.     

Methodology for intraoperatively eliciting motor evoked potentials in the vocal muscles by electrical stimulation of the corticobulbar tract

ObjectiveTo establish a methodology for recording corticobulbar motor evoked potentials (CoMEPs) from vocal muscles after transcranial electrical stimulation (TES) and direct cortical stimulation (DCS).MethodsTwenty-four patients were included in this study (22 for TES, 2 for DCS, 3 for TES plus DCS) that underwent different surgical procedures. We used two methods to elicit CoMEPs: (a) TES by stimulation over C3/Cz or C4/Cz and (b) DCS with a strip electrode placed over the primary motor area (M1) for laryngeal muscles. To record CoMEPs from vocal muscles we used two hook wire electrodes 76 μm of diameter passing through 27 gauge needle endotracheally placed in the vocal muscles after intubation.ResultsRecording of CoMEPs in the vocal muscles after TES was successfully performed in 22 patients. TES over the right or left hemisphere elicit responses bilaterally. The onset latencies for the right vocal muscle was 12.4 ± 3.1 ms (ipsilateral stimulation) and 12.7 ±2.2 ms (contralateral stimulation) while for the left vocal muscle, onset latency was 12.9 ± 2.3 ms (ipsilateral stimulation) and 14.1 ± 3.4 ms (contralateral stimulation). In five patients DCS elicited CoMEPs in right and left vocal muscle with latency of 16.6 ± 4.7 and 15.6 ± 3.7 ms, respectively.ConclusionThe method to elicit and record CoMEPs in vocal muscles shows reliable results and adds one more tool in the armamentarium of intraoperative neurophysiology.SignificanceThis method shows the ability to continuously monitor the functional integrity of corticobulbar pathways, vagal nucleus and laryngeal nerves.     

Parallel spinal pathways generate the middle-latency N1 and the late P2 components of the laser evoked potentials

ObjectiveTo investigate the possible presence of multiple spino-thalamic pathways with different conduction velocities (CVs) in the human spinal cord.MethodsLaser evoked potentials (LEPs) were recorded in 10 healthy subjects after stimulation of the dorsal midline at four vertebral level: C5, T2, T6, and T10. This method allowed us to minimize the influence of the conduction in the peripheral fibers and to calculate the spinal CV in two different ways: (1) the reciprocal of the slope of the regression line was obtained from the latencies of the different LEP components, and (2) the distance between C5 and T10 was divided by the latency difference of the responses at the two sites. In particular, we considered the middle-latency N1 potential (latencies of around 135, 150, 157, and 171 ms after stimulation at C5, T2, T6, and T10 levels, respectively), which is generated in the second somatosensory (SII) area, and the late P2 response (latencies of around 336, 344, 346, and 362 ms after stimulation at C5, T2, T6, and T10 levels, respectively), which is generated in the anterior cingulate cortex (ACC).ResultsThe calculated CV of the spinal fibers generating the N1 potential (around 9 m/s) was significantly different (P < 0.05) from the one of the pathway producing the P2 response (around 13 m/s).ConclusionsOur results suggest that the N1 and the P2 LEP components are generated by two parallel spinal pathways.SignificanceBoth the N1 and P2 potentials should be recorded in the clinical routine since a dissociated abnormality of either response may be found in lesions of the nociceptive system not only in the brain, but also at spinal cord level.     

Central nervous system abnormalities in vaginismus

ObjectiveTo investigate possible altered CNS excitability in vaginismus.MethodsIn 10 patients with primary idiopathic lifelong vaginismus, 10 with vulvar vestibulitis syndrome accompanied by vaginismus and healthy controls we recorded EMG activity from the levator ani (LA) and external anal sphincter (EAS) muscles and tested bulbocavernosus reflex (BCR). Pudendal-nerve somatosensory evoked potentials (SEPs) were tested after a single stimulus. Pudendal-nerve SEP recovery functions were assessed using a paired conditioning-test paradigm at interstimulus intervals (ISIs) of 5, 20 and 40 ms.ResultsEMG in patients showed muscular hyperactivity at rest and reduced inhibition during straining. The BCR polysynaptic R2 had larger amplitude (p < 0.01) and longer duration (p < 0.01) in patients from both groups than in controls. In controls, paired-pulse SEPs were suppressed at the 5 ms ISI for N35–P40 (p < 0.05) and P40–N50 ms (p < 0.001) and facilitated at the 20 ms ISI for N35–P40 (p < 0.05) and P40–N50 (p < 0.05). No significant differences were found in the paired-pulse N35–P40 in patients and controls but the cortical P40–N50 at 20 ISI was facilitated in patients (p < 0.05).ConclusionsEMG activity is enhanced and the cortical SEP recovery cycle and BCR are hyperexcitable in vaginismus.SignificanceThe neurophysiological abnormalities in patients with vaginismus indicate concomitant CNS changes in this disorder.     

Neurophysiologic markers in laryngeal muscles indicate functional anatomy of laryngeal primary motor cortex and premotor cortex in the caudal opercular part of inferior frontal gyrus

ObjectiveThe aim of this study was to identify neurophysiologic markers generated by primary motor and premotor cortex for laryngeal muscles, recorded from laryngeal muscle.MethodsTen right-handed healthy subjects underwent navigated transcranial magnetic stimulation (nTMS) and 18 patients underwent direct cortical stimulation (DCS) over the left hemisphere, while recording neurophysiologic markers, short latency response (SLR) and long latency response (LLR) from cricothyroid muscle. Both healthy subjects and patients were engaged in the visual object-naming task. In healthy subjects, the stimulation was time-locked at 10–300 ms after picture presentation while in the patients it was at zero time.ResultsThe latency of SLR in healthy subjects was 12.66 ± 1.09 ms and in patients 12.67 ± 1.23 ms. The latency of LLR in healthy subjects was 58.5 ± 5.9 ms, while in patients 54.25 ± 3.69 ms. SLR elicited by the stimulation of M1 for laryngeal muscles corresponded to induced dysarthria, while LLR elicited by stimulation of the premotor cortex in the caudal opercular part of inferior frontal gyrus, recorded from laryngeal muscle, corresponded to speech arrest in patients and speech arrest and/or language disturbances in healthy subjects.ConclusionIn both groups, SLR indicated location of M1 for laryngeal muscles, and LLR location of premotor cortex in the caudal opercular part of inferior frontal gyrus, recorded from laryngeal muscle, while stimulation of these areas in the dominant hemisphere induced transient speech disruptions.SignificanceDescribed methodology can be used in preoperative mapping, and it is expected to facilitate surgical planning and intraoperative mapping, preserving these areas from injuries.     

Altered cortical excitability in patients with untreated obstructive sleep apnea syndrome

ObjectiveTo investigate cortical excitability in patients with obstructive sleep apnea syndrome (OSAS) during wakefulness.MethodsThe authors recruited 45 untreated severe OSAS (all males, mean age 47.2 years, mean apnea–hypopnea index = 44.6 h^?1) patients and 44 age-matched healthy male volunteers (mean apnea–hypopnea index = 3.4 h^?1). The TMS parameters measured were resting motor threshold (RMT), motor evoked potential (MEP) amplitude, cortical silent period (CSP), and short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). These parameters were measured in the morning (9–10 am) more than 2 h after arising and the parameters of patients and controls were compared. The Epworth Sleepiness Scale (ESS) and the Stanford Sleepiness Scale (SSS) were also measured before the TMS study.ResultsOSAS patients had a significantly higher RMT and a longer CSP duration (t-test, p < 0.001) compared to healthy volunteers. No significant difference was observed between MEP amplitudes at any stimulus intensity or between the SICI (2, 3, 5 ms) and ICF (10, 15, 20 ms) values of OSAS patients and healthy volunteers (p > 0.05).ConclusionsThis TMS-based study suggests that untreated severe OSAS patients have imbalanced cortical excitabilities that enhanced inhibition or decreased brain excitability when awake during the day.     

Sensory afferent inhibition within and between limbs in humans

ObjectiveTo examine the distribution and inter-limb interaction of short-latency afferent inhibition (SAI) in the arm and leg.MethodsMotor evoked potentials (MEPs) in distal and proximal arm, shoulder and leg muscles induced with ranscranial magnetic stimulation (TMS) were conditioned by painless electrical stimuli applied to the index finger (D2) and great toe (T1) at interstimulus intervals (ISIs) of 15, 25–35, 80 ms (D2) and 35, 45, 55, 65 and 100 ms (T1) in 27 healthy human subjects. TMS was delivered over primary motor cortex (M1) arm and leg areas. Electrical stimulus intensities were varied between 1 and 3 times the sensory perception thresholds. We also tested effects of posterior cutaneous brachial nerve (PCBN) stimulation on MEPs in arm muscles at ISIs of 18 and 28 ms.ResultsD2 but not PCBN electrical conditioning reduced MEP amplitudes in upper limb muscles at ISIs of 25 and 35 ms. SAI was more pronounced in distal as compared to proximal arm muscles. Also, SAI following D2 stimulation increased with higher conditioning intensities. D2 stimulation did not change lower limb muscles MEPs. In ontrast, T1 stimulation did not induce SAI in any muscles but caused MEP facilitation in a foot muscle at an ISI of 55 ms and in upper limb muscles at ISIs of 35 and 55 ms. Short interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were not affected by electrical T1 conditioning.ConclusionD2 stimulation causes segmental SAI in upper limb muscles with a distal to proximal attenuation without affecting leg muscles. In contrast, toe stimulation facilitates motor output both in foot and upper arm muscles.SignificanceOur data suggest that cutaneo-motor pathways in arms and legs are functionally organized in a different way with cutaneo-motor interactions induced by toe stimulation probably relayed at a thalamic level. Abnormal cutaneo-motor interactions following electrical toe stimulation may serve as an electrophysiological marker of thalamic dysfunction, e.g. in neurodegenerative diseases.     

Blink reflex prepulse inhibition and excitability recovery: Influence of age and sex

ObjectiveAge and sex affect various reflexes in healthy humans. Their respective influence on prepulse inhibition (PPI) of the trigeminofacial blink reflex (BR) and BR excitability recovery has not as yet been investigated in detail.MethodsWe studied the trigeminofacial BR bilaterally in 62 healthy volunteers (31 males, age 41.0 ± 13.2 years, mean ± SD, 31 females, 39.2 ± 11.7 years) following right supraorbital nerve stimulation. Single sweeps were recorded either alone (n = 8) or conditioned by a prepulse applied 100 ms earlier to the dominant index finger though ring electrodes (n = 8). Latency and amplitude of the ipsilateral R1 component, as well as latency and area-under-the-curve of the ipsilateral R2 and contralateral R2c components were measured in single traces and then averaged per subject. BR excitability recovery was established bilaterally following right supraorbital nerve stimulation with paired pulses. Six responses were averaged on-line per interstimulus interval (ISI 160, 300, and 500 ms).ResultsUnconditioned BR did not differ significantly between males and females, but R2 and R2c latencies increased with age. Prepulse stimulation caused significant facilitation of R1 (latency and amplitude), and inhibition of R2 and R2c (latency and area), irrespective of age. PPI of R2 and R2c area was significantly more pronounced in men. BR excitability recovery was significantly influenced by age, but not by sex. Multiple regression showed inverse correlation of age with conditioned R2 and R2c area at ISI 300 ms and 500 ms (P < 0.01 each), indicating reduced excitability recovery. No parameter showed significant interaction of age × sex.ConclusionThese data indicate less pronounced PPI of the trigeminofacial BR in females, concurring with previous reports of sex differences in protective reflexes, but also suggesting less rigorous filtering of information flow to the brain in females. Reduced BR excitability to paired-pulse stimulation may counteract age-related disinhibition of brainstem interneuronal circuitry.SignificanceThe present findings allow new insight into human brainstem physiology.     

Low and high-frequency somatosensory evoked potentials recorded from the human pedunculopontine nucleus

ObjectiveTo investigate the generators of the somatosensory evoked potential (SEP) components recorded from the Pedunculopontine Tegmental nucleus (PPTg).MethodsTwenty-two patients, suffering from Parkinson’s disease (PD), underwent electrode implantation in the PPTg area for deep brain stimulation (DBS). SEPs were recorded from the DBS electrode contacts to median nerve stimulation.ResultsSEPs recorded from the PPTg electrode contacts could be classified in 3 types, according to their waveforms. (1) The biphasic potential showed a positive peak (P16) whose latency (16.05 ± 0.61 ms) shifted of 0.18 ± 0.07 ms from the lower to the upper contact of the electrode. (2) The triphasic potential showed an initial positive peak (P15) whose latency (15.4 ± 0.2 ms) did not change across the DBS electrode contacts. (3) In the last SEP configuration (mixed biphasic and triphasic waveform), the positive peak was bifid including both the P15 and P16 potentials.ConclusionWhile the P16 potential is probably generated by the somatosensory volley travelling along the medial lemniscus, the P15 response represents a far-field potential probably generated at the cuneate nucleus level.SignificanceOur results show the physiological meaning of the somatosensory responses recorded from the PPTg nucleus area.     

Fasciculations and their F-response revisited: High-density surface EMG in ALS and benign fasciculations

ObjectiveTo compare the prevalence of fasciculation potentials (FPs) with F-responses between patients with amyotrophic lateral sclerosis (ALS) and patients with benign fasciculations.MethodsIn seven patients with ALS and seven patients with benign fasciculations, high-density surface EMG was recorded for 15 min from the gastrocnemius muscle. Template matching was used to search for pairs of FPs with a repetition within 10–110 ms.ResultsInterspike interval (ISI) histograms were constructed from 282 pairs of benign fasciculations and from 337 FP pairs in ALS. Peaks attributable to F-waves were found at latencies of 32 ms (benign) and 35 ms (ALS). Five patients with benign fasciculations and four patients with ALS had FPs with F-waves.ConclusionsF-waves of FPs occur in both conditions – therefore they are not diagnostically helpful.SignificanceF-waves confirm the distal origin of FPs for an individual axon. The occurrence of these FPs in a benign condition suggests that the generation of ectopic discharges in the distal axons is not specific to progressive neurodegeneration.     

Deconvolution of overlapping cortical auditory evoked potentials recorded using short stimulus onset-asynchrony ranges

ObjectiveThe first aim of this study is to validate the theoretical framework of least-squares (LS) deconvolution on experimental data. The second is to investigate the waveform morphology of the cortical auditory evoked potential (CAEP) for five stimulus onset-asynchronies (SOAs) and effects of alternating stimulus frequency in normally hearing adults.MethodsEleven adults (19–55 years) with normal hearing were investigated using tone-burst stimuli of 500 and 2000 Hz with SOAs jittered around 150, 250, 450, and 850 ms in a paired-interval paradigm with fixed or alternating stimulus frequency.ResultsThe LS deconvolution technique disentangled the overlapping responses, which then provided the following insights. The CAEP amplitude reached a minimum value for SOAs jittered around 450 ms, in contrast with significantly larger amplitudes for SOAs jittered around 150 and 850 ms. Despite this, longer latencies of N1 and P2 consistently occurred for decreasing SOAs. Alternating stimulus frequency significantly increased the amplitude of the CAEP response and decreased latencies for SOAs jittered around 150 ms. Effects of SOAs and alternating stimuli on CAEP amplitude can be modelled using a quantitative model of latent inhibition.ConclusionsLS deconvolution allows correction for cortical response overlap. The amplitude of the CAEP is sensitive to SOA and stimulus frequency alternation.SignificanceCAEPs are emerging as an important tool in the objective evaluation of hearing aid and cochlear implant fittings. Responses to closely spaced stimuli provide objective information about integration and inhibition mechanisms in the auditory cortex.     

New method to perform medial plantar proper digital nerve conduction studies

ObjectiveWe describe a technique that records the sensory nerve action potential (SNAP) of the medial plantar proper digital nerve (MPPDN), which is the final sensory branch of the medial plantar nerve.MethodsWe obtained antidromic MPPDN responses from 118 healthy volunteers, with surface recording electrodes placed on the medial side of the first metatarsal head of the great toe, with electrical stimulation applied at the 40% distance of the heel to great toe reference line. Antidromic SNAP parameters were recorded and normative reference values were obtained.ResultsThe stimulation site that corresponded to 40% of the reference line was located at a mean distance of 8.7 ± 1.2 cm from the recording electrodes. MPPDN responses were easily obtained in all but 9 limbs. The mean SNAP amplitudes obtained by our technique were 16.1 ± 6.7 μV, and the lower and upper range values were 6.4 μV and 34.4 μV, respectively.ConclusionAntidromic stimulation of the MPPDN at a distance of 8–10 cm from the medial side of the first metatarsal head of the great toe yields in reliable SNAP responses.SignificanceThis technique should be useful in the evaluation of the MPPDN involvement in Joplin’s neuroma.     

Differentiated effects of deep brain stimulation and medication on somatosensory processing in Parkinson’s disease

ObjectivesDeep brain stimulation (DBS) and dopaminergic medication effectively alleviate the motor symptoms in Parkinson’s disease (PD) patients, but their effects on the sensory symptoms of PD are still not well understood. To explore early somatosensory processing in PD, we recorded magnetoencephalography (MEG) from thirteen DBS-treated PD patients and ten healthy controls during median nerve stimulation.MethodsPD patients were measured during DBS-treated, untreated and dopaminergic-medicated states. We focused on early cortical somatosensory processing as indexed by N20m, induced gamma augmentation (31–45 Hz and 55–100 Hz) and induced beta suppression (13–30 Hz). PD patients’ motor symptoms were assessed by UPDRS-III.ResultsUsing Bayesian statistics, we found positive evidence for differentiated effects of treatments on the induced gamma augmentation (31–45 Hz) with highest gamma in the dopaminergic-medicated state and lowest in the DBS-treated and untreated states. In contrast, UPDRS-III scores showed beneficial effects of both DBS and dopaminergic medication on the patients’ motor symptoms. Furthermore, treatments did not affect the amplitude of N20m.ConclusionsOur results suggest differentiated effects of DBS and dopaminergic medication on cortical somatosensory processing in PD patients despite consistent ameliorating effects of both treatments on PD motor symptoms.SignificanceThe differentiated effect suggests differences in the effect mechanisms of the two treatments.     

Ocular vestibular evoked myogenic potentials (OVEMPs) produced by air- and bone-conducted sound

ObjectiveTo determine the origin and properties of short latency extraocular potentials produced by activation of the vestibular apparatus using two modes of acoustic stimulation.MethodsExtraocular potentials were measured in 10 normal subjects using a bipolar montage to increase selectivity. Three dimensional eye movements were also recorded in five subjects. The subjects were stimulated with both air-conducted (AC) and bone-conducted (BC) sound using a single cycle of a 500 Hz sine wave.ResultsShort latency positive and negative potentials that peaked at 8.1–12.7 ms for AC and 7.5–13.9 ms for BC stimulation were recorded, which were distinct for the two eyes and for the two modes of stimulation. The extraocular potentials began prior to the onset of eye movements, which peaked at 16.5–20.1 ms for AC, 17.8–25.0 ms for BC stimulation.ConclusionsThe pattern of short latency eye movements and extraocular potentials induced by AC and BC vestibular stimulation are distinct. As the potentials preceded the eye movements and were not correlated morphologically with them, the source of the observed potentials is not an eye movement and thus we refer to them as ocular vestibular evoked myogenic potentials (OVEMPs).SignificanceThe potentials had properties consistent with modulation of the electromyogenic activity of the extraocular muscles and if interpreted as originating from displacement of the eye will give misleading results. AC and BC acoustic stimulation are likely to activate differing profiles of vestibular end organs.     

Neuromagnetic activation of primary and secondary somatosensory cortex following tactile-on and tactile-off stimulation

ObjectiveMagnetoencephalography (MEG) recordings were performed to investigate the cortical activation following tactile-on and tactile-off stimulation.MethodsWe used a 306-ch whole-head MEG system and a tactile stimulator driven by a piezoelectric actuator. Tactile stimuli were applied to the tip of right index finger. The interstimulus interval was set at 2000 ms, which included a constant stimulus of 1000 ms duration.ResultsProminent somatosensory evoked magnetic fields were recorded from the contralateral hemisphere at 57.5 ms and 133.0 ms after the onset of tactile-on stimulation and at 58.2 ms and 138.5 ms after the onset of tactile-off stimulation. All corresponding equivalent current dipoles (ECDs) were located in the primary somatosensory cortex (SI). Moreover, long-latency responses (168.7 ms after tactile-on stimulation, 169.8 ms after tactile-off stimulation) were detected from the ipsilateral hemisphere. The ECDs of these signals were identified in the secondary somatosensory cortex (SII).ConclusionsThe somatosensory evoked magnetic fields waveforms elicited by the two tactile stimuli (tactile-on and tactile-off stimuli) with a mechanical stimulator were strikingly similar. These mechanical stimuli elicited both contralateral SI and ipsilateral SII activities.SignificanceTactile stimulation with a mechanical stimulator provides new possibilities for experimental designs in studies of the human mechanoreceptor system.     

Developmental sex-specific change in auditory–vocal integration: ERP evidence in children

ObjectiveThe present event-related potential (ERP) study examined the developmental mechanisms of auditory–vocal integration in normally developing children. Neurophysiological responses to altered auditory feedback were recorded to determine whether they are affected by age and sex.MethodForty-two children were pairwise matched for sex and were divided into a group of younger (10–12 years) and a group of older (13–15 years) children. Twenty healthy young adults (20–25 years) also participated in the experiment. ERPs were recorded from the participants who heard their voice pitch feedback unexpectedly shifted ?50, ?100, or ?200 cents during sustained vocalization.ResultsP1 amplitudes became smaller as subjects increased in age from childhood to adulthood, and males produced larger N1 amplitudes than females. An age-related decrease in the P1–N1 latencies was also found: latencies were shorter in young adults than in school children. A complex age-by-sex interaction was found for the P2 component, where an age-related increase in P2 amplitudes existed only in girls, and boys produced longer P2 latencies than girls but only in the older children.ConclusionsThese findings demonstrate that neurophysiological responses to pitch errors in voice auditory feedback depend on age and sex in normally developing children.SignificanceThe present study provides evidence that there is a sex-specific development of the neural mechanisms involved in auditory–vocal integration.     

Lack of visual evoked potentials amplitude decrement during prolonged reversal and motion stimulation in migraineurs

ObjectiveWe evaluated response decrement during a short time repetitive low and high contrast reversal and low contrast motion stimulation in controls and migraineurs.MethodsA total of 39 migraine patients (out of which 19 were in the interictal period and without prophylactic treatment) and 36 healthy volunteers were examined using pattern-reversal (PR-VEP) and motion-onset (M-VEP) visual evoked potentials. Binocular stimulation lasted 2.5 min and the decrement assessment was blinded.ResultsEvidence of significant decrement was observed in healthy volunteers for high contrast PR-VEP amplitude of P100-N75 ratios between the fifth and first blocks (0.9; p = 0.001) with a linear decline (−0.7 μV/min, p = 0.001) and in the P100-N145 amplitude with linear decline (−0.5 μV/min, p = 0.004). Significant decrement was also observed for the ratio between the fifth and first block P1-N2 amplitudes in M-VEP (0.9, p = 0.006). No significant decrement was noted in the low contrast PR-VEP or among migraineurs.ConclusionsWe confirm differences in decrease of VEPs amplitude during short term examination between controls and migraineurs. We showed the decrement deficit also in the extrastriatal regions of the migraineurs’ visual cortex.SignificanceLow contrast and motion-onset stimuli in short time decrement assessment did not increase the test sensitivity.     

Cutaneous silent period changes in Type 2 diabetes mellitus patients with small fiber neuropathy

ObjectiveSmall myelinated (A-δ) and unmyelinated (C) somatic sensory fibers are initially affected and may be the earliest exhibited sign of neuropathy in glucose dysmetabolism. Cutaneous silent period (CSP) is an inhibitory spinal reflex and its afferents consist of A-δ nerve fibers. The aim of this study was to evaluate CSP changes in Type 2 diabetic patients with small fiber neuropathy.MethodsForty-three patients and 41 healthy volunteers were included. CSP latency and duration, as well as CSP latency difference of the upper and lower extremities, were examined.ResultsNerve conduction studies were within normal limits in both groups. Lower extremity CSP latency was longer (122.1 ± 15.5 vs. 96.4 ± 6.4 ms; p < 0.001), CSP duration was shorter (29.5 ± 8.9 vs. 43.1 ± 5.0 ms; p < 0.001), and latency difference was longer (48.1 ± 12.6 vs. 22.7 ± 3.7; p < 0.001) in patients than controls. The difference was more significant in patients with neuropathic pain. No significant difference existed in upper extremity on CSP evaluation.ConclusionThe CSP evaluation together with nerve conduction study, has been demonstrated to be beneficial and performance of latency difference in addition to CSP latency and duration may be a valuable parameter in electrophysiological assessment of diabetic patients with small fiber neuropathy.SignificanceAn additional CSP evaluation may be considered in cases which nerve conduction studies do not provide sufficient information.     

Asymmetric bilateral effect of the supplementary motor area proper in the human motor system

ObjectiveThis study aimed to clarify the function of human supplementary motor area proper (SMA) by the single-pulse electric stimulation method and its clinical usefulness for SMA mapping.MethodsWe studied five patients with epilepsy or brain tumour who underwent invasive functional mapping with subdural electrodes. Single-pulse electric stimulation of primary motor area (MI) and SMA was carried out through pairs of subdural electrodes, and motor-evoked potentials (MEPs) were recorded from surface electromyogram on both sides and also cortico-cortical-evoked potentials (CCEPs) from electrocorticogram.ResultsSMA stimulation elicited: (1) MEPs and following silent periods (SPs) in the contralateral upper and lower extremities, (2) SPs with or without minimal MEPs in the ipsilateral upper extremity and (3) CCEPs in the somatotopically corresponding region of the ipsilateral MI. Compared with MI stimulation, SMA stimulation required higher stimulus intensities (mean 14.2 mA (SMA) vs. 8.5 mA (MI)) to elicit MEPs and showed significantly longer onset latencies in upper extremity (range: 4–10 ms).ConclusionsThe results demonstrated an asymmetric bilateral effect of human SMA upon the corticospinal pathway.SignificanceSingle-pulse electric cortical stimulation would be clinically useful for distinguishing SMA from MI. The asymmetric bilateral effect of SMA might be conveyed through the direct descending pathway.