Origin of frontal N15 component of somatosensory evoked potential in man

Origin of the frontal somatosensory evoked potential (SEP) by median nerve stimulation was investigated in normal volunteers and in patients with localized cerebrovascular diseases, and the following results were obtained. (1) In normal subjects, SEPs recorded at F3 (or F4) contralateral to the stimulating median nerve were composed of P12, N15, P18.5 and N26. Similar components were recognized in SEP recorded at Fz. (2) In patients in whom putaminal or thalamic hemorrhages had destroyed the posterior limbs of the internal capsules, frontal N15 and parietal N18 (N20) disappeared. These components were also absent in patients with cortical (parietal) infarctions. Among these patients, the thalamus was not affected in cases with putaminal hemorrhages and cortical infarctions. These facts indicate that the generator of the frontal N15 does not exist in the thalamus but that it originates from the neural structure central to the internal capsule, which suggests a similarity to the generator of the parietal N18. Because N15 was recorded in the midline of the frontal region with shorter latency than parietal N18, the frontal N15 might represent a response to the sensory input of the frontal lobe via the non-specific sensory system.     

Gating of the early components of the frontal and parietal somatosensory evoked potentials in different sensory-motor interference modalities.

Three different interfering conditions were studied during the recording of pre- and postcentral somatosensory evoked potentials (SEPs) following median nerve stimulation at the wrist in 16 normal subjects: active finger movement (MVT), light superficial massage (LSM) and deep muscular massage (DMM) of the hand. Special attention was focused on selective effects on individual SEP components. The frontal N30 component showed the most significant amplitude reduction during the three interfering conditions (76.4% of reduction in MVT, 36.4% in DMM and 32.9% in LSM). In contrast the frontal N23 was not significantly changed and the preceding P22 component was only reduced in the MVT condition. Postcentral N20 was unchanged by the three conditions while P27 was clearly gated by movement but not significantly by LSM and DMM. The three interfering conditions enhanced the parietal N32 and had no significant effect on the parietal P45. An important point was the interindividual variability of these effects and it appeared that group average wave forms would therefore be confusing. The peak latency of some SEP components was changed during the interfering conditions. The most important effect was an increase of postcentral P45 latency which was found to be related to the amplitude enhancement of N32.     

Time course of frontal somatosensory evoked potentials. Relation to L-dopa plasma levels and motor performance in PD.

OBJECTIVE: To verify whether the change in L-dopa plasma levels after a single dose of carbidopa/L-dopa 50/200 (controlled-release) transiently modifies frontal components of somatosensory evoked potentials (SEPs) in patients with PD in parallel with improvement of motor performance. BACKGROUND: Apomorphine, a potent dopamine-agonist drug, transiently increases frontal SEP components, which may be depressed in PD; however, relationships between clinical status, frontal SEPs, and therapy are still unclear. METHODS: Nineteen PD patients (mean age 65.9 years, range 52 to 77, responders to L-dopa therapy, were studied in the same day at times T0 (baseline predose level), T1 (presumed L-dopa peak time), and T2 (end of dose-induced motor response). The following were monitored: L-dopa plasma concentration, tapping test, reaction times, peak latency (with central conduction times), and amplitude of cervical, subcortical, as well as cortical parietal and frontal SEP components elicited by median nerve stimulation of the more clinically affected arm. RESULTS: The average amplitude of frontal components of PD patients was significantly reduced at T0 with respect to control subjects. A significant and transient amplitude increase of frontal SEPs was found at T1, in parallel with the L-dopa peak concentration and improvement in motor performance (tapping and reaction times), without significant changes in amplitude of parietal SEP waves. No latency shifts were observed in brain and spinal waves. CONCLUSIONS: L-Dopa may influence the responsiveness of the parkinsonian brain as assessed by frontal somatosensory evoked potentials. The time course of these modifications coincides with that of the clinical response in the motor performance.     

Callosal alien hand sign following a right parietal lobe infarction

Callosal alien hand syndrome is characterized primarily by intermanual conflict and is associated with an anterior callosal lesion. We report a patient who presented with topographical disorientation and the callosal type alien hand sign. An MRI of the brain showed a right parietal lobe infarction. This is a rare example of callosal alien hand sign associated with a right parietal lesion. The right parietal lobe appeared to be responsible for the callosal hand sign in this patient, possibly due to interference with peristriate outflow pathways toward the parietal zones, where visual somatosensory interactions are likely to occur.     

Focal capsular vascular lesions can selectively deafferent the prerolandic or the parietal cortex: somatosensory evoked potentials evidence

Four patients with a unilateral focal vascular accident involving the internal capsule (but not the cortex) were studied electrophysiologically. Averaged somatosensory evoked potentials (SEPs) to electrical stimulation of the median nerve on the left or the right side were analyzed. In the 3 patients with hemiparesis and normal somatic sensation, the precentral P22 and N30 SEP components were lost, whereas the parietal components were preserved. In another patient with clinical somatosensory loss unaccompanied by any central motor impairment, the precentral SEP components were preserved, whereas the parietal SEP components were lost. Thus, a small capsular lesion can eliminate distinct cortical SEP components by selectively involving either the axons of the thalamic VPLc nucleus going to parietal receiving cortex or the axons of thalamic VPLo going to motor area 4. These findings extend to subcortical lesions the diagnostic value of SEPs in patients with dissociated clinical motor and sensory signs.     

Alteration of SEP topography in Huntington's patients and their relatives at risk.

We studied the amplitude maps of median SEP parameters in patients with Huntington's disease (HDP) and their relatives at risk (HDF). Corresponding to the small amplitude of SEP in HDP, the power (microV2) was significantly smaller at all electrodes, and the maximum power was shifted anteriorly as a result of greater reduction of the power in the parietal than in the frontal region. In HDF, significant power reduction at the parietal region resulted in a similar anterior shift of the power to that noted in HDP. In addition to the overall reduction of SEP amplitude, the field distributions of parietal N20, frontal N29 and central N60 were significantly different in HDP, as compared to the normals. The typical relationship of the frontal positive and parietal negative fields normally present at N20 latency was lost in HDP due to the loss of the frontal P20. Frontal N29 was absent. Also N60 field shifted anteriorly. In HDF, the degree of deviation was in between those of HDP and normals. These alterations of SEP amplitude, wave form and field distribution in HDP and in some of HDF may be viewed as a result of aberrant modulatory effect exerted by the non-sensory system upon the somatosensory input.     

Ipsilateral cortical connections of motor, premotor, frontal eye, and posterior parietal fields in a prosimian primate, Otolemur garnetti

The ipsilateral connections of motor areas of galagos were determined by injecting tracers into primary motor cortex (M1), dorsal premotor area (PMD), ventral premotor area (PMV), supplementary motor area (SMA), and frontal eye field (FEF). Other injections were placed in frontal cortex and in posterior parietal cortex to define the connections of motor areas further. Intracortical microstimulation was used to identify injection sites and map motor areas in the same cases. The major connections of M1 were with premotor cortex, SMA, cingulate motor cortex, somatosensory areas 3a and 1, and the rostral half of posterior parietal cortex. Less dense connections were with the second (S2) and parietal ventral (PV) somatosensory areas. Injections in PMD labeled neurons across a mediolateral belt of posterior parietal cortex extending from the medial wall to lateral to the intraparietal sulcus. Other inputs came from SMA, M1, PMV, and adjoining frontal cortex. PMV injections labeled neurons across a large zone of posterior parietal cortex, overlapping the region projecting to PMD but centered more laterally. Other connections were with M1, PMD, and frontal cortex and sparsely with somatosensory areas 3a, 1-2, S2, and PV. SMA connections were with medial posterior parietal cortex, cingulate motor cortex, PMD, and PMV. An FEF injection labeled neurons in the intraparietal sulcus. Injections in posterior parietal cortex revealed that the rostral half receives somatosensory inputs, whereas the caudal half receives visual inputs. Thus, posterior parietal cortex links visual and somatosensory areas with motor fields of frontal cortex.     

体感诱发电位监测技术在脑深部病变导航手术中的初步应用

目的初步探讨体感诱发电位(SEP)监测技术辅助神经导航手术治疗脑深部病变的应用价值。方法回顾性分析23例脑深部病变的临床资料,病变位于脑室和胼胝体11例,丘脑4例,基底核区2例,岛叶2例,额叶深部3例,顶叶深部1例。在应用导航指导病灶切除的同时实时监测SEP。当术中波形发生明显异常时即通知术者调整或停止操作。结果病变全切除15例,大部切除6例,部分切除2例。术中SEP正常19例,其中发生可逆性变化1例,术中无变化18例;术后肌力较术前减退2例,术后肌力下降率10.5%。术中SEP发生不可逆性变化4例,其中波幅降低2例,波幅消失2例;术后肌力较术前均减退,术后肌力下降率100%。术中SEP正常者肌力下降率显著低于术中SEP发生不可逆变化者(P=0.002)。结论 SEP监测联合神经导航技术有助于安全、精确切除脑深部病变。     

Frontal and parietal components of enhanced somatosensory evoked potentials: a comparison between pathological and pharmacologically induced conditions

Pathologically enhanced somatosensory evoked potentials (giant SEPs) were recorded in 10 patients with cortical myoclonus of various origins. With non-cephalic reference electrodes a giant frontal negativity corresponding to normal N30 was found over the contra- and ipsilateral hemispheres which was not simply a phase reversal of the well-known enhanced parietal P25. The preceding far-field P14, parietal N20 and frontal P22 were of normal size. A similar result was found when SEPs were studied during the action of etomidate, an ultrashort-acting non-barbiturate hypnotic which produced a marked increase of the parietal P25 and frontal N30 after intravenous administration. These increased components, on the other hand, were abolished when recording was repeated immediately after application of electroconvulsive shock whereas P14, N20, and P22 remained more or less unchanged in both conditions. Our results indicate that there are neuronal elements in the sensorimotor cortex which are more resistant to influences such as narcotic drugs and seizure activity than others, being highly modifiable by these alterations. It is speculated whether these highly modifiable cortical systems are those in which giant SEPs, as well as pharmacologically increased SEP components, arise.     

Projection of thenar muscle afferents to frontal and parietal cortex of human subjects.

There is some controversy about the projection of muscle afferents from the human upper limb to cerebral cortex and about their contribution to somatosensory evoked potentials. In 8 normal volunteers, the somatosensory projections of muscle and cutaneous afferents from the hand were recorded at 21 scalp sites, using a non-cephalic reference. Low-threshold thenar muscle afferents were selectively activated by intramuscular microstimulation. In addition, the averaged data for the projections were mapped for each individual. In each subject a focal parietal negativity was detected over the contralateral parietal cortex at a mean latency of 20.8 msec (S.D. 1.15 msec) following stimulation of thenar muscle afferents. The amplitude of the parietal 'N20-P25' was relatively small (mean 0.49 microV, range 0.18-1.56 microV). A small focal positivity was detected, maximal over contralateral frontal cortex at 22.8 msec (S.D. 2.05 msec) but recorded bilaterally. In all subjects subcortical positive waves (P9 and P14) were defined for the muscle afferent volley. This pattern of cortical activity was similar to that for the projection from the digital nerves of the index finger. For the cutaneous input the latency of the parietal 'N20' was 21.7 msec (S.D. 1.17 msec) and of the frontal 'P22' was 24.2 msec (S.D. 3.09 msec). The amplitude of the parietal 'N20-P25' was larger for the cutaneous projection (mean 1.59 microV; range 0.65-4.28 microV).     

Differences of cortical activation in spontaneous and reflex myoclonias.

Frontal and parietal components of somatosensory evoked potentials (SEPs) following median nerve stimulation and scalp potentials preceding myoclonic jerks (jerk-locked averaging, JLA) were compared in 6 patients with cortical reflex myoclonus. Giant potentials were found over the parietal cortex in both conditions. Prominent frontal activity was detected following median nerve stimulation which, however, was absent in jerk-locked averages. Therefore an identical generator of the giant SEP and the JLA is unlikely. As the frontal component is lacking in jerk-locked averaging, the spontaneous jerks produced in our experimental paradigm are believed to be due to spontaneous hyperactivity of the parietal cortex rather than to pathologically enhanced transcortical reflexes.     

Four "alien" hands for two hands after a lesion in corpus callosum

Callosal lesions, associated or not to internal frontal lesions, may produce different types of complex gestural behaviors. Four signs can be identified, each of which has been generally reported separately: the "alien hand" sign, the "diagnostic apraxia", the "wayward hand" and the "callosal apraxia". Some authors justify considering these signs as different entities, while others propose regrouping them either in an unique syndrome--the "alien hand"--or as two syndromes--the "frontal alien hand" and the "callosal alien hand". We present the observation of a patient who presented with the four mentioned syndromes in association. In this context, we review the clinical features of each of the four signs and the arguments supporting their individualization.     

Changes of somatosensory evoked potentials during writing with the dominant and non-dominant hands

Since close attention and special effort are necessary to perform difficult unskilled movements, particular brain activities underlying such movements could be expected to take place in the primary sensori-motor cortices (SI and MI). In this study we focused on such activities by analyzing the difference in the somatosensory evoked potential (SEP) in presence to the electrical stimulation of the median nerve during writing using the dominant and non-dominant hands in twelve right-handed and eight left-handed normal subjects. By alternately stimulating the right and left median nerves during the writing with either hand, SEPs were recorded from both hemispheres. During the dominant hand writing, the middle latency SEP components, i.e., parietal P25 and N33 and frontal N30, were significantly attenuated only in the hemisphere contralateral to the writing hand, corresponding to the conventional gating effect. During the non-dominant hand writing, not only those components recorded from the hemisphere contralateral to the writing hand, but also those from the hemisphere ipsilateral to the writing hand were significantly attenuated. In addition, N20 in the hemisphere contralateral to the writing hand was also significantly attenuated. There was no significant difference in the attenuation between the right-handed and left-handed subjects. The results indicated that the specific interaction between the signals after electrical stimulation and the sensory cortical activities related to the writing using the non-dominant hand occurred in both hemispheres, while it was recognized only in the hemisphere contralateral to the writing hand during the dominant hand writing. We speculate that the somatosensory cortex was more activated and thus interacted with the applied stimulation during the unskilled movement of the non-dominant hand compared to the movement of the dominant hand.     

Differential effects of isoflurane on SEP recorded over parietal and frontal scalp

We evaluated the effects of different concentrations of isoflurane on short-latency somatosensory evoked potentials recorded over the parietal and frontal scalp in 14 patients during general anesthesia at stable end-tidal concentrations between 0% and 2.5%. At concentrations between 0% and 1%, there was a marked discrepancy between the amplitude of the parietal N20, which remained stable, and the striking increase of the frontal P22. At concentrations above 1.5%, the parietal N20 disappeared in 6 patients whereas the P22 was clearly identified in 12. The central conduction time increased significantly whereas the spinal conduction was not delayed by increasing levels of isoflurane. These results show that isoflurane anesthesia is a useful pharmacologic model to demonstrate the independence of the N20 recorded over the parietal scalp and the P22 recorded over the frontal scalp.     

Asymmetrical alien hands in corticobasal degeneration.

There are several forms of alien limb, but alien limb in corticobasal degeneration (CBD) is not well understood. We studied a patient with CBD who demonstrated two different types of alien limb. With his right hand he demonstrated a tactile avoidance response with levitation. With his left hand, he demonstrated continuous tactile pursuit of the examiner's hand ("tactile mitgehen"). Mitgehen is often associated with frontal dysfunction, but avoidance response and levitation are often associated with parietal dysfunction.     

N30 and the effect of explorative finger movements: a model of the contribution of the motor cortex to early somatosensory potentials.

OBJECTIVES: The source of the N30 potential in the median nerve somatosensory evoked potentials (SEP) has been previously attributed to a pre-central origin (motor cortex or the supplementary motor area, SMA) or a post-central located generator (somatosensory cortex). This attribution was made from results of lesion studies, the behavior of the potential under pathological conditions, and dipole source localization within spherical volume conductor models. METHODS: The present study applied dipole source localization and current density reconstruction within individual realistically shaped head models to median nerve SEPs obtained during explorative finger movements. RESULTS: The SEPs associated with movement of the stimulated hand showed a minor reduction of the N20 amplitude and a markedly reduced amplitude for the frontal N30 and parietal P27, exhibiting a residual frontal negativity around 25 ms. The brain-stem P14 remained unchanged. Mapping of the different SEPs (movement of the non-stimulated hand minus movement of the stimulated hand) showed a bipolar field pattern with a maximum around 30 ms post-stimulus. In eight out of ten normal subjects, both the N30 and the gN30 (subtraction data) sources resided within the pre-central gyrus, more medially than the post-centrally located N20. Two subjects, in contrast, showed rather post-centrally localized sources in this time range. A model of the cortical SEP sources is introduced, explaining the data with respect to previously described findings of dipole localization, and from lesion studies and the alterations seen in motor diseases. CONCLUSIONS: The results provide evidence for a pre-central N30 generator, predominantly tangentially oriented, located within the motor cortex, while no sources were detected elsewhere. It is suggested that the mechanisms underlying the 'gating' effect during explorative finger movements in the 30 ms time range predominantly arise in the motor cortex.     

Somatosensory evoked potentials in minor cerebral ischaemia: diagnostic significance and changes in serial records

Frontal, central and parietal short and middle latency somatosensory evoked potentials (SEPs) arising after stimulation of the contralateral median nerve were studied in 10 normal adults. Stable SEPs were recorded: a frontal P21-N30 complex and an N20-P23-P28-N35-P42 complex in the centro-parietal region. The use of a chin reference electrode allowed identification of (the thalamic) P15 and N18. SEP studies of 20 patients with unilateral cerebral ischaemia were also performed, about 4 and 18 days after the stroke. In 13 out of 18 patients with a minor stroke (TIA, RIND and PNS) abnormalities of the frontal and/or parietal SEPs were demonstrated. Improvement in these SEPs occurred in 5 cases. In two patients who suffered from a major ischaemic deficit, the SEPs were highly abnormal and did not show any change in the course of time. SEP studies may be useful for the diagnosis of minor cerebral ischaemia as well as quantification of recovery; an even more important indication for this neurophysiological method might be detection of subclinical lesions in patients who have suffered from transient cerebral ischaemia even weeks before the SEP studies are carried out.     

Vulnerability of the medial frontal corticospinal projection accompanies combined lateral frontal and parietal cortex injury in rhesus monkey

Concurrent damage to the lateral frontal and parietal cortex is common following middle cerebral artery infarction, leading to upper extremity paresis, paresthesia, and sensory loss. Motor recovery is often poor, and the mechanisms that support or impede this process are unclear. Since the medial wall of the cerebral hemisphere is commonly spared following stroke, we investigated the spontaneous long‐term (6 and 12 month) effects of lateral frontoparietal injury (F2P2 lesion) on the terminal distribution of the corticospinal projection (CSP) from intact, ipsilesional supplementary motor cortex (M2) at spinal levels C5 to T1. Isolated injury to the frontoparietal arm/hand region resulted in a significant loss of contralateral corticospinal boutons from M2 compared with controls. Specifically, reductions occurred in the medial and lateral parts of lamina VII and the dorsal quadrants of lamina IX. There were no statistical differences in the ipsilateral CSP. Contrary to isolated lateral frontal motor injury (F2 lesion), which results in substantial increases in contralateral M2 labeling in laminae VII and IX (McNeal et al. [2010] J. Comp. Neurol. 518:586–621), the added effect of adjacent parietal cortex injury to the frontal motor lesion (F2P2 lesion) not only impedes a favorable compensatory neuroplastic response but results in a substantial loss of M2 CSP terminals. This dramatic reversal of the CSP response suggests a critical trophic role for cortical somatosensory influence on spared ipsilesional frontal corticospinal projections, and that restoration of a favorable compensatory response will require therapeutic intervention. J. Comp. Neurol. 523:669–697, 2015. © 2014 Wiley Periodicals, Inc.     

Alien hand sign after a right parietal infarction

Involuntary movements are unusual during or after acute stroke, and alien hand sign has not been reported after single parietal infarction. We report on a woman who presented with involuntary movements and a sense of alienness of her left upper limb following a right parietal infarction. This combination, that can meet the criteria for the 'alien hand syndrome', is rarely seen after acute lesions sparing the corpus callosum and the mesial frontal areas.     

Sequelae of a left-sided parietal stroke: Posterior alien hand syndrome

Posterior alien hand syndrome is a new addition to a poorly understood group of movement disorders. Historically, anatomical lesions causing uncontrolled limb movement and a feeling of foreignness were found to be located in the corpus callosum or frontal lobe. Recent case reports, however, demonstrate the typical symptoms of alien hand syndrome with lesions located in the parietal/occipital lobes. Disturbance of normal function in these regions tends to produce less complex motor activity, such as hand levitation, along with a sensory component characterized by feeling of estrangement. We discuss a patient who presented with unusual symptoms following an outpatient procedure and was found to have posterior alien hand syndrome.