Middle-latency somatosensory evoked potentials following median and posterior tibial nerve stimulation in Down's syndrome.

Middle-latency somatosensory evoked potentials (SEPs) following median and posterior tibial nerve stimulation were studied in 40 patients with Down's syndrome and in age- and gender-matched healthy controls as well as in middle-aged and aged healthy subjects. In median nerve SEPs, latencies of the initial cortical potentials, N18 and P18, showed no significant difference, but the following potentials N22, P25, N32, P41 and P46 were relatively or significantly shorter in latency in Down's patients than in the controls. Amplitudes of all components in Down's patients were significantly larger than those of age- and gender-matched controls as well as of those of middle-aged healthy subjects, but there was only a small difference in their amplitudes from aged healthy subjects. Results of posterior tibial nerve SEPs were generally consistent with those of median nerve SEPs. Therefore, 'short latency with large amplitude' is the main characteristic of middle-latency SEPs in Down's syndrome, possibly related to accelerated physiological aging of the central nervous system.     

Scalp topography and distribution of cortical somatosensory evoked potentials to median nerve stimulation

Topographies and distributions of cortical SEPs to median nerve stimulation were studied in 8 normal adults and 5 neurological patients. SEPs recorded from C4, P4, Pz, T6-A1A2 derivations to left median nerve stimulation were composed of 2 early negative (N16, N20) and 2 positive components (P12, P23), whereas those recorded from frontal electrodes (Fz, Fp1, Fp2) disclosed 2 early negativities (N16, N24) and 2 early positivities (P12, P20). N20 and P20, and P23 and N24, reversed across the rolandic fissure with no significant difference in their peak latencies. P23 was of slightly shorter latency at C4 than at more posterior electrodes (P4, T6, Pz). In 3 patients with complete hemiplegia but normal sensation, all the early SEP components were normal in scalp distribution and peak latencies except for a decrease of N24 amplitude. In 2 patients with complete hemiplegia and sensory loss no early cortical SEPs were seen. These findings suggest that N20 and P20 are generated as a single horizontal dipole in the central fissure, whereas P23 and N24 are a reflection of multiple generators in pre- and postrolandic regions.     

The scalp topography of human somatosensory and auditory evoked potentials.

The waveform and topography of components of the scalp recorded somatosensory evoked poal (AEP) to click stimulation of the right ear, were determined for scalp electrode locations of the 10-20 system and for locations at the eye, mastoids, and posterior neck. Twenty-one SEP and twenty-two AEP components were analyzed. Differentiation of neurogenic and myogenic components was attempted on the basis of localization and variability. Some components of extracranial origin, apparently originating in frontal musculature, were small in most experienced subjects and large in most experimentally naive subjects. These and other presumptive myogenic potentials can distort adjacent neurogenic components. These data should aid in predicting SEP and AEP characteristics and in assessing myogenic distortion of neurogenic components.     

Effects of age, gender, and stimulus side on scalp topography of somatosensory evoked potentials following median nerve stimulation

This is the first study to evaluate the effects of age, gender, and stimulus side on scalp topography of somatosensory evoked potentials (SEPs) following stimulation of the median nerve by using computerized bit-mapped color images. Seventy-four normal subjects whose ages ranged from 7 to 88 years were studied, and Student's t test was performed on averaged mean maps and their standard deviations of each recognizable component by using the significance probability mapping method. Topographic maps of most components in aged subjects were significantly different from those in young subjects, mainly because of higher amplitudes of the components in the aged group. This difference was particularly significant for later components with the peak latencies of longer than 40 ms. Gender and stimulus side caused no significant differences in amplitude and topography of the components. Therefore, for clinical application of topographic maps of median nerve SEPs, a difference of gender and stimulus side could be disregarded, but it is necessary to consider the age effect.     

Bipolar recording of short-latency somatosensory evoked potentials after median nerve stimulation

Generators of median short-latency somatosensory evoked potentials were studied with three orthodiagonal pairs of bipolar electrodes. N11 was attributed to the dorsal root and dorsal column volleys. N13 had at least two subcomponents, generator dipoles of which are directed horizontally (N13a) and axially (N13b). N13a was generated in the lower cervical cord. N13b (bipolar) and P14 far-field (noncephalic reference) appeared to originate in the cuneate nucleus or spinocerebellar tracts as well as in the medial lemniscus. Bipolar recordings were useful in localizing cervical cord lesions, which was impossible in conventional monopolar recordings.     

Interactions of somatosensory evoked potentials: simultaneous stimulation of two nerves.

To analyse the mechanism by which sensory inputs are integrated, interactions of somatosensory evoked potentials (SEPs) in response to simultaneous stimulation of two nerves were examined in 12 healthy subjects. Right, left and bilateral median nerves were stimulated in random order so that a precise comparison could be made among the SEPs. The arithmetical sum of the independent right and left median nerve SEPs was almost equal within 40 msec of stimulus onset to that evoked by the simultaneous stimulation of bilateral median nerves. However, a difference emerged after 40 msec. The greatest difference was recorded after 100 msec. Sensory information from right and left median nerves may interact in the late phase of sensory processing. Left median, left ulnar, and both nerves together were stimulated. The sum of the SEPs of left median and ulnar nerves was not equal to that evoked by the simultaneous stimulation of the two nerves even at early latencies. Differences between them were first recorded at 14-18 msec and became greater after 30-40 msec. It is suggested that the neural interactions between impulses in the median and ulnar nerves begin below the thalamic level.     

Short latency somatosensory evoked potentials from radial, median and ulnar nerve stimulation in man

Short latency somatosensory evoked potentials (SEPs) were elicited by stimulation at the wrist of median, radial, and ulnar nerves, singly or in combination, using normal subjects. Amplitude of P10 was strikingly lower with radial stimulation than with median stimulation, while ulnar-derived P10 was intermediate in amplitude. This difference probably reflects the antidromic firing of motor fibers contained in median nerves as compared with the superficial branch of radial nerve, which is entirely sensory. Beyond P10, there appear to be no significant differences between median, radial and ulnar-derived SEPs. With simultaneous stimulation of several nerves within one arm, larger potentials were sometimes achieved but with poorer definition of P12 and P14. The clinical utility of radial, ulnar, and median stimulation for localizing peripheral lesions derives from the distinct anatomical pathways of the stimulated fibers through the brachial plexus and from the separable motor and sensory components of P10. SEP is less invasive than EMG; this fact, plus its freedom from sampling error, make it potentially more suitable than conventional EMG for sequentially following a patient's clinical course.     

Short latency somatosensory evoked potentials to peroneal nerve stimulation: scalp topography and the effect of different frequency filters

Short latency SEPs to peroneal nerve stimulation were recorded from the scalp of 22 normal adults. The scalp topography and the effect of different frequency filters on these potentials were investigated. Using a wider bandpass (5-3000 Hz), this response usually consisted of 3 positive potentials (peak latencies 17, 22 and 27 msec) followed by a negative potential (peak latency 34 msec). Using a narrower bandpass (150-3000 Hz), these potentials were fractionated into subcomponents and up to 6 positive potentials were followed by an often bilobed negative potential occurring 4-10 msec earlier than the first negative potential recorded with the wider bandpass filters. The negative potential and the preceding major positive potentials were well defined and stable within and across normal subjects which suggests they will be useful in the clinical evaluation of patients with spinal cord pathology and in monitoring patients during surgery. Certain of these potentials recorded using the wider bandpass were often characterized by progressive differences in their peak latencies over the scalp. Evidence is provided which suggests that this occurred because subcomponents of these potentials, observed in recordings using the narrower bandpass had different scalp distributions. Evoked potentials were also recorded from surface electrodes placed over the spine of some of these subjects. These recordings when combined with the scalp recordings provided information concerning the conduction characteristics of SEPs from cauda equina to cerebral cortex.     

Cortical generators of somatosensory evoked potentials to median nerve stimulation

In 12 patients with intractable partial seizures, chronically implanted subdural electrodes were used to define the relationship of the epileptogenic focus to cortical functional areas. Cortical somatosensory evoked potentials (SEPs) to median nerve stimulation were recorded from these electrodes. The initial cortical positivity, postrolandic primary cortical potential (PCP), was recorded in all 12 patients with a mean latency of 22.3 +/- 1.6 msec. A potential of opposite polarity, prerolandic PCP, was defined in nine patients with a mean latency of 24.1 +/- 2.7 msec. The latency of the postrolandic PCP was 1.61 +/- 1.59 msec shorter than the prerolandic PCP (p less than 0.01, paired t test). The maximum amplitude postrolandic PCP was 2.1 times larger than the maximum prerolandic PCP (p less than 0.02, paired t test). The phase reversal of the SEPs was compared with the position of the rolandic fissure (RF) defined by electrical stimulation. This study shows that the latency and amplitude characteristics of post- and prerolandic PCPs are significantly different and give support to the concept that they are produced by different generators; and cortical SEPs are helpful in locating the RF.     

Short-latency scalp somatosensory evoked potentials and central spine to scalp propagation characteristics during peroneal and median nerve stimulation in multiple sclerosis

Peripheral (cauda-lumbar, wrist-Erb, Erb-cervical) and central (cauda-vertex, cervical-scalp) nervous impulse propagation velocities and times to peroneal and median nerve stimulation were investigated in 34 patients suffering from definite (17 cases), probable (6 cases) and possible (11 cases) forms of multiple sclerosis (MS). In 6 cases short- and intermediate-latency scalp somatosensory evoked potentials to peroneal nerve stimulation were recorded with 'open' (1-5000 Hz, -6 dB) bandpass filters and subsequently digitally filtered through a 'narrow' bandpass (200-5000 Hz, -6 dB). The lumbar response was abnormal in 2.95% of legs, while the Erb response was always within normal limits. The cauda-vertex conduction was altered in 75% of the examined limbs (86.2% definite, 58.3% probable, 63.6% possible MS). Absent scalp responses to peroneal stimulation were often encountered during narrow bandpass recording (54.9%), while a slowed central conduction was less frequent (33.3%). Scalp responses when recorded with open bandpass were always identifiable, being delayed in 3 out of 6 cases. In 5 of these the short-latency wavelets were either absent or showed a prolonged interpeak time even when open filter records were normal. Median nerve SEPs were altered in 60.3% of cases, more frequently because of a delayed scalp response or of a prolonged cervical-scalp conduction time than because of an absent cervical or scalp response. When peroneal and median nerve data were considered together, the rate of abnormality rose to 88.2% of patients. Due to their length, afferent pathways from the lower limb might suffer from a loss of high frequency impulse coding as an early sign of defective impulse propagation.     

Origins of short latency somatosensory evoked potentials to median nerve stimulation

Short latency SEPs recorded in hand-scalp, ear-scalp and upper neck-scalp leads with stimulation of the median nerve were examined in 27 normal subjects and in 11 selected patients with unilateral complete loss of position sense in order to provide information concerning the generator sources of these potentials. Evidences obtained from both normal subjects and patients suggest the following origins for these short latency SEPs. In hand reference recording, P1 may arise in the brachial plexus just beneath the clavicle, P2 in the cervical dorsal column, P3 mainly in the caudal brain stem, and P4 primarily in the brain stem lemniscal pathways and partly in the thalamus. The initial negative potential recorded in upper neck-scalp leads may originate largely in the cervical dorsal columns. The early positive potential recorded in ear-scalp leads may reflect activity mainly in the brain stem lemniscal pathways and partly in the thalamus. The initial negative component of the cortical SEPs (N1) may arise in the thalamus, and the subsequent positive component (P1) may reflect activity in the primary somatosensory cortex.     

Short-latency somatosensory evoked potentials following median nerve stimulation in Down's syndrome

Short-latency somatosensory evoked potentials (SEPs) following median nerve stimulation were recorded in 42 patients with Down's syndrome and in 42 age- and sex-matched normal subjects. There were no significant differences between the 2 groups in the absolute peak latencies of N9, N11 and N13 components. However, interpeak latencies, N9-N11, N11-N13 and N9-N13, were prolonged significantly in Down's syndrome. These findings suggest impaired impulse conduction in the proximal part of the brachial plexus, posterior roots and/or posterior column-medial lemniscal pathway. Interpeak latency N13-N20, representing conduction time from cervical cord to sensory cortex, was not significantly different between the 2 groups. Cortical potentials N20 and P25 in the parietal area and P20 and N25 in the frontal area were of significantly larger amplitude in Down's syndrome. P25 had double peaks in 16 of 42 normal subjects, but these were not apparent in any of the patients.     

Short latency somatosensory evoked potentials following median nerve stimulation in children

We investigated short latency somatosensory evoked potentials (SSEP) to median nerve stimulation in normal children and children with neurological disorders. The waveform of SSEP in normal children was almost the same as that in adults. The peak latency and interpeak latency in normal children changed during their development. Moreover, after 3 years of age, each peak latency was positively correlated with the body length and arm length. Each peak latency per 1 m of body length decreased with age. We examined SSEP in children with various neurological disorders and found that SSEP was useful for evaluating sensory functions and somatosensory damages in children who were unable to cooperate in clinical examinations. Using SSEP, we could estimate the distal margin of the lesion in the somatosensory pathway, but it was difficult to determine the accurate range of the lesion.     

Cortical and subcortical somatosensory evoked potentials to median nerve stimulation in man

In order to define the precise locations of precentral and postcentral gyri during neurosurgical operations, somatosensory evoked potentials to contralateral median nerve stimulation were recorded from the cerebral cortex in 19 cases with organic cerebral lesions which located near the central sulcus. In addition to that, distribution patterns of early components of SEPs were displayed by Nihonkoden Atac 450 in 3 cases who had bone defects after wide decompressive craniectomy but were without any sensory disturbances In 4 cases, in whom deep electrodes were inserted for the stereotaxic operations or other reasons, frontal subcortical SEPs were recorded in order to know the origins of frontal components of SEPs. From the parietal cortex, N19, P22 and P23 were observed. And from the frontal cortex, P20 and N25 were obtained. Their average peak latencies were as follows; (table; see text) Because all subjects had organic lesion in the brain, the peak latencies were a little bit longer, and their standard deviations were larger than those in normal cases. Usually, clear-cut phase reversal could be observed between N19 and P20 across the central sulcus. So, the precentral and postcentral gyri were easily identified during the operations. N19 and P23 appeared over the wide areas of the parietal cortex. Also, P20 and N25 were recorded almost whole areas of the frontal cortex. On the other hand, P22 appeared from relatively restricted part of the postcentral gyrus where sensory hand area might have been located. Depth recording from the frontal subcortical area revealed that P20 could be recorded from the bilateral frontal subcortical areas and there observed no phase reversal between the cortical and subcortical SEPs.(ABSTRACT TRUNCATED AT 250 WORDS)     

Subcortical, thalamic and cortical somatosensory evoked potentials to median nerve stimulation

Subcortical and cortical somatosensory evoked potentials (SEPs) to median nerve stimulation were studied in 16 normal controls, 3 patients with Parkinson's disease, and 2 patients with thalamic lesions. Multiple electrodes were placed over the scalp and cervical spines and connected with a hand electrode or Fz in grid II. Thalamic SEPs were recorded directly from the Vim nucleus in 3 patients with Parkinson's disease during the stereotaxic operation. SEPs recorded from the scalp-hand derivations were composed of 4 negative (N9, N11, N16, N18) and 3 positive potentials (P8, P10, P12), whereas, at the scalp-Fz electrode, only one negative peak was identified (N20). N18 is of higher amplitude on the parieto-occipital areas and corresponds to N20. On the other hand, N16 can be identified more clearly on the fronto-central areas at scalp-hand derivations because of intermixture with N18 on the posterior head areas and disappears at scalp-scalp derivation. This suggests that N16 represents a subcortical component that is picked up as a far-field potential at the scalp electrodes. Components preceding N16 at scalp-hand derivations are also interpreted as far-field potentials because of their short latency and wide distribution over the scalp. The peak latency of N16 is not significantly different from the major negativity recorded directly from the thalamus, whereas N18 (N20) occurs significantly later. From this we conclude that N16 is most probably generated in the thalamus with the potentials of shorter latency originating caudal to the thalamus and N18 rostral to the thalamus.     

Multichannel recording of median nerve somatosensory evoked potentials.

OBJECTIVES: Clinical applications of multichannel (>or=64 electrodes) electroencephalography (EEG) have been limited so far. Amplitude variability of evoked potentials in healthy subjects is large, which limits their diagnostic applicability. This amplitude variability may be partially due to spatial undersampling of anatomical variations in cortical generators. In the present study, we therefore investigated whether 128-channel recordings of somatosensory evoked potentials (SEPs) can reduce this amplitude variability in healthy subjects. Additionally, we explored the relation between amplitude and age. METHODS: We recorded median nerve SEPs using a 128-channel EEG system in 50 healthy subjects (20-70 years) and compared N20, P27, and P45 amplitude as obtained with a 128-channel analysis method - based on butterfly plots and spatial topographies - and as obtained using a conventional one-cortical-channel configuration and analysis. Scalp and earlobe references were compared. RESULTS: Although amplitude variability itself was not reduced, a reduced coefficient of variation was obtained with the 128-channel method due to higher SEP amplitudes, compared to the conventional one-channel method, independent of reference. CONCLUSION: These results suggest that at the cost of some additional preparation time, the 128-channel method can measure SEP amplitude more accurately and might therefore be more sensitive to physiological and pathological changes. For optimal amplitude estimation, we recommend to increase the number of centroparietal electrodes or, preferably, to perform at least a 64-channel recording.     

Frontal distribution of early cortical somatosensory evoked potentials to median nerve stimulation

The topography of early frontal SEPs (P20 and N26) to left median nerve stimulation was studied in 30 normal subjects and 3 patients with the left frontal bone defect. The amplitudes of P20 and N26 were maximum at the frontal electrode (F4) contralateral to the stimulation and markedly decreased at frontal electrodes ipsilateral to the site of stimulation. There was, however, no latency difference of P20 and N26 between ipsilateral and contralateral frontal electrodes. These results suggest that the origin of the ipsilateral and contralateral P20 and N26 is the same. The wide distribution of P20 and N26 over both frontal areas could be explained by assuming a smearing effect from generators actually located in the rolandic fissure and motor cortex.     

Scalp topography of somatosensory evoked potentials following electrical stimulation of femoral nerve

Up to 29 channels of somatosensory evoked potentials (SEPs) were recorded in 10 normal volunteers following unilateral femoral nerve (FN) and tibial nerve (TN) electrical stimulation. Typical short latency FN SEPs consisted of 6 components, P15, N19, P26, N34, P44 and N56. P15 and N19 were widely distributed on the scalp. The first localized scalp component, P26, was strictly postrolandic and distributed on the contralateral parietal scalp close to midline with a prerolandic phase reversal, N26. This scalp distribution is clearly different from the first localized potential of tibial nerve SEPs. N34 and P44 were maximal at the vertex with a distribution that spread to the ipsilateral central and parietal scalp. The amplitude of P26 increased and latency shortened with increasing stimulus intensity and both values plateaued after the stimulus intensity reached motor threshold. No correlation was found between the peak latency of P26 and body height.