Sympathetic skin response evoked by laser skin stimulation

The objective of this study was to evoke sympathetic skin responses (SSRs) in healthy subjects using laser stimulation and to compare these responses with those induced by conventional electrical stimuli. Twenty healthy subjects were investigated. SSRs were obtained using electrical and laser stimuli delivered to the wrist controlateral to the recording site. The sympathetic sudomotor conduction velocity (SSFCV) was measured in 8 subjects by simultaneously recording the SSR from the hand and the axilla. The latency (L) of the laser-induced SSR (ISSR) was significantly longer than that of the electrically-evoked SSR (eSSR) (mean ISSRL= 1.7 +/- 0.145 ms, mean eSSRL= 1.56 +/- 0.14 ms, p<0.05). The amplitude (A) of the ISSR was lower than the eSSR amplitude (mean ISSRA = 1.31 +/- 0.26 mV, mean eSSRA = 2.59 +/- 0.49 mV, p<0.05). No significant difference between the ISSR and eSSR was observed in either the SSFCV or the variability and reproducibility parameters. Our findings show that SSRs can easily be induced by laser stimuli and that this method shares the technical limitations of conventional eSSRs.     

Human masseter inhibitory reflexes evoked by repetitive electrical stimulation.

OBJECTIVES: The relationship between the masseter inhibitory reflex (MIR) and nociceptive processing in the trigeminal region was studied in 10 healthy subjects. Based on the known increase in perceived sensory intensity following repetitive stimulation of the nociceptive system, we examined the hypothesis that the MIR reflects noxious activity in the trigeminal system by determining the possible relation between changes in MIR and perceived sensory intensity. METHODS: The MIR was quantitated and compared with psychophysical measures following repetitive peri-oral electrical stimulation (5 square wave pulses of 0.5ms repeated at 2Hz). In addition to the early (ES1) and late (ES2) periods of exteroceptive suppression, two periods with apparent excitation could be distinguished from the background electromyografical activity: (a) the inter-suppression period (ISP) between the ES1 and the ES2, and (b) the post-suppression period (PSP) after the ES2. A computer algorithm was used to detect and quantitate ES1, ES2, ISP, and PSP. The response variables were (a) onset latencies and (b) magnitudes of suppression (ES1 and ES2) and excitation (ISP and PSP). RESULTS: Consistent reduction of the magnitude of ES2 suppression in response to repetitive stimuli was observed below as well as above the pain detection threshold. CONCLUSIONS: The observed reduction of the magnitude of ES2 suppression is not specifically related to nociceptive processing. Habituation or net inhibitory effects on inhibitory pre-motor neurones (i.e. disinhibition) are possible mechanisms for the observed reduction of the magnitude of ES2 suppression after repetitive stimulation.     

Nociceptive inputs transmission in Huntington's disease: a study by laser evoked potentials

The aim of the present study was to evaluate pain perception and evoked responses by laser stimuli (LEPs) in mild not demented Huntington's Disease (HD) patients. Twenty-eight HD patients and 30 control subjects were selected. LEPs were obtained by four scalp electrodes, (Fz, Cz, referred to the nasion; T3, T4, referred to Fz), stimulating the dorsum of both hands. All patients were also evaluated by somatosensory evoked potentials (SEPs) by median nerve stimulation. Only 3 patients referred pain of arthralgic type. Laser pain perception was similar between HD patients and controls. An abnormal N2, P2 and N1 latency increase was evident in the majority of HD patients. LEPs features were similar between patients taking and not taking neuroleptics. The N2 and P2 latencies, showed a negative correlation with functional score and Mini Mental State Examination, and a positive correlation with the severity of hyperkinetic movements. A delay in nociceptive input processing emerged in HD, concurring with the main features of the disease, in absence of clinical evidence of abnormalities in pain perception. The dysfunction of pain signals transmission in HD may induce sub-clinical changes of sensory functions, which may probably interfere with sensory-motor integration and contribute to functional impairment.     

Somatosensory evoked potentials by mechanical stimulation of tooth in humans

We examined topographical analysis of the PM-SEP (periodontal mechanoreceptor-sensory evoked potential) inducing by mechanical stimulation of the tooth in eight subjects. Sensory evoked potential were recorded from various regions of the scalp by the mechanical stimulation of the normal tooth. Eleven electrodes were placed according to the International 10-20 system (T3, T4, C3, C4, T5, T6, F7, F8, Fz, Cz, Oz). The mechanical stimulation was applied to the right upper first incisor tooth. PM-SEPs were averaged 100 times following the mechanical stimulation of the tooth produced six waves of SEP at the ipsilateral temporal area (T4), but did not evoked any potential from the other regions. PM-SEP included I, II, III, IV, V and VI. The earliest latency (I wave) was approximately 11ms and latest latency (VI wave) was approximately 40 ms. These PM-SEP observed by intensity with 3 times of the threshold. In addition, the all components were abolished after local anesthesia of the periodontal ligament. These data suggests that the six waves of the PM -SEP were evoked the ipsilateral temporal region following mechanical stimulation of the tooth, and these regions were projected by afferent impulse from the periodontal mechanoreceptor.     

Head extensor reflex evoked by trigeminal stimulation in humans.

OBJECTIVE: Excitatory and inhibitory responses have been recognized in human cervical muscles following trigeminal stimulation. However, no evidence has so far been published of a crossed, short-latency, excitatory response resembling the early head extensor reflex seen in the cat. We seek its existence in humans. METHODS: The study was carried out in 14 voluntary healthy subjects. Percutaneous and surface electrical stimulation of the supraorbital and infraorbital nerves was performed with single, double and repetitive stimuli. Signals were recorded from the relaxed splenius and sternomastoid muscles bilaterally. RESULTS: Percutaneous stimulation of infraorbital nerve with single stimuli evoked an early response in the contralateral splenius muscle, with onset latency ranging from 11 to 14 ms (HR1). This response was greatly facilitated by double or repetitive stimuli. Single stimuli also gave rise to two larger responses in all 4 muscles in the latency ranges 50-70 ms (HR2) and 100-160 ms (HR3). Surface stimulation of one nerve alone could not elicit any early activity. Single surface stimuli delivered simultaneously to the supraorbital and infraorbital nerves evoked HR1 in only 5 subjects. CONCLUSIONS: We detected a crossed early reflex of the head extensor muscles to trigeminal stimuli. Its timing is similar to the 8-ms response seen in cats. The evidence provided suggests that the reflex is mediated by an oligosynaptic circuit and that it needs a strong spatial summation at central synapses.     

Scalp topography of ultralate (C-fibres) evoked potentials following thulium YAG laser stimuli to tiny skin surface areas in humans.

AIM: To investigate (1) the scalp topography of ultralate laser evoked potentials (LEPs) related to C-fibre activation, which can directly be obtained by thulium YAG (Tm YAG) laser stimulation of tiny skin surface areas (about 0.23 mm(2)) and (2) the influence of the performance of a motor task on ultralate LEPs. METHODS: Laser stimuli were applied to the dorsum of the left hand. LEPs were recorded with 58 scalp electrodes from 9 healthy subjects in two different conditions, with and without a reaction time (RT) task (press a button upon detection). RESULTS: On high resolution electroenchephalogram recordings, ultralate LEPs were characterized by a broad positive component (peak latency: 1133+/-91 ms) with maximum amplitude about the vertex. Moreover, the performance of a RT task had no influence on latency, amplitude and topographical patterns of two maps chosen at the positive peak latency in ultralate LEPs. Nevertheless, a negative inflexion (latency 1300 ms) appeared after the positive component in the task condition possibly reflecting movement-related potentials. CONCLUSION: Tm YAG laser stimulation of tiny skin surface areas allows recording the dynamic scalp topography of ultralate (C-fibres) LEPs, with or without the performance of a RT task.     

Visceral and postural reflexes evoked by genital stimulation in urethane-anesthetized female rats.

The present study describes several muscular reflexes produced by genital stimulation, the nerves that subserve them, and the visceral and postural effects induced by these reflexes. Electrical stimulation of the iliococcygeus (ic) and pubococcygeus (pc) (striated) muscles produced movement of the vaginal orifice and wall, membranous urethra, tail and pelvis. Electrical stimulation of the psoas major (pm) or iliacus (i) (striated) muscles produced movements of the lumbar vertebrae and extension of the ipsilateral hindlimb. Sensory mechanostimulation elicited responses of these muscles as follows: stimulation of the perineal skin, clitoral sheath or distal vagina produced reflex contraction of the ic and pc muscles. Stimulation of the cervix produced reflex contraction of the pm and i muscles and also blocked the above reflex contraction of the ic and pc muscles. Both the cervical stimulation-induced blockage of the ic and pc reflex response, and the cervical stimulation-induced activation of pm and i muscles was prevented by bilateral transection of the viscerocutaneous branch of the pelvic nerve. Based on the above observations, it is proposed that stimulation of the vaginal surface of the cervix resulting from penile intromission and/or seminal plug deposition during mating behavior in the rat may reflexively active pm and i, thereby contributing to the hindleg postural rigidity and lordotic dorsiflexion that are characteristic of the normal mating posture in female rats.     

Characteristics of sympathetic reflexes evoked by electrical stimulation of phrenic nerve afferents.

In chloralose-anaesthetized cats, sympathetic reflex responses were recorded in left cardiac and renal nerve during stimulation of afferent fibres in the ipsilateral phrenic nerve. In cardiac nerve, a late reflex potential with a mean onset latency of 75.6 +/- 13.8 ms was regularly recorded which, in 20% of the experiments, was preceded by an early, very small reflex component (latency between 35 and 52 ms). In contrast, in renal nerve only a single reflex component after a mean latency of 122.1 +/- 13.1 ms was observed. Bilateral microinjections of the GABA-agonist muscimol into the rostral ventrolateral medulla oblongata resulted in a nearly complete abolition of sympathetic background activity and in an 88% reduction of the late reflex amplitude with only small effects on the latency of the evoked potentials. Under this condition, an early reflex component was never observed to appear. After subsequent high cervical spinalization, the residual small potentials which persisted after bilateral muscimol injections were completely abolished and in cardiac nerve an early reflex potential with a mean latency of 45 +/- 10 ms was observed in all but one experiment. The early reflex was therefore referred to as a spinal reflex component which, however, is suppressed in most animals with an intact neuraxis. In the renal nerve a spinal response was only observed in one experiment after spinalization. The results suggest that sympathetic reflexes evoked by stimulation of phrenic nerve afferent fibres possess similar spinal and supraspinal pathways as previously described for somato-sympathetic and viscero-sympathetic reflexes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pain-related magnetic fields evoked by intra-epidermal electrical stimulation in humans.

OBJECTIVES: We recently developed a new method for the preferential stimulation of Adelta fibers in humans. The aim of the present study was to examine whether this method can serve as an appropriate stimulus in a magnetoencephalographic study. METHODS: We recorded somatosensory-evoked magnetic fields (SEFs) following intra-epidermal electrical stimulation applied to the hand and elbow. Superficial parts of the skin were electrically stimulated through a needle electrode whose tip was inserted in the epidermis. RESULTS: In all 13 subjects, the equivalent current dipole was estimated in the secondary somatosensory cortices (SII). In 5 out of 13 subjects, simultaneous activation of the primary somatosensory cortex (SI) in the hemisphere contralateral to the stimulation was identified. The mean peak latencies of magnetic fields corresponding to contralateral SI, SII and ipsilateral SII activation following hand stimulation were 162, 158 and 171 ms, respectively. The respective latency following elbow stimulation was 137, 139 and 157 ms, respectively. Estimated peripheral conduction velocity was 15.6m/s. CONCLUSIONS: All the results were consistent with previous findings in pain SEF studies. We concluded that our novel intra-epidermal electrical stimulation is useful for pain SEF studies since it does not need special equipment and is easy to control.     

Corticospinal volleys evoked by transcranial stimulation of the brain in conscious humans

The direct recording in conscious humans of corticospinal volleys evoked by different magnetic and electric techniques of transcranial stimulation demonstrates that it is possible to activate neurones of the motor cortex in several different ways. Lateral electrical stimulation of the motor cortex preferentially activates the axons of corticospinal neurones in the subcortical white matter, and evokes a D-wave in pyramidal tract. The way of activation of corticospinal neurones using magnetic stimulation depends on the direction of the electrical current induced in the brain and on the shape of the coil. Monophasic magnetic stimulation with a focal figure-of-eight coil inducing posterior-anterior current in the brain activates corticospinal neurones trans-synaptically recruiting an 11-wave, with later I-waves appearing in sequence at higher intensities and a D-wave at very high intensities. If the induced current is rotated to the anterior-posterior direction late I-waves are preferentially recruited and when a D-wave is recruited, it has a later onset than the electrical D-wave, suggesting an activation nearer the cell body of the pyramidal neurones. A latero-medial induced current activates both corticospinal axons at the same point as electrical stimulation evoking a D wave and cortico-cortical axons evoking I-waves. A nonfocal large circular coil centered at the vertex is capable of activating pyramidal neurones both at the initial segment and trans-synaptically evoking a D wave with a longer latency than the electrical D-wave and I-waves. Using a biphasic magnetic stimulation, both phases of the biphasic pulse are capable of activating descending motor output and the pattern of recruitment of descending activity depends on the intensity of the stimulus and the relative threshold of each volley to each direction of current flow.     

Early scalp responses evoked by stimulation of the mental nerve in humans

In 20 subjects, we stimulated the mental nerve through needle electrodes inserted into the homonymous foramen; recording electrodes were placed on the scalp and along the jaw. Within the 1st 5 msec after the stimulus we recorded 4 constant waves, thought to reflect the afferent activity from the mandibular nerve up to the trigeminal nuclei. These waves have similar characteristics and the same high degree of reliability as those obtained after stimulation of the infraorbital and supraorbital nerves; therefore, they should be a useful complement for a complete exploration of trigeminal nerve function.     

Corticospinal volleys evoked by transcranial stimulation of the brain in conscious humans

Abstract

The direct recording in conscious humans of corticospinal volleys evoked by different magnetic and electric techniques of transcranial stimulation demonstrates that it is possible to activate neurones of the motor cortex in several different ways. Lateral electrical stimulation of the motor cortex preferentially activates the axons of corticospinal neurones in the subcortical white matter, and evokes a D-wave in pyramidal tract. The way of activation of corticospinal neurones using magnetic stimulation depends on the direction of the electrical current induced in the brain and on the shape of the coil. Monophasic magnetic stimulation with a focal figure-of-eight coil inducing posterior–anterior current in the brain activates corticospinal neurones trans-synaptically recruiting an I1-wave, with later I-waves appearing in sequence at higher intensities and a D-wave at very high intensities. If the induced current is rotated to the anterior–posterior direction late I-waves are preferentially recruited and when a D-wave is recruited, it has a later onset than the electrical D-wave, suggesting an activation nearer the cell body of the pyramidal neurones. A latero–medial induced current activates both corticospinal axons at the same point as electrical stimulation evoking a D wave and cortico–cortical axons evoking I-waves. A nonfocal large circular coil centered at the vertex is capable of activating pyramidal neurones both at the initial segment and transsynaptically evoking a D wave with a longer latency than the electrical D-wave and I-waves. Using a biphasic magnetic stimulation, both phases of the biphasic pulse are capable of activating descending motor output and the pattern of recruitment of descending activity depends on the intensity of the stimulus and the relative threshold of each volley to each direction of current flow.     

Soleus muscle reflexes evoked by stimulation of the posterior tibial nerve compared to tendon reflexes in man (author's transl)]

The characteristics of the reflex response evoked in the soleus muscle after stimulation of the posterior tibial nerve at the ankle were contrasted with the achilleus tendon reflex in 14 healthy volunteers and in a group of selected neurological patients. The following features were examined: conditions of stimulation including stimulation frequency; appearance of reflex activity in muscles other than soleus, effect of the vibratory stimulation, interactions with voluntary contraction. Moreover, a reflex response is described in the soleus following stimulation of the sural nerve. The results have shown a marked jitter in latencies of the responses, a pattern of coactivation of antagonistic muscles, a clear increase of amplitude under vibration or voluntary contraction, normal responses both in spasticity and in S1 radiculopathy with achilleus areflexia. All these data differ from those observed with the tendon jerk of the same amplitude and differentiate the two responses. It is concluded that the reflex evoked by stimulation of the tibial nerve at the ankle is a polysynaptic response of cutaneous origin.     

Nociceptive spinal withdrawal reflexes but not spinal dorsal horn wide-dynamic range neuron activities are specifically inhibited by halothane anaesthesia in spinalized rats

The aim of the present study was to investigate the spinal cord effects and sites of action of different inhaled concentrations (0.5-2%) of the anaesthetic, halothane. Simultaneous recordings were made of 3 Hz, suprathreshold (1.5 x T) electrically evoked spinal dorsal horn (DH) wide-dynamic range (WDR) neuron responses and of single motor unit (SMU) electromyographic (EMG) responses underlying the spinal withdrawal reflex in spinalized Wistar rats. Compared with the baseline responses obtained with 0.5% halothane, the electrically evoked early responses of the DH WDR neurons as well as the SMUs were only depressed by the highest, 2% concentration of halothane. In contrast, 1.5% halothane markedly inhibited the late responses of the DH WDR neurons, whereas 1% halothane started to significantly depress the late responses of the SMUs. Likewise, wind-up of the WDR neuron late responses was inhibited by 1.5-2% halothane, whereas 1-2% halothane significantly depressed wind-up of the SMU EMG late responses. The inhibitory effects of 2% halothane on the early and the late responses of the DH WDR neurons, but not of the SMUs, were completely reversed by opioid micro-receptor antagonist naloxone (0.04 mg/kg). However, no significant effects of naloxone were found on different responses of the DH WDR neurons as well as the SMUs at 0.5-1% halothane, suggesting that different concentrations of halothane may modulate different spinal receptors. We conclude that halothane at high concentrations (1.5-2%) seems to play a predominant inhibitory role via spinal multireceptors on ventral horn (VH) motor neurons, and less on DH sensory WDR neurons, of the spinal cord.     

Modular organization of human leg withdrawal reflexes elicited by electrical stimulation of the foot sole.

Human withdrawal reflex receptive fields were determined for leg muscles by randomized, electrical stimulation at 16 different positions on the foot sole. Tibialis anterior, gastrocnemius medialis, peroneus longus, soleus, rectus femoris, and biceps femoris reflexes, and ankle joint angle changes were recorded from 14 subjects in sitting position. Tibialis anterior reflexes were evoked at the medial, distal foot and correlated well with ankle dorsal flexion. Gastrocnemius medialis reflexes were evoked on the heel and correlated with plantar flexion. Stimulation on the distal, medial sole resulted in inversion (correlated best with tibialis anterior activity), whereas stimulation of the distal, lateral sole evoked eversion. Biceps femoris reflexes were evoked on the entire sole followed by a small reflex in rectus femoris. A detailed withdrawal reflex organization, in which each lower leg muscle has its own receptive field, may explain the ankle joint responses. The thigh activity consisted primarily of flexor activation.     

Comparison of descending volleys evoked by transcranial magnetic and electric stimulation in conscious humans

Objectives: The present experiments were designed to compare the understanding of the transcranial electric and magnetic stimulation of the human motorcortex.Methods: The spinal volleys evoked by single transcranial magnetic or electric stimulation over the cerebral motor cortex were recorded from a bipolar electrode inserted into the cervical epidural space of two conscious human subjects. These volleys were termed D- and I waves, according to their latency. Magnetic stimulation was performed with a figure-of-eight coil held over the right motor cortex at the optimum scalp position, in order to elicit motor responses in the contralateral FDI using two different orientations over the motor strip. The induced current flowed either in a postero-anterior or in a latero-medial direction.Results: At active motor threshold intensity, the electric anodal stimulation evoked pure D activity. At this intensity, magnetic stimulation with the induced current flowing in a posterior-anterior direction evoked pure I₁ activity. When a latero-medial induced current was used, magnetic stimulation evoked both D and I₁ activity. Using electric anodal stimulation, at a stimulus intensity of 9% of the stimulator output above the active motor threshold (corresponding approximately to 1.5 active motor threshold), a small I₁ wave appeared only in subject 1. Using magnetic stimulation with a posterior-anterior induced current, at a stimulus intensity of 21% of maximum stimulator output above the active motor threshold (corresponding approximately to 1.8 times threshold in subject 1 and to two times threshold in subject 2), a small D wave appeared in subject 1 but not in subject 2.Conclusions: Present results demonstrate that, in conscious humans at threshold intensities, electric stimulation evokes D waves and magnetic stimulation (with a posterior-anterior induced current) evokes I waves, while magnetic stimulation (with a latero-medial induced current) evokes both activities.     

Pain relief by various kinds of interference stimulation applied to the peripheral skin in humans: pain-related brain potentials following CO2 laser stimulation

Pain perception is changed by various kinds of interference stimulation applied to the peripheral skin in humans. We investigated pain-related somatosensory evoked brain potentials (pain SEPs) following CO2 laser stimulation applied to the hand or foot in normal subjects, to elucidate the underlying mechanisms. A pain visual analogue scale (VAS) was also scored to determine the degree of subjective feeling of painful sensation. The following stimulations were applied as the interference: (1) vibration, (2) active and passive movements of the hand or foot, (3) noxious warming by hot water (46 degrees C) and (4) noxious cooling by ice water (0 degrees C). These interference stimulations were applied not only to the same hand or foot as the laser stimuli but also to the contralateral hand or foot. Significant changes in the amplitude of pain SEPs and VAS score were observed to some degree for each type of interference, and we concluded that gate control theory and diffuse noxious inhibitory control were the most appropriate hypotheses to account for this particular phenomenon of pain relief. Some movement-related cortical activities were also considered to be an important factor. These findings could not be accounted for by simple changes in the subjects' attention. Pain relief was more prominent at the second pain ascending through C fibers than that of the first pain ascending through Adelta fibers. The responsible sites for this phenomenon are considered to be the dorsal horn of the spinal cord, the brainstem and some parts of the brain such as the second sensory cortex and the cingulate cortex.