Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex

Weak transcranial direct current stimulation (tDCS) of the human motor cortex results in excitability shifts which occur during and after stimulation. These excitability shifts are polarity-specific with anodal tDCS enhancing excitability, and cathodal reducing it. To explore the origin of this excitability modulation in more detail, we measured the input–output curve and motor thresholds as global parameters of cortico-spinal excitability, and determined intracortical inhibition and facilitation, as well as facilitatory indirect wave (I-wave) interactions. Measurements were performed during short-term tDCS, which elicits no after-effects, and during other tDCS protocols which do elicit short- and long-lasting after-effects. Resting and active motor thresholds remained stable during and after tDCS. The slope of the input–output curve was increased by anodal tDCS and decreased by cathodal tDCS. Anodal tDCS of the primary motor cortex reduced intracortical inhibition and enhanced facilitation after tDCS but not during tDCS. Cathodal tDCS reduced facilitation during, and additionally increased inhibition after its administration. During tDCS, I-wave facilitation was not influenced but, for the after-effects, anodal tDCS increased I-wave facilitation, while cathodal tDCS had only minor effects. These results suggest that the effect of tDCS on cortico-spinal excitability during a short period of stimulation (which does not induce after-effects) primarily depends on subthreshold resting membrane potential changes, which are able to modulate the input-output curve, but not motor thresholds. In contrast, the after-effects of tDCS are due to shifts in intracortical inhibition and facilitation, and at least partly also to facilitatory I-wave interaction, which is controlled by synaptic activity.     

Buchbesprechungen

Ohne Zusammenfassung     

The ophthalmic artery and its branches,measurements and clinical importance

Summary Seventy-one Caucasian orbits (36 right, 35 left) were studied by dissection. The diameter of the ophthalmic a. (2 mm from the origin) was 1.54 ± 0.04 mm (male) and 1.31 ± 0.05 mm (female). In individual cases, there were no significant differences in vessel diameter between the right and left sides but, differences in vessel diameter between males and females were more commonly observed in the arteries which leave the orbit (extraorbital group), the individual vessels having a larger diameter in males. The incidence of the ophthalmic a. passing in the orbit medially under the optic n. was 18.6%. The lacrimal a. was observed to arise from the ophthalmic a. in only 82.5% of the cases examined, 15.9% of the cases showed the origin to be at the anastomotic branch of the middle meningealThis article is dedicated to Pr Dr Hoepke on occasion of his 100th birthday     

The measurements of the clivus, the foramina on the external base of the skull and the superior vertebrae

Anatomical measurements are made on the clivus and the upper cervical column. These values are important for transoral, transpalatinal approaches to the clivus and to atlas and axis. The mean-values of the length of clivus in adults were 45 mm on the internal cranial base, on the external the length between the basion and the vomer was estimated with 27.9 mm, the tuberculum pharyngeum is situated on our material 11.2 mm rostral of the basion. The anterior part of clivus in the external cranial base has a width of 22.5 mm, the posterior part has one of 42.8 mm. Included are measurements of the hypoglossal canal and measurements of foramen lacerum externum. The postnasal enlargement of the most portals of the cranial base is given in Fig. 5. The occipital condyles are 22.9 mm in length, the angle between the condyles was 51.4 degrees. The thickness of clivus was 18.3 mm in a level 28 mm rostral of basion and 9.3, 11 mm rostral of basion. Given are also the thickness of substantia corticalis of clivus and the area of posterior wall of sphenoid sinus. Measured are also the distances between dens axis and anterior arch of atlas and basion. The height of anterior arch was found larger than by other researchers. Included are length and width values of the upper cervical column and the insertion areas of the longus capitis and rectus capitis anterior muscles.     

Identification of high risk patients with severe, but asymptomatic aortic stenosis

Whether asymptomatic patients with severe aortic stenosis benefit from surgery remains unclear. We report our data recently published in the New England Journal of Medicine on the natural history of this disease and predictors of outcome.     

Evidence for inhibition of fusion of lysosomal and prelysosomal compartments with phagosomes in macrophages infected with pathogenic Mycobacterium avium.

Bone marrow-derived cultured macrophages were infected with the pathogenic organism Mycobacterium avium. Immediately after infection and at 1 to 28 days later, cells either were stained for acid phosphatase activity or given horseradish peroxidase, which served as a pinocytotic marker. With the former, fusions between phagosomes and lysosomes exclusively were assessed; with the latter, those between phagosomes and both pinosomes and lysosomes were determined. As a control, similar experiments were undertaken by infecting macrophages with gamma ray-killed M. avium and the nonpathogenic live organisms Mycobacterium aurum and Bacillus subtilis. After infection with live M. avium, fusions between phagosomes and acid phosphatase-positive vesicles (lysosomes) were inhibited. The same inhibition was observed whether phagosomes contained damaged or structurally intact (presumed to be live) bacteria, except for the early time points. This inhibition was, however, partial, suggesting that some of the live bacteria are resistant to the hydrolytic enzymes of the phagolysosomal environment. Fusions between horseradish peroxidase-positive vesicles (pinosomes and lysosomes) and phagosomes depended upon the morphological state of the bacteria. Damaged bacteria did not inhibit fusions, whereas with intact bacteria, a partial inhibition which increased with time was observed. The two types of experiment suggest that viable M. avium can impair phagosome-pinosome fusions.     

Subsensitivity of T lymphocytes to sympathomimetic and cholinergic stimulation in bronchial asthma.

The effect of adrenergic and cholinergic drugs on short incubation “active” E rosette formation was studied in 19 patients with bronchial asthma and 17 healthy controls. Both groups had an equal absolute number of baseline “active” E rosettes, but the asthmatics demonstrated a higher percent baseline value. The beta adrenergic drug isoproterenol (10^?3 M) inhibited the formation of “active” E rosettes in asthmatics by only 18.0% as compared to a 60.8% inhibition in the control group. Carbamylcholine (10^?5 M) a cholinergic agonist, also showed a lower than normal response in asthmatics, 34.3% enhancement of “active” E rosetting compared to a 52.4% enhancement in the controls. The alpha adrenergic agent phenylephrine (10^?5 M) exhibited equal enhancing effects in both groups, 34.2% in the asthmatics and 36.5% in the controls. Isoproterenol (10^?3 M) had a minimal effect on inhibition of long incubation “total” E rosettes in both groups studied. The beta adrenergic abnormality conforms to the beta blockade theory of asthma of Szentivanyi. The cholinergic abnormality is unexplained in view of the hyperresponsiveness of patients with asthma to cholinergic agents in vivo. Patients with bronchial asthma probably have an autonomic dysfunction that may play a role in the pathogenesis of their disease.     

Presentation of Leishmania donovani promastigotes occurs via a brefeldin A-sensitive pathway.

For the presentation of Leishmania promastigotes to polyclonal CD4+ T cells, a processing period within activated macrophages of 3-4 h is required. Presentation can be inhibited by both chloroquine and brefeldin A (BFA), the latter implicating a requirement for newly synthesized MHC class II molecules. This inhibition is both reversible and specific, in that BFA did not inhibit mixed lymphocyte reaction stimulation by these infected macrophages. Immunogold labeling demonstrated that class II was associated with the parasite-containing phagolysosome. The level of class II was not significantly altered in BFA-treated cells in the time period studied, suggesting that antigen may exist the phagolysosome and interact with class II in another cellular compartment.