Patients seeking symmetrical recontouring for “Perceived” deformities in the width of the face and skull

This article describes plastic surgery patients who sought symmetrical recontouring of the width of the face and skull. The basic demographic and personality characteristics of these facial width deformity (FWD) patients and the surgical procedures performed on them are discussed. Details of the surgical and psychological management of three representative cases are given. Speculative conclusions regarding the general characteristics of the FWD population are offered. Suggestions are proposed for a combined surgical-medical psychotherapeutic collaboration in managing these patients.     

Impaired motor imagery in patients with essential tremor: a case control study.

Motor imagery (MI), which refers to the process of mental representation of movements, has not been studied in patients with essential tremor (ET). We investigated the presence of impaired MI in ET patients compared with healthy controls. A group of drug-naive and nondemented ET patients and age-matched controls were studied using transcranial magnetic stimulation, while they were specifically instructed to try and imagine themselves performing two motor tasks. The various clinical and electrophysiological variables were evaluated and compared. Repeated measures ANOVA demonstrated a significant difference between ET patients and controls with respect to mean motor-evoked potential (MEP) amplitudes (F(1,38) = 31.92, P < 0.005) during MI. The process of MI effectively facilitated MEP amplitude in controls but not in ET patients, regardless of side of stimulation or motor tasks. We provide evidence to demonstrate impairment of MI in a group of ET patients compared with healthy controls. The basis for this novel finding is unclear, and further studies are warranted to determine whether it is related to cerebellar or motor cortical dysfunction.     

Brainstem control of sensory information: a mechanism for perception

We have proposed a theory in which pathways ascending from the brainstem reticular formation control sensory centers in the dorsal thalamus and neocortex. We assumed that the sensory messages received at a given level are transformed by a stochastic process, called Alopex, in a way which maximizes responses in central feature analyzers. Perception is seen as a process involving a close cyclic interaction between brainstem and sensory relays. We discuss the specific case of visual information flow and the proposed modification of visual images at the level of the dorsal lateral geniculate nucleus (dLGN). Computer simulations of a simple model, representing the dLGN and reafferent control emanating from the reticular formation, show that sensory features are effectively enhanced and--in the absence of sensory input--quasi-sensory features may be generated by feedback of a simple scalar variable that is formed by the non-linear superposition of the responses of any number of feature analyzers. The model proposes a specific mechanism for such processes as visual imagery, hallucinations, and dreaming, and provides a framework for further studies into the nature of cognitive brain functions.     

Further evidence for excitability changes in human primary motor cortex during ipsilateral voluntary contractions

The present study aimed to further investigate whether the intracortical neural circuits within the primary motor cortex (M1) are modulated during ipsilateral voluntary finger movements. Single- and paired-pulse (interstimulus intervals, ISIs; 3 ms and 12 ms) transcranial magnetic stimulations of the left M1 were applied to elicit motor evoked potential (MEP) in the right first dorsal interosseous (Rt-FDI) muscle during voluntary contractions (10% and 30% maximum voluntary contraction) of the left FDI (Lt-FDI) muscle. F-waves of Rt-FDI muscle were recorded under these left index-finger conditions for ensuring that the excitability changes occur at the supraspinal level. MEPs were also recorded during motor imagery of the left index-finger abduction instead of overt movement. The results showed that, in single-pulse transcranial magnetic stimulation (TMS) paradigm, MEPs in Rt-FDI muscle were markedly enhanced during voluntary contractions of Lt-FDI muscle compared with the complete resting state. In paired-pulse TMS paradigm, the short intracortical inhibition was significantly reduced in proportion to increments of the ipsilateral muscle contraction, whereas the intracortical facilitation had no change. F-wave of Rt-FDI muscle was unchanged under these conditions, while MEP in Rt-FDI muscle was also enhanced during motor imagery of the left index-finger abduction. Based on the present results, it is suggested that the intracortical inhibitory neural circuits may be modulated in the transition from rest to activity of the ipsilateral homonymous muscle. The excitability changes in M1 might be induced by overflows of voluntary drive given to the ipsilateral limb, probably via the transcallosal pathway.     

Fear Imagery and Text Processing

This study examined the effect of three variables held to influence heart rate response during imagery-related text processing: mode of processing, content of text, and inclusion of response information in the text. Sixty-four undergraduates imagined and silently repeated fearful and neutral sentences in a paradigm designed to allow for self-initiation of sentence processing. Fear sentences either included or did not include information about bodily responses in the image. Heart rate accelerated more during fear imagery than during neutral imagery or silent repetition of either type of sentence. Inclusion of response information in fear material did not increase heart rate response to imagery, but did affect self-report in the predicted direction. Heart rate waveform prior to the sentence tasks indicated pre-processing of fearful material. The results were discussed in relation to a bio-informational theory of imagery, which asserts that emotional imagery accesses the same centrally-mediated response program as is evoked in the target reality context, and thus occasions measurable activity in the appropriate effectors.     

Dynamic changes in corticospinal excitability during motor imagery

 We investigated temporal changes in the amplitudes of motor-evoked potentials (MEPs) induced by transcranial magnetic stimulation over the left motor cortex during motor imagery. Nine subjects were instructed to imagine repetitive wrist flexion and extension movements at 1 Hz, in which the flexion timing was cued by a tone signal. Electromyographs (EMGs) were recorded from the first dorsal interosseous, flexor carpi radialis and extensor carpi radialis muscles of the right hand, and magnetic stimulation was delivered at 0, 250, 500 and 750 ms after the auditory cue. On average, the evoked EMG responses were larger in the flexor muscle during the phase of imagined flexion than during extension, whilst the opposite was true for the extensor muscle. There were no consistent changes in the amplitudes of MEPs in the intrinsic hand muscle (first dorsal interosseous). The EMG remained relaxed in all muscles and did not show any significant temporal changes during the test. The H-reflex in the flexor muscle was obtained in four subjects. There was no change in its amplitude during motor imagery. These observations lead us to suggest that motor imagery can have dynamic effects on the excitability of motor cortex similar to those seen during actual motor performance. Received: 23 July 1998 / Accepted: 26 October 1998     

Effect of brain and spinal cord injuries on motor imagery

Summary The timing of mentally executed movements was measured in ten patients with hemiplegia, tetraplegia and paraplegia. In hemiplegic patients a significant difference in mental duration times was found between the paralysed and the normal represented limb. The paralysed limb was mentally much slower than the healthy one. In contrast, movement times in tetraplegic and paraplegic patients did not differ from those in normal subjects. All patients reported a sensation of subjective effort accompanying the execution of the mental tasks. These observations are compatible with an outflow processing underlying motor imagery.