Central motor conduction studies in motor neurone disease using magnetic brain stimulation

Central motor conduction (CMC) to abductor digiti minimi (ADM) was evaluated in 22 patients with motor neurone disease (MND) using magnetic stimulation of the motor cortex and electrical stimulation at the C7/T1 interspace. CMC was abnormal in 14 patients; prolonged CMC time and absence of response to brain stimulation were more frequent abnormalities than low amplitude responses without prolonged CMC time. The technique can reveal subclinical upper motor neurone involvement and document central motor pathway dysfunction in MND. The patterns of abnormality are not specific to MND; all may occur in other neurological disorders including multiple sclerosis.     

Vitamin B12 status does not influence central motor conduction time in asymptomatic elderly people: A transcranial magnetic stimulation study

Introduction: Vitamin B12 deficiency causes neurologic and psychiatric disease, especially in older adults. Subacute combined degeneration is characterized by damage to the posterior and lateral spinal cord affecting the corticospinal tract.

Objective: To test corticospinal tract projections using motor evoked potentials (MEPs) by transcranial magnetic stimulation (TMS) in asymptomatic older adults with low vitamin B12 (B12) levels.

Methods: Cross-sectional study of 53 healthy older adults (>70 years). MEPs were recorded in the abductor pollicis brevis and tibialis anterior muscles, at rest and during slight tonic contraction. Central motor conduction time (CMCT) was derived from the latency of MEPs and peripheral motor conduction time (PMCT). Neurophysiological variables were analyzed statistically according to B12 status.

Results: Median age was 74.3?±?3.6 years (58.5% women). Twenty-six out of the 53 subjects had low vitamin B12 levels (B12?p?=?0.014).

Conclusions: No subclinical abnormality of the corticospinal tract is detected in asymptomatic B12-deficient older adults. The peripheral nervous system appears to be more vulnerable to damage attributable to this vitamin deficit. The neurophysiological evaluation of asymptomatic older adults with lower B12 levels should be focused mainly in peripheral nervous system evaluation.     

Comparison of magnetic and electrical phrenic nerve stimulation in assessment of phrenic nerve conduction time

Similowski, Thomas, Selma Mehiri, Alexandre Duguet,Valérie Attali, Christian Straus, and Jean-Philippe Derenne.Comparison of magnetic and electrical phrenic nerve stimulation inassessment of phrenic nerve conduction time. J. Appl.Physiol. 82(4): 1190-1199, 1997.Cervicalmagnetic stimulation (CMS), a nonvolitional test of diaphragm function,is an easy means for measuring the latency of the diaphragm motorresponse to phrenic nerve stimulation, namely, phrenic nerve conductiontime (PNCT). In this application, CMS has some practical advantagesover electrical stimulation of the phrenic nerve in the neck (ES).Although normal ES-PNCTs have been consistently reported between7 and 8 ms, data are less homogeneous for CMS-PNCTs, with some reportssuggesting lower values. This study systematically compares ES-and CMS-PNCTs for the same subjects. Surface recordings ofdiaphragmatic electromyographic activity were obtained for sevenhealthy volunteers during ES and CMS of varying intensities. Onaverage, ES-PNCTs amounted to 6.41 ± 0.84 ms and were littleinfluenced by stimulation intensity. With CMS, PNCTs were significantlylower (average difference 1.05 ms), showing a marked increase as CMSintensity lessened. ES and CMS values became comparable for a CMSintensity 65% of the maximal possible intensity of 2.5 Tesla. Thesefindings may be the result of phrenic nerve depolarization occurringmore distally than expected with CMS, which may have clinicalimplications regarding the diagnosis and follow-up of phrenic nervelesions.

     

Vessels of the brachial plexus]

The blood supply of brachial plexus is described by means of lightened injected specimens of older human fetus. The following arteries have direct branches to brachial plexus: the aortic arch/brachiocephalica trunk, subclavia a., thyrocervical trunk, ascending cervical a., transverse cervical a., suprascapular a., and the acromial network. Secondary branches leave them that partly anastomose and also return from distal to proximal. The blood supply is luxurious.     

Application of transcranial magnetic stimulation for monitoring of the motor cortex condition in dynamics in healthy subjects

Transcranial magnetic stimulation (TMS) is used already for sixteen years for studying human central nervous system. The main objective of this work was to study motor thresholds and their hemispheric asymmetry in healthy subjects during TMS. We examined 31 righthanded healthy students. Their motor thresholds were measured in May (before vacations), September (immediately after vacations), and November (two months after vacations). Magnetic stimulator Neurosoft-MS (Ivanovo, Russia) was used for TNS of the motor cortex. It was shown that in the absence of regular active functional loads on the right hand, the motor thresholds in healthy righthanders significantly increased under the TMS of the left hemisphere, and hemispheric asymmetry disappeared under conditions both of muscle relaxation and voluntary contraction. Motor thresholds under the left-side TMS decreased and hemispheric asymmetry recovered with the restart of the regular active functional loads on the right hand.     

Effects of anesthesia and nociceptive stimulation in an experimental model of brachial plexus avulsion

Unilateral dorsal rhizotomy of brachial plexus nerves (C5-Th1) performed under general anesthesia is known to induce self-mutilation in rats. The aim of this study was to determine the effect of different anesthetic agents, and of pre-rhizotomy nociceptive stimulation on the appearance of self-mutilation. Self-mutilation appeared in 78% of animals after rhizotomy had been performed under pentobarbital anesthesia. When ketamine was used as the general anesthetic, self-mutilation was almost suppressed (13%) and consisted of superficial erosions. Mechanical nociceptive stimulation, when applied just before the induction of ketamine anesthesia and subsequent rhizotomy, provoked self-mutilation in 91% of rats. Furthermore, a serious type of self-mutilation consisting of total amputation of the distal part of the forepaw was present in 28% of all self-mutilating animals after previous nociceptive stimulation. In terms of self-mutilation, these results suggest 1) the crucial role of anesthesia, especially that which involved NMDA receptors (ketamine), and 2) the need of an additional factor to chronic deafferentation, formed either by activity of nociceptive pathways just before rhizotomy (nociceptive stimulation preceding ketamine anesthesia) or by injury discharges (pentobarbital anesthesia).     

Angiosomes of the brachial plexus: an anatomical study

This anatomical study analyzed the neurovascular relationships of the brachial plexus. Ten fresh cadaveric brachial plexuses were examined after injection of the arterial system. The vascular anatomical features of the brachial plexus were documented with microdissection after lead oxide/gelatin injection. The specimens were analyzed by using radiography (including digital subtraction techniques) and light-microscopic, macroscopic, and digital photography. Four angiosomes, based on the subclavian, axillary, vertebral, and dorsal scapular arteries, were observed. As noted in previous angiosome studies, connections between angiosome territories lay within tissues, in this case, nerve trunks. Nutrient vessels penetrated nerve trunks at points of branching within the brachial plexus, with a Y-shaped mode of division on entry. The vascular supply was markedly rich, often with true anastomotic connections occurring within the nerves. There was much variation in supply, depending on the vascular anatomical features of the subclavian artery.     

Prediction of lower limb motor outcomes based on transcranial magnetic stimulation findings in patients with an infarct of the anterior cerebral artery

Abstract

The aim was to investigate the relationship between transcranial magnetic stimulation (TMS) at the early stage of stroke and 6-month motor outcome for patients with anterior cerebral artery territory infarct. Patients were classified into TMS(+) and TMS(?) groups. At the 6-month evaluation, lower limb motor function for the TMS(+) group was significantly better than those for the TMS(?) group. Thus, early TMS evaluation is useful for predicting recovery of lower limb motor function in patients experiencing this type of stroke.