Study of Thresholds of Motor Evoked Responses during Transcranial Magnetic Stimulation in Healthy Subjects and Patients with Brain Tumors

Since 1985, transcranial magnetic stimulation (TMS) has been widely used for the investigation of different processes in the human central nervous system. We studied the thresholds of the motor-evoked responses (MER) during TMS and their hemispheric differences in healthy subjects and patients with brain tumors of different localization: in the brainstem projection, left and right motor areas, and left frontal-temporal area. The obtained results testify to a lower threshold of MER in healthy subjects during TMS of the dominant hemisphere. In patients with brainstem tumors, there was a decrease in the thresholds of MER during TMS. In patients with tumors in the motor area, the thresholds of MER were increased on the lesion side, whereas in patients with tumors in the left temporal area, the thresholds were significantly decreased during TMS of the lesioned hemisphere.     

The effect of sex steroid hormones on interhemispheric asymmetry in rats]

The effect of gonadectomy and sex-steroid hormones treatment on functional interhemispheric asymmetry to the reaction of pain cry avoidance of another species (emotional reactions) and motor and exploratory activity of open-field behavior in Wistar rats of 3 months old has been investigated. A spreading depression technique for hemisphere inactivation has been used. The hemispheric asymmetry of the reactions in intact rats was characterized by sex dimorphism; the left hemisphere dominated to a great extent in males than in females under the control of emotional reactions; in motor and exploratory activity in open-field behavior of rats the left hemisphere dominated in males and the right one--in female. In both sexes the neonatal gonadectomy levelled the interhemispheric differences in reactions under investigation. The following treatment of females with estradiol and males with testosterone didn't restore the asymmetry. After the castration at the age of 3 months the correlation between the size and direction of interhemispheric differences became reverse. The treatment of females with testosterone and males with estradiol both castrated in adulthood restored the interhemispheric asymmetry in males and had no effect in females. The treatment of intact rats with hormones of opposite sex led to the enhancement of left hemisphere dominance in motor and exploratory activity in males and levelled the asymmetry in females. It has been shown that in adult rats sex-steroids effect predominantly the right hemisphere.     

Reaction time and interhemispheric interaction

The study was made on healthy adult subjects. The reaction time of the hand (RT) was measured under two conditions: 1) the choice of reaction (right or left hand) is determined by the nature of the warning stimulus; 2) decision on the choice is taken, depending on the second, trigger stimulus. Stimuli are presented at random sequences to different visual fields. The reaction time to the visual signal presented to the visual field ipsilateral to the hand is significantly shorter (by 15 to 26 msec) than to the stimulus in the contralateral visual field. In a simple motor reaction, when no discrimination of trigger stimulus and the decision on the choice of reaction is required, a hemispheric asymmetry of reaction time is manifested: the left hemisphere only responds differently to direct visual stimulation and to that mediated through the contralateral hemisphere.     

Prognostic value of cortically induced motor evoked activity by TMS in chronic stroke: Caveats from a revealing single clinical case

Background

We report the case of a chronic stroke patient (62?months after injury) showing total absence of motor activity evoked by transcranial magnetic stimulation (TMS) of spared regions of the left motor cortex, but near-to-complete recovery of motor abilities in the affected hand.

Case presentation

Multimodal investigations included detailed TMS based motor mapping, motor evoked potentials (MEP), and Cortical Silent period (CSP) as well as functional magnetic resonance imaging (fMRI) of motor activity, MRI based lesion analysis and Diffusion Tensor Imaging (DTI) Tractography of corticospinal tract (CST). Anatomical analysis revealed a left hemisphere subinsular lesion interrupting the descending left CST at the level of the internal capsule. The absence of MEPs after intense TMS pulses to the ipsilesional M1, and the reversible suppression of ongoing electromyographic (EMG) activity (indexed by CSP) demonstrate a weak modulation of subcortical systems by the ipsilesional left frontal cortex, but an inability to induce efficient descending volleys from those cortical locations to right hand and forearm muscles. Functional MRI recordings under grasping and finger tapping patterns involving the affected hand showed slight signs of subcortical recruitment, as compared to the unaffected hand and hemisphere, as well as the expected cortical activations.

Conclusions

The potential sources of motor voluntary activity for the affected hand in absence of MEPs are discussed. We conclude that multimodal analysis may contribute to a more accurate prognosis of stroke patients.     

Functionally specific reorganization in human premotor cortex

After unilateral stroke, the dorsal premotor cortex (PMd) in the intact hemisphere is often more active during movement of an affected limb. Whether this contributes to motor recovery is unclear. Functional magnetic resonance imaging (fMRI) was used to investigate short-term reorganization in right PMd after transcranial magnetic stimulation (TMS) disrupted the dominant left PMd, which is specialized for action selection. Even when 1 Hz left PMd TMS had no effect on behavior, there was a compensatory increase in activity in right PMd and connected medial premotor areas. This activity was specific to task periods of action selection as opposed to action execution. Compensatory activation changes were both functionally specific and anatomically specific: the same pattern was not seen after TMS of left sensorimotor cortex. Subsequent TMS of the reorganized right PMd did disrupt performance. Thus, this pattern of functional reorganization has a causal role in preserving behavior after neuronal challenge.     

The Role of Left Supplementary Motor Area in Grip Force Scaling

Skilled tool use and object manipulation critically relies on the ability to scale anticipatorily the grip force (GF) in relation to object dynamics. This predictive behaviour entails that the nervous system is able to store, and then select, the appropriate internal representation of common object dynamics, allowing GF to be applied in parallel with the arm motor commands. Although psychophysical studies have provided strong evidence supporting the existence of internal representations of object dynamics, known as “internal models”, their neural correlates are still debated. Because functional neuroimaging studies have repeatedly designated the supplementary motor area (SMA) as a possible candidate involved in internal model implementation, we used repetitive transcranial magnetic stimulation (rTMS) to interfere with the normal functioning of left or right SMA in healthy participants performing a grip-lift task with either hand. TMS applied over the left, but not right, SMA yielded an increase in both GF and GF rate, irrespective of the hand used to perform the task, and only when TMS was delivered 130–180 ms before the fingers contacted the object. We also found that both left and right SMA rTMS led to a decrease in preload phase durations for contralateral hand movements. The present study suggests that left SMA is a crucial node in the network processing the internal representation of object dynamics although further experiments are required to rule out that TMS does not affect the GF gain. The present finding also further substantiates the left hemisphere dominance in scaling GF.     

Precision grasping in humans: from motor control to cognition

In the past decade, functional neuroimaging has proved extremely useful in mapping the human motor circuits involved in skilled hand movements. However, one major drawback of this approach is the impossibility to determine the exact contribution of each individual cortical area to precision grasping. Because transcranial magnetic stimulation (TMS) makes it possible to induce a transient 'virtual' lesion of discrete brain regions in healthy subjects, it has been extensively used to provide direct insight into the causal role of a given area in human motor behaviour. Recent TMS studies have allowed us to determine the specific contribution, as well as the timing and the hemispheric lateralisation, of distinct parietal and frontal areas to the control of both the kinematics and dynamics of precision grasping. Moreover, recent researches have shown that the same cortical network may contribute to language and number processing, supporting the existence of tight interactions between processes involved in cognition and actions. The aim of this paper is to offer a concise overview of recent studies that have investigated the neural correlates of precision grasping and the possible contribution of the motor system to higher cognitive functions such as language and number processing.     

Excitability of the motor cortex ipsilateral to the moving body side depends on spatio-temporal task complexity and hemispheric specialization

Unilateral movements are mainly controlled by the contralateral hemisphere, even though the primary motor cortex ipsilateral (M1(ipsi)) to the moving body side can undergo task-related changes of activity as well. Here we used transcranial magnetic stimulation (TMS) to investigate whether representations of the wrist flexor (FCR) and extensor (ECR) in M1(ipsi) would be modulated when unilateral rhythmical wrist movements were executed in isolation or in the context of a simple or difficult hand-foot coordination pattern, and whether this modulation would differ for the left versus right hemisphere. We found that M1(ipsi) facilitation of the resting ECR and FCR mirrored the activation of the moving wrist such that facilitation was higher when the homologous muscle was activated during the cyclical movement. We showed that this ipsilateral facilitation increased significantly when the wrist movements were performed in the context of demanding hand-foot coordination tasks whereas foot movements alone influenced the hand representation of M1(ipsi) only slightly. Our data revealed a clear hemispheric asymmetry such that MEP responses were significantly larger when elicited in the left M1(ipsi) than in the right. In experiment 2, we tested whether the modulations of M1(ipsi) facilitation, caused by performing different coordination tasks with the left versus right body sides, could be explained by changes in short intracortical inhibition (SICI). We found that SICI was increasingly reduced for a complex coordination pattern as compared to rest, but only in the right M1(ipsi). We argue that our results might reflect the stronger involvement of the left versus right hemisphere in performing demanding motor tasks.     

Hemispheric Lateralization of Motor Thresholds in Relation to Stuttering

Stuttering is a complex speech disorder. Previous studies indicate a tendency towards elevated motor threshold for the left hemisphere, as measured using transcranial magnetic stimulation (TMS). This may reflect a monohemispheric motor system impairment. The purpose of the study was to investigate the relative side-to-side difference (asymmetry) and the absolute levels of motor threshold for the hand area, using TMS in adults who stutter (n = 15) and in controls (n = 15). In accordance with the hypothesis, the groups differed significantly regarding the relative side-to-side difference of finger motor threshold (p = 0.0026), with the stuttering group showing higher motor threshold of the left hemisphere in relation to the right. Also the absolute level of the finger motor threshold for the left hemisphere differed between the groups (p = 0.049). The obtained results, together with previous investigations, provide support for the hypothesis that stuttering tends to be related to left hemisphere motor impairment, and possibly to a dysfunctional state of bilateral speech motor control.     

Effect of Parietal Transcranial Magnetic Stimulation on Spatial Working Memory in Healthy Elderly Persons - Comparison of Near Infrared Spectroscopy for Young and Elderly

In a previous study, we succeeded in improving the spatial working memory (WM) performance in healthy young persons by applying transcranial magnetic stimulation (TMS) to the parietal cortex and simultaneously measuring the oxygenated hemoglobin (oxy-Hb) level using near-infrared spectroscopy (NIRS). Since an improvement in WM was observed when TMS was applied to the right parietal cortex, the oxy-Hb distribution seemed to support a model of hemispheric asymmetry (HA). In the present study, we used the same study design to evaluate healthy elderly persons and investigated the effect of TMS on WM performance in the elderly, comparing the results with those previously obtained from young persons. The application of TMS did not affect WM performance (both reaction time and accuracy) of 38 elderly participants (mean age  = 72.5 years old). To investigate the reason for this result, we conducted a three-way ANOVA examining oxy-Hb in both young and elderly participants. For the right parietal TMS site in the elderly, TMS significantly decreased the oxy-Hb level during WM performance; this result was the opposite of that observed in young participants. An additional three-way ANOVA was conducted for each of the 52 channels, and a P value distribution map was created. The P value maps for the young participants showed a clearly localized TMS effect for both the WM and control task, whereas the P map for the elderly participants showed less significant channels and localization. Further analysis following the time course revealed that right-side parietal TMS had almost no effect on the frontal cortex in the elderly participants. This result can most likely be explained by age-related differences in HA arising from the over-recruitment of oxy-Hb, differentiation in the parietal cortex, and age-related alterations of the frontal-parietal networks.     

The effect of gonadectomy on interhemispheric asymmetry in rats

The influence was studied of the gonadectomy in the newborn and mature male and female rats on functional interhemispheric asymmetry of the reaction of avoidance of pain scream of another rat ("emotional resonance"), and motor and investigatory activity in the open field. Consecutive inactivation of the hemispheres was realized by K+ spreading depression. It has been shown that neonatally gonadectomized rats have no interhemispheric asymmetry of the studied reactions. In male rats gonadectomized in mature state, interhemispheric asymmetry of "the emotional resonance" reaction is not significant and in the motor and investigatory activity in the open field, in contrast to intact animals, the right hemisphere is dominant and not the left one. Ovariectomy of mature female rats led to the increase of the dominance of the left hemisphere in the control of "the emotional resonance" and change of the right hemispheric dominance in the control of the motor and investigatory activity in the open field for the left hemispheric one. Gonadectomy of male and female mature rats had an opposite effect on the functioning of the right hemisphere: facilitating in male rats and inhibitory in female ones.     

Task-dependent interaction between parietal and contralateral primary motor cortex during explicit versus implicit motor imagery

Both mental rotation (MR) and motor imagery (MI) involve an internalization of movement within motor and parietal cortex. Transcranial magnetic stimulation (TMS) techniques allow for a task-dependent investigation of the interhemispheric interaction between these areas. We used image-guided dual-coil TMS to investigate interactions between right inferior parietal lobe (rIPL) and left primary motor cortex (M1) in 11 healthy participants. They performed MI (right index-thumb pinching in time with a 1 Hz metronome) or hand MR tasks, while motor evoked potentials (MEPs) were recorded from right first dorsal interosseous. At rest, rIPL conditioning 6 ms prior to M1 stimulation facilitated MEPs in all participants, whereas this facilitation was abolished during MR. While rIPL conditioning 12 ms prior to M1 stimulation had no effect on MEPs at rest, it suppressed corticomotor excitability during MI. These results support the idea that rIPL forms part of a distinct inhibitory network that may prevent unwanted movement during imagery tasks.     

Motor cortex excitability during unilateral muscle activity.

The effect of unilateral tonic muscle activity with and without co-activation of the antagonists on motor cortex excitability has been studied. Motor evoked potentials (MEPs) were recorded from the first dorsal interosseus muscles of both hands in response to transcranial magnetic stimulation (TMS) during relax, isometric index finger abduction and antagonistic co-activation. The intracortical inhibition (ICI) and intracortical facilitation (ICF) were investigated by paired-pulse TMS with interstimulus intervals of 3 and 13 ms. The unilateral tonic activation of the right hand facilitated contralateral and ipsilateral responses (cMEP and iMEP) recorded from both hands with an exception of iMEPs recorded from the left hand. During paired-pulse TMS ICI for cMEPs was not influenced by the unilateral tonic activity in both hands, while ICF was suppressed when MEPs were recorded from the active right hand. The effect of unilateral tonic activity on iMEP in response to paired-pulse TMS was essentially different: generally, ICI was greater for iMEPs and ICF was completely abolished with an exception of iMEPs recorded from the left hand during right finger isometric abduction when a strong ICF was evident. The decreased ICF and/or increased ICI are assumed to reflect mechanisms underlying the co-activation of antagonists.     

Sensory lateralization in pain subjective perception for noxious heat stimulus

The aim of the present study was to identify and characterize hemispheric lateralization for pain intensity perception. A sample of 351 healthy volunteers was tested by the immersion of the right hand for 10 s followed by the same test for the left hand (RL group; n = 199) or in a random sequence (RND group; n = 152) into a water bath (48 degrees C, 15 s). Pain intensity was self-reported by the Visual Analogue Scale (VAS). The motor hemispherical Lateralization Index (LI) was obtained by the Edinburgh Inventory. Gender, hand skin fold, interstimulus time and menstrual cycle data in case of female subjects were recorded. The sample, 60.7% females and 39.3% males, 20.4 +/- 0.18 (mean +/- SEM) years old, showed 92.1% right-handed subjects. Left hand VAS was significantly higher than right hand VAS for RL (7.24 +/- 1.31 vs 6.74 +/- 1.52; p < 0.01) and RND (7.24 +/- 0.82 vs 6.73 +/- 1.25; p < 0.01) both for right- and left-handed subjects. A low but significant correlation for VAS scores and LI was found (r = 0.14; p < 0.05 or r = 0.18; p < 0.05, for left or right hand, respectively). Skin fold was statistically similar in both hands (p > 0.05) being highly correlated with each other (r = 0.68; p < 0.05). Pain subjective perception was not correlated to interstimulus time (r = -0.01; p > 0.05). Females showed significantly higher values than males for both left and right hand VAS scores. Periovulatory phase VAS value was significantly higher than luteal phase VAS only for the right hand test (7.57 +/- 0.20 vs 6.47 +/- 0.33; p < 0.01). The results of the present study suggest a lateralization of pain intensity perception to the right hemisphere not correlated with the motor hemispheric lateralization.     

Relationship of focal epileptogenesis to hemispheric motor prevalence in human ontogenesis

The authors describe the clinical and electroencephalographic findings in 220 children with focal and secondary generalized epilepsies without gross structural aetiology, with the aim of evaluating the significance of hemispheric motor prevalence for the formation, activity and possibility of compensation of the focus. Focal epileptogenesis was observed significantly more often: a) in partial seizures with elementary symptomatology in the motor non-dominant hemisphere, b) in the motor non-dominant hemisphere in boys, c) in the whole series, irrespective of the form of epilepsy and sex, in the motor nondominant hemisphere in children under the age of six and in the motor dominant hemisphere in children over the age of six. The findings in partial seizures with an elementary motor symptomatology probably arise from the very close relationship to motor areas of the cerebral cortex, in boys from evidently greater hemispheric functional asymmetry than in girls and the age correlation from unequal maturation of functionally identical parts of the brain hemispheres during ontogenesis.     

Association Process and Functional Brain Asymmetry

Analysis is presented of word associations produced by subjects with left hemispheric (group 1), right hemispheric (group 2), and bilateral (group 3) speech representation. The strategy for producing extralinguistic responses was found to prevail over the strategy for producing linguistic associations in all subjects, irrespective of their type of speech representation. This strategy was more pronounced in subjects with right hemispheric speech laterality, suggesting a correlation between the generation of extralinguistic associations and functional brain asymmetry. Producing linguistic associations also depended on the type of cerebral organization of speech. The most important linguistic associations are syntagmatic. Syntagmatic associations were more closely related to the lateralization of speech to the left hemisphere. The data are compared to the results of studies of the ontogeny of associative processes.     

Functional asymmetry of the brain and effectiveness of sensorimotor function of oral cavity organs]

It has been established that in healthy persons functional brain asymmetry positively influences the effective performance of sensomotor function of oral cavity organs. Individual brain asymmetry is of considerable importance, the higher it is, the quicker the final results of sensomotor function are achieved. The character of brain asymmetry (right hand or left hand) does not practically influence the performance of sensomotor functions.     

Electrophysiologic characteristics of functional interhemispheric asymmetry

Change of biopotentials spatial synchronization under functional loads addressed predominantly to one or the other hemisphere (correlative analysis of the first EEG derivative of more than two thousands healthy subjects of various age), allowed to single out three phenotypes of hemispheric relations differing mainly by different types of information processing: right-hemispheric, left-hemispheric or mixed. Expressed EEG activation in both hemispheres (judged by alpha-index change) is manifest when the subject is presented with a task, the context of which does not correspond to the initially dominating type: in right-hemispheric--at solution of tasks, oriented to logical-verbal context and in left-hemispheric--to spatial-image one. The high level of non-specific EEG activation may be considered as an attempt of compensation of relative functional insufficiency of the right hemisphere systems in initially left-hemispheric or left-hemisphere systems in right-hemispheric individuals.     

Unimanual Reaction Time during Comparison of Lateralized Verbal Stimuli: the Features of Interhemispheric Interactions Related to Subjects' Gender

Reaction time (RT) and number of correct responses to letter stimuli were measured in 49 male and 47 female subjects under conditions of crossed and uncrossed lateralization of a pair of stimuli and the hand that performed motor reaction. Gender differences were detected on the basis of RT in the hemispheric organization when a task was performed. Males reacted more rapidly to the stimuli presented in the right visual field, while females demonstrated no lateral effects. There was a significant difference in the case of the males' right hand between crossed and uncrossed lateralization of visual stimuli, which exceeded that in the females and in the case of the males' left hand. There were no gender differences in the number of correct responses. When motor response was performed by either hand, the number of correct responses was significantly higher when the stimuli were presented in the right visual field.     

Unilateral Left-Hand Contractions Produce Widespread Depression of Cortical Activity after Their Execution

The execution of unilateral hand contractions before performance has been reported to produce behavioral aftereffects in various tasks. These effects have been regularly attributed to an induced shift in activation asymmetry to the contralateral hemisphere produced by the contractions. An alternative explanation proposes a generalized state of reduced bilateral cortical activity following unilateral hand contractions. The current experiment contrasted the above explanation models and tested the state of cortical activity after the termination of unilateral hand contractions. Twenty right-handed participants performed hand contractions in two blocks, one for each hand. Using electroencephalogram (EEG), the broad alpha band and its asymmetry between hemispheres before, during, and after hand contractions were analyzed. During contractions, significant bilateral decrease in alpha amplitudes (indicating cortical activation) emerged for both hands around sensory-motor regions. After contractions, alpha amplitudes increased significantly over the whole scalp when compared to baseline, but only for the left hand. No modulation of hemispheric asymmetry was observed at any phase. The results suggest that unilateral hand contractions produce a state of reduced cortical activity after their termination, which is more pronounced if the left hand was used. Consequently, we propose that the reduced cortical activity (and not the persistent activation asymmetry) may facilitate engagement in subsequent behavior, probably due to preventing interference from other, nonessential cortical regions.