Glossopharyngeal evoked potentials in normal subjects following mechanical stimulation of the anterior faucial pillar

The anterior faucial pillar, which is innervated by the glossopharyngeal nerve, is thought to be important in eliciting the pharyngeal swallow in awake humans. Glossopharyngeal evoked potentials (GPEP), elicited by mechanically stimulating this structure, were recorded from 30 normal adults using standard averaging techniques and a recording montage of 16 scalp electrodes. Ten of the subjects experienced a desire to swallow in response to stimulation. Repeatable responses were recorded from all 30 subjects. The GPEPs recorded from the posterior scalp were W-shaped and consisted of P1, N1, P2, N2 and P3 peaks. Mean latencies of P1, N1 and P2 were 11, 16 and 22 msec, respectively, for both left and right pillar stimulation. In contrast, latencies of N2 and P3 varied significantly between left and right pillar stimulation. Mean latencies of N2 and P3 were 27 and 34 msec for left, and 29 and 35 msec for right pillar stimulation. Topographical maps acquired at peak latencies for P1, N1 and P2 revealed consistent asymmetrical voltage distributions between the two hemispheres; the largest responses were recorded from the hemisphere ipsilateral to the side of stimulation. The scalp topography of N2 and P3 varied between male and female subjects as well as between left and right pillar stimulation. These findings support the hypothesis that mechanical stimulation to the anterior faucial pillar alone can elicit repeatable responses from the central nervous system. The integration of this subcortical/cortical activity with that of the medullary swallowing center may play an important role in eliciting the pharyngeal swallow.     

Direct recording of somatosensory evoked potentials in the vicinity of the dorsal column nuclei in man: their generator mechanisms and contribution to the scalp far-field potentials

Somatosensory evoked potentials (SEPs) in the vicinity of the dorsal column nuclei in response to electrical stimulation of the median nerve (MN) and posterior tibial nerve (PTN) were studied by analyzing the wave forms, topographical distribution, effects of higher rates of stimulation and correlation with components of the scalp-recorded SEPs. Recordings were done on 4 patients with spasmodic torticollis during neurosurgical operations for microvascular decompression of the eleventh nerve. The dorsal column SEPs to MN stimulation (MN-SEPs) were characterized by a major negative wave (N1; 13 msec in mean latency), preceded by a small positivity (P1) and followed by a large positive wave (P2). Similar wave forms (P1′-N1′-P2′) were obtained with stimulation of PTN (PTN-SEPs), with a mean latency of N1′ being 28 msec. Maximal potentials of MN-SEPs and PTN-SEPs were located in the vicinity of the ipsilateral cuneate and gracile nuclei, respectively, at a level slightly caudal to the nuclei. The latencies of P1 and N1 increased progressively at more rostral cervical cord segments and medulla, but that of P2 did not. A higher rate of stimulation (16 Hz) caused no effects on P1 and N1, while it markedly attenuated the P2 component. These findings suggest that P1 and N1 of MN-SEPs, as well as P1′ and N1′ of PTN-SEPs, are generated by the dorsal column fibers, and P2 and P2′ are possibly of postsynaptic origin in the respective dorsal column nuclei.The peak latency of N1 recorded on the cuneate nucleus was identical with the scalp-recorded far-field potential of P13–14 in all patients, while no scalp components were found which corresponded to P2. These findings support the previous assumption that the scalp-recorded P13–14 is generated by the presynaptic activities of the dorsal column fibers at their terminals in the cuneate nucleus.     

Recovery functions of somatosensory vertex potentials in man: interaction of evoked responses from right and left fingers

Somatosensory vertex potentials (SVPs) were examined in 12 healthy subjects in response to painful electrical stimulation of the finger. SVPs consisted of N1, P1, and N2. The average latencies of the 3 peaks were 150, 225, and 350 msec, respectively. The latency and amplitude of each potential were reproducible for each subject. Recovery functions of the SVPs were analyzed in 10 subjects. A pair of stimuli were delivered to the right or left finger with interstimulus intervals (ISIs) of 50, 100, 150, 200, 350, 500 and 650 msec. SVPs partially recovered with the shortest ISI (50 msec). Full recovery could not be obtained even with the longest ISI (650 msec). Differences in recoveries within 650 msec of ISI were not observed between right and left stimulations. To examine the interaction between SVPs evoked by right and left finger stimulation, recovery functions from prior contralateral finger stimulation were analyzed with the same ISIs. SVP recoveries for right after left or left after right patterns of stimulus delivery were nearly the same as those for ipsilateral ones. It is suggested that SVPs are generated at nearly the same site in the sensory pathway regardless of the side stimulated.     

Brainstem auditory evoked potentials in the rabbit.

Eight white New Zealand rabbits were submitted to auditory stimulation in order to obtain normative BAEP parameters. A monaural alternating 0.1 ms click stimulation at 20 Hz, 90 dB was used. Two series of 1000 responses were averaged (10 ms time-base, 160-3000 Hz band-pass) and highly reproducible peaks were obtained. Peaks P1, P2, P3, P4 were obtained in all ipsilateral recordings, whereas peak P5 was detectable in only 6 animals. In contralateral recordings P1 was absent and the following peaks were similar to those of ipsilateral recordings. Normative values of absolute and interpeak latencies, peak amplitudes and amplitude ratios were obtained. The procedure was repeated 24 hours after basal recordings and measures of test-retest variability were obtained.     

P300 in young and elderly subjects: Auditory frequency and intensity effects

Auditory event-related potentials (ERPs) were assessed in young and elderly subjects when stimulus intensity (40 vs. 60 dB SL) and standard/target tone frequency (250/500 Hz and 1000/2000 Hz) were manipulated to study the effects of these variables on the P3(00) and N1, P2 and N2 components. Auditory thresholds for each stimulus type were obtained, and the stimulus intensity was adjusted to effect perceptually equal intensities across conditions for each subject. Younger subjects demonstrated larger P3 amplitudes and shorter latencies than elderly subjects. The low frequency stimuli produced larger P3 amplitude and shorter latencies than the high frequency stimuli. Low intensity stimuli yielded somewhat smaller P3 amplitudes and longer peak latencies than high intensity stimulus tones. Although additional stimulus intensity and frequency effects were obtained for the N1, P2 and N2 components, these generally differed relatively little with subject age. The findings suggest that auditory stimulus parameters contribute to P3 measures, which are different for young compared to elderly subjects.     

Development of lumbar spinal cord and cortical evoked potentials after tibial nerve stimulation in the pre-term newborns: effects of gestational age and other factors

Pre-term neonates are at increased risk for neurological dysfunction. Several investigators have found scalp recorded somatosensory evoked potential studies (SSEPs) after median nerve stimulation useful in the evaluation of newborn infants with asphyxiation and the effects of other adverse prenatal and perinatal factors. In order to evaluate the entire developing neuraxis, we undertook SSEPs after tibial nerve stimulation (PTN-SSEP) in pre-term neonates. Using bilateral simultaneous stimulation, potentials were recorded from the following sites: PF-spT6 (N5), spL1-spT6 (N16), spC7-Fpz (N27), Cz′ (1 cm behind the vertex)-Fpz (P55). In all newborns studied, the N5 and N16 were reliably recorded. The N5 appeared relatively independent of the length of the newborns. The N16 correlated inversely with length. The N27 and P55 were recorded in 52% and 65% of the newborns, respectively. N27 inversely correlated modestly with length. The P55 was independent of most factors and probably reflects variable rates of cerebral myelination, neuronogenesis, varying states of alertness, and possibly subclinical encephalopathies. These results demonstrate the feasibility of obtaining such data in pre-term newborns.     

Effect of stimulus mode on middle latency auditory evoked potentials in humans

Middle Latency Auditory Evoked Potentials (MLAEPs) were recorded in 35 healthy subjects; all underwent monaural stimulation and 18 of them additionally underwent binaural stimulation. The aim of the study was to determine the effect of stimulus mode on MLAEP Na, Pa and Nb components and to assess normative data for clinical purposes. MLAEPs were respectively obtained from Cz-ipsilateral ear lobe (monaural mode) and from Cz-A1 and Cz-A2 (binaural mode) by twice averaging 1000 responses to 65 dBHL alternating clicks delivered at a repetition rate of 8.1 Hz. Time base was 100 msec; analogical band-pass filter setting was 5-1000 Hz (off-line digital badpass: 20-100 Hz). The statistical analyses (paired t-test, repeated measures analysis of variance) were not able to demonstrate any differences that derived from differing sides of stimulation (monaural mode) or from differing recording derivations (binaural mode); on the contrary, we demonstrated a slight increase in waveform amplitudes when the binaural mode was employed. In particular, we observed an increase in Na-Pa peak-to-peak amplitude, whereas Pa-Nb amplitude was unmodified. This finding is explicable in terms of a binaural interaction effect. Finally, we propose some guidelines for the correct performance and evaluation of MLAEPs in clinical practice.     

Scalp-recorded oscillatory potentials evoked by transient pattern-reversal visual stimulation in man

Replicable oscillatory potentials, time-locked to pattern stimuli (9.0° central; counterphase reversal at 2.13 Hz) were dissociated from conventional, broad-band VEPs recorded in healthy volunteers at occipital scalp locations by high-pass digital filtering at 17.0–20.0 Hz. Nine consecutive wavelets were identified with a 56.4 ± 8.4 msec mean latency of the first replicable wavelet and mean peak-to-peak amplitude varying between 0.9 and 2.0 μV. The first 2 wavelets had significantly shorter latencies than wave N70 of unfiltered VEP, whereas the last 2 wavelets had longer latencies than N145. Latency and amplitude values varied as a function of contrast and spatial frequency of the stimulus, with shorter latencies and larger amplitudes at 60–90% contrast level and tuning of amplitude at 5.0 c/deg. All wavelets were correlated with wave P100 of unfiltered VEP, while a correlation with N70 of VEP was observed only for those wavelets with latencies in the range of wave P100. Two patients with documented brain lesions involving the visual system are described as examples of oscillatory responses occurring irrespective of filter bandpass and instead of the expected conventional VEP when the generation of these is interfered with by brain pathology. A substantial cortical contribution to the origin of the oscillatory response is conceivable. It is suggested that the oscillatory response to pattern-reversal stimulation reflects events in the visual system that are parallel to, and partly independent of, the conventional VEP, with potential application in research or for clinical purposes.     

Trigeminal chemosensitivity: Differences in relation to the time of the day

Day-night differences of trigeminal chemosensitivity were investigated in 18 healthy volunteers employing both pain-related cortical potentials and pain ratings in response to stimulation of the nasal mucosa with CO2. Day-night differences were found with N 1 P2 amplitudes, P2 latencies and pain ratings. It is concluded that the time of the day must not be ignored when human chemosensitivity is investigated at suprathreshold levels.      

Spinal and cortical potentials evoked by tibial nerve stimulation in humans: effects of sex, age and height.

Somatosensory evoked potentials by posterior tibial nerve stimulation at the ankle were performed in 74 healthy volunteers (36 females and 38 males) aged 14-76 years. Cortical potentials were obtained in all subjects and spinal potentials (N22) in 71 subjects. All parameters were related to subject's age, height and sex. Sex influenced only P40-N50 amplitude, which was greater in females. All latencies of spinal and cortical components increased in a similar manner with subject's height (about 0.16-0.18 ms per cm), whereas the N22-P40 interpeak latency was independent from height, but related to T12-Cz distance. Absolute latencies of the spinal and of most cortical components, but not interpeak latencies, increased with subject's age (about 0.06-0.09 ms per year). The parameters to compute normative data (according to univariate or bivariate regression models) are furnished. Limits of right-left differences are reported.     

Early scalp responses evoked by stimulation of the supraorbital nerve in man

In 25 healthy volunteers the supraorbital nerve was stimulated and evoked potentials were recorded. Leads were placed on the scalp and along the ipsilateral eyebrow-mastoid line and were either referred to a non-cephalic reference (on the neck, or Cv7) or linked to form bipolar derivations. As template wave form was chosen the one obtained from derivation Cz-Cv7, which had an initial triphasic component with negative (SW1a), positive (SW1b), negative (SW1c) polarity (mean latencies 0.63, 0.95 and 1.43 msec), followed by 2 negative waves (SW2 and SW3, mean latencies of 2.20 and 2.89 msec). A final positive wave could be observed in most cases (SP4, mean latency of 4.08 msec). The records collected from the various derivations showed that each component (SW1, SW2, SW3 and SP4) had a different behaviour, thus suggesting separate origins. SW1 would originate from a volley travelling from the point of stimulation towards the mastoid, probably across the ophthalmic branch of the trigeminal nerve. The subsequent components would be generated by deeply situated structures: double pulse stimulation suggests that SW1, SW2 and SW3 are generated before the first synapse, whereas SP4 is a postsynaptic event. A strong similarity exists between the components evoked by stimulation of the supraorbital and the infraorbital nerves. Local anaesthetic block of the frontal nerve on the stimulated side and monitoring of the EMG activity of m. orbicularis oculi and m. frontalis ruled out any muscle contamination of the responses described in this paper.     

Questions regarding the sequential neural generator theory of the somatosensory evoked potential raised by digital filtering

Digital bandpass filtering (300–2500 Hz) designed for zero phase shift was applied to somatosensory evoked potentials recorded with cephalic bipolar montages. Four consistent negative and corresponding positive peaks with latencies of about 16, 18, 19, and 20 msec were elicited with median nerve stimulation. Peroneal nerve stimulation also elicited 4 reproducible negative-positive peaks having latencies of about 24, 26, 28, and 30 msec. Interpeak latencies measured 1.3 ± 0.2 msec and 1.8 ± 0.25 msec for median and peroneal elicited SEPs respectively. Becaise cephalic bipolar recordings cancel most far-field potentials, multiple generators cannot account for all the additional components seen. It is hypothesized that some of the high frequency components recorded are due to activity in recurrent intrathalamic neuronal networks.     

Short latency trigeminal evoked potentials: normative data and clinical correlations

A very short latency trigeminal evoked potential (STEP) to electrical stimulation of the upper lip has been recorded from over the scalp. This potential consists of 5 distinct peaks within the 12 msec range.Normative data were obtained from 25 healthy volunteers. The impact of the stimulus rate and intensity on the response was studied in each subject.These results were compared to those of 19 patients suffering from lesions involving the trigeminal system in its peripheral aspect or the brain-stem. The STEP was consistently abnormal whenever the involved side was stimulated. Changes in peak latencies and in interpeak latency differences (IPLD) correlated well with clinical and radiological findings and improved with the removal of the offending lesion. The STEP proved to be a reliable method for evaluating the trigeminal system in its peripheral and central pathways; it may thus serve as an additional parameter for studying brain-stem functions.     

Somatosensory evoked potentials in neonates and infants: developmental and normative data

Fifty-two sets of cortical somatosensory evoked potentials (SEPs) were recorded from 23 normal children between the ages of 1 day and 13 weeks with median nerve stimulation. Two bandpass settings 5–1500 Hz and 30–3000 Hz were used; rate of stimulation was 1.1 Hz and sweep-time was 200 msec. The state of wakefulness was documented, but SEPs were obtained and evaluated independently of the child being awake or asleep during the recording. SEPs were present in every recording. The bandpass 30–3000 Hz best differentiated positive and negative early potentials. The bandpass 5–1500 Hz was helpful in some cases, as late slow waves were recorded with this setting. Normative data were established. Mean values were calculated for 3 age groups: 0–2 weeks, 2–6 weeks and 7–13 weeks. P15 and N20 were the first components seen in the newborn, with the P22 becoming the major component by 2–3 weeks of age. The study indicates that maturation of the somatosensory system is fastest during the first 3 weeks of life.     

Parameters of somatosensory evoked potentials in normal subjects in relation to age and height

Cortical SEPs by stimulation of median nerve at wrist (159 measurements; 144 subjects, 63 M - 81 F; mean age 39.7, range 11-70; mean height 162.5, range 134-190) and cortical SEPs by stimulation of posterior tibial nerve at ankle (100 measurements; 81 subjects, 37 M - 44 F; mean age 34.7, range 11-60; mean height 161.1, range 134-180 cm) have been performed. The latencies of N1 of median SEPs and of N1 and P1 of tibial SEPs significantly increase with the height of subjects. The statistical evaluation of latency values of each subject normalized at a height of 165 cm show a little increase of latency according to the age of the subjects; this increase is quite evident for the latency of P1 of tibial SEP.     

k tibial nerve stimulation: Normative values

Cortical somatosensory evoked potentials to posterior tibial nerve stimulation were obtained in 29 normal controls varying in age and body height. In obtaining these potentials we varied recording derivations and frequency settings. Our recordings demonstrated the following points:

• 1.(1) N20 (dorsal cord potential) and the early cortical components (P2, N2) were the only potentials that were consistently recorded. All other subcortical components (N18, N24, P27, N30) were of relatively low amplitude and not infrequently absent even in normals.
• 2.(2) All absolute latencies other than N2 were correlated with body height. However, interpeak latency differences were independent of body height.
• 3.(3) Below the age of 20, subcortical but not cortical peak latencies correlated with age, but this appeared to be due to changes in body height in this age group.
• 4.(4) Absolute amplitudes and amplitude ratios (left/right and uni/bilateral) showed marked interindividual variability and have very limited value in defining abnormality.
• 5.(5) The use of restricted filter windows facilitated the selective recording of postsynaptic potentials (30–250 Hz) and action potentials (150–1500 Hz).

     

Topography of middle-latency somatosensory evoked potentials following painful laser stimuli and non-painful electrical stimuli

The aim of this study was to compare cerebral evoked potentials following selective activation of Aβ and Aδ fibers. In 15 healthy subjects, Aβ fibers were activated by electrical stimulation of the left radial nerve at the wrist. Aδ fibers were activated by short painful radian heat pulses, applied to the dorsum of the left hand by a CO₂ laser. Evoked potentials were recorded with 15–27 scalp electrodes, evenly distributed over both hemispheres (bandpass 0.5–200 Hz). The laser-evoked potentials exhibited a component with a mean peak latency of 176 msec (N170). Its scalp topography showed a parieto-temporal maximum contralateral to the stimulus side. In contrast, the subsequent vertex negativity (N240), which appeared about 60 msec later, had a symmetrical scalp distribution. Electrically evoked potentials showed a component at 110 msec (N110), that had a topography similar to the laser-evoked N170. The topographies of the N170 and N110 suggest that they may both be generated in the secondary somatosensory cortex. There was no component in the electrically evoked potential that had a comparable interpeak latency to the following vertex potential: for N60 it was longer, for N110 it was shorter. On the other hand, in the laser-evoked potentials no component could be identified the topography of which corresponded to the primary cortical component N20 following electrical stimulation.     

Auditory event-related potentials to the apparent auditory image motion

Auditory event-related potentials (ERP) were registered to the dichotically presented white noise stimuli (duration 1500 ms, band 150-1200 Hz). Abrupt or gradual change ofinteraural time difference in the middle of stimuli (750 ms after sound offset) was perceived as an apparent auditory image (AI) instant relocation or motion from the midline to one of the ears. In responses these stimuli two ERPs were observed: one to the sound onset, and second--to the onset of motion or AI relocation. ERPs to AI relocation differed from those to sound onset in longer components latencies (123 ms versus 105 ms for N 1,227 ms versus 190 ms for P2). In responses to AI motion component latencies were even longer (N1: 137 ms, P2: 240 ms); N1 amplitude was greater at sites contralateral to the AI motion direction.     

Neurophysiological evaluation of central-peripheral sensory and motor pudendal fibres

Extensive neurophysiological investigations were carried out in 18 healthy volunteer subjects, and 6 patients with neurological disease. The tests consisted of spinal and scalp somatosensory evoked potentials (SEPs) to stimulation of the dorsal nerve of penis/clitoris, motor evoked potentials (MEPs) from the bulbocavernosus muscle (BC) and anal sphincter (AS) in response to scalp and sacral root stimulation, and measurement of sacral reflex latency (SRL) from BC and AS.In the control subjects, the mean sensory total conduction time (sensory TCT), as measured at the peak of the scalp P40 wave was 40.9 msec (range: 37.8–44.2). The mean sensory central conduction time (sensory CCT = spine-to-scalp conduction time) was 27.0 msec (range: 23.5–30.4).Transcranial brain stimulation was performed by using a magnetic stimulator both at rest and during voluntary contraction of the examined muscle. Sacral root stimulation was performed at rest. Motor total conduction times (motor TCT) to BC and AS muscles were respectively 28.8 and 30.0 msec at rest, and 22.5 and 22.8 msec during contraction. Motor central conduction times (motor CCT) to sacral cord segments controlling BC and AS muscles were respectively 22.4 and 21.2 msec at rest, and 15.1 and 12.4 msec during contraction.The mean latencies of SRL were respectively 31.4 msec in the bulbocavernosus muscle and 35.9 msec in the anal sphincter. Combined or isolated abnormalities of SEPs, MEPs and SRL were found in a small group of patients with neurological disorders primarily or secondarily affecting the genito-urinary tract.     

Scalp-recorded short and middle latency peroneal somatosensory evoked potentials in normals: comparison with peroneal and median nerve SEPs in patients with unilateral hemispheric lesions

Peroneal somatosensory evoked potentials (SEPs) were performed on 23 normal subjects and 9 selected patients with unilateral hemispheric lesions involving somatosensory pathways.Recording obtained from right and left peroneal nerve (PN) stimulations were compared in all subjects, using open and restricted frequency bandpass filters. Restricted filter (100–3000 Hz) and linked ear reference (A1–A2) enhanced the detection of short latency potentials (P1, P2, N1 with mean peak latency of 17.72, 21.07, 24.09) recorded from scalp electrodes over primary sensory cortex regions. Patients with lesions in the parietal cortex and adjacent subcortical areas demonstrated low amplitude and poorly formed short latency peroneal potentials, and absence of components beyond P3 peak with mean latency of 28.06 msec. In these patients, recordings to right and left median nerve (MN) stimulation showed absence or distorted components subsequent to N1 (N18) potential.These observations suggest that components subsequent to P3 potential in response to PN stimulation, and subsequent to N18 potential in response to MN stimulation, are generated in the parietal cortical regions.