Pain-related somatosensory evoked potentials following CO2 laser stimulation of foot in man

Since our previous study of pain somatosensory evoked potentials (SEPs) following CO₂ laser stimulation of the hand dorsum could not clarify whether the early cortical component NI was generated from the primary somatosensory cortex (SI) or the secondary somatosensory cortex (SII) or both, the scalp topography of SEPs following CO₂ laser stimulation of the foot dorsum was studied in 10 normal subjects and was compared with that of the hand pain SEPs and the conventional SEPs following electrical stimulation of the posterior tibial nerve recorded in 8 and 6 of the 10 subjects, respectively. Three components (N1, N2 and P2) were recorded for both foot and hand pain SEPs. N1 of the foot pain SEPs was maximal at the midline electrodes (Cz or CPz) in all data where that potential was recognized, but the potential field distribution was variable among subjects and even between two sides within the same subject. N1 of the hand pain SEPs was maximal at the contralateral central or midtemporal electrode. The scalp distribution of N2 and P2, however, was not different between the foot and hand pain SEPs. The mean peak latency of N1 following stimulation of foot and hand was found to be 191 msec and 150 msec, respectively, but there was no significant difference in the interpeak latency of Nl-N2 between foot and hand stimulation. It is therefore concluded that NI of the foot pain SEPs is generated mainly from the foot area of SI. The variable scalp distribution of the N7 component of the foot pain SEPs is likely due to an anatomical variability among subjects and even between sides.     

Pain-related and cognitive components of somatosensory evoked potentials following CO2 laser stimulation in man

We recorded cortical potentials evoked by painful CO₂ laser stimulation (pain SEP), employing an oddball paradigm in an effort to demonstrate event-related potentials (ERP) associated with pain. In 12 healthy subjects, frequent (standard) pain stimuli (probability 0.8) were delivered to one side of the dorsum of the left hand while rare (target) pain stimuli (probability 0.2) were delivered to the other side of the same hand. Subjects were instructed to perform either a mental count or button press in response to the target stimuli. Two early components (N2 and P2) of the pain SEP demonstrated a Cz maximal distribution, and showed no difference in latency, amplitude or scalp topography between the oddball conditions or between response tasks. In addition, another positive component (P3) following the P2 was recorded maximally at Pz only in response to the target stimuli with a peak latency of 593 msec for the count task and 560 msec for the button press task. Its scalp topography was the same as that for electric and auditory P3. The longer latency of pain P3 can be explained not only by its slower impulse conduction but also by the effects of task difficulty in the oddball paradigm employing the pain stimulus compared with electric and auditory stimulus paradigms. It is concluded that the P3 for the pain modality is mainly related to a cognitive process and corresponds to the P3 of electric and auditory evoked responses, whereas both N2 and P2 are mainly pain-related components.     

Influence of concurrent tactile stimulation on somatosensory evoked potentials following posterior tibial nerve stimulation in man

A topographical study was made of SEPs following stimulation of the right posterior tibial nerve at the ankle, with and without concurrent tactile stimulation of the soles of either foot or the palm of the right hand. Effects of the interfering stimulus were best demonstrated by subtracting the wave forms to derive ‘difference’ potentials.The majority of SEP components were significantly attenuated by tactile stimulation of the ipsilateral foot, and the difference wave form was of similar morphology to the control response. Components of opposite polarity peaking at 39 msec were consistent with the field of a cortical generator with dipolar properties, situated in the contralateral hemisphere just posterior to the vertex with the positive poles oriented towards the ipsilateral side. By analogy with median SEP findings, these potentials were believed to originate in the foot region of area 3b where neurones are mainly concerned with cutaneous sensory processing.When the tactile stimulus was applied to the contralateral foot, difference potentials maximally recorded just posterior to the vertex were of smaller amplitude but similar morphology to ipsilateral foot difference components. This suggested the possibility that input from the two lower extremities may converge at cortical or subcortical level, the effect being manifested in the response of certain neurones in area 3b. With both contralateral foot and ipsilateral hand stimulation, other difference potentials were present which suggested that there may be cortical regions responding to combinations of sensory stimuli applied to various parts of the body surface.     

Short-latency somatosensory evoked potentials following median nerve stimulation in Down's syndrome

Short-latency somatosensory evoked potentials (SEPs) following median nerve stimulation were recorded in 42 patients with Down's syndrome and in 42 age- and sex-matched normal subjects. There were no significant differences between the 2 groups in the absolute peak latencies of N9, N11 and N13 components. However, interpeak latencies, N9-N11, N11-N13 and N9-N13, were prolonged significantly in Down's syndrome. These findings suggest impaired impulse conduction in the proximal part of the brachial plexus, posterior roots and/or posterior column-medial lemniscal pathway. Interpeak latency N13-N20, representing conduction time from cervical cord to sensory cortex, was not significantly different between the 2 groups. Cortical potentials N20 and P25 in the parietal area and P20 and N25 in the frontal area were of significantly larger amplitude in Down's syndrome. P25 had double peaks in 16 of 42 normal subjects, but these were not apparent in any of the patients.     

Middle-latency somatosensory evoked potentials following median and posterior tibial nerve stimulation in Down's syndrome

Middle-latency somatosensory evoked potentials (SEPs) following median and posterior tibial nerve stimulation were studied in 40 patients with Down's syndrome and in age- and gender-matched healthy controls as well as in middle-aged and aged healthy subjects. In median nerve SEPs, latencies of the initial cortical potentials, N18 and P18, showed no significant difference, but the following potentials N22, P25, N32, P41 and P46 were relatively or significantly shorter in latency in Down's patients than in the controls. Amplitudes of all components in Down's patients were significantly larger than those of age- and gender-matched controls as well as of those of middle-aged healthy subjects, but there was only a small difference in their amplitudes from aged healthy subjects. Results of posterior tibial nerve SEPs were generally consistent with those of median nerve SEPs. Therefore, ‘short latency with large amplitude’ is the main characteristic of middle-latency SEPs in Down's syndrome, possibly related to accelerated physiological aging of the central nervous system.     

Somatosensory evoked potentials after removal of somatosensory cortex in man

Somatosensory evoked potentials (SEPs) to median nerve, ulnar nerve, thumb, middle finger, and posterior tibial nerve stimulation were recorded in a patient with a discrete resection of part of the postcentral somatosensory cortex as a treatment for focal epilepsy. Comparison of the different stimulation sites confirmed electrophysiologically the restricted locus of the lesion. The results strongly suggest that the early negative component (N20) and subsequent components recorded postcentrally are of cortical origin and depend upon postcentral gyrus cytoarchitectonic areas 3, 2, and 1. Moreover, these postcentral SEPs are distinct from precentrally recorded activity.     

Serial changes in somatosensory evoked potentials following cerebral infarction

The relationship between somatosensory evoked potentials (SEPs) and recovery from stroke was investigated in 12 patients. All had suffered recent cerebral infarction. SEPs were performed within the first week, 6 weeks, 3 months and 6 months after stroke onset. Improvement of initially abnormal SEPs was maximal in the first 6 weeks and this correlated closely with the period of maximum clinical improvement. The results of this study suggest that the major effect of stroke on on SEPs occurs acutely and is little affected by secondary degenerative processes.     

Correlation of subjective assessments with somatosensory evoked potentials to electrical stimulation of the finger in man

The relationship between 5 positive components of somatosensory evoked potentials (EPs) and subjective response to electrical stimuli, which were recorded in the same human subjects, was assessed in the present study. Five levels of tactile stimuli and 6 levels of noxious stimuli were applied to the tip of the right index finger. The relationship between the magnitude of subjective response and stimulus intensity was well expressed by a power function. Of 5 major positive components in an EP, P30 and P50 were localized at contralateral primary somatic projection area, while P90, P190 and P270 were at the vertex area. The amplitude of the 5 components systematically increased as increasing stimulus intensity, and also increased with the magnitude of subjective response. A significant correlation between the amplitude of P30 or P50 and stimulus intensity was found when the effect of subjective response was partially out. By contrast, the amplitudes of P190 and P270 were associated with subjective response when the effect of stimulus intensity was partially out. These results suggest that the earlier EP components reflect sensory signal processing, while the latter ones concern the subjective evaluating system.     

Effects of halothane on intraoperative scalp-recorded somatosensory evoked potentials to posterior tibial nerve stimulation in man

Somatosensory evoked potentials (SEPs) were monitored in 116 patients receiving halothane anesthesia during spinal fusion surgery. Whereas it has been generally assumed that the use of halogenated inhalational anesthetics should be avoided with SEP monitoring because of their purported deleterious effects on scalp-recorded sensory responses, we found that reproducible SEPs were obtained throughout the surgical procedure in 91% of the cases we monitored while using halothane at concentrations of 0.25–2.0%. In those cases in which halothane was delivered continuously at 0.5%, reproducible evoked responses were recorded in 96% (75 of 78) of the patients. Our data demonstrated 3 major effects of halothane on the SEP: (a) a small but significant decrease in the average amplitude of the first two components (N₂₅ and P₃₀), (b) a significant increase in the average latency of the late positive component (P₅₃) of the wave form, and (c) occasional obliteration of components N₂₅, N₄₀, P₅₃, and N₇₁,but never of P₃₀. These effects did not, in most cases, interfere with our ability to obtain clinically useful recordings. Our results suggest that in many instances the use of halothane anesthesia can be combined successfully with the recording of intraoperative SEPs.     

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.     

Scalp topography of mechanically and electrically evoked somatosensory potentials in man

Scalp topography of somatosensory evoked potentials following mechanical (SEPs(M)) and electrical (SEPs(E)) stimulation of the left middle finger was investigated with linked ear reference in 21 normal young adults. A small plastic ball (touch) or needle (pain) was used for the mechanical stimulation. With mechanical stimulation, at least 3 positive and 3 negative potentials (P19(M), N24(M), P29(M), N36(M), P49(M) and N61(M)) were found in the post-rolandic area contralateral to the stimulation. The wave form in SEPs(M) was similar to those in SEPs(E), but the peak latency of each component in SEPs(M) was 1–4 msec longer than that in SEPs(E). Earlier components such as P19(M), N24(M) and P29(M) were not as clearly recognized as corresponding components in SEPs(E). However, the wave form recorded on the hemisphere ipsilateral to the stimulation or in the frontal area contralateral to the stimulation showed a greater difference from subject to subject. P19(M), N24(M) and P29(M) correlated positively both with arm length and height of the subject. There was no significant difference of the wave form between the linked ear reference and the bipolar (C4-Fz) derivation. Wave form of SEPs(M) by needle stimulation did not significantly differ from that by plastic ball stimulation.     

Scalp topography and dipolar source modelling of potentials evoked by CO2 laser stimulation of the hand

CO₂ laser evoked potentials to hand stimulation recorded using a scalp 19-channel montage in 11 normal subjects consistently showed early N1/P1 dipolar field distribution peaking at a mean latency of 159 ms. The N1 negativity was distributed in the temporoparietal region contralateral to stimulation and the P1 positivity in the frontal region. The N1/P1 response was followed by 3 distinct components: (1) N2a reaching its maximal amplitude at the vertex and ipsilaterally to the stimulated hand, (2) N2b mostly distributed in the frontal region, and (3) P2 with a mid-central topography. Brain electrical source analysis showed that this sequence was explained, with a residual variance below 5%, by a model including two dipoles in the upper bank of the Sylvian fissure of each hemisphere, a frontal dipole close to the midline, and two anterior medial temporal dipoles, thus suggesting a sequential activation of the two second somatosensory areas, anterior cingulate gyrus and the amygdalar nuclei or the hippocampal formations, respectively. This model fitted well with the scalp field topography of grand average responses to stimulation of left and right hand obtained across all subjects as well as when applied to individual data. Our findings suggest that the second somatosensory area contralateral to the stimulation is the first involved in the building of pain-related responses, followed by ipsilateral second somatosensory area and limbic areas receiving noxious inputs from the periphery.     

Enhancement of the amplitude of somatosensory evoked potentials following magnetic pulse stimulation of the human brain

In this study we have demonstrated an enhancement of cortically generated wave forms of the somatosensory evoked potential (SEP) following magnetic pulse stimulation of the human brain. Subcortically generated activity was unaltered. The enhancement of SEP amplitude was greatest when the median nerve was stimulated 30–70 msec following magnetic pulse stimulation over the contralateral parietal scalp. We posit that the enhancement of the SEP is the result of synchronization of pyramidal cells in the sensorimotor cortex resulting from the magnetic pulse.     

Interactions of somatosensory evoked potentials: simultaneous stimulation of two nerves

To analyse the mechanism by which sensory inputs are integrated, interactions of somatosensory evoked potentials (SEPs) in response to simultaneous stimulation of two nerves were examined in 12 healthy subjects. Right, left and bilateral median nerves were stimulated in random order so that a precise comparison could be made among the SEPs. The arithmetical sum of the independent right and left median nerve SEPs was almost equal within 40 msec of stimulus onset to that evoked by the simultaneous stimulation of bilateral median nerves. However, a difference emerged after 40 msec. The greatest difference was recorded after 100 msec. Sensory information from right and left median nerves may interact in the late phase of sensory processing. Left median, left ulnar, and both nerves together were stimulated. The sum of the SEPs of left median and ulnar nerves was not equal to that evoked by the simultaneous stimulation of the two nerves even at early latencies. Differences between them were first recorded at 14–18 msec and became greater after 30–40 msec. It is suggested that the neural interactions between impulses in the median and ulnar nerves begin below the thalamic level.     

Three-dimensional human somatosensory evoked potentials

Median nerve somatosensory evoked potentials were recorded from 30 normal adults using conventional scalp derivations and an orthogonal bipolar surface electrode montage. This allowed the determination of the spatial orientation of the hypothetical centrally located equivalent dipole derived from the evoked response recorded in 3-dimensional voltage space. The 3-dimensional voltage trajectory describing changes in equivalent dipole orientation and magnitude revealed 4 major apices between 5 and 25 msec, 3 of which corresponded to the traditional P14, N20 and P25 peaks. A fourth apex at 17 msec was not as evident in the conventional recordings and signaled a transition from a vertical P14–N18 generator process to a horizontal N20 generator process. The normal within- and between-subject variability of trajectory apices, segments and planes are described, along with the theoretical and practical implications of this recording technique.     

Topographic analyses of somatosensory evoked potentials following stimulation of tibial,sural and lateral femoral cutaneous nerves

Using topographic maps, we studied the scalp field distribution of somatosensory evoked potentials (SEPs) in response to the stimulation of the tibial (TN), sural (SN) and lateral femoral cutaneous (LFCN) nerves in 24 normal volunteers. Cortical peaks, i.e., N35, P40, N50 and P60 were generally dominant in the contralateral hemisphere for the LFCN-SEP, whereas all peaks except N35 had dominance in the ipsilateral hemisphere for TN- and SN-SEPs. The findings imply that ipsilateral or contralateral peak dominance for the lower extremity SEP is determined by where the cortical leg representation occurs. As a result, mesial hemisphere representation results in peak dominance projected to the hemisphere ipsilateral to stimulation. Representations at the superior lip of the interhemispheric fissure or lateral convexity lead to midline or contralateral peak dominance. These findings also suggest that the paradoxically lateralized P40 is not the result of a positive field dipole shadow generated by the primary negative wave in the mesial hemisphere, but is the primary positive wave, analogous to P26 of the median nerve SEP. Accordingly, contralaterally dominant N35 is likely equivalent to the first cortical potential of N20 in the median nerve SEP. The difference in vector directions of potential fields between N35 and P40 may account for the opposite hemispheric dominance for these peaks in TN- and SN-SEPs.     

Changes in late components of somatosensory evoked potentials in humans during repetitive stimulation

Human evoked potentials to somatosensory stimuli of non-painful and painful intensity recorded from the vertex have been studied. The indices of variability of N150 and P250 components registered in the same subject as well as indices of interrelationship between spontaneous changes of these components decreased when stimulus intensity increased. A supposition is advanced that the role of general source responsible for generations N150 and P250 components diminished when stimulus intensity increased, accordingly participation of autonomic sources became more prominent.