Long sensory tracts (cuneate fascicle) in cervical somatosensory evoked potential after median nerve stimulation

Low amplitude high frequency waves (LHW) were investigated in normal and patient cervical somatosensory evoked potentials after median nerve stimulation (CSEP) in parallel to normal and patient conducted somatosensory evoked potentials (SEP) after tibial nerve stimulation. Normal recordings were obtained in five subjects undergoing dorsal root entry zone (DREZ) coagulation for pain relief. Patient recordings were obtained in 11 subjects suffering from either syringomyelia, spinal cord tumour, or both. All recordings were made intraoperatively from the dorsal spinal cord surface using the subpial recording technique. Normal CSEP showed typical triphasic potential starting with an initial P9, followed by N13 and a final positivity, P1. Numerous LHW were superimposed on slow triphasic potential. To improve the visibility of LHW, slow triphasic potential was removed from the original CSEP. Potentials thus obtained contained only high frequency components of CSEP, i.e. LHW. They were compared with conducted SEP after tibial nerve stimulation. Comparison revealed similarities in high frequency, low amplitude and general wave form, LHW thus showing characteristics of conducted potential. Duration was found to be significantly shorter than normal duration in both patient LHW (Student's t-test, P<0.0005) and patient conducted SEP (Student's t-test, P=0.064). A shorter duration was associated with worsening of configuration in patient LHW and patient conducted SEP. These changes of LHW could not be connected with distortion of N13 seen in patient CSEP. A shorter duration and worsening of configuration in patient LHW were most prominent in cases with a loss of vibration and posture senses, but were also observed in cases where only pain and temperature senses were affected. We therefore concluded that cuneate fascicle is the most likely generator of LHW, although the participation of other cervical long sensory tracts, e.g. spinothalamic tract, cannot be ruled out.     

Frontal distribution of early cortical somatosensory evoked potentials to median nerve stimulation

The topography of early frontal SEPs (P20 and N26) to left median nerve stimulation was studied in 30 normal subjects and 3 patients with the left frontal bone defect. The amplitudes of P20 and N26 were maximum at the frontal electrode (F4) contralateral to the stimulation and markedly decreased at frontal electrodes ipsilateral to the site of stimulation. There was, however, no latency difference of P20 and N26 between ipsilateral and contralateral frontal electrodes. These results suggest that the origin of the ipsilateral and contralateral P20 and N26 is the same. The wide distribution of P20 and N26 over both frontal areas could be explained by assuming a smearing effect from generators actually located in the rolandic fissure and motor cortex.     

Scalp topography and distribution of cortical somatosensory evoked potentials to median nerve stimulation

Topographies and distributions of cortical SEPs to median nerve stimulation were studied in 8 normal adults and 5 neurological patients. SEPs recorded from C4, P4, Pz, T6-A1A2 derivations to left median nerve stimulation were composed of 2 early negative (N16, N20) and 2 positive components (P12, P23), whereas those recorded from frontal electrodes (Fz, Fp1, Fp2) disclosed 2 early negativities (N16, N24) and 2 early positivities (P12, P20). N20 and P20, and P23 and N24, reversed across the rolandic fissure with no significant difference in their peak latencies. P23 was of slightly shorter latency at C4 than at more posterior electrodes (P4, T6, Pz).In 3 patients with complete hemiplegia but normal sensation, all the early SEP components were normal in scalp distribution and peak latencies except for a decrease of N24 amplitude. In 2 patients with complete hemiplegia and sensory loss no early cortical SEPs were seen. These findings suggest that N20 and P20 are generated as a single horizontal dipole in the central fissure, whereas P23 and N24 are a reflection of multiple generators in pre- and postrolandic regions.     

Topography of somatosensory evoked potentials to median nerve stimulation in patients with cerebral lesions

Scalp distributions and topographies of early cortical somatosensory evoked potentials (SEPs) to median nerve stimulation were studied in 22 patients with 5 different types of cerebral lesion due to cerebrovascular disease or tumor (thalamic, postcentral subcortical, precentral subcortical, diffuse subcortical and parieto-occipital lesions) in order to investigate the origins of frontal (P20, N24) and central-parietal SEPs (N20, P22, P23).In 2 patients with thalamic syndrome, N16 was delayed in latency and N20/P20 were not recorded. No early SEP except for N16 was recorded in 2 patients with pure hemisensory loss due to postcentral subcortical lesion. In all 11 patients with pure hemiparesis or hemiplegia due to precentral subcortical lesion N20/P20 and P22, P23/N24 components were of normal peak latencies. The amplitude of N24 was significantly decreased in all 3 patients with complete hemiplegia. These findings support the hypothesis that N20/P20 are generated as a horizontal dipole in the central sulcus (3b), whereas P23/N24 are a reflection of multiple generators in pre- and post-rolandic fissures. P22 was very localized in the central area contralateral to the stimulation.Topographical studies of early cortical SEPs are useful for detecting each component in abnormal SEPs     

Findings of somatosensory evoked potential to stimulation of the sciatic nerve in two different rat strains.

No comparative study about somatosensory evoked potentials (SEP) on different rat strains has been done yet. It is evident that comparative SEP studies are important since different rat strains have different physiological properties. We aimed to compare early latency SEP values from stimulation of sciatic nerve in Wistar (Wr) and Sprague-Dawley (SDr) rats which are frequently used rat strains in experimental studies. In Wr group, the mean of first far field potential (Ff1) latency was shorter and the mean Ff1 amplitude was lower than that of Sprague-Dawley rat group. Mean cortical potential latency in Wr group was longer than that of SDr group while amplitude was not different. Central conduction time (CCT) in Wistar rat group was found to be longer than that of SDr group. Shorter Ff1 latency in Wr group implies that afferent volley reaches cervical posterior fasciculus from sciatic nerve earlier than SDr group while longer CP latency implies that afferent volley reaches cortex later than SDr group. Similarity between the latencies of lumbar potentials implies that peripheral conduction velocity has no effect on the difference of Ff1 latencies.     

Short latency somatosensory evoked potentials following mechanical taps to the face. Scalp recordings with a non-cephalic reference

Trigeminal somatosensory evoked potentials were recorded over the scalp using non-cephalic reference sites following mechanical taps to the face. A negative wave form, Nf17, was recorded bilaterally with its highest amplitude over the frontal scalp contralateral to the side of stimulation. A localized negative form, Np25, was recorded over the centro-parietal scalp contralateral to the side of stimulation. Np25 had an onset latency of 16.46 msec. The location and restricted spatial distribution of Np25 suggest that it represents the initial activation of the face area of the primary sensory cortex. The widespread bilateral nature of Nf17 and its latency of onset preceding that of Np25 suggest that Nf17 may be a ‘far-field’ potential reflecting activity in subcortical sensory pathways subserving the face.     

Short latency vestibular evoked potentials (VsEPs) to linear acceleration impulses in rats

In this study, short latency (t<12.7 ms) vestibular evoked potentials (VsEPs) in response to linear acceleration impulses were recorded in 37 rats. A new technique (based on a solenoid) was used for generating linear force impulses that were delivered to the animal's head. The impulse had a maximal peak acceleration of 12 g. During the impulse, the displacement was 50 μm (at 4 g) and the rise time was 1.0 ms. A stimulation rate of 2/s was usually used. The VsEPs (averaged responses to 128 stimulations, digital filter: 300–1500 Hz) were recorded with electrodes on pinna and vertex, and were composed of 4–6 clear waves with mean amplitudes (for a 4 g stimulus) of 1–5 μV. The VsEPs were resistant to white noise masking, and were significantly suppressed (P<0.05) following bilateral application of a saturated KCl solution to the inner ear, showing that contributions of the auditory and somatosensory systems are negligible. The latency of the response decreased as a power law function of stimulus magnitude, and the amplitude of the first wave increased as a sigmoid function of stimulus magnitude. VsEP responses were still present at the lowest intensities attainable (0.06–0.4 g) and reached saturation at 9 g. The amplitude of the later components was reduced when stimulus rate was elevated to 20/s. These results suggest that VsEPs in response to linear accelerations are similar in their nature to VsEPs in response to angular acceleration impulses that were previously recorded. These VsEPs to linear accelerations are most likely initiated in the otolith organs.     

Comparison of scalp distribution of short latency somatosensory evoked potentials (SSEPs) to stimulation of different nerves in the lower extremity

SSEPs to stimulation of the CPN at the knee and PTN, PN and SN at the ankle were recorded from 15 cephalic sites and compared in 8 normal subjects. The configuration, amplitude, peak latency and distribution of P27, N35 (CPN) and P37, N45 (PTN, PN and SN) were analyzed. The configuration and distribution of SSEPs to stimulation of the 3 nerves at the ankle were similar across subjects. Both P37 and N45 were greatest in amplitude at the vertex and at recording sites ipsilateral to the side of stimulation. At contralateral sites either negative (N37) or negative, positive, negative potentials were recorded. The peak latency of N37 was the same or slightly less than that of P37. CPN-SSEPs were lower in amplitude and their configuration and scalp distribution showed much greater intersubject variability. This suggests that complex mechanisms which variably interact with one another are reflected in scalp SSEPs to CPN stimulation at the knee. The larger amplitude plus the minimal intersubject variability in morphology and topography of PTN-SSEPs indicate that this nerve is the most suitable for routine clinical use.     

Somatosensory evoked potentials recorded from the posterior pharynx to stimulation of the median nerve and cauda equina

Somatosensory evoked potentials (ppSEPs) in response to stimulation of the median nerve at the wrist and the cauda equina at the epidural space (the L4 level) were recorded from the posterior wall of the pharynx in 15 patients who underwent spinal surgery under general anesthesia, using disc electrodes attached to the endotracheal tube, and compared with segmental spinal cord potentials (seg-SCPs) that were recorded simultaneously from the posterior epidural space (PES). ppSEPs consisted of the initially positive spike (P9) followed by slow positive (P13) and negative (N22) waves. The P13 and N22 of ppSEPs had phase reversal relationship with the P2 and N2 recorded from the PES, respectively. The peak latencies of P9 (9.40 ± 0.7 ms) (mean ± SD), P13 (13.1 ± 0.9 ms), and N22 (22.0 ± 2.1 ms) of ppSEPs coincided with those of P1, N1 and P2 of seg-SCPs, respectively. ppSEPs were recorded more clearly with a reference electrode on the dorsal surface of the neck than with the reference electrode at the earlobe or back of the hand. The threshold and maximal stimulus intensities were also similar between the ppSEPs and seg-SCPs. Thus, the P9, P13, and N22 components of ppSEPs were thought to have the same origin as the P1, N1 and P2 of seg-SCPs, respectively. Therefore, the P9, P13 and N22 of ppSEPs may reflect incoming volleys through the root, synchronized activities of the interneurons and primary afferent depolarizations (PAD), respectively. ppSEPs in response to cauda equina stimulation showed that the latencies of the two initial components (4.6 ± 0.4 and 6.4 ± 0.6 ms) corresponded to those of the SCPs recorded from the PES (4.6 ± 0.3 and 6.3 ± 0.5 ms), suggesting that these potentials reflect impulses conducting through the spinal cord, similar to epidurally recorded SCPs.     

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.     

Subject-based P1 latency inter-root comparison,a method to evaluate P1 latency in scalp recorded somatosensory evoked potentials obtained with sensory nerve stimulation in the lower extremities

The purpose of the present study was to establish a method that allows the general use of subject-based criteria to evaluate P1 latency in scalp recorded somatosensory evoked potentials obtained with stimulation of the sural (S1), superficial peroneal (L5) and saphenous (L4) nerves bilaterally. The nerves were stimulated at the same distance from the registration electrode.Two groups of normal nerve roots were studied: (1) nerve roots on both sides in 20 asymptomatic volunteers, and (2) neuroradiologically normal nerve roots on the asymptomatic side in 22 patients with unilateral sciatica.The results presented show that the P1 latencies after stimulation of the 6 different nerves in the same person can be regarded as equal. On this basis 2 criteria to evaluate P1 latency by within-subject P1 latency inter-root comparison were defined. They were the difference between P1 latency of 1 registration and (1) that of any one of the other 5 registrations and (2) the mean P1 latency of the other registrations.The variability of these subject-based criteria and the width of their reference limits were compared to those of the population-based criteria of height- and height-age-corrected P1 latency. This comparison showed that the use of within-subject P1 latency inter-root comparison should enhance the ability to demonstrate small bilateral P1 latency prolongations at the same segmental level.     

Somatosensory evoked potentials from the thalamic sensory relay nucleus (VPL) in humans: correlations with short latency somatosensory evoked potentials recorded at the scalp

Somatosensory evoked potentials (SEPs) were recorded in humans from an electrode array which was implanted so that at least two electrodes were placed within the nucleus ventralis posterolateralis (VPL) of the thalamus and/or the medial lemniscus (ML) of the midbrain for therapeutic purposes. Several brief positive deflections (e.g., P11, P13, P14, P15, P16) followed by a slow negative component were recorded from the VPL. The sources of these components were differentiated on the basis of their latency, spatial gradient, and correlation with the sensory experience induced by the stimulation of each recording site. The results indicated that SEPs recorded from the VPL included activity volume-conducted from below the ML (P11), activity in ML fibers running through and terminating within the VPL (P13 and P14), activity in thalamocortical radiations originating in and running througn the VPL (P15, P16 and following positive components) and postsynaptic local activity (the negative component). The sources of the scalp-recorded SEPs were also analyzed on the basis of the timing and spatial gradients of these components. The results suggested that the scalp P11 was a potential volume-conducted from below the ML, the scalp P13 and P14 were potentials reflecting the activity of ML fibers, the small notches on the ascending slope on N16 may potentially reflect the activity of thalamocortical radiations, and N16 may reflect the sum of local postsynaptic activity occurring in broad areas of the brain-stem and thalamus.     

Auditory brain-stem (ABP) and somatosensory evoked potentials (SEP) in an animal model of a synaptic lesion: elevated plasma barbiturate levels

Experiments were conducted to determine whether a consistent pattern of auditory nerve brain-stem evoked potential (ABP) abnormalities could be demonstrated in the presence of a synaptic lesion model in cats (elevated levels of the barbiturate thiopental). The ABP in response to low (10/sec) and high (80/sec) stimulus rates was recorded. In order to differentiate between the effects of the elevated drug levels on axonal propagation and on synaptic transmission, the early components of the somatosensory evoked potential (SEP) were also recorded, with particular attention to the first SEP wave, which is solely an axonal event without any intervening synapse. Calculations showed that the effect on synapses was 3.0–9.5 times greater than the effect of the drug on axonal propagation. As the level of barbiturates increased (representing a more severe synaptic lesion), the interpeak latencies of the ABP and the SEP became progressively prolonged, more so than the dependence of the first waves of both the ABP and the SEP on drug level. In general, amplitudes were not affected. At progressively elevated drug levels, higher stimulus repetition rates did not have an increasingly greater effect than lower rates on evoked response latencies and amplitudes so that this study also shows that the use of elevated stimulus rates does not hold much promise in the diagnosis of synaptic lesions.     

Detailed analysis of the latencies of median nerve somatosensory evoked potential components, 1: selection of the best standard parameters and the establishment of normal values

In order to objectively select the standard parameters best suited for the evaluation of somatosensory conduction in median nerve somatosensory evoked potentials (SEP), we performed a detailed statistical analysis of intersubject variability for the latencies of SEP components based on the recordings of 62 normal subjects. Multiple regression analyses for height, age, (age - 20)² and sex were performed for the latencies of 13 components and 78 intercomponent intervals, and the residual variance was used as an indicator of the stability of each parameter. As a result, N9 onset in EPi-NC lead, N11′ onset in C6S-Fz lead, P13/14 onset in scalp-NC leads, for which N13′ onset recorded in C6S-Fz lead may substitute, and N20 onset in CPc-Fz lead were the most stable time-points selected as standards. N11 onset in C6S-NC, which other authors have recommended as the standard point representing spinal entry, was not recorded consistently, and P11 onset in scalp-NC leads was also unstable. N20 and peak and N13′-N20 interval (equivalent to conventional central conduction time) were extremely unstable. We presented the nomograms to find normal limits of the standard parameters corresponding to the given values of the predictor variables (height, age or sex). As the standard recording montage in routine clinical examinations, we recommended a simple method using Fz reference, for example (1) EPi-Fz, (2) C6S-Fz, (3) CPc-Fz, because this montage is sufficient to measure the stable standard parameters.     

Detailed analysis of the latencies of median nerve somatosensory evoked potential components, 2: analysis of subcomponents of the P13/14 and N20 potentials

Detailed analysis of P13/14 and N20 wavelets was performed for 62 normal subjects and patients with various lesions along the somatosensory pathway. A histogram of the latencies of all the identified P13/14 wavelets (measured from P13/14 onset) demonstrated three latency-groups, which were named P13, P14a and P14b subcomponents. The relationship between the three newly identified subcomponents and the conventional naming of P13 and P14 was inconstant, indicating the ambiguity of the latter. P14b was most prominent in the contralateral central region, and therefore a P15 positivity slightly after P14b was often recorded in the CPc-Fz and CPc-CPi leads (CPc and CPi are centroparietal electrodes contralateral and ipsilateral to the stimulation). P14b/P15 was lost even in patients with cortical lesions, and thalamocortical fibers were assumed for its origin. The CPc-Fz and CPi-Fz leads registered a low negativity named broad N13', suggesting frontal predominance of the overall P13/14 complex. Both P13 and P14a were identified in a patient with a pontine lesion, and a caudal brainstem origin for both was suspected due to the onset of two repetitive bursts of the ascending lemniscal volley. We refuted the presynaptic origin of the scalp P13 potential and pointed out that a prolonged and/or polyphasic P11 frequently observed in patients with high cervical lesions can be mistaken as scalp P13. A histogram of the latencies of all the identified negative wavelets of N20 in the CPc-Fz lead (measured from N20 onset) revealed five definite latency-groups, which were named N20a, N20b, N20c, N20d and N20e subcomponents. The highest peak of N20 actually corresponded to either N20b, N20c or N20d, and this uncertainty, which must be related to intracortical processes, resulted in a large instability of the N20 peak latency as well as the age and sex dependence of the N20 onset-peak interval, both of which were demonstrated by our preceding study (Sonoo, M., Kobayashi, M., Genba-Shimizu, K., Mannen, T. and Shimizu, T. Detailed analysis of the latencies of median nerve SEP components, 1: selection of the best standard parameters and the establishment of the normal values. Electroenceph. clin. Neurophysiol., 1996b, 100: 319–331). Negative subcomponents in the CPc-NC lead and positive subcomponents in the Fz-NC lead constituted mirror images of each other, which suggested that these subcomponents were generated within area 3b.     

Activation of a distributed somatosensory cortical network in the human brain. A dipole modelling study of magnetic fields evoked by median nerve stimulation. Part I: location and activation timing of SEF sources

Cortical areas responsive to somatosensory inputs were assessed by recording somatosensory evoked magnetic fields (SEF) to electrical stimulation of the left median nerve at wrist, using a 122-SQUID neuromagnetometer in various conditions of stimulus rate, attentional demand and detection task. Source modelling combined with magnetic resonance imaging (MRI) allowed localisation of six SEF sources on the outer aspect of the hemispheres located respectively: (1) in the posterior bank of the rolandic fissure (area SI), the upper bank of the sylvian fissure (parietal opercular area SII) and the banks of the intraparietal fissure contralateral to stimulation, (2) in the SII area ipsilateral to stimulation and (3) in the mid-frontal or inferior frontal gyri on both sides. All source areas were found to be simultaneously active at 70–140 ms after the stimulus, the SI source was the only one active already at 20–60 ms. The observed activation timing suggests that somatosensory input from SI is processed to higher-order areas through serial feedforward projections. However the long-lasting activations of all sources and their overlap in time is also compatible with a top-down control mediated via backward projections.     

Activation of a distributed somatosensory cortical network in the human brain: a dipole modelling study of magnetic fields evoked by median nerve stimulation. Part II: effects of stimulus rate,attention and stimulus detection

In this study we used a repeated measures design and univariate analysis of variance to study the respective effects of ISI, spatial attention and stimulus detection on the strengths of the sources previously identified by modelling SEFs during the 200 ms following mentally counted left median nerve stimuli delivered at long and random ISIs (Part I). We compared the SEF source strengths in response to frequent and rare stimuli, both in detection and ignoring conditions. This permitted us to establish a hierarchy in the effects of ISI, attention and stimulus detection on the activation of the cortical network of SEF sources distributed in SI and posterior parietal cortex contralateral to stimulation, and in the parietal operculum (SII) and premotor frontal cortex of both hemispheres. In all experimental conditions the SI and parietal opercular sources were the most active. All sources were more active in response to stimuli delivered at long and random ISIs and the frontal sources were activated only in this condition of stimulation. Driving the subject's attention toward the side stimulated had no detectable effect on the activity of SEF sources at short ISI. At long ISIs mental counting of the stimuli increased the responses of all sources except SI. These results suggest that activation of frontal sources during mental counting could reflect a working memory process, and that of posterior parietal sources a spatial attention effect detectable only at long ISIs.     

Latency and amplitude abnormalities of the scalp far-field P14 to median nerve stimulation in multiple sclerosis. A SEP study of 122 patients recorded with a non-cephalic reference montage

The frequency and characteristics of P14 abnormalities were investigated in 122 patients with probable (68), or definite (54) multiple sclerosis by recording SEPs to median nerve stimulation with a non-cephalic reference montage. The most frequent SEP abnormality found in our series (62% of abnormal results) combined latency increase and amplitude reduction of P14. Interindividual variability, inherent in absolute amplitude measurements, was by-passed by calculating the ration between the amplitudes of far-field P9 and P14 components, which proved to be normally distributed in controls. In spite of the strong association (P ⪡ 0.001) between the P9–P14 interpeak interval (IPL) and the P9/P14 amplitude ratio in MS patients, the latter parameter was found to be the only abnormality in 12 patients whose P9–P14 and P14–N20 IPLs were normal. Also IPLs were increased in 12 patients with normal P14 amplitudes. These results suggest that adding the P9/P14 amplitude criterion to standard IPL data might be useful to detect conduction troubles in MS patients.     

Maps of somatosensory evoked potentials (SEPs) to mechanical (tapping) stimuli: comparison with P14, N20, P22, N30 of electrically elicited SEPs

Bit mapped color imaging of SEPs was recorded from 19 derivations in 11 healthy volunteers after electrical stimulation of the median nerve at the wrist, index finger digital nerve stimulation, and mechanical stimulation of the index fingertips by an electromechanically driven vibrating thin metallic plate. The latencies of SEP components increased for the various stimulation modalities, being shortestafter median nerve stimulation at the wrist and longest after mechanical stimulation of the index fingertips.The scalp distribution of SEPs to mechanical stimuli was, however, the same as other SEPs, independently of the stimulation employed, and components corresponding to N20 and P22 were recorded only contralaterally to the stimulated side.