The impact of stimulus properties on low- and high-frequency median nerve somatosensory evoked potentials.

Questioning whether stimulation properties in median nerve somatosensory evoked potentials show interactions multichannel recordings were performed in a three-factorial repeated measures design with the parameters (i) eyes opened versus eyes closed, (ii) stimulation intensity above motor threshold versus intensity sub motor threshold, (iii) stimulation rate 0.5 Hz versus 9 Hz resulting in somatosensory evoked potentials recorded during eight different conditions. Varying the stimulation intensity revealed an impact on the amplitude and the latency of the N20 source activity and on the amplitude, the duration and the number of peaks of the high frequency oscillatory (HFOs) sources. Modifying the stimulation rate lead to an effect on the amplitude and latency of the N20 and on the amplitude of the high-frequency oscillatory sources. The condition opened/closed eyes had an impact on the duration and number of high-frequency oscillatory. No relevant interactions between the stimulation properties were found. In consequence, varying one stimulus parameter already leads to a saturation of the low as well as high-frequency somatosensory evoked potentials components. Thus, the careful choice of stimulation parameters is a condition precedent for reasonable data interpretation.

Short-term cortical reorganization by deafferentation of the contralateral sensory cortex.

The topographic arrangement of the human primary somatosensory cortex following deafferentation of the contralateral cortex has been investigated by means of dipole source analysis. Somatosensory-evoked potentials were obtained by electrical stimulation of digit 1 and digit 5 of the left hand before and after anesthesia of digits 2-4 of the right hand during different terms of attention. Anesthesia induced an expansion of the three-dimensional distance between digits 1 and 5. This suggests intercortical plasticity modulated between bilateral primary somatosensory cortical areas, which is unaffected by spatial attention. These changes occur rapidly and are probably mediated by disinhibition of intercortical connections, leading to hyperexcitability of the primary sensory cortex that is contralateral to the region undergoing deafferentation.

Intrathecal synthesis of anti-viral antibodies in pediatric patients.

INTRODUCTION: Detection of intrathecal synthesis of specific antibodies (antibody index (AI)) is an established method to prove cerebral viral infection. Experience on its clinical application in large patient groups, however, is sparse. METHODS: Retrospective analysis of pediatric patients with positive viral AI treated at RWTH Aachen University Hospital between 1999 and 2005. RESULTS: 63 patients were studied, including 14 with encephalitis, 12 with neuritis, nine with cerebral vasculitis, six with multiple sclerosis (MS), five with severe cephalgia, five with psychiatric symptoms, three with hearing loss, two with seizures, three with white matter diseases, two with movement disorders, one with meningococcal meningitis and one with sinus venous thrombosis. Seven had several positive AI among them only one patient with MS. Of the 51 patients with a single positive AI and not having MS, 16 showed a positive AI for herpes simplex-, 13 for varicella zoster-, nine for Epstein-Barr-, four for cytomegalo-, four for mumps-, three for rubella- and two for measles virus. Frequent combinations were varicella zoster virus (VZV) and vasculitis (n = 8), herpes simplex virus (HSV) and neuritis (n = 6), Epstein-Barr virus (EBV) (n = 5), respectively, VZV (n = 4) and encephalitis as wells as mumps virus (n = 2) and hearing loss. Matched polymerase chain reaction (PCR) and AI data were available in 25 patients. PCR was simultaneously positive in three cases only. DISCUSSION: AI testing identifies a similar spectrum of pathogens as known from cerebrospinal fluid (CSF) PCR studies. It complements the PCR and increases the chance for adequate diagnosis and treatment of patients with assumed cerebral viral infections.

Transcranial direct current stimulation applied over the somatosensory cortex - differential effect on low and high frequency SEPs.

OBJECTIVE: Transcranial direct current stimulation (tDCS) has an influence on the excitability of the human motor cortex measured by motor evoked potentials (MEPs) after transcranial magnetic stimulation. Low and high frequency (HFOs) components of somatosensory evoked potentials (SEPs) were studied questioning whether a comparable effect can be observed after applying tDCS to the human somatosensory cortex. METHODS: Multichannel median nerve SEPs were recorded before and after applying tDCS of 1mA over a period of 9min with the cathode placed over the somatosensory cortex and the anode over the contralateral forehead and vice versa in a second session. The source activity of the N20, N30 and HFOs was evaluated before and after application of tDCS. RESULTS: After cathodal tDCS to the somatosensory cortex we found a significant reduction of the N20 source amplitude while there was no effect after anodal stimulation. For the N30 component and HFOs no change in source activity was observed. CONCLUSIONS: Corresponding to the results for the motor cortex a sustained reduction of the excitability of the somatosensory cortex after cathodal tDCS was shown. SIGNIFICANCE: We demonstrated differential effects of tDCS on the high and low frequency components of SEPs confirming the hypothesis of locally and functionally distinct generators of these two components.

Patterns of disturbed impulse propagation in multiple sclerosis identified by low and high frequency somatosensory evoked potential components.

In human median nerve somatosensory evoked potentials (SSEPs), high frequency (600 Hz) oscillations (HFOs) are superimposed onto the low frequency SSEP component N20. High frequency oscillations are generated both in deep axon segments of thalamo-cortical projection neurons and at the primary somatosensory cortex. The present study aimed to test the hypothesis that HFOs might be more sensitive to temporal dispersion caused by demyelinating lesions in multiple sclerosis (MS) than the N20. The authors recorded HFOs in median nerve SSEPs in 50 patients with definite MS and in 30 healthy controls. Three patterns of SSEP alterations were found: (1) abolished HFOs with either normal (11% of stimulated limbs), or delayed N20 (16% of stimulated limbs); (2) an attenuation of N20 amplitude with preserved HFOs (13%); and (3) a mixture of both patterns (21%). The first pattern--normal N20 with abolished HFOs--indicates that the HFOs are a sensitive marker of slight demyelination. The second pattern is suggestive of a mainly axonal lesion type, while the third pattern points to a combined axonal/demyelinating process or a conduction block. Analysis of HFOs allows identification of slight demyelinating processes in MS patients in whom the N20 SSEP component remains unaffected. The HFOs provide a tool to distinguish different patterns of disturbed impulse propagation.