Antidromic corticospinal tract potential of the brain.

OBJECTIVE: To describe a novel potential component (antidromic corticospinal tract potential, ACSP) of the brain after translaminar spinal stimulation of a relaxed patient during scoliosis surgery. To study the origin of this component and to compare its source to known sources of the somatosensory evoked potentials (SEPs). METHODS: We studied 17 consecutive patients during posterior scoliosis surgery. SEPs and ACSPs were elicited by translaminar spinal stimulation at the Th 2 and L 1 levels. ACSPs and SEPs were recorded on the scalp midline. Neurogenic motor evoked potentials (NMEPs) were recorded on the popliteal spaces. Preoperative tibial SEPs were also recorded. RESULTS: ACSP was distinctly separated from the corresponding spinally evoked cortical SEP that showed longer latency than the ACSP. ACSPs decreased and disappeared when stimulation was moved to the caudal direction in the conus region while SEP persisted. In addition, the hemispheric origin of ACSP was confirmed with multichannel midline recordings of the scalp and neck. Thus there was no confusion to the response of nucleus gracilis, corresponding the P 31 response of the tibial nerve SEP. CONCLUSIONS: The origin of ACSP seemed to be in the rostral part of the corticospinal tract. ACSP diminished in the conus region when stimulation was moved caudally and it disappeared when the stimulus was given to the root level. This proves that ACSP is not a response of the somatosensory tract, instead ACSP represents antidromic response of the pyramidal tract. ACSP can be used in monitoring of the motor tracts during scoliosis surgery together with NMEPs.

Reduced mismatch negativity (MMN) suggests deficits in pre-attentive auditory processing in distractible children.

Mismatch negativity (MMN) event-related brain potential reflects the brain's automatic auditory change detection mechanism that depends on integrity of the auditory sensory memory. We studied MMN in easily distractible (n = 20) and in non-distractible (n = 20) healthy 9-year-old children. Two MMN phases were revealed in both groups: an earlier MMN peak at approximately 220 ms and a later negative slope approximately 300-500 ms after stimulus presentation. The results suggested a strong frontal lobe contribution in the generation of the later MMN phase, and this response was significantly reduced in amplitude in the distractible children. The present findings suggest that distractible children may have deficits in the frontally mediated aspects of auditory sensory memory.

Persistent frontal P300 brain potential suggests abnormal processing of auditory information in distractible children.

The P300 event-related potential (ERP) was studied at the beginning, in the middle, and at the end of an auditory stimulus discrimination task in 70 normal 9-year-old children. Easily distractible children showed frontally a short-latency P300 response to target stimuli throughout the task, whereas in the non-distractible children the corresponding response was distinctly smaller and also showed a tendency to decrease in size towards the end of the task. The short-latency frontal P300 response reflects activation of the brain's orienting networks, and it normally decreases in size when stimuli lose their 'novelty value' with stimulus repetition. Persistent frontal P300 suggest that distractible children continued to show enhanced orienting to stimuli that should have already been well encoded and/or categorized.

What does the P300 brain response measure in children? New insight from stimulus sequence studies.

The decrease in the P300 brain response latency with increasing age is often taken to reflect maturation of cognitive processes in children. We found that in abnormally distractible children the auditory P300 latency decreased significantly when the inter-target interval (ITI) increased in a stimulus discrimination task. We speculate that the sensory memory trace of the target stimulus may decay in distractible children during longer ITIs, and consequently the next target stimulus may activate the brain's orienting networks that are known to generate shorter latency brain responses. The relative strength by which the functionally different neural networks underlying the cognitive brain responses are activated may contribute significantly to the latency measures of these responses. The presumption that a short P300 latency equals to fast processing may thus be over-simplistic, especially in children.

Distractible children show abnormal orienting to non-attended auditory stimuli.

Event-related potentials were recorded in response to intermittently presented, non-attended trains of identical auditory stimuli in healthy 9-year-old children. In abnormally distractible children (n =24), the first tone in each train elicited a significantly larger N1 vertex response than in the non-distractible children (n 24), suggesting that increased distractibility may be associated with an abnormally strong cerebral orienting towards non-attended stimuli. A later negativity at around 300 ms, which increases in amplitude with stimulus repetition and may thus reflect the building up of a functional neuronal representation of the stimulus properties, was significantly smaller in the distractible than in the non-distractible children. These findings demonstrate that event-related potential measures may be useful in helping to understand the information processing found in distractible children.

P300 sequence effects differ between children and adults for auditory stimuli.

Variation of the P300 component was studied in normal children and adults during an auditory oddball paradigm. In children, the target stimuli that were preceded by a large number of standard stimuli elicited about twice as large P300 with a significantly shorter latency, a more widespread distribution, and an earlier positivity in the frontal area than those that were preceded by a small number of standard stimuli. The P300 variation was not as marked in adults as in children. Based on the context updating theory of the P300, the finding suggests that a long intertarget interval (ITI) results in a profound decay of the neural representation of the target stimulus in children; consequently, more resources are needed to update the neural representation, and the target may even be processed as a novel input. The P300 variation may provide information about the brain functions related to memory, attention, and orienting in children. This variation should be considered when assessing cognitive brain functions with event-related potentials in children.

Relationship between EEG reactivity and neuropsychological tests in vascular dementia.

17 patients with vascular dementia (VaD) representing moderate to severe stage of the disease and 11 age-matched control subjects were examined with spectral analysis of EEG and a neuropsychological test battery comprising visual, praxic, verbal and memory functions as well as Mini-Mental Status test. VaD patients did not have less activity in the alpha band than control subjects, but the alpha amplitude ratio between eyes closed (EC) and eyes open (EO) situations (EC/EO ratio) was decreased in VaD patients, compared to controls. In VaD the variables of the awake background EEG with eyes closed (amplitude of alpha, beta, theta and delta activity; mean frequency) had only a few correlations to neuropsychological test scores. However, the (EC)/(EO) alpha ratio showed significant correlations with several neuropsychological variables in the temporo-occipital and centro-parietal derivations and some of these correlations were lateralized to the left or right hemisphere. Frontal EEG derivations with less alpha activity did not reveal any correlations to neuropsychological variables. We conclude that the dynamic EC/EO alpha ratio variable may be even more sensitive in the assessment of brain dysfunction in VaD than the background EEG variables.

EEG reactivity correlates with neuropsychological test scores in Down's syndrome.

INTRODUCTION: Down's syndrome patients express a neurodegenerative disorder and mental retardation. We studied the reactivity of EEG and its correlation with neuropsychological test score in Down's syndrome. MATERIAL AND METHODS: We studied 32 patients with Down's syndrome and 31 controls for blocking of occipital EEG activity. The temporo-occipital EEG with eyes open (EO) was compared with resting EEG with eyes closed (EC), (EC/EO ratio). RESULTS: Both Down patients and controls showed significant diminution of alpha, beta and theta activity and decrease of EEG frequency with EO. However, there was a significant impairment in Down patients in the EC/EO ratio in alpha band, compared to controls. The controls had no correlation of the alpha EC/EO ratio with age or gender. The Down patients showed a significant correlation of this variable with age which is in accordance with a gradually progressing disease. They had also significant correlations of the alpha EC/EO ratio and neuropsychological test scores which indicates that this ratio may be a more general measure of cerebral or hemispherical dysfunction than a mere impairment of visual activation. Down patients also showed significant differences in resting EEG variables, compared to the controls, even if the conventional EEG showed normal or mildly slowed dominant occipital rhythm in most of the patients. The correlation analysis between resting EEG and EC/EO ratio variables pointed out that they are relatively independent, representing different factors in the regulation of EEG. CONCLUSIONS: We believe that the alpha EC/EO ratio of EEG add a new domain in the assessment of cerebral dysfunction in Down's syndrome.