Electromagnetic function of polymicrogyric cortex in congenital bilateral perisylvian syndrome.

BACKGROUND: Congenital bilateral perisylvian syndrome (CBPS) is characterised by bilateral perisylvian polymicrogyria and suprabulbar paresis. Mild tetraparesis, cognitive impairment, and epilepsy are frequently associated. Sensory deficits are surprisingly rare, even though polymicrogyria often extends to auditory and sensorimotor cortex. OBJECTIVES: To study the sensorimotor and auditory cortex function and location in CBPS patients. METHODS: We mapped the sensory and motor cortex function onto brain magnetic resonance images in six CBPS patients and seven control subjects using sources of somatosensory and auditory evoked magnetic fields, and of rhythmic magnetoencephalographic (MEG) activity phase-locked to surface electromyogram (EMG) during voluntary hand muscle contraction. RESULTS: MEG-EMG coherence in CBPS patients varied from normal (if normal central sulcus anatomy) to absent, and could occur at abnormally low frequency. Coherent MEG activity was generated at the central sulcus or in the polymicrogyric frontoparietal cortex. Somatosensory and auditory evoked responses were preserved and also originated within the polymicrogyric cortex, but the locations of some source components could be grossly shifted. CONCLUSION: Plastic changes of sensory and motor cortex location suggest disturbed cortex organisation in CBPS patients. Because the polymicrogyric cortex of CBPS patients may embed normal functions in unexpected locations, functional mapping should be considered before brain surgery.

Dorsal penile nerve stimulation elicits left-hemisphere dominant activation in the second somatosensory cortex.

Activation of peripheral mixed and cutaneous nerves activates a distributed cortical network including the second somatosensory cortex (SII) in the parietal operculum. SII activation has not been previously reported in the stimulation of the dorsal penile nerve (DPN). We recorded somatosensory evoked fields (SEFs) to DPN stimulation from 7 healthy adults with a 122-channel whole-scalp neuromagnetometer. Electrical pulses were applied once every 0.5 or 1.5 sec to the left and right DPN. For comparison, left and right median and tibial nerves were stimulated alternatingly at 1.5-sec intervals. DPN stimuli elicited weak, early responses in the vicinity of responses to tibial nerve stimulation in the primary somatosensory cortex. Strong later responses, peaking at 107-126 msec were evoked in the SII cortices of both hemispheres, with left-hemisphere dominance. In addition to tactile processing, SII could also contribute to mediating emotional effects of DPN stimuli.

Task-dependent modulations of cortical oscillatory activity in human subjects during a bimanual precision grip task.

Oscillations are a widespread feature of normal brain activity and have been reported at a variety of different frequencies in different neuronal systems. The demonstration that oscillatory activity is present in motor command signals has prompted renewed interest in the possible functions of synchronous oscillatory activity within the primate sensorimotor system. In the current study, we investigated task-dependent modulations in coupling between sensorimotor cortical oscillators during a bimanual precision grip task. The task required a hold-ramp-hold pattern of grip force to be exerted on a compliant object with the dominant right hand, while maintaining a steady grip with the nondominant hand. We found significant task-related modulation of 15- to 30-Hz coherence between magnetoencephalographic (MEG) activity recorded from the left sensorimotor cortex and electromyographic (EMG) activity in hand muscles on the right side. This coherence was maximal during steady hold, but disappeared during the ramp movements. Interestingly coherence between the right sensorimotor MEG and left-hand EMG showed a similar, although less deeply modulated, task-related pattern, even though this hand was maintaining a simple steady grip. No significant ipsilateral MEG-EMG coherence was observed in the 15- to 30-Hz passband for either hand. These results suggest that the cortical oscillators in the two sensorimotor cortices are independent to some degree but that they may share a common mechanism that attenuates the cortical power in both hemispheres in the 15- to 30-Hz range during movements of one hand. The results are consistent with the hypothesis that oscillatory activity in the motor system is important in resetting the descending motor commands needed for changes in motor state, such as those that occur in the transition from movement to steady grip.

Oscillatory cortical drive to isometrically contracting muscle in Unverricht-Lundborg type progressive myoclonus epilepsy (ULD).

OBJECTIVE: We investigated with whole-scalp magnetoencephalography (MEG) oscillatory cortical drive to isometrically contracting muscle in 8 genetically verified, and thus etiologically homogeneous, Unverricht-Lundborg type progressive myoclonus epilepsy (ULD) patients suffering from cortical myoclonus and generalized tonic-clonic seizures. The results were compared with those of 8 healthy control subjects. METHODS: Cortical MEG signals were measured simultaneously with surface electromyography (EMG) during isometric contraction of the left and right first dorsal interosseus muscles. Cortex-muscle coherence and cross-correlograms between MEG and EMG signals were calculated as indicators of oscillatory cortical drive to muscle. The cortical areas involved in the maximum cortex-muscle coherence were also identified. RESULTS: In patients, the strengths of the dominant coherent peaks were 2-4 fold compared with the healthy controls. Whereas the coherence was found strictly in the contralateral primary motor cortex in controls, additional coherent activity was observed ipsilaterally in 5 out of 8 patients. CONCLUSIONS: The remarkably increased MEG-EMG coherence in ULD patients suggests altered oscillatory cortical drive to the muscle during isometric contraction. We suggest that the enhanced cortex-muscle coherence in ULD patients reflects reduced inhibition in the motor cortex, and may contribute to disturbed voluntary movements.

Whose arm is it anyway? An fMRI case study of supernumerary phantom limb.

Under normal circumstances, information from a number of sources is combined to compute a unitary percept of the body. However, after pathology these influences may be perceived simultaneously, resulting in multiple dissociated conscious representations. In a recent paper, we described subject E.P., a right-handed female stroke patient with a right frontomesial lesion who sporadically experiences a supernumerary 'ghost' left arm that occupies the previous position of the real left arm after a delay of 60-90 s. We used a delayed response paradigm with functional MRI to examine the haemodynamic correlates of E.P.'s illusion. Comparison of periods of time during scanning when the ghost arm was present against when it was not revealed a single cluster (9 voxels, t = 5.11, P < 0.012 corrected for multiple comparisons) located on the right medial wall in the supplementary motor area ('SMA proper'). Our results suggest that areas traditionally classified as part of the motor system can influence the conscious perception of the body. We propose that, as a consequence of her injury, E.P. is aware of the position of the phantom limb in this 'action space' while also continuing to be aware of the true position of her real limb on the basis of afferent somatosensory information.

Oscillatory interaction between human motor cortex and trunk muscles during isometric contraction.

We investigated oscillatory interaction between magnetoencephalographic signals of the human motor cortex and surface electromyogram from the paraspinal (PS) and abdominal (ABD) muscles. The results were compared with data obtained during contraction of the first dorsal interosseus (FDI) and tibialis anterior (TA) muscles. Significant coherence at 15-35 Hz was observed for both PS and ABD muscles in all subjects but the coherence was weak compared with that for FDI and TA. The cortical sources for both the PS and the ABD coherences were located in the motor cortex between the source areas for the FDI and TA coherences, thereby agreeing with the classical trunk area of the motor homunculus previously determined by invasive studies. The sources were strictly contralateral for PS but bilateral for ABD contractions. Our results indicate that during isometric contractions descending motor commands are modulated by cortical oscillations for both limb and trunk muscles, although the modulation is weaker and may be bilateral for trunk muscles.

Increased synchronization of cortical oscillatory activities between human supplementary motor and primary sensorimotor areas during voluntary movements.

In human, both primary and nonprimary motor areas are involved in the control of voluntary movements. However, the dynamics of functional coupling among different motor areas has not been fully clarified yet. Because it has been proposed that the functional coupling among cortical areas might be achieved by the synchronization of oscillatory activity, we investigated the electrocorticographic coherence between the supplementary motor and primary sensorimotor areas (SMA and S1-M1) by means of event-related partial coherence analysis in 11 intractable epilepsy patients. We found premovement increase of coherence between the SMA proper and S1-M1 at the frequency of 0-33 Hz and between the pre-SMA and S1-M1 at 0-18 Hz. Coherence between the SMA proper and M1 started to increase 0.9 sec before the movement onset and peaked 0.3 sec after the movement. There was no systematic difference within the SMA (SMA proper vs pre-SMA) or within the S1-M1, in terms of the time course as well as the peak value of coherence. The phase spectra revealed near-zero phase difference in 57% (20 of 35) of region pairs analyzed, and the remaining pairs showed inconsistent results. This increase of synchronization between multiple motor areas in the preparation and execution of voluntary movements may reflect the multiregional functional interactions in human motor behavior.

Involvement of the sensorimotor cortex in physiological force and action tremor.

Whole scalp magnetoencephalography (MEG) signals were recorded in 10 healthy subjects simultaneously with the surface electromyogram (EMG) of the contralateral forearm extensor muscles during isometric contraction and phasic movement of the wrist. In eight subjects, coherence and time domain analyses demonstrated correspondence between the MEG signal, originating near or in the hand region of the motor cortex, and the 6-12 Hz EMG recorded during isometric postural contractions. In contrast, we found little evidence for correspondence between the contralateral EMG and the MEG recorded over the Rolandic region during phasic movements. We conclude that the sensorimotor cortex is differentially involved in physiological force and action tremor at the wrist.

Cortical representation of sign language: comparison of deaf signers and hearing non-signers.

Numerous studies have demonstrated activation of the classical left-hemisphere language areas when native signers process sign language. More recently, specific sign language-related processing has been suggested to occur in homologous areas of the right hemisphere as well. We now show that these cortical areas are also activated in hearing non-signers during passive viewing of signs that for them are linguistically meaningless. Neuromagnetic activity was stronger in deaf signers than in hearing non-signers in the region of the right superior temporal sulcus and the left dorsal premotor cortex, probably reflecting familiarity and linguistic meaningfulness of the observed movement sequences. In contrast, the right superior parietal lobule, the mesial parieto-occipital region, and the mesial paracentral lobule were more strongly activated in hearing non-signers, apparently reflecting active visuomotor encoding of complex unfamiliar movement sequences.

Three-dimensional integration of brain anatomy and function to facilitate intraoperative navigation around the sensorimotor strip.

We studied 12 patients with brain tumors in the vicinity of the sensorimotor region to provide a preoperative three-dimensional visualization of the functional anatomy of the rolandic cortex. We also evaluated the role of cortex-muscle coherence analysis and anatomical landmarks in identifying the sensorimotor cortex. The functional landmarks were based on neuromagnetic recordings with a whole-scalp magnetometer, coregistred with magnetic resonance images. Evoked fields to median and tibial nerve and lip stimuli were recorded to identify hand, foot and face representations in the somatosensory cortex. Oscillatory cortical activity, coherent with surface electromyogram during isometric muscle contraction, was analyzed to reveal the hand and foot representations in the precentral motor cortex. The central sulcus was identified also by available anatomical landmarks. The source locations, calculated from the neuromagnetic data, were displayed on 3-D surface reconstructions of the individual brains, including the veins. The preoperative data were verified during awake craniotomy by cortical stimulation in 7 patients and by cortical somatosensory evoked potentials in 5 patients. Sources of somatosensory evoked fields identified correctly the postcentral gyrus in all patients. Useful corroborative information was obtained from anatomical landmarks in 11 patients and from cortex-muscle correlograms in 8 patients. The preoperative visualization of the functional anatomy of the sensorimotor strip assisted in designing the operational strategy, facilitated orientation of the neurosurgeon during the operation, and speeded up the selection of sites for intraoperative stimulation or mapping, thereby helping to prevent damage of eloquent brain areas during surgery.

Electrocorticogram-electromyogram coherence during isometric contraction of hand muscle in human.

OBJECTIVE: To clarify how the primary sensorimotor and supplementary motor areas are involved in the generation of the rhythmicity of electromyogram (EMG) activity during continuous muscle contraction. METHOD: We analyzed the coherence between subdurally recorded cortical electroencephalograms (EEG) and EMGs of the contralateral wrist extensor muscle during continuous isometric contraction in 8 patients with medically intractable epilepsy. RESULTS: In all subjects, a significant coherence between the primary motor area (M1) and EMG was observed at the peak frequency of 15+/-3 Hz (means+/-SD). In the primary somatosensory area (S1) of 7 subjects and the supplementary motor area proper (SMA proper) of 4 subjects, significant coherence with EMG was observed at 12+/-5 and 15+/-4 Hz, respectively. The time lags revealed by cross-correlogram were 10+/-3, 7+/-1 and 22+/-8 ms in the M1, S1 and SMA proper, respectively, with the EMG lagging in all areas. CONCLUSION: These findings suggest that the rhythmic activity in the SMA proper, as well as in the S1 and M1, is related to the generation of the rhythmicity of EMG activity.

Cortico-muscular synchronization during isometric muscle contraction in humans as revealed by magnetoencephalography.

Magnetoencephalographic (MEG) and electromyographic (EMG) signals were recorded from six subjects during isometric contraction of four different muscles. Cortical sources were located from the MEG signal which was averaged time-locked to the onset of motor unit potentials. A spatial filtering algorithm was used to estimate the source activity. Sources were found in the primary motor cortex (M1) contralateral to the contracted muscle. Significant coherence between rectified EMG and M1 activity was seen in the 20 Hz frequency range in all subjects. Interactions between the motor cortex and spinal motoneuron pool were investigated by separately studying the non-stationary phase and amplitude dynamics of M1 and EMG signals. Delays between M1 and EMG signals, computed from their phase difference, were found to be in agreement with conduction times from the primary motor cortex to the respective muscle. The time-dependent cortico-muscular phase synchronization was found to be correlated with the time course of both M1 and EMG signals. The findings demonstrate that the coupling between the primary motor cortex and motoneuron pool is at least partly due to phase synchronization of 20 Hz oscillations which varies over time. Furthermore, the consistent phase lag between M1 and EMG signals, compatible with conduction time between M1 and the respective muscle with the M1 activity preceding EMG activity, supports the conjecture that the motor cortex drives the motoneuron pool.

Characteristics of the human contra- versus ipsilateral SII cortex.

OBJECTIVES: In order to study the interaction between left- and right-sided stimuli on the activation of cortical somatosensory areas, we recorded somatosensory evoked magnetic fields (SEFs) from 8 healthy subjects with a 122 channel whole-scalp SQUID gradiometer. METHODS: Right and left median nerves were stimulated either alternately within the same run, with interstimulus intervals (ISIs) of 1.5 and 3 s, or separately in different runs with a 3 s ISI. In all conditions 4 cortical source areas were activated: the contralateral primary somatosensory cortex (SI), the contra- and ipsilateral secondary somatosensory cortices (SII) and the contralateral posterior parietal cortex (PPC). RESULTS: The earliest activity starting at 20 ms was generated solely in the SI cortex, whereas longer-latency activity was detected from all 4 source areas. The mean peak latencies for SII responses were 86-96 ms for contralateral and 94-97 ms for ipsilateral stimuli. However, the activation of right and left SII areas started at 61+/-3 and 62+/-3 ms to contralateral stimuli and at 66+/-2 and 63+/-2 ms to ipsilateral stimuli, suggesting a simultaneous commencing of activation of the SII areas. PPC sources were activated between 70 and 110 ms in different subjects. The 1.5 s ISI alternating stimuli elicited smaller SII responses than the 3 s ISI non-alternating stimuli, suggesting that a considerable part of the neural population in SII responds both to contra- and ipsilateral stimuli. The earliest SI responses did not differ between the two conditions. There were no significant differences in source locations of SII responses to ipsi- and contralateral stimuli in either hemisphere. Subaverages of the responses in sets of 30 responses revealed that amplitudes of the SII responses gradually attenuated during repetitive stimulation, whereas the amplitudes of the SI responses were not changed. CONCLUSIONS: The present results implicate that ipsi- and contralateral SII receive simultaneous input, and that a large part of SII neurons responds both to contra- and ipsilateral stimulation. The present data also highlight the different behavior of SI and SII cortices to repetitive stimuli.

Human cortical muscle coherence is directly related to specific motor parameters.

Cortical oscillations have been the target of many recent investigations, because it has been proposed that they could function to solve the "binding" problem. In the motor cortex, oscillatory activity has been reported at a variety of frequencies between approximately 4 and approximately 60 Hz. Previous research has shown that 15-30 Hz oscillatory activity in the primary motor cortex is coherent or phase locked to activity in contralateral hand and forearm muscles during isometric contractions. However, the function of this oscillatory activity remains unclear. Is it simply an epiphenomenon or is it related to specific motor parameters? In this study, we investigated task-dependent modulation in coherence between motor cortex and hand muscles during precision grip tasks. Twelve right-handed subjects used index finger and thumb to grip two levers that were under robotic control. Each lever was fitted with a sensitive force gauge. Subjects received visual feedback of lever force levels and were instructed to keep them within target boxes throughout each trial. Surface EMGs were recorded from four hand and forearm muscles, and magnetoencephalography (MEG) was recorded using a 306 channel neuromagnetometer. All subjects showed significant levels of coherence (0.086-0.599) between MEG and muscle in the 15-30 Hz range. Coherence was significantly smaller when the task was performed under an isometric condition (levers fixed) compared with a compliant condition in which subjects moved the levers against a spring-like load. Furthermore, there was a positive, significant relationship between the level of coherence and the degree of lever compliance. These results argue in favor of coherence between cortex and muscle being related to specific parameters of hand motor function.

'Human see, human do' cortex.

Recent magnetoencephalographic (MEG) recordings support the existence of a system for matching observed and executed actions in humans and suggest that this system involves even the primary motor cortex.

Rhythmical corticomotor communication.

Recent non-invasive human studies show that rhythmic oscillatory activity of the motor cortex and the firing of motor units of the muscle are coherent during isometric contraction, with peak frequencies around 20 Hz or 40 Hz, depending on the contraction strength. The cortical signals precede the motor unit firing and appear to reflect modulation of the common central drive to the spinal motoneuron pool. The rhythmic modulation may form a tool for efficient driving of motor units but we express some reservations about the assumed binding and attention-related roles of the rolandic brain rhythms. The cortex-muscle coherence is of interest for understanding of cortical control of voluntary movements and the pathophysiology of various motor disorders, as well as for unravelling the functional significance of cortical rhythms.

Task-dependent modulation of 15-30 Hz coherence between rectified EMGs from human hand and forearm muscles.

1. Recent reports have shown task-related changes in oscillatory activity in the 15-30 Hz range in the sensorimotor cortex of human subjects and monkeys during skilled hand movements. In the monkey these oscillations have been shown to be coherent with oscillatory activity in the electromyographic activity of hand and forearm muscles. 2. In this study we investigated the modulation of oscillations in the electromyogram (EMG) of human volunteers during tasks requiring precision grip of two spring-loaded levers. 3. Two tasks were investigated: in the 'hold' task, subjects were required to maintain a steady grip force (ca 2.1 N or 2.6 N) for 8 s. In the 'ramp' task, there was an initial hold period for 3 s (force ca 2.1 N) followed by a linear increase in grip force over a 2 s period. The task ended with a further steady hold for 3 s at the higher force level (ca 2.6 N). 4. Surface EMGs were recorded from five hand and forearm muscles in 12 subjects. The coherence of oscillatory activity was calculated between each muscle pair. Frequencies between 1 and 100 Hz were analysed. 5. Each subject showed a peak in the coherence spectra in the 15-30 Hz bandwidth during the hold task. This coherence was absent during the initial movement of the levers. During the ramp task the coherence in the 15-30 Hz range was also significantly reduced during the movement phase, and significantly increased during the second hold period, relative to the initial hold. 6. There was coherence between the simultaneously recorded magnetoencephalogram (MEG) and EMG during steady grip in the hold task; this coherence disappeared during the initial lever movement. Using a single equivalent current dipole source model, the coherent cortical activity was localized to the hand region of the contralateral motor cortex. This suggests that the EMG-EMG coherence was, therefore, at least in part, of cortical origin. 7. The results are discussed in terms of a possible role for synchrony in the efficient recruitment of motor units during maintained grip.

Mandibular metastasis in a patient with endometrial cancer.

Gynecologic cancers metastatic to bone are a rare entity, and a metastasis to the mandible at initial presentation is even more infrequently seen. We present a case of a 71-year-old woman with stage IV endometrial cancer with a metastasis to the mandible, with no other sites of distal spread apparent. The endometrial tumor was a FIGO grade III adenocarcinoma. The pathologic evaluation of the mandibular lesion revealed poorly differentiated adenocarcinoma with focal squamous differentiation. She was treated with a total abdominal hysterectomy and bilateral salpingo-oophorectomy, radiation therapy to the mandible, and chemotherapy consisting of Taxol and carboplatin for six cycles. She had a complete response, but 10 months after the original diagnosis developed spinal cord compression and progressive disease in the pelvis. Patients in good clinical condition with a single bone metastasis should be treated aggressively, as survival can be extended.

Cortical correlate of the Piper rhythm in humans.

Cortical correlate of the Piper rhythm in humans. J. Neurophysiol. 80: 2911-2917, 1998. The electromyogram (EMG) of healthy humans demonstrates a tendency to rhythmic oscillations at around 40 Hz (the Piper rhythm) during strong voluntary contraction. Why motor units should discharge synchronously locked to such a high-frequency is unclear. We recorded whole scalp magnetoencephalographic (MEG) signals simultaneously with surface EMG from 10 healthy subjects. In eight subjects, coherence and time domain analyses demonstrated correspondence between the MEG signal, originating near or in the hand region of the motor cortex, and the 35- to 60-Hz EMG recorded during repeated maximal isometric contractions of the contralateral forearm extensor muscles. Three of these subjects also showed similar coherence during isometric contractions of moderate strength and slow extension movements of the wrist. In addition, coherence and time domain analyses demonstrated correspondence between the MEG signals originating near or in the foot area of the motor cortex and EMG recorded during repeated maximal isometric contractions of the contralateral tibialis anterior muscle in the 30- to 60-Hz range. Most important, the frequency at the peak of the coherence spectrum differed between forearm and leg by as much as 10 Hz in the same subject. In contrast, the peak of the coherence spectrum occurred during sustained weak contraction in the 20- to 30-Hz range similarly for both forearm and foot. The lag between EMG and MEG activity in the leg was approximately 15 ms greater than that seen in the forearm, an interval appropriate for conduction in fast pyramidal pathways. It is concluded that the Piper rhythm in muscle may be driven by a comparable oscillatory activity in the contralateral motor cortex. This cortical rhythmicity can be picked up in several types of movement and seems distinct from the 20- to 30-Hz rhythmicity recorded during weak sustained contractions.