Induction of smell through transethmoid electrical stimulation of the olfactory bulb.

BACKGROUND: Anosmia has an estimated prevalence of 5% of the general population. Outside of inflammatory causes, therapeutic options are limited despite research advances. Bypassing peripheral neuronal damage through central stimulation is a potential therapeutic option that has shown success in other sensory systems, most notably with hearing. We performed a pilot study to determine the feasibility of inducing smell through artificial electrical stimulation of the olfactory bulbs in humans. METHODS: Subjects with a history of sinus surgery, including total ethmoidectomy, with intact ability to smell were enrolled. The ability to smell was confirmed with a 40-item smell identification test. Awake subjects underwent nasal endoscopy and either a monopolar or bipolar electrode was positioned at 3 areas along the lateral lamella of the cribriform plate within the ethmoid sinus cavity. A graded stimulation current of 1-20 mA at 3.17 Hz was administered while cortical evoked potential (CEP) recordings were collected. Subjective responses of perceived smell along with reports of discomfort were recorded. Subjects with artificially induced smell underwent repeat stimulation after medically induced anosmia. RESULTS: Five subjects (age, 43-72 years) were enrolled. Three subjects reported smell perception smell with electrical stimulation. This was reproducible after inducing anosmia, but CEP recordings could not provide objective support. All subjects tolerated the study with minimal discomfort. CONCLUSION: This is the first report of induced smell through transethmoid electrical stimulation of the olfactory bulb. These results provide a proof of concept for efforts in development of an olfactory implant system.

Intraoperative somatosensory evoked potential monitoring decreases EEG burst suppression ratio during deep general anesthesia.

PURPOSE: The burst suppression (BS) EEG patterns induced by general anesthesia can react to somatosensory stimuli. We investigated this reactivity by studying the effect of peripheral nerve stimulation used for routine intraoperative spinal cord monitoring by somatosensory evoked potentials on BS patterns. METHODS: The relative time spent in suppression expressed as BS ratio (BSR) and mean burst duration were measured before (BSR(Pre)), during (BSR(Stim)), and after (BSR(Post)) a 60-second repetitive electrical ulnar nerve stimulation in nine patients under total intravenous general anesthesia with propofol. The BS reactivity was measured as BSR(Pre)-BSR(Stim). RESULTS: Overall, 27 trials were included with BSR(Pre) up to 77%, indistinguishable from BSR(Post). During stimulation, the mean BSR transiently decreased from 42% to 35%. For each 1% increase in BSR(Pre), the BS reactivity increased with 0.6%, whereas the burst duration remained approximately 3 seconds. For BSR(Pre) below 30%, the BS reactivity was negligible. CONCLUSIONS: Data from this study show that somatosensory input can evoke bursts, altering the "spontaneous" deep BS patterns (BSR(Pre) >30%). Further studies are necessary to objectively assess the clinical relevance of stimulus-induced BS reactivity during deep general anesthesia.

Intraoperative mapping of roots, plexuses, and nerves.

The use of intraoperative mapping of neural structures has come to be an indispensable technique to prevent or minimize postoperative morbidity. In this article, I briefly mention its use in mapping nerve roots, plexuses, and peripheral nerves. The reader may find some mention of monitoring techniques, too, as monitoring and mapping are seldom done separately. I include the technical details of different mapping modalities, relevant anatomy, and clinical applications, as appropriate.

Optimizing recovery potential through simultaneous occupational therapy and non-invasive brain-stimulation using tDCS.

PURPOSE: It is thought that following a stroke the contralesional motor region exerts an undue inhibitory influence on the lesional motor region which might limit recovery. Pilot studies have shown that suppressing the contralesional motor region with cathodal transcranial Direct Current Stimulation (tDCS) can induce a short lasting functional benefit; greater and longer lasting effects might be achieved with combining tDCS with simultaneous occupational therapy (OT) and applying this intervention for multiple sessions. METHODS: We carried out a randomized, double blind, sham controlled study of chronic stroke patients receiving either 5 consecutive days of cathodal tDCS (for 30 minutes) applied to the contralesional motor region and simultaneous OT, or sham tDCS+OT. RESULTS: we showed that cathodal tDCS+OT resulted in significantly more improvement in Range-Of-Motion in multiple joints of the paretic upper extremity and in the Upper-Extremity Fugl-Meyer scores than sham tDCS+OT, and that the effects lasted at least one week post-stimulation. Improvement in motor outcome scores was correlated with decrease in fMRI activation in the contralesional motor region exposed to cathodal stimulation. CONCLUSIONS: This suggests that cathodal tDCS combined with OT leads to significant motor improvement after stroke due to a decrease in the inhibitory effect that the contralesional hemisphere exerts onto the lesional hemisphere.

Imaging correlates of motor recovery from cerebral infarction and their physiological significance in well-recovered patients.

We studied motor representation in well-recovered stroke patients. Eighteen right-handed stroke patients and eleven age-matched control subjects underwent functional Magnetic Resonance Imaging (fMRI) while performing unimanual index finger (abduction-adduction) and wrist movements (flexion-extension) using their recovered and non-affected hand. A subset of these patients underwent Transcranial Magnetic Stimulation (TMS) to elicit motor evoked potentials (MEP) in the first dorsal interosseous muscle of both hands. Imaging results suggest that good recovery utilizes both ipsi- and contralesional resources, although results differ for wrist and index finger movements. Wrist movements of the recovered arm resulted in significantly greater activation of the contralateral (lesional) and ipsilateral (contralesional) primary sensorimotor cortex (SM1), while comparing patients to control subjects performing the same task. In contrast, recovered index finger movements recruited a larger motor network, including the contralateral SM1, Supplementary Motor Area (SMA) and cerebellum when patients were compared to control subjects. TMS of the lesional hemisphere but not of the contralesional hemisphere induced MEPs in the recovered hand. TMS parameters also revealed greater transcallosal inhibition, from the contralesional to the lesional hemisphere than in the reverse direction. Disinhibition of the contralesional hemisphere observed in a subgroup of our patients suggests persistent alterations in intracortical and transcallosal (interhemispheric) interactions, despite complete functional recovery.

Contralateral and ipsilateral motor effects after transcranial direct current stimulation.

Transcranial direct current stimulation over the left motor area influenced both contralateral and ipsilateral finger sequence movements in seven healthy adults. Effects for the two hands were reversed: anodal stimulation improved right-hand performance significantly more than cathodal stimulation, whereas cathodal stimulation improved left-hand performance significantly more than anodal stimulation. The results show that stimulating a motor region directly, or indirectly by modulating activity in the homologous region on the opposite hemisphere, can affect motor skill acquisition, presumably by facilitating effective synaptic connectivity. This outcome provides evidence for the role of interhemispheric inhibition in corticomotor functioning, and also has implications for treatment methods aimed at facilitating motor recovery after stroke.

About being BOLD.

The last decade has seen an unprecedented increase in the use of functional magnetic resonance imaging (fMRI) to understand the neural basis of cognition and behavior. Being non-invasive and relatively easy to use, most studies relied on changes in the blood oxygenation level dependent (BOLD) contrast as an indirect marker of variations in brain activity. However, the fact that BOLD fMRI is dependent on the blood flow response that follows neural activity and does not measure neural activity per se is seen as an inherent cause for concern while interpreting data from these studies. In order to characterize the BOLD signal correctly, it is imperative that we have a better understanding of neural events that lead to the BOLD response. A review of recent studies that addressed several aspects of BOLD fMRI including events at the level of the synapse, the nature of the neurovascular coupling, and some parameters of the BOLD signal is provided. This is intended to serve as background information for the interpretation of fMRI data in normal subjects and in patients with compromised neurovascular coupling. One of the aims is also to encourage researchers to interpret the results of functional imaging studies in light of the dynamic interactions between different brain regions, something that often is neglected.

Cortical and cerebellar activity of the human brain during imagined and executed unimanual and bimanual action sequences: a functional MRI study.

The neural (blood oxygenation level dependent) correlates of executed and imagined finger sequences, both unimanual and bimanual, were studied in adult right-handed volunteers using functional magnetic resonance imaging (fMRI) of the entire brain. The finger to thumb opposition tasks each consisted of three conditions, two unimanual and one bimanual. Each experimental condition consisted of overt movement of the fingers in a prescribed sequence and imagery of the same task. An intricate network consisting of sensorimotor cortex, supplementary motor area (SMA), superior parietal lobule and cerebellum was identified when the tasks involved both planning and execution. During imagery alone, however, cerebellar activity was largely absent. This apparent decoupling of sensorimotor cortical and cerebellar areas during imagined movement sequences, suggests that cortico-cerebellar loops are engaged only when action sequences are both intended and realized. In line with recent models of motor control, the cerebellum may monitor cortical output and feed back corrective information to the motor cortex primarily during actual, not imagined, movements. Although parietal cortex activation occurred during both execution and imagery tasks, it was most consistently present during bimanual action sequences. The engagement of the superior parietal lobule appears to be related to the increased attention and memory resources associated, in the present instance, with coordinating difficult bimanual sequences.