Motor Response (motor + response)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Language-Related Potentials in Temporal Lobe Epilepsy Before and After Surgical Treatment

EPILEPSIA, Issue 2000
Toshihiko Ito
Purpose: Temporal lobectomy has contributed to treatment for medically intractable epilepsies. However, influence of the surgical treatment on cognitive function is not still clear, especially from the electrophysiological viewpoint. N400, an event related potential (ERP) named for its negative polarity and peak latency of 400 ms, is reported to be an electrophysiological sign of neural activities associated with semantic priming in language perception. In the present study, ERPs are applied to evaluate the cognitive function of temporal lobe epilepsy before and after temporal lobectomy. Methods: Two patients with intractable temporal lobe epilepsy participated in this study. Fifteen normal subjects served as controls. The incongruous sentence task (Kutas and Hillyard 1980) was used to record N400 components in an auditory modality. Two types of sentences (40 Japanese sentences for each type) were prepared, in which the terminal words were either semantically congruent or incongruent. The scntences were randomly presented at approximately 65 dB SPL peak intensity. ERPs were recorded according to the international 10,20 system, with a balanced non-cephalic electrode reference and 2 1 channels. The band-pass filter was set from 0.5 to 30 Hz, and the ERPs were sampled at 500 Hz from 200 ms before the onset of terminal words to 824 ms post-stimulus. Waves were calculated by subtracting ERPs in the congruent condition from those in the incongruent condition. N400 was scored as the most negative point between 250 and 450 ms in the subtraction waves. Amplitudes were measured from the baseline of 100 ms before the terminal words. Motor responses were also measured with a right index finger, to estimate the accuracy of understanding sentences. Results: Case I was a 22-year-old male who had intractable epilepsy for 7 years. Magnetic resonance imaging (MRI) showed high-intensity signals in the right amygdalo-hippocampal region. The epileptic seizures were confirmed to originate from the region hy electroencephalography/closed-circuit television monitoring, and single-photon-emission computed tomography. ERPs were recorded I month before and after the right anterior temporal lobectomy. Before the surgery, the rate of correct responses showed no difference between the patient (96 %) and the controls (96 %). The amplitudes of N400 for the patient reduced in the right frontal and central areas (F4, C4), comparing to 99 % confidence limit for control subjects. After the surgery, the rate of correct responses was 97 %, and the amplitudes reduced in the right central, parietal, and posterior temporal areas (C4, P4, 0 2, T6). Case 2 (37-year-old female) had intractable epilepsy for 30 years. MRI showed brain atrophy in the right hippocampal region. The epileptic seizures were confirmed to originate from the region. N400 was recorded 3 months after the resection. The rate of correct responses was 95 %. The amplitudes of N400 were lower in the right frontal, parietal, and temporal areas (electrodes Fp2, F4, P4, T6, Pz), comparing to 99 % confidence limit of controls. Conclusions: Before the lpbectomy, the reduction of amplitudes of N400 indicated that the pathogenesis of intractable temporal lobe epilepsy would influence the process of semantic priming in language perception. After the resection, it was suggested that the right temporal lobectomy might affect the cognitive function in the brain from electrophysiological aspects. We could benefit from further study including analysis of the discrepancy between the amplitudes of N400 and behavioral responses. [source]


Cognitive response control in writer's cramp

EUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2001
D. Berg
Disturbances of the motor and sensory system as well as an alteration of the preparation of movements have been reported to play a role in the pathogenesis of dystonias. However, it is unclear whether higher aspects of cortical , like cognitive , functions are also involved. Recently, the NoGo-anteriorization (NGA) elicited with a visual continuous performance test (CPT) during recording of a 21-channel electroencephalogram has been proposed as an electrophysiological standard-index for cognitive response control. The NGA consists of a more anterior location of the positive area of the brain electrical field associated with the inhibition (NoGo-condition) compared with that of the execution (Go-condition) of a prepared motor response in the CPT. This response control paradigm was applied in 16 patients with writer's cramp (WC) and 14 age matched healthy controls. Topographical analysis of the associated event-related potentials revealed a significant (P < 0.05) NGA effect for both patients and controls. Moreover, patients with WC showed a significantly higher global field power value (P < 0.05) in the Go-condition and a significantly higher difference-amplitude (P < 0.05) in the NoGo-condition. A source location analysis with the low resolution electromagnetic tomography (LORETA) method demonstrated a hypoactivity for the Go-condition in the parietal cortex of the right hemisphere and a hyperactivity in the NoGo-condition in the left parietal cortex in patients with WC compared with healthy controls. These results indicate an altered response control in patients with WC in widespread cortical brain areas and therefore support the hypothesis that the pathogenesis of WC is not restricted to a pure sensory-motor dysfunction. [source]


Modulation of spinal inhibitory reflex responses to cutaneous nociceptive stimuli during upper limb movement

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2008
Romildo Don
Abstract In the present study we investigated the probability, latency and duration of the inhibitory component of the withdrawal reflex elicited by painful electrical stimulation of the index finger in humans. The stimulus consisted of a train of high-intensity pulses. The investigation was carried out in several upper limb muscles during isometric contractions of different strengths and during a motor sequence consisting of reaching, picking up and transporting an object. We used a new algorithm to detect and characterize the inhibitory reflex. The reflex was found in all muscles except the brachioradialis at all the isometric contraction strengths, and showed a distal-to-proximal gradient of latency and duration. Conversely, during movement the reflex probability was high (> 80%) in the anterior deltoid and triceps muscles during reaching, in the extensor carpi radialis muscle during transporting of the object, and in the first interosseous muscle during both picking up and transporting of the object. This modulation of inhibitory reflex transmission in the upper limb muscles suggests that the motor response is organized in such a way as to inhibit the overall ongoing motor task by interrupting motion during reaching and by releasing the object during transporting. This pattern of modulation appears to differ markedly from that previously reported for the excitatory component of the withdrawal reflex. Study of the nociceptive inhibitory reflexes during movement offers new and more profound insights into the functional anatomical organization of the spinal interneuronal network mediating sensory,motor integration. [source]


Corrective movements in response to displacements in visual feedback are more effective during periods of 13,35 Hz oscillatory synchrony in the human corticospinal system

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 11 2006
Alexandros G. Androulidakis
Abstract Oscillatory synchronization in the beta (,20 Hz) band is a common feature of human motor control, manifest at cortical and muscular levels during tonic contraction. Here we test the hypothesis that the influence of visual feedback on performance in a positional hold task is increased during bursts of beta-band synchrony in the corticospinal motor system. Healthy subjects were instructed to extend their forefinger while receiving high-gain visual feedback of finger position on a PC screen. Small step displacements of the feedback signal were triggered either by bursts of beta oscillations in scalp electroencephalogram or randomly with respect to cortical beta activity, and the resulting positional corrections expressed as a percentage of the step displacement. Corrective responses to beta and randomly triggered step changes in visual feedback were 41.7 ± 4.9 and 31.5 ± 6.8%, respectively (P < 0.05). A marked increase in the coherence in the beta band was also found between muscle activity and cortical activity during the beta-triggered condition. The results suggest that phasic elevations of beta activity in the corticospinal motor system are associated with an increase in the gain of the motor response to visual feedback during a tonic hold task. Beta activity may index a motor state in which processing relevant to the control of positional hold tasks is promoted, with behavioural consequences. [source]


The role of the medial caudate nucleus, but not the hippocampus, in a matching-to sample task for a motor response

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 7 2006
Raymond P. Kesner
Abstract A delayed-match-to-sample task was used to assess memory for motor responses in rats with control, hippocampus, or medial caudate nucleus (MCN) lesions. All testing was conducted on a cheeseboard maze in complete darkness using an infrared camera. A start box was positioned in the centre of the maze facing a randomly determined direction on each trial. On the sample phase, a phosphorescent object was randomly positioned to cover a baited food well in one of five equally spaced positions around the circumference of the maze forming a 180-degree arc 60 cm from the box. The rat had to displace the object to receive food and return to the start box. The box was then rotated to face a different direction. An identical baited phosphorescent object was placed in the same position relative to the start box. A second identical object was positioned to cover a different unbaited well. On the choice phase, the rat must remember the motor response made on the sample phase and make the same motor response on the choice phase to receive a reward. Hippocampus lesioned and control rats improved as a function of increased angle separation used to separate the correct object from the foil (45, 90, 135, and 180 degrees) and matched the performance of controls. However, rats with MCN lesions were impaired across all separations. Results suggest that the MCN, but not the hippocampus, supports working memory and/or a process aimed at reducing interference for motor response selection based on vector angle information. [source]


Prefrontal-subcortical dissociations underlying inhibitory control revealed by event-related fMRI

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 11 2004
A. M. Clare Kelly
Abstract Using event-related fMRI, this study investigated the neural dynamics of response inhibition under fluctuating task demands. Fourteen participants performed a GO/NOGO task requiring inhibition of a prepotent motor response to NOGO events that occurred as part of either a Fast or Slow presentation stream of GO stimuli. We compared functional activations associated with correct withholds (Stops) required during the Fast presentation stream of stimuli to Stops required during the Slow presentation stream. A predominantly right hemispheric network was activated across conditions, consistent with previous studies. Furthermore, a functional dissociation of activations between conditions was observed. Slow Stops elicited additional activation in anterior dorsal and polar prefrontal cortex and left inferior parietal cortex. Fast Stops showed additional activation in a network that included right dorsolateral prefrontal cortex, insula and dorsal striatum. These results are discussed in terms of our understanding of the impact of preparation on the distributed network underlying response inhibition and the contribution of subcortical areas, such as the basal ganglia, to executive control processes. [source]


Interaction between genioglossus and diaphragm responses to transcranial magnetic stimulation in awake humans

EXPERIMENTAL PHYSIOLOGY, Issue 4 2007
Wei Wang
The modulation of activity of the upper airway dilator and respiratory muscles plays a key role in the regulation of ventilation, but little is known about the link between their neuromuscular activation processes in vivo. This study investigated genioglossus and diaphragm responses to transcranial magnetic stimulation applied in different facilitatory conditions. The amplitude and latency of motor-evoked potential responses and the stimulation intensity threshold leading to a motor response (motor threshold) were recorded with stimulation applied at the vertex and anterolateral area in 13 awake normal subjects. Stimuli were applied during inspiration with and without resistance, during expiration with and without maximal tongue protrusion and during deep inspiration. In each stimulation location and condition, no diaphragmatic response was obtained without previous genioglossus activity (diaphragmatic and genioglossus responses latencies during expiration: 18.1 ± 2.9 and 6.3 ± 2.6 ms, respectively, mean ±s.d., P < 0.01). Genioglossus motor-evoked potential amplitude, latency and motor threshold were significantly modified with tongue protrusion with a maximal effect observed for stimulation in the anterolateral area. Deep inspiration was associated with a significant facilitatory effect on both genioglossus and diaphragm motor responses. The facilitatory effects of respiratory and non-respiratory manoeuvres were also observed during focal stimulation where isolated genioglossus responses were observed. Genioglossus and diaphragm differed in their motor threshold both at baseline and following facilitatory manoeuvres. Conclusions: (1) transcranial magnetic stimulation-induced genioglossus response systematically precedes that of diaphragm; (2) this sequence of activation is not modified by respiratory and non-respiratory manoeuvres; and (3) the genioglossus and diaphragm are differently influenced by these manoeuvres in terms of latency of the motor response and of motor threshold. [source]


Individual differences in socioaffective skills influence the neural bases of fear processing: The case of alexithymia

HUMAN BRAIN MAPPING, Issue 10 2010
Lydia Pouga
Abstract Being exposed to fear signals makes us feel threatened and prompts us to prepare an adaptive response. In our previous studies, we suggested that amygdala (AMG) and premotor cortex (PM) play a role in the preparation of the observers' motor response required by the situation. The present experiment aimed at assessing how interindividual differences in alexithymia,a personality trait associated with deficits in emotional reactivity and regulation,influence the neural network associated with the perception of fear. Using fMRI, we scanned 34 healthy subjects while they were passively observing fearful body expressions. Applying a dimensional approach, we performed correlation analyses between fear-related brain areas and alexithymia scores among all participants. Using a categorical approach, we conducted a between-group comparison (13 high vs. 12 low-alexithymia subjects). Our results were threefold. First, the right AMG activity in response to fearful stimuli was negatively correlated with the level of difficulty to identify emotions. Second, PM activity was linked to reduced subjective emotional reactivity. Third, the between-group comparison revealed greater activity in anterior cingulate cortex (ACC) for high than low-alexithymia scorers. Moreover, the relationship between ACC and PM was in opposite direction in individuals with high (negative link) and low (positive link) alexithymia. Therefore, compared to our previous findings, we hereby further reveal how ACC interacts with PM to sustain self-regulation of one's own emotional state in response to threatening social signals. Moreover, this neural mechanism could account for the description of the "cold-blooded" personality of individuals with alexithymia. Hum Brain Mapp, 2010. © 2010 Wiley-Liss, Inc. [source]


Crossmodal influences in somatosensory cortex: Interaction of vision and touch

HUMAN BRAIN MAPPING, Issue 1 2010
Jennifer K. Dionne
Abstract Previous research has shown that information from one sensory modality has the potential to influence activity in a different modality, and these crossmodal interactions can occur early in the cortical sensory processing stream within sensory-specific cortex. In addition, it has been shown that when sensory information is relevant to the performance of a task, there is an upregulation of sensory cortex. This study sought to investigate the effects of simultaneous bimodal (visual and vibrotactile) stimulation on the modulation of primary somatosensory cortex (SI), in the context of a delayed sensory-to-motor task when both stimuli are task-relevant. It was hypothesized that the requirement to combine visual and vibrotactile stimuli would be associated with an increase in SI activity compared to vibrotactile stimuli alone. Functional magnetic resonance imaging (fMRI) was performed on healthy subjects using a 3T scanner. During the scanning session, subjects performed a sensory-guided motor task while receiving visual, vibrotactile, or both types of stimuli. An event-related design was used to examine cortical activity related to the stimulus onset and the motor response. A region of interest (ROI) analysis was performed on right SI and revealed an increase in percent blood oxygenation level dependent signal change in the bimodal (visual + tactile) task compared to the unimodal tasks. Results of the whole-brain analysis revealed a common fronto-parietal network that was active across both the bimodal and unimodal task conditions, suggesting that these regions are sensitive to the attentional and motor-planning aspects of the task rather than the unimodal or bimodal nature of the stimuli. Hum Brain Mapp, 2010. © 2009 Wiley-Liss, Inc. [source]


Toddlers' use of cues in a search task

INFANT AND CHILD DEVELOPMENT, Issue 3 2008
Rachel Keen
Abstract Search for a ball that has undergone hidden motion rapidly improves during the second year of life (Dev. Psychol., 2000; 36:394,401). In three experiments we investigated whether the poor performance of younger toddlers was due to attentional failure by highlighting the major cue for the hidden object. We observed only slight improvement in search behaviour. We performed two other experiments that tested the depth of understanding of 3-year-olds in this task and found that their performance was robust to changes in the apparatus and experimental procedures. Overall, the results point to a rapidly developing ability in the second year of life to either reason about space or select the correct motor response in search tasks. Copyright © 2008 John Wiley & Sons, Ltd. [source]


The angiotensin converting enzyme (ACE) inhibitor, perindopril, modifies the clinical features of Parkinson's disease

INTERNAL MEDICINE JOURNAL, Issue 1 2000
K. A. Reardon
Abstract Background: Animal studies have demonstrated an interaction within the striatum between the angiotensin and dopaminergic systems. In rats, the angiotensin converting enzyme (ACE) inhibitor, perindopril, crosses the blood brain barrier and increases striatal dopamine synthesis and release. In humans, angiotensin type 1 receptors have been found on dopaminergic neurons in the substantia nigra and striatum. In Parkinson's disease, there is a marked reduction of these receptors associated with the nigrostriatal dopaminergic neuron loss. Aims: We performed a double blind placebo controlled crossover pilot study in seven patients to investigate the effect of the ACE inhibitor, perindopril on the clinical features of moderately severe Parkinson's disease. Results: After a four week treatment period with perindopril, patients had a faster onset in their motor response to L-dopa and a reduction in ,on phase' peak dyskinesia, p=0.021 and p=0.014 respectively. Patients also reported more ,on' periods during their waking day in their movement diary, p=0.007. Perindopril was well tolerated without any significant postural hypotension or renal dysfunction. Conclusions: These results suggest that ACE inhibitors such as perindopril may have a place in the management of motor fluctuations and dyskinesia in Parkinson's disease and justify further study. [source]


Diagnostic and therapeutic value of apomorphine in Parkinsonian patients

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2004
J.C. Sharma
Summary Apomorphine is a dopamine agonist administered subcutaneously for the management of motor symptoms of Parkinson's disease (PD). Patients with Parkinsonian syndrome underwent an apomorphine challenge for therapeutic efficacy, a positive response being a reduction of >15% score on motor unified PD rating scale. Of the 42 patients, aged 37,81, disease duration 12 months to 20 years, 36 had a positive response. Six non-responders were later diagnosed as non-PD as compared with only two of the 36 responders. Tremor-predominant patients obtained higher motor response. Few patients demonstrated a delayed positive response. Seven (three idiopathic PD (iPD), four non-PD) suffered adverse reactions of nausea, vomiting or ill-sustained symptomatic fall in BP. Majority of the patients who continued with apomorphine therapy were able to reduce levodopa and achieved an improvement in dyskinesia and motor symptoms. Thirteen responding patients were managed by increasing dopamine agonists. Five patients, intolerant of oral dopamine agonists, were able to beneficially tolerate apomorphine. Age and disease duration did not influence tolerability or efficacy. The patients treated with apomorphine were able to significantly reduce the dose of levodopa, and there was a reduction in dyskinesia, hallucinations and fluctuations (all p < 0.05). In some patients, apomorphine prevented admission to institutions. We also describe the use of apomorphine in acutely ill patients unable to ingest oral medication. Apomorphine seems to have a diagnostic element for iPD. Its use leads to a reduction in dyskinesia, improvement in motor symptoms and prevention of institutional care. Apomorphine test also identifies patients likely to benefit with an increase in oral medication. Age and disease duration should not prevent the use of this valuable drug. Apomorphine also has a role in acutely ill PD patients. [source]


High or low current threshold for nerve stimulation for regional anaesthesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009
T. STEINFELDT
Background: The purpose of this study was to determine whether the application of high stimulation current thresholds (SCT) leads to a distant needle to nerve proximity (NNP) compared with low SCT during nerve localization for regional anaesthesia in pigs. Methods: A minimal motor response to the stimulation of femoral or brachial plexus nerves in 16 anaesthetized pigs was triggered either by a minimal SCT of a low (0.01,0.3 mA) or a high (0.8,1.0 mA) current in a random order. After eliciting a motor response with a predetermined SCT, synthetic resin was injected via the needle. After postmortem dissection of the injection site, the localization of the resin deposition was determined verifying the final position of the needle tip. Depending on the proximity of resin deposition to the nerve epineurium, the needle tip placement was considered either as a close or a distant NNP. Results: A total of 235 punctures were performed. Ninety-one punctures were carried out with low SCT and 92 with a high SCT. Fifty-two punctures served as a control (1.8,2.0 mA). All injectates following both high or low SCT were considered ,close needle tip to nerve placement', whereas 27 of 52 injectates of the control group appeared distant to nerve epineurium. Conclusion: Regardless of the applied SCT, i.e. high or low, all resin deposition was found adjacent to nerve epineurium. These findings suggest that high and low SCT result in equivalent needle tip localization in pigs. [source]


Contingent negative variation elicited before jaw and tongue movements

JOURNAL OF ORAL REHABILITATION, Issue 12 2005
K. YOSHIDA
summary, Contingent negative variation (CNV) is a negative brain potential occurring between two successive stimuli when the first stimulus is a warning and the second stimulus requires a motor response. The CNV is interpreted as an expression of the cognitive processes in preparation for a response directed to a purpose. Using 19 electrodes we recorded CNVs for mouth opening, closing and lateral movements, tongue protrusion and hand extension in 10 healthy subjects. The aim of the study was to examine the motor control mechanism underlying jaw and tongue movements in a cognitive paradigm. The first stimulus (S1) served as a preparatory warning signal for the imperative stimulus (S2) 2 s after the S1. The subject performed the experimental tasks after the S2. The grand average CNVs for jaw and tongue movements showed a bilaterally widespread negativity with the maximum in the vertex region (Cz). The early CNV was identified about 400 ms after the S1 and its amplitude was highest at the midline-frontal area. The late CNV started approximately 1000 ms after the S1 with the maximum at Cz. The mean amplitude was significantly lower for hand extension than for the other tasks, and significantly higher for lateral movement than for mouth closing, suggesting that the CNV amplitude can be affected by the complexity of the task. The CNV recording may provide a means to study the neuronal activity necessary for the sensorimotor integration of jaw and tongue movements. [source]


Cervical epidural analgesia via a thoracic approach using nerve-stimulation guidance in adult patients undergoing total shoulder replacement surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2007
B. C. H. Tsui
Background:, Continuous cervical epidural anesthesia can provide excellent peri- and post-operative analgesia, although several factors prevent its widespread use. Advancing catheters from thoracic levels to the cervical region may circumvent these barriers, provided they are accurately positioned. We hypothesize that guiding catheters from thoracic to cervical regions using low-current epidural stimulation will have a high success rate and enable excellent analgesia in adults undergoing total shoulder arthroplasty. Methods:, After Institutional Review Board approval, adult patients were studied consecutively. A 17-G Tuohy needle was inserted into the thoracic epidural space using a right paramedian approach with loss of resistance. A 20-G styletted epidural catheter, with an attached nerve stimulator, was primed with saline and a 1,10 mA current was applied as it advanced in a cephalad direction towards the cervical spine. Muscle twitch responses were observed and post-operative X-ray confirmed final placement. After a test dose, an infusion (2,8 ml/h) of ropivacaine 2 mg/ml and morphine 0.05 mg/ml (or equivalent) was initiated. Verbal analog pain scale scores were collected over 72 h. Results:, Cervical epidural anesthesia was performed on 10 patients. Average current required to elicit a motor response was 4.8 ± 2.0mA. Post-operative X-ray of catheter positions confirmed all catheter tips reached the desired region (C4,7). The technical success rate for catheter placement was 100% and excellent pain control was achieved. Catheters were positioned two to the left, four to the right and four to the midline. Conclusion:, This epidural technique provided highly effective post-operative analgesia in a patient group that traditionally experiences severe post-operative pain and can benefit from early mobilization. [source]


Congenital hypomyelination neuropathy in a newborn infant: unusual cause of diaphragmatic and vocal cord paralyses

JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2002
JS Hahn
We report a case of congenital hypomyelination neuropathy presenting at birth. The infant had generalized hypotonia and weakness. There was decreased respiratory effort along with a right phrenic nerve and left vocal cord paralyses. Tongue fasciculations were present. Deep tendon reflexes were absent in the upper extremities and hypoactive (1+) in the lower extremities. Magnetic resonance imaging of the head revealed no intracranial abnormalities, including normal cerebral myelination. Nerve conduction study showed absence of motor and sensory action potentials in the hands when the nerves in the upper limbs were stimulated. A motor response could be elicited only in the proximal leg muscles. Needle electromyography study was normal in the proximal limb muscles, but showed active denervation in the distal muscles of the arm and leg. These findings were thought to be consistent with a length-dependent sensorimotor peripheral polyneuropathy of axonal type with greater denervation of the distal muscles. A biopsy of the quadriceps muscle showed mild variability in fiber diameter, but no group typing or group atrophy. The muscle fibers showed no intrinsic abnormalities. Biopsy of the sural nerve showed scattered axons with very thin myelin sheaths. There was also a nearly complete loss of large diameter myelinated fibers. No onion bulb formations were noted. These findings were thought to be consistent with congenital hypomyelination neuropathy with a component of axonopathy. DNA analysis for identification of previously characterized mutations in the genes MPZ, PMP22, and EGR2 was negative. Several attempts at extubation failed and the infant became increasingly ventilator-dependent with increasing episodes of desaturation and hypercapnea. He also developed increasing weakness and decreased movement of all extremities. He underwent surgery at 2 months of age for placement of a gastrostomy tube and a tracheostomy. He was discharged from the hospital on a ventilator at 6 months of age. The infant was 13 months old at the time of submission of this report. Although he appears cognitively normal, he remains profoundly hypotonic and is on a home ventilator. There was no evidence of progressive weakness. Congenital hypomyelination neuropathy is a rare form of neonatal neuropathy that should be considered in the differential diagnosis of a newborn with profound hypotonia and weakness. It appears to be a heterogeneous disorder with some of the cases being caused by specific genetic mutations. [source]


Electrophysiological Changes In Diabetic Neuropathy: From Subclinical Alterations To Disabling Abnormalities

JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 3 2000
M. Baba
Clinical spectrum of diabetic neuropathy is variable; it may be asymptomatic, but once established, it becomes irreversible and disabling. Some investigators suggested that earliest change in diabetic nerve function is alteration in axonal excitability due to alterations in ion conductance of axon membrane, although these functional changes of ion channels necessarily cause permanent damage or degeneration of nerve fibers. Among various parameter of nerve conduction study in diabetics, prolonged F-wave latency in the peroneal and tibial nerve seems the commonest abnormality in asymptomatic patients. Decrease in amplitude of compound sensory action potential of sural nerve is another earlier abnormality, which is, then, accompanied by a fall in motor amplitude of peroneal and tibial nerves in advanced patients. In disabled patients no motor response is often elicited in the legs. Previous electrophysiological studies could not make clear if central axons were involved or not in diabetic neuropathy. Recently, our group has demonstrated that somatosensory central conduction from the spinal cord to the sensory cortex is delayed in diabetics as well as in the peripheral conduction, which might be partly responsible for the irreversible clinical presentation of diabetic neuropathy. [source]


Dextrose 5% in water: fluid medium for maintaining electrical stimulation of peripheral nerves during stimulating catheter placement

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2005
B. C. H. Tsui
It is well documented that a higher electrical current is required to elicit a motor response following a normal saline (NS) injection during the placement of stimulating catheters for peripheral nerve block. We present three cases of continuous brachial plexus catheter placement in which Dextrose 5% in water (D5W) was used to dilate the perineural space instead of NS. Three brachial plexus blocks (two interscalene and one axillary) were performed in three different patients for pain relief. In each case, an insulated needle was advanced towards the brachial plexus. A corresponding motor response was elicited with a current less than 0.5 mA after needle repositioning. A stimulating catheter was advanced with ease after 3,5 ml of D5W was injected to dilate the perineural space. A corresponding motor response was maintained when the current applied to the stimulating catheter was less than 0.5 mA. Local anesthetic was then injected and the motor response immediately ceased. All blocks were successful and provided excellent pain relief with the continuous infusion of local anesthetics. [source]


Colonic motility in chronic ulcerative proctosigmoiditis and the effects of nicotine on colonic motility in patients and healthy subjects

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2001
B. Coulie
Background: Nicotine decreases diarrhoea and pain in ulcerative colitis without reducing inflammation. Aims: (i) To evaluate the effect of ulcerative proctosigmoiditis on motor functions of an uninflamed segment of descending colon; and (ii) to assess nicotine's effects on colonic motor functions in patients and healthy subjects. Methods: In healthy subjects (n=30) and patients with ulcerative colitis (13; 11 active, two quiescent colitis), we studied the effects of intravenous nicotine on colonic transit of solid residue by scintigraphy (healthy subjects) and on colonic motility in healthy subjects and 11 patients. Results: In ulcerative colitis, fasting colonic motility was increased, whereas motor response to a meal was significantly reduced; compliance was unchanged. In healthy subjects, high-dose nicotine induced transient high amplitude propagated contractions and relaxation of the descending colon followed by decreased phasic contractions. This dose also accelerated colonic transit. Low-dose nicotine (mimicking a transdermal nicotine patch) reduced colonic compliance in healthy subjects, but did not affect motor function in ulcerative colitis. Conclusions: Ulcerative proctosigmoiditis increases fasting colonic motility and reduces tone response to a meal in the descending colon without affecting colonic compliance, suggesting changes in physiological responses but not intrinsic wall properties. Nicotine has dose-dependent effects on colonic motor activity in healthy subjects. [source]


Sensory nerve conduction deficit in experimental monoclonal gammopathy of undetermined significance (MGUS) neuropathy

MUSCLE AND NERVE, Issue 6 2001
Michael W. Lawlor BS
Abstract An emerging body of evidence from in vitro studies and in vivo animal models supports a pathogenic role of antibodies in the development of peripheral neuropathy associated with monoclonal gammopathy of undetermined significance (MGUS). Although the assessment of motor and sensory nerve fiber function is of clinical importance, it is seldom applied experimentally. We describe the application of an electrophysiologic method for the evaluation of motor and sensory nerve fiber function using an experimental model of MGUS neuropathy. Supramaximal stimulation of the tibial nerve elicited an early motor response (M-wave, 1.7 ± 0.1 ms, n = 10) and a late sensory (H-reflex, 7.8 ± 0.1 ms, n = 10) response that was recorded from the hind foot of anesthetized rats. Intraneural injection of serum antibodies from a MGUS patient with sensorimotor polyneuropathy, but not from an age-matched control subject, produced a marked attenuation of the H-reflex (P < 0.01, n = 10) without affecting the M-wave. Light and electron microscopy of affected nerve showed myelinoaxonal degeneration with sparing of the smaller unmyelinated nerve fibers. The combined electrophysiologic and morphologic findings presented in this study are consistent with a selective sensory conduction deficit in MGUS neuropathy. Selective injury of afferent nerve fibers by this patient's serum antibodies may result from reactivity to neural antigens uniquely expressed by sensory neurons. © 2001 John Wiley & Sons, Inc. Muscle Nerve 24: 809,816, 2001 [source]


Mucosal mast cells mediate motor response induced by chronic oral exposure to ovalbumin in the rat gastrointestinal tract

NEUROGASTROENTEROLOGY & MOTILITY, Issue 1 2010
E. Traver
Abstract, We previously demonstrated that oral chronic exposure to ovalbumin (OVA) causes intestinal hypermotility in Sprague-Dawley rats. In this study, the objective was to determine the mechanism of action of OVA and the role of mucosal mast cells in the regulation of motor activity in this model. Rats were orally exposed to OVA during 6 weeks. Intestinal mucosal mast cells (IMMCs) were counted and rat mast cell protease II (RMCPII) measured in duodenum, jejunum, ileum and colon. Anti-OVA IgE, IgG, and IL-4 were measured in serum. Eosinophils and IgE+ cells were counted in jejunum. In an additional study rats were treated with the mast cell stabilizer ketotifen and mast cell number, RMCPII concentration and motor activity in vitro were evaluated. OVA exposed rats showed an increase in mucosal mast cell number and in RMCPII content in small intestine and colon. However, variables of a Th2 type response were not affected by exposure to OVA: (i) neither OVA specific IgE nor IgG were found; (ii) IL-4 did not increase and, (iii) the number of eosinophils and IgE+ cells was identical in the exposed and unexposed groups. These results brought us to hypothesize a possible non-Ig-mediated action of OVA on mast cells. Ketotifen significantly diminished the response to OVA: Ketotifen reduced the number of mast cells and the RMCPII content and blocked increased intestinal contractility. In addition ketotifen modified motor response in both OVA exposed and unexposed animals giving evidence of the importance of mast cells in intestine motor activity driving. [source]


Differences in circular muscle contraction and peristaltic motor inhibition caused by tachykinin NK1 receptor agonists in the guinea-pig small intestine

NEUROGASTROENTEROLOGY & MOTILITY, Issue 2 2000
Shahbazian
The tachykinin NK1 receptor agonist substance P methyl ester (SPOME) impedes intestinal peristalsis by releasing nitric oxide (NO) from inhibitory motor neurones. Since NK1 receptor agonists differ in their receptor interaction, we set out to compare a range of NK1 receptor agonists including SPOME, septide and GR-73 632 in their effects on propulsive peristalsis and circular muscle activity in the guinea-pig isolated small intestine. SPOME (100,300 n M) inhibited peristalsis by a rise of the pressure threshold at which peristaltic waves were triggered, whereas septide and GR-73 632 (30,300 n M) interrupted peristalsis by causing circular muscle spasms. Separate experiments showed that all three NK1 receptor agonists caused contraction of the circular muscle, which was enhanced by the NO synthase inhibitor NG -nitro- L -arginine methyl ester (300 ,M) and the P2X purinoceptor antagonist suramin (300 ,M). In contrast, tetrodotoxin (300 n M) augmented the contractile effect of septide and GR-73 632 but not that of SPOME. It is concluded that the motor response to NK1 receptor agonists involves release of NO and adenosine triphosphate from inhibitory motor neurones. However, the NK1 receptor agonists differ in the mechanism by which they cause inhibitory transmitter release, which corresponds to differences in their antiperistaltic action. [source]


Prognostication after cardiac arrest and hypothermia: A prospective study

ANNALS OF NEUROLOGY, Issue 3 2010
Andrea O. Rossetti MD
Objective Current American Academy of Neurology (AAN) guidelines for outcome prediction in comatose survivors of cardiac arrest (CA) have been validated before the therapeutic hypothermia era (TH). We undertook this study to verify the prognostic value of clinical and electrophysiological variables in the TH setting. Methods A total of 111 consecutive comatose survivors of CA treated with TH were prospectively studied over a 3-year period. Neurological examination, electroencephalography (EEG), and somatosensory evoked potentials (SSEP) were performed immediately after TH, at normothermia and off sedation. Neurological recovery was assessed at 3 to 6 months, using Cerebral Performance Categories (CPC). Results Three clinical variables, assessed within 72 hours after CA, showed higher false-positive mortality predictions as compared with the AAN guidelines: incomplete brainstem reflexes recovery (4% vs 0%), myoclonus (7% vs 0%), and absent motor response to pain (24% vs 0%). Furthermore, unreactive EEG background was incompatible with good long-term neurological recovery (CPC 1,2) and strongly associated with in-hospital mortality (adjusted odds ratio for death, 15.4; 95% confidence interval, 3.3,71.9). The presence of at least 2 independent predictors out of 4 (incomplete brainstem reflexes, myoclonus, unreactive EEG, and absent cortical SSEP) accurately predicted poor long-term neurological recovery (positive predictive value = 1.00); EEG reactivity significantly improved the prognostication. Interpretation Our data show that TH may modify outcome prediction after CA, implying that some clinical features should be interpreted with more caution in this setting as compared with the AAN guidelines. EEG background reactivity is useful in determining the prognosis after CA treated with TH. ANN NEUROL 2010;67:301,307 [source]


Prognostic value of brain diffusion-weighted imaging after cardiac arrest,

ANNALS OF NEUROLOGY, Issue 4 2009
Christine A. C. Wijman MD
Objective Outcome prediction is challenging in comatose postcardiac arrest survivors. We assessed the feasibility and prognostic utility of brain diffusion-weighted magnetic resonance imaging (DWI) during the first week. Methods Consecutive comatose postcardiac arrest patients were prospectively enrolled. AWI data of patients who met predefined specific prognostic criteria were used to determine distinguishing apparent diffusion coefficient (ADC) thresholds. Group 1 criteria were death at 6 months and absent motor response or absent pupillary reflexes or bilateral absent cortical responses at 72 hours or vegetative at 1 month. Group 2 criterion was survival at 6 months with a Glasgow Outcome Scale score of 4 or 5 (group 2A) or 3 (group 2B). The percentage of voxels below different ADC thresholds was calculated at 50 × 10,6 mm2/sec intervals. Results Overall, 86% of patients underwent DWI. Fifty-one patients with 62 brain DWIs were included. Forty patients met the specific prognostic criteria. The percentage of brain volume with an ADC value less than 650 to 700 × 10,6mm2/sec best differentiated between Group 1 and Groups 2A and 2B combined (p < 0.001), whereas the 400 to 450 × 10,6mm2/sec threshold best differentiated between Groups 2A and 2B (p = 0.003). The ideal time window for prognostication using DWI was between 49 and 108 hours after the arrest. When comparing DWI in this time window with the 72-hour neurological examination, DWI improved the sensitivity for predicting poor outcome by 38% while maintaining 100% specificity (p = 0.021). Interpretation Quantitative DWI in comatose postcardiac arrest survivors holds promise as a prognostic adjunct. Ann Neurol 2009;65:394,402 [source]


Predictive factors for successful sacral nerve stimulation in the treatment of faecal incontinence: a 10-year cohort analysis

COLORECTAL DISEASE, Issue 3 2008
T. C. Dudding
Abstract Objective, Sacral nerve stimulation (SNS) is an established treatment for faecal incontinence. We aimed to identify specific factors that could predict the outcome of temporary and permanent stimulation. Method, A cohort analysis was performed to identify potential predictive factors in 81 patients who underwent temporary SNS at a single institution over a 10-year period (June 1996 to June 2006). Data were obtained from prospectively collected patient symptom diaries and quality of life questionnaires, operation reports, anorectal physiological studies, endoanal ultrasound images and radiology of lead placement. Results, Clinical outcome of temporary screening was not affected by patient gender, age, body mass index, severity or length of symptoms. The need for a repeated temporary procedure was associated with subsequent failure during screening (P = 0.008). A low threshold to obtain a motor response during temporary lead insertion was associated with improved outcome (P = 0.048). Evidence of anal sphincter trauma was associated with a greater risk of failure (P = 0.040). However, there was no difference in medium-term outcome between patients with external anal sphincter (EAS) defects and patients with intact anal sphincter muscles. Conclusion, Variables have been identified that help to predict the outcome of SNS. The presence of an EAS defect should not preclude treatment. [source]


Repeated exposures to gustatory stimuli produce habituation or positive contrast effects in perinatal rats

DEVELOPMENTAL PSYCHOBIOLOGY, Issue 3 2004
G. Andrew Mickley
Abstract Adult rats exhibit a decrease in consummatory responses following repeated presentations of a taste (habituation) and an increase in consummatory responses if they experience an upward shift in the magnitude or intensity of a gustatory stimulus (e.g., sucrose or saccharin). These responses do not represent a direct sensorimotor reaction to a gustatory cue, but rather reflect a change in responding based on the memory of a previous taste. Here, we sought to determine if fetal rats could (like adults) adjust their orofacial motor responses based on a memory of recent gustatory experience. Embryonic Day 18 (E18) or Day 19 (E19) rat fetuses received oral lavage with either 0.15 or 0.30% saccharin (SAC). Subsequently, observations of orofacial movements (mouthing and licking) following oral lavage with 0.30% SAC were made 50 min later, 24 hr later, or on postnatal Day 3 (P3). Thus, some animals were in a "shifted" condition in which they first experienced a relatively low concentration of SAC and then a higher one while control rats ("nonshifted") received 0.30% SAC during both taste exposures. Fetuses exhibited evidence of both habituation (with repeated presentation of the 0.30% SAC) and positive contrast effects (PCEs) (following an upward shift in SAC concentration) when retested 50 min after their first exposure to SAC on E19. However, these animals did not exhibit PCEs 24 hr later or 5 days later (on P3). Contrast effects were not observed when the initial SAC exposure was on E18, and habituation responses were variable depending on the time interval between the taste presentations to these animals. Rats with a 5- to 6-day latency between the two taste presentations showed neither PCEs nor habituation. Our data indicate that PCEs and habituation effects emerge at different ages, and their demonstration is dependent upon the latency between the taste presentations. © 2004 Wiley Periodicals, Inc. Dev Psychobiol 44: 176,188, 2004. [source]


Chronic inflammatory demyelinating polyneuropathy, phrenic nerve and respiratory symptoms

EUROPEAN JOURNAL OF NEUROLOGY, Issue 1 2005
J. Costa
Respiratory involvement in chronic inflammatory demyelinating polyneuropathy (CIDP) has been very recently described. Phrenic nerve conduction studies have been described as useful to detect respiratory impairment in these patients. This study describes two patients with CIDP, in whom neurophysiological studies of the respiratory muscles were performed. The first patient had severe respiratory insufficiency, and phrenic nerve studies disclosed no motor responses and electromyography (EMG) of the diaphragm confirmed severe loss of motor units, bilaterally. On treatment, we documented clinical and neurophysiological improvement. In the second patient, phrenic nerve studies showed abnormal results; however, EMG of the diaphragm ruled out loss of motor units. The first case represents the risk of phrenic nerve involvement in this disorder, and the potential recovery on treatment. The second case illustrates that the temporal dispersion of the motor responses can be misleading, and EMG of diaphragm should be performed to confirm the loss of motor units. [source]


Afferent-induced facilitation of primary motor cortex excitability in the region controlling hand muscles in humans

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2009
H. Devanne
Abstract Sensory inputs from cutaneous and limb receptors are known to influence motor cortex network excitability. Although most recent studies have focused on the inhibitory influences of afferent inputs on arm motor responses evoked by transcranial magnetic stimulation (TMS), facilitatory effects are rarely considered. In the present work, we sought to establish how proprioceptive sensory inputs modulate the excitability of the primary motor cortex region controlling certain hand and wrist muscles. Suprathreshold TMS pulses were preceded either by median nerve stimulation (MNS) or index finger stimulation with interstimulus intervals (ISIs) ranging from 20 to 200 ms (with particular focus on 40,80 ms). Motor-evoked potentials recorded in the abductor pollicis brevis (APB), first dorsalis interosseus and extensor carpi radialis muscles were strongly facilitated (by up to 150%) by MNS with ISIs of around 60 ms, whereas digit stimulation had only a weak effect. When MNS was delivered at the interval that evoked the optimal facilitatory effect, the H-reflex amplitude remained unchanged and APB motor responses evoked with transcranial electric stimulation were not increased as compared with TMS. Afferent-induced facilitation and short-latency intracortical inhibition (SICI) and intracortical facilitation (ICF) mechanisms are likely to interact in cortical circuits, as suggested by the strong facilitation observed when MNS was delivered concurrently with ICF and the reduction of SICI following MNS. We conclude that afferent-induced facilitation is a mechanism which probably involves muscle spindle afferents and should be considered when studying sensorimotor integration mechanisms in healthy and disease situations. [source]


The role of the medial caudate nucleus, but not the hippocampus, in a matching-to sample task for a motor response

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 7 2006
Raymond P. Kesner
Abstract A delayed-match-to-sample task was used to assess memory for motor responses in rats with control, hippocampus, or medial caudate nucleus (MCN) lesions. All testing was conducted on a cheeseboard maze in complete darkness using an infrared camera. A start box was positioned in the centre of the maze facing a randomly determined direction on each trial. On the sample phase, a phosphorescent object was randomly positioned to cover a baited food well in one of five equally spaced positions around the circumference of the maze forming a 180-degree arc 60 cm from the box. The rat had to displace the object to receive food and return to the start box. The box was then rotated to face a different direction. An identical baited phosphorescent object was placed in the same position relative to the start box. A second identical object was positioned to cover a different unbaited well. On the choice phase, the rat must remember the motor response made on the sample phase and make the same motor response on the choice phase to receive a reward. Hippocampus lesioned and control rats improved as a function of increased angle separation used to separate the correct object from the foil (45, 90, 135, and 180 degrees) and matched the performance of controls. However, rats with MCN lesions were impaired across all separations. Results suggest that the MCN, but not the hippocampus, supports working memory and/or a process aimed at reducing interference for motor response selection based on vector angle information. [source]


Interaction between genioglossus and diaphragm responses to transcranial magnetic stimulation in awake humans

EXPERIMENTAL PHYSIOLOGY, Issue 4 2007
Wei Wang
The modulation of activity of the upper airway dilator and respiratory muscles plays a key role in the regulation of ventilation, but little is known about the link between their neuromuscular activation processes in vivo. This study investigated genioglossus and diaphragm responses to transcranial magnetic stimulation applied in different facilitatory conditions. The amplitude and latency of motor-evoked potential responses and the stimulation intensity threshold leading to a motor response (motor threshold) were recorded with stimulation applied at the vertex and anterolateral area in 13 awake normal subjects. Stimuli were applied during inspiration with and without resistance, during expiration with and without maximal tongue protrusion and during deep inspiration. In each stimulation location and condition, no diaphragmatic response was obtained without previous genioglossus activity (diaphragmatic and genioglossus responses latencies during expiration: 18.1 ± 2.9 and 6.3 ± 2.6 ms, respectively, mean ±s.d., P < 0.01). Genioglossus motor-evoked potential amplitude, latency and motor threshold were significantly modified with tongue protrusion with a maximal effect observed for stimulation in the anterolateral area. Deep inspiration was associated with a significant facilitatory effect on both genioglossus and diaphragm motor responses. The facilitatory effects of respiratory and non-respiratory manoeuvres were also observed during focal stimulation where isolated genioglossus responses were observed. Genioglossus and diaphragm differed in their motor threshold both at baseline and following facilitatory manoeuvres. Conclusions: (1) transcranial magnetic stimulation-induced genioglossus response systematically precedes that of diaphragm; (2) this sequence of activation is not modified by respiratory and non-respiratory manoeuvres; and (3) the genioglossus and diaphragm are differently influenced by these manoeuvres in terms of latency of the motor response and of motor threshold. [source]