Experiment for teaching virtual cathode in nerve conduction studies

Differential effects of stimulus intensity on peripheral and neuromagnetic cortical responses to median nerve stimulation

Clinical usefulness of ulnar motor responses recording from first dorsal interosseous

Distilling the essence of TMS-evoked EEG potentials (TEPs): A call for securing mechanistic specificity and experimental rigor

Nerve conduction studies (NCS) and electromyography (EMG), often shortened to 'EMGs', are a useful adjunct to clinical examination of the peripheral nervous system and striated skeletal muscle. NCS provide an efficient and rapid method of quantifying nerve conduction velocity (CV) and the amplitude of both sensory nerve action potentials (SNAPs) and compound motor action potentials (cMAPs). The CV reflects speed of propagation of action potentials, by saltatory conduction, along large myelinated axons in a peripheral nerve. The amplitude of SNAPs is in part determined by the number of axons in a sensory nerve, whilst amplitude of cMAPs reflects integrated function of the motor axons, neuromuscular junction and striated muscle. Repetitive nerve stimulation (RNS) can identify defects of neuromuscular junction (NMJ) transmission, pre- or post-synaptic. Needle EMG examination can detect myopathic changes in muscle and signs of denervation. Combinations of these procedures can establish if motor and/or sensory nerve cell bodies or peripheral nerves are damaged (e.g. motor neuronopathy, sensory ganglionopathy or neuropathy), and also indicate if the primary target is the axon or the myelin sheath (i.e. axonal or demyelinating neuropathies). The distribution of nerve damage can be determined as either generalised, multifocal (mononeuropathy multiplex) or focal. The latter often due to compression at the common entrapment sites (such as the carpal tunnel, Guyon's canal, cubital tunnel, radial groove, fibular head and tarsal tunnel, to name but a few of the reported hundred or so 'entrapment neuropathies').

12 - Electrodiagnostic Examination

Spiking Irregularity and Frequency Modulate the Behavioral Report of Single-Neuron Stimulation

The auditory brainstem response (ABR) is a measure of subcortical activity in response to auditory stimuli. The wave V peak of the ABR depends on the stimulus intensity level, and has been widely used for clinical hearing assessment. Conventional methods estimate the ABR average electroencephalography (EEG) responses to short unnatural stimuli such as clicks. Recent work has moved toward more ecologically relevant continuous speech stimuli using linear deconvolution models called temporal response functions (TRFs). Investigating whether the TRF waveform changes with stimulus intensity is a crucial step toward the use of natural speech stimuli for hearing assessments involving subcortical responses. Here, we develop methods to estimate level-dependent subcortical TRFs using EEG data collected from 21 participants listening to continuous speech presented at 4 different intensity levels. We find that level-dependent changes can be detected in the wave V peak of the subcortical TRF for almost all participants, and are consistent with level-dependent changes in click-ABR wave V. We also investigate the most suitable peripheral auditory model to generate predictors for level-dependent subcortical TRFs and find that simple gammatone filterbanks perform the best. Additionally, around 6 min of data may be sufficient for detecting level-dependent effects and wave V peaks above the noise floor for speech segments with higher intensity. Finally, we show a proof-of-concept that level-dependent subcortical TRFs can be detected even for the inherent intensity fluctuations in natural continuous speech.

BackgroundAlthough reaction time is commonly used as an indicator of central nervous system integrity, little is currently understood about the mechanisms that determine processing time. In the current study, we are interested in determining the differences in electrophysiological events associated with significant changes in reaction time that could be elicited by changes in stimulus intensity. The primary objective is to assess the effect of increasing stimulus intensity on the latency and amplitude of afferent inputs to the somatosensory cortex, and their relation to reaction time.MethodsMedian nerve stimulation was applied to the non-dominant hand of 12 healthy young adults at two different stimulus intensities (HIGH & LOW). Participants were asked to either press a button as fast as possible with their dominant hand or remain quiet following the stimulus. Electroencephalography was used to measure somatosensory evoked potentials (SEPs) and event related potentials (ERPs). Electromyography from the flexor digitorum superficialis of the button-pressing hand was used to assess reaction time. Response time was the time of button press.ResultsReaction time and response time were significantly shorter following the HIGH intensity stimulus compared to the LOW intensity stimulus. There were no differences in SEP (N20 & P24) peak latencies and peak-to-peak amplitude for the two stimulus intensities. ERPs, locked to response time, demonstrated a significantly larger pre-movement negativity to positivity following the HIGH intensity stimulus over the Cz electrode.DiscussionThis work demonstrates that rapid reaction times are not attributable to the latency of afferent processing from the stimulated site to the somatosensory cortex, and those latency reductions occur further along the sensorimotor transformation pathway. Evidence from ERPs indicates that frontal planning areas such as the supplementary motor area may play a role in transforming the elevated sensory volley from the somatosensory cortex into a more rapid motor response.

During early development, peripheral sensory systems generate physiological activity prior to exposure to normal environmental stimuli. This activity is thought to facilitate maturation of these neurons and their connections, perhaps even promoting efficacy or modifying downstream circuitry. In the mammalian auditory system, initial connections form at embryonic ages, but the functional characteristics of these early neural connections have not been assayed. We investigated processes of embryonic auditory development using a whole-head slice preparation that preserved connectivity between peripheral and brainstem stations of the auditory pathway. Transgenic mice expressing fluorescent protein provided observation of spiral ganglion and cochlear nucleus neurons to facilitate targeted electrophysiological recording. Here we demonstrate an apparent peripheral-to-central order for circuit maturation. Spiral ganglion cells acquire action potential-generating capacity at embryonic day 14 (E14), the earliest age tested, and action potential waveforms begin to mature in advance of comparable states for neurons of the ventral cochlear nucleus (VCN) and medial nucleus of the trapezoid body (MNTB). In accordance, auditory nerve synapses in the VCN are functional at E15, prior to VCN connectivity with the MNTB, which occurs at least 1 day later. Spiral ganglion neurons exhibit spontaneous activity at least by E14 and are able to drive third-order auditory brainstem neurons by E17. This activity precedes cochlear-generated wave activity by 4 days and ear canal opening by at least 2 weeks. Together, these findings reveal a previously unknown initial developmental phase for auditory maturation, and further implicate the spiral ganglion as a potential controlling centre in this process.

Workshop 3: Nerve Conduction Studies (NCS)/Electromyography (EMG) WS3.1. Basic Principles and Pitfalls of NCS

A molecular genetic approach was exploited to directly test the hypothesis that voltage-gated K+ (Kv) channel pore-forming (alpha) subunits of the Kv4 subfamily encode the fast transient outward K+ current (IA) in cortical pyramidal neurons and to explore the functional role of IA in shaping action potential waveforms and in controlling repetitive firing in these cells. Using the biolistic gene gun, cDNAs encoding a mutant Kv4.2 alpha subunit (Kv4.2W362F), which functions as a dominant negative (Kv4.2DN), and enhanced green fluorescent protein (EGFP) were introduced in vitro into neurons isolated from postnatal rat primary visual cortex. Whole-cell voltage-clamp recordings obtained from EGFP-positive pyramidal neurons revealed that IA is selectively eliminated in cells expressing Kv4.2DN. The densities and properties of the other Kv currents are unaffected. In neurons expressing Kv4.2DN, input resistances are increased and the (current) thresholds for action potential generation are decreased. In addition, action potential durations are prolonged, the amplitudes of afterhyperpolarizations are reduced, and the responses to prolonged depolarizing inputs are altered markedly in cells expressing Kv 4.2DN. At low stimulus intensities, firing rates are increased in Kv4.2DN-expressing cells, whereas at high stimulus intensities, Kv4.2DN-expressing cells adapt strongly. Together, these results demonstrate that Kv4alpha subunits encode IA channels and that IA plays a pivotal role in shaping the waveforms of individual action potentials and in controlling repetitive firing in visual cortical pyramidal neurons.

Waveform changes of compound muscle action potential (CMAP) with muscle length

Background and purpose: Magnetic fields have been widely used in diagnosis and treatment of diseases. The purpose of this study is to investigate the effects of magnets on nerve conduction studies (NCS) in human. Methods: After excluding subjects with peripheral neuropathy or diabetic neuropathy, 12 normal subjects were recruited (mean age is 30.0 ± 5.2 years old; 5 are female and 7 are male). Two magnets were individually placed on the left distal wrist crease and on the forearm 5 cm distal to the elbow crease, where the median nerve goes underneath. NCS was performed before and 15 minutes during application, and 10 minutes after removal of magnets. The NCS's include motor nerve conduction study (MNCS), sensory nerve conduction study (SNCS) and F-wave study of the median nerve. Results: The motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) became slower. Distal latency and F-latency were prolonged and F-persistence showed a significant decrease during application of magnets. The effects persisted even 10 minutes after removal of magnets. The amplitudes of compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) showed a trend of decrease but not significant statistically. The area of CMAP was also significantly decreased during application of magnets. Conclusions: We conclude that magnets have significant effects on NCS's in human.

Despite interest in dopamine's role in emotion-based decision-making, few reports of the effects of dopamine manipulations are available in this area in humans. This study investigates dopamine's role in emotion-based decision-making through a common measure of this construct, the Iowa Gambling Task (IGT), using Acute Tyrosine Phenylalanine Depletion (ATPD). In a between-subjects design, 40 healthy adults were randomized to receive either an ATPD beverage or a balanced amino acid beverage (a control) prior to completing the IGT, as well as pre- and post-manipulation blood draws for the neurohormone prolactin. Together with conventional IGT performance metrics, choice selections and response latencies were examined separately for good and bad choices before and after several key punishment events. Changes in response latencies were also used to predict total task performance. Prolactin levels increased significantly in the ATPD group but not in the control group. However, no significant group differences in performance metrics were detected, nor were there sex differences in outcome measures. However, the balanced group's bad deck latencies speeded up across the task, while the ATPD group's latencies remained adaptively hesitant. Additionally, modulation of latencies to the bad decks predicted total score for the ATPD group only. One interpretation is that ATPD subtly attenuated reward salience and altered the approach by which individuals achieved successful performance, without resulting in frank group differences in task performance.

Functional neuroimaging experiments have revealed an organization of frequency-dependent responses in human auditory cortex suggestive of multiple tonotopically organized areas. Numerous studies have sampled cortical responses to isolated narrow-band stimuli, revealing multiple locations in auditory cortex at which the position of response varies systematically with frequency content. Because appropriate anatomical or functional grouping of these distinct frequency-dependent responses is uncertain, the number and location of tonotopic mappings within human auditory cortex remains unclear. Further, sampling does not address whether the observed mappings exhibit continuity as a function of position. This functional magnetic resonance imaging study used frequency-swept stimuli to identify progressions of frequency sensitivity across the cortical surface. The center-frequency of narrow-band, amplitude-modulated noise was slowly swept between 125 and 8,000 Hz. The latency of response relative to sweep onset was determined for each cortical surface location. Because frequency varied systematically with time, response latency indicated the frequency to which a location was maximally sensitive. Areas of cortex exhibiting a progressive change in response latency with position were considered tonotopically organized. There exist two main findings. First, six progressions of frequency sensitivity (i.e., tonotopic mappings) were repeatably observed in the superior temporal plane. Second, the locations of the higher- and lower-frequency endpoints of these progressions were approximately congruent with regions reported to be most responsive to discrete higher- and lower-frequency stimuli. Based on these findings and previous anatomical work, we propose a correspondence between these progressions and anatomically defined cortical areas, suggesting that five areas in human auditory cortex exhibit at least six tonotopic organizations.