Kiyohito Terada

Simultaneous Recording of Epileptiform Discharges by MEG and Subdural Electrodes in Temporal Lobe Epilepsy

Spontaneous epileptiform discharges were recorded by whole head magnetoencephalography (MEG) and subdural electrodes simultaneously from two patients with medically intractable temporal lobe epilepsy. In one patient whose epileptiform discharges emerged from the lateral temporal lobe, simultaneously recorded MEG could estimate equivalent current dipole reliably near the tumor. The amplitude of the dipole was in proportion not only to the amplitude of epileptiform discharge but also to the number of subdural electrodes involved. In the other patient, MEG detected only a small proportion of epileptiform discharges, even when they were recorded by subdural electrodes from the mesial temporal lobe. It is concluded that the amplitude and the depth of epileptiform discharges would largely affect the sensitivity of dipole localization by MEG.

Dissociation between contingent negative variation (CNV) and Bereitschaftspotential (BP) in patients with parkinsonism.

In order to clarify the generator mechanism of the late component of contingent negative variation (CNV), we compared the late CNV with Bereitschaftspotential (BP) in patients with parkinsonism (Parkinsons disease and progressive supranuclear palsy). In patients with mild symptoms (Hoehn Yahr grade I and II) both the late CNV and BP were clearly seen. In patients with severe symptoms (Hoehn Yahr grade III, IV and V) the BP was normally seen, but the late CNV was significantly smaller or absent (P < 0.001 at Cz) and it was also significantly smaller than that obtained from age-matched normals. In one patient (H-Y grade II) who had normal BP, the late CNV was diminished selectively at the midline area. Since it was reported that the late CNV arises from at least the supplementary motor area (SMA), selective diminution of the late CNV at the midline could be explained by the decreased activity of the SMA in parkinsonism. It was also previously reported that the BP was absent but the late CNV was normally present in a patient with cerebellar efferent lesion (Ikeda et al., 1994). Taken together with the experimental results indicating that movement-related neurons in the putamen behave contingent on external stimuli, it is suggested that subcortical generating mechanism is different for the late CNV and BP although both commonly share at least some cortical generators, and that the basal ganglia are most likely responsible for the generation of the late CNV and the cerebellar efferent system for the generation of the BP.

Subdural Recording of Ictal DC Shifts in Neocortical Seizures in Humans

Summary: Purpose: Invasive ictal EEG recording is often necessary to delineate epileptogenic areas in patients with intractable partial epilepsy, but even intracranial ictal recordings often reveal ill‐defined onset zones in neocortical epilepsy. We studied the physiologic significance of ictal direct current (DC) potentials recorded intracranially in human epilepsy.

Somatosensory evoked potentials following proprioceptive stimulation of finger in man

Brisk passive flexion of the proximal interphalangeal joint of the middle finger, produced by using a newly devised instrument, elicited evoked potentials on the scalp. The present study carefully excluded the possible contribution of sensory modalities other than proprioception. The initial part of cortical response was a positive deflexion at the contralateral central area (P1 at 34.6 ms after the stimulus). This was followed by a midfrontal negative wave (N1 at 44.8 ms) and a clear positivity at the contralateral centroparietal area (P2 at 48.0 ms). The evoked responses persisted in spite of the abolition of cutaneous and joint afferents of the finger caused by ischemic anesthesia, but they were lost by ischemic anesthesia of the forearm. Thus, the cortical evoked responses obtained in this study most probably reflect muscle afferent inputs. The scalp distribution of P1 suggested that its cortical generator source was different from that of the N20-P20 components of evoked potentials to electrical median nerve stimulation. Brodmann areas 2 and 3a of human brain, which are known to receive deep receptor inputs, are the most plausible generator sites for the early components of the proprioception-related evoked responses. The amplitude of P2 was related to the velocity but not to the magnitude of movement. In conclusion, the present study established a method for recording the evoked responses to the brisk passive movement of the finger joint, which mainly reflect the dynamic aspects of proprioception mediated through muscle afferent.

Dissociation between contingent negative variation and Bereitschaftspotential in a patient with cerebellar efferent lesion

Contingent negative variation (CNV) and Bereitschaftspotential (BP) were from the scalp in a patient with a discrete infarct in the mesial tegmentum of the midbrain involving the decussation of the superior cerebellar peduncle. Bereitschaftspotential in association with hand movements was completely absent while CNV was normally present at the frontocentral midline. This indicates that CNV is, as opposed to BP, generated without cerebro-cerebellar interactivation, suggesting different generating mechanisms.

Presence of Bereitschaftspotential preceding psychogenic myoclonus: clinical application of jerk-locked back averaging.

The method of jerk-locked back averaging was applied to six patients with clinically diagnosed psychogenic myoclonus. Five patients had a slow negative EEG shift corresponding to Bereitschaftspotential at the central region starting 0.7 to 2.1 seconds before the onset of the myoclonic jerk. One patient had no potential preceding the myoclonic jerk, whereas a small negative potential preceded the voluntary movement mimicking the jerk. The demonstration of Bereitschaftspotential before an apparently involuntary myoclonic jerk helps the clinical diagnosis of psychogenic myoclonus, although the absence of Bereitschaftspotential does not necessarily indicate that the movement is involuntary. Jerk-locked back averaging is clinically useful as a specific laboratory examination in this condition.

Cortical mechanism underlying externally cued gait initiation studied by contingent negative variation

In order to clarify the cortical mechanism underlying gait initiation, we examined the scalp distribution of the contingent negative variation (CNV) preceding externally cued gait initiation in a simple reaction-time paradigm in 10 healthy right-handed men, and compared the results with the CNV preceding simple foot dorsiflexion. A pair of auditory stimuli was given with an interstimulus (S1-S2) interval of 2 s and gait consisting of at least 3 steps was initiated with the right footstep as fast as possible in response to S2. Brisk dorsiflexion of the right foot was employed as a control task. It was found that the late CNV in the gait initiation task started about 1 s before S2, and was largest at Cz (-9.3 +/- 3.1 microV) without clear asymmetry over the scalp. However, it was ill defined in the parietal area. In the foot dorsiflexion task, the late CNV was maximal at Cz (-7.1 +/- 2.9 microV), and clearly seen also over the parietal area. The late CNV at Cz was significantly (P < 0.01) larger in the gait initiation than in the simple foot dorsiflexion. The amplitude of the late CNV preceding the foot dorsiflexion task was not significantly different between the sitting and the standing posture. In view of the results of previous invasive studies in both humans and animals which showed some frontal areas, including the supplementary motor area (SMA) and the primary motor cortex, as the generators of the late CNV, it is suggested that the cerebral cortex is active in initiation of externally triggered gait in a different way from the simple foot movement, and that bilateral SMAs may play a more important role in gait initiation than in simple foot movement.

Human supplementary motor area is active in preparation for both voluntary muscle relaxation and contraction : Subdural recording of bereitschaftspotential

Bereitschaftspotentials (BPs) preceding muscle relaxation and contraction were compared by using subdural electrodes which were implanted onto the right medial frontal surface in two patients with supplementary motor area (SMA) seizure. The applied movement paradigm (muscle relaxation and contraction tasks) was completely the same as employed in our previous study [Terada, K., Ikeda, A., Nagamine, T. and Shibasaki, H., Electroenceph. clin. Neurophysiol., 95 (1995) 335-345]. In both patients, either negative or positive BPs were observed in the SMA-proper and supplementary negative motor area (SNMA) starting at 1.2-1.8 prior to both movements. In one patient, BP was more widespread in the relaxation task whereas more restricted to the hand area in the contraction task. In the other patient, the BPs were observed in the cortical area rostral to SNMA (pre-SMA), in addition to the SMA-proper, in both tasks. It is concluded that SMA-proper and SNMA, and probably pre-SMA as well, in humans are similarly active in preparation for both voluntary muscle contraction and relaxation.

Clinical Usefulness of the Dipole Tracing Method for Localizing Interictal Spikes in Partial Epilepsy

Summary: Purpose: To clarify the clinical usefulness of the dipole tracing method in evaluation of interictal EEG spikes in patients with partial epilepsy.

Peri-rolandic and fronto-parietal components of scalp-recorded giant SEPs in cortical myoclonus

Scalp topography of giant SEPs to median nerve stimulation was studied in 4 patients with cortical myoclonus of various etiology. The positive peak (P30) at the contralateral parietal area was simultaneously accompanied by a negative peak at the frontal area (N30), and at least one of these two peaks was enhanced in 2 patients. Another positive peak (P25) and a negative peak (N35) were also identified at the peri-rolandic area with different latency from P30 and N30, respectively, in all patients. N35 was enhanced in 3 patients, and P25 in 2 patients. It is concluded that, as seen in normal subjects, tangential (P30-N30) and radial (P25 and N35) components of SEPs are most likely distinguishable in giant SEPs, and that either one or both of those components is enhanced in different ways depending on the patients.