186 research outputs found

    Motor cortex excitability in Alzheimer's disease: A transcranial magnetic stimulation study

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    Motor deficits affect patients with Alzheimer's disease only at later stages. Recent studies demonstrate that the primary motor cortex is affected by neuronal degeneration accompanied by the formation of amyloid plaques and neurofibrillary tangles. It is conceivable that neuronal loss is compensated by reorganization of the neural circuitries occurring along the natural course of the disease, thereby maintaining motor performances in daily living. Cortical motor output to upper limbs was tested via motor-evoked potentials from forearm and hand muscles elicited by transcranial magnetic stimulation of motor cortex in 16 patients with mild Alzheimer's disease without motor deficits. Motor cortex excitability was increased, and the center of gravity of motor cortical output, as represented by excitable scalp sites, showed a frontal and medial shift, without correlated changes in the site of maximal excitability (hot-spot). This may indicate functional reorganization, possibly after the neuronal loss in motor areas. Hyperexcitability might be caused by a dysregulation of the intracortical GABAergic inhibitory circuitries and selective alteration of glutamatergic neurotransmission. Such findings suggest that motor cortex hyperexcitability and reorganization allows prolonged preservation of motor function during the clinical course of Alzheimer's disease

    Neuromagnetic integrated methods tracking human brain mechanisms of sensorimotor areas 'plastic' reorganisation.

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    The potential for reorganization in the adult brain has been largely underestimated in the past and we are just beginning to understand the organisational principles involved in functional recovery. A bulk of experimental evidences have been accumulated in support of the hypothesis that neuronal aggregates adjacent to a lesion in the cortical brain areas can be progressively vicarious to the function of the damaged neurones. Such a reorganisation, if occurring in the affected hemisphere of a patient with a monohemispheric lesion, should significantly modify the interhemispheric symmetry of somatotopic organisation of the sensorimotor cortices, both in terms of absolute surfaces and number of 'recruited' neurons, as well as of spatial coordinates. In fact, a roughly symmetrical organisation of sensorimotor - particularly for the hand contorl - in the right and left hemisphere has been observed in healthy humans by different methods of functional brain imaging, including fMRI, TMS, MEG, HD-EEG. Not uniform results about the functional brain activity related to sensory, motor and cognitive functions in normal and diseased subjects are often due to differences in the experimental paradigm designed as well as in the spatial and temporal resolution of the neuroimaging techniques used. The multi-modal integration of data obtained with several neuroimaging techniques allowed a coherent modelling of human brain higher functions. Functional magnetic resonance imaging (fMRI) provided fine spatial details (millimetres) of the brain responses, which were compared with the cortical maps of the motor output to different body districts obtained with transcranial magnetic stimulation (TMS). Magnetoencephalography (MEG) ability to study sensorimotor areas by analysing cortical magnetic fields, is also complementary to the motor cortex topographical mapping provided by TMS. MEG high temporal resolution allows to detect relatively restricted functional neuronal pools activated during cerebral processing of external stimuli. Moreover, these brain responses can be investigated with magnetoencephalography (MEG) and high density electroencephalography (EEG) techniques, with elevated time resolution (ms). With respect to the high resolution EEG technique, the MEG technique allowed a more precise localisation of the sites of neural activity buried into the cortical sulci, but was unable to detect the response of the crown of the cortical giri and of the frontal-mesial cortex (including the supplementary motor area), because of its poor sensitivity to radially oriented dipoles. The integration of functional and anatomical information provide cues on the relationship between brain activity and anatomic sites where this takes place, allowing the characterisation of the physiological activity of the cortical brain layers as well as to study the plastic reorganisation of the brain in different pathological conditions following stroke, limb amputation, spinal cord injury, hemisperectom

    SOMATOSENSORY EVOKED POTENTIALS OF INFERIOR ALVEOLAR NERVE.

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    Purpose: The use of inferior alveolar nerve somatosensory evoked potentials may represent an objective means of evaluating sensory nerve function in the maxillofacial region. The aim of this work was to confirm the existence of a standard sequence of prominent events in the trigeminal somatosensory evoked potentials (TSEPs) of inferior alveolar nerve (IAN) waveform, examine those components and their normal variability by statistical analysis, and discuss TSEPs' nervous origin and some patterns of TSEPs' abnormalities due to dysfunctional nerves. Materials and Methods: TSEPs were obtained following electrical stimulation (square wave pulses 0.2 millisecond [ms] in duration, 4 to 6.5 mA, 0.7/second repetition rate, 200 averages) of the gum at the mental foramen level via intraoral surface electrodes and recorded from the contralateral central scalp sites. Results: We successfully recognized steady waveforms of sufficient quality and consistently recorded a "W"-shaped response: latency onset and peak of the initial deflection of positive polarity were approximately 12 ms and 20 ms, respectively. Negative and positive deflections followed with respective peak latencies at around 26 ms and 36 ms. One side of the lower lip can be compared with the contralateral side and patients may serve as their own control in cases of unilateral nerve injury. The anaesthetic block showed the total abolition of responses. Reproducible TSEP waveform was only obtained during nerve stimulation and not during masseter muscle stimulation. Conclusions: TSEPs, obtained with the present technique, may represent an objective, low-invasive, and reliable way of testing sensory nerve function in the maxillofacial region. © 2006 American Association of Oral and Maxillofacial Surgeons
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