The CSA of paraspinal muscles and erector spinae width can be good predictive markers for improving camptocormia in patients with PD after deep brain stimulation.
Motor and sensory cortical tongue representations were examined in 40 patients with intractable seizures who underwent chronic subdural electrode grid implantation. Tongue responses were observed in a wide area 4.5 cm anterior and 3 cm posterior to the central sulcus. The distribution of the responses was not influenced by whether the responses were unilateral or bilateral. In patients with fronto-parietal lesions, the tongue motor area was located significantly more superior to the Sylvian fissure and more anterior to the central sulcus than was the tongue motor area of patients without organic lesion. Both motor and sensory responses were found outside of the classic precentral or postcentral area on the lateral surface of the cortex. Motor responses ('parietal motor responses') could occur posterior to the central sulcus and, rarely, sensory responses ('frontal sensory responses') were identified anterior to the central sulcus. These paradoxical parietal motor and frontal sensory responses were seen in 17 out of 40 (42.5%) patients. Nine of these 17 patients had no organic brain lesion on MRI. Clinical factors, such as patient's age, duration of seizures and cognitive functions (IQ, word fluency score), did not influence the frequency of the paradoxical responses. However, patients with brain lesions showed a tendency to have associated paradoxical responses (P < 0.05). In conclusion, paradoxical responses are not uncommon in epilepsy patients, particularly in those with organic lesions. The physiological and clinical implications of the paradoxical responses are discussed.
The effect of transcutaneous electrical nerve stimulation (TENS) on the central nervous system amplification process was investigated focusing on the dorsal column-medial lemniscal pathway, because the dorsal column nucleus was recently shown to receive multiple sources of sensory information, including pain. Short latency somatosensory evoked potentials (SSEPs) were recorded in ten healthy normal volunteers. Amplitude changes in each SSEP component (the N9 brachial plexus potential, the P14 potential that originates from the cervicomedullary junction, spinal N13/P13 generated by the cervical dorsal horn and the cortical N20/P25 potential) were studied at stimulus strengths ranging from the threshold (40% maximum stimulus) to 2.5 times the threshold (maximum). The findings suggest that sensory amplification begins at the P14 generator source near the cuneate nucleus. There was no statistically significant difference in sensory amplification between P14 and cortical N20/P25, indicating that the cuneate nucleus is the main site of the central amplifying process. When TENS was applied to the palm distal to the median nerve stimulation used for SSEP, cortical N20/P25 amplification disappeared, evidence that TENS suppresses the central amplification phenomenon, most probably at the level of the cuneate nucleus.
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