Background Although a mainstay of clinical sensory examination after damage in the spinal cord, pinprick sensation represents only one afferent modality conveyed in the spinothalamic tract. As an objective outcome, complementary information regarding spinothalamic tract conduction may be elucidated by measuring contact heat evoked potentials (CHEPs). Objective To assess the value of CHEPs to measure spinothalamic tract function in spinal cord disorders compared with pinprick scoring. Methods CHEPs were examined using a standard (35°C) and increased baseline (42°C) contact heat temperature. Pinprick sensation was rated as absent, impaired, or normal according to the International Standards for the Neurological Classification of Spinal Cord Injury. Results Fifty-nine dermatomes above, at, and below the sensory level of impairment were analyzed in 37 patients with defined spinal cord disorder. In dermatomes with absent or impaired pinprick sensation, CHEPs using a standard baseline temperature were mainly abolished (3/16 and 8/35, respectively). However, when applying an increased baseline temperature, CHEPs became recordable (absent: 11/16; impaired: 31/35). Furthermore, CHEPs with increased baseline temperature allowed discerning between dermatomes with absent, impaired, and normal pinprick sensation when using an objective measure (ie, N2P2 amplitude). In contrast, the pain perception to contact heat stimulation was independent of pinprick scores. Conclusion Applying pinprick testing is of limited sensitivity to assess spinothalamic tract function in spinal cord disorders. The application of CHEPs (using standard and increased baseline temperatures) as an objective readout provides complementary information of spinothalamic tract functional integrity beyond pinprick testing.

Assessment of spinothalamic pathways with CHEPs is reliable and revealed the highest sensitivity in all SCDs. Specifically in incomplete lesions that spare dorsal pathways, CHEPs are sensitive to complement the clinical diagnosis.

The aim of the present study was to assess changes in EEG coherence and phase locking between fronto-parietal areas, including the frontal and parietal motor areas, during early audio-and visuo-motor learning of continuous tracking movements. Subjects learned to turn a steering-wheel according to a given trajectory in order to minimise the discrepancy between a changing foreground stimulus (controllable by the subjects) and a constant background stimulus (uncontrollable) for both the auditory and the visual modality. In the auditory condition, we uncovered a learning-related increase in inter-hemispheric phase locking between inferior parietal regions, suggesting that coupling between areas involved in audiomotor integration is augmented during early learning stages. Intrahemispheric phase locking between motor and superior parietal areas increased in the left hemisphere as learning progressed, indicative of integrative processes of spatial information and movement execution. Further tests show a significant correlation of intra-hemispheric phase locking between the motor and the parietal area bilaterally and movement performance in the visual condition. These results suggest that the motor-parietal network is operative in the auditory and in the visual condition. This study confirms that a complex fronto-parietal network subserves learning of a new movement that requires sensorimotor transformation and demonstrates the importance of interregional coupling as a neural correlate for successful acquisition and implementation of externally guided behaviour.

BackgroundThe aim of this study was to investigate the effects of a massed compared to a distributed practice upon visuomotor learning as well as upon the regional oscillatory activity in the sensorimotor cortex.MethodsA continuous visuomotor tracking task was used to assess visuomotor learning; the underlying neuronal correlates were measured by means of EEG. The massed practice group completed a continuous training of 60 minutes, while the distributed practice group completed four 15 minutes practice blocks separated by rest intervals.ResultsWhile the massed and the distributed practice group did not differ in performance, effects of practice distribution were evident in the regional oscillatory activity. In the course of practice, the massed training group showed a higher task-related theta power and a strong task-related power decrease in the upper alpha frequency over the sensorimotor cortex compared to the distributed practice group.ConclusionsThese differences in the regional oscillatory activity indicate a higher cognitive effort and higher attention demands in the massed practice group. The results of this study support the hypothesis, that a distributed practice is superior to a massed practice in visuomotor learning.

The purpose of this study was to investigate the test-retest reliability of contact heat-evoked potentials (CHEPs) in neurologically healthy subjects from cervical dermatomes (C4-C8). Seventeen individuals underwent test-retest examination of cervical CHEPs. Peak latencies and peak-to-peak amplitude of N2-P2 and ratings of perceived intensity were analyzed using test-retest reliability statistics (intraclass correlation coefficients [ICCs] and Bland-Altman confidence parameters). For comparison, a group of similar age and gender was also examined with dermatomal somatosensory-evoked potentials (dSSEPs, n = 17). The ICC values for CHEP latency and amplitude parameters were significant (P < 0.05) and corresponded to at least "fair" reliability, while peak-to-peak amplitude demonstrated "substantial" (≥0.81) reliability for all dermatomes. The coefficients of repeatability (i.e., 2SD of the difference between examinations) confirm that CHEPs and dSSEPs are reliable according to measures of latency. Superior peak-to-peak amplitude test-retest reliability was found for CHEPs. In conclusion, the test-retest reliability of dSSEP and CHEP parameters supports the fact that these outcomes can be used to objectively track changes in spinal conduction in the dorsal column and spinothalamic tract, respectively. The reliable acquisition of CHEPs may depend on the intensity of the sensation reported by the subject for a given area of skin stimulated.

The study supports CHEPs as a feasible tool for assessing discrete dermatomes corresponding to spinal cord segments. The results suggest that the proximodistal pattern in the intensity of perceived pain and CHEP amplitudes is likely attributable to the distribution of heat nociceptors and the increase in conduction distance from proximal to distal dermatomes. The present findings emphasize on the importance that if patients are assessed segment by segment, the underlying topographical differences need to be accounted for.

Imaging studies have identified a wide network of brain areas activated by nociceptive stimuli and revealed differences in somatotopic representation of highly distinct stimulation sites (foot vs. hand) in the primary (S1) and secondary (S2) somatosensory cortices. Somatotopic organization between adjacent dermatomes and differences in cortical coding of similarly perceived nociceptive stimulation are less well studied. Here, cortical processing following contact heat nociceptive stimulation of cervical (C4, C6, and C8) and trunk (T10) dermatomes were recorded in 20 healthy subjects using functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). Stimulation of T10 compared with the C6 and C8 revealed significant higher response intensity in the left S1 (contralateral) and the right S2 (ipsilateral) even when the perceived pain was equal between stimulation sites. Accordingly, contact heat evoked potentials following stimulation of T10 showed significantly higher N2P2 amplitudes compared to C6 and C8. Adjacent dermatomes did not reveal a distinct somatotopical representation. Within the assessed cervical and trunk dermatomes, nociceptive cortical processing to heat differs significantly in magnitude even when controlling for pain perception. This study provides evidence that controlling for pain perception is not sufficient to compare directly the magnitude of cortical processing [blood oxygen level dependence (BOLD) response and amplitude of evoked potentials] between body sites. Hum Brain Mapp 35:1379-1389,

The aim of the present study was to assess changes in electroencephalogram (EEG) phase locking between fronto-parietal areas, including the frontal and parietal motor areas, during audiomotor learning of continuous tracking movements. Subjects learned to turn a steering wheel according to a given trajectory in order to minimise the discrepancy between a changing foreground stimulus (controllable by the subjects) and a constant background stimulus. The results of the present study show that increasing practice of continuous tracking movements that are continuously performed in the presence of auditory feedback is not accompanied by decrease in phase locking between areas involved. Moreover, the study confirms that internally produced movements show enhanced coherent activities compared to externally guided movements and therefore suggests that the motor-parietal network is more engaged during internally produced than externally produced movements.