Cortical visuomotor interactions in Freezing of Gait: A TMS approach

OBJECTIVES: Altered cortical visuomotor integration has been involved in the pathophysiology of freezing of gait (FoG) in parkinsonism. The aim of this study was to assess the connections between the primary visual (V1) and motor (M1) areas with a paired-pulse, twin-coil transcranial magnetic stimulation (TMS) technique in patients with FoG. METHODS: Twelve Parkinson's disease (PD) patients suffering from levodopa-responsive-FoG (off-FoG) were compared with 12 PD patients without FoG and 12 healthy subjects of similar age/sex. In the "off" condition, visuomotor connections (VMCs) were assessed bilaterally. A conditioning stimulus over the V1 phosphene hotspot was followed at interstimulus intervals (ISIs) of 18 and 40ms by a test stimulus over M1, to elicit motor evoked potentials (MEPs) in the contralateral first dorsal interosseous muscle. RESULTS: Significant (P<0.01), bilateral effects due to VMCs were detected in all three groups, consisting of a MEP suppression at ISI 18 and 40ms. However, in PD patients with FoG, the MEP suppression was significantly (P<0.05) enhanced, both at ISI 18-40ms, in comparison with the other two groups. The phenomenon was limited to the right hemisphere. CONCLUSIONS: PD patients with FoG showed an excessive inhibitory response of the right M1 to inputs travelling from V1 at given ISIs. Right-sided alterations of the cortical visuomotor integration may contribute to the pathophysiology of FoG

Transorbital Sonography in Acute Optic Neuritis: A Case-Control Study

BACKGROUND AND PURPOSE: Acute unilateral optic neuritis is associated with a thickening of the retrobulbar portion of the optic nerve as revealed by transorbital sonography, but no comparison has been made between nerve sheath diameter and optic nerve diameter in patients with acute optic neuritis versus healthy controls. We evaluated optic nerve sheath diameter and optic nerve diameter in patients with acute optic neuritis and healthy controls and compared optic nerve sheath diameter and optic nerve diameter with visual-evoked potentials in patients. MATERIALS AND METHODS: A case-control study was performed in 2 centers. Twenty-one consecutive patients with onset of visual loss during the prior 10 days and established acute noncompressive unilateral optic neuritis were compared with 21 healthy controls, matched for sex and age (±5 years). Two experienced vascular sonographers performed the study by using B-mode transorbital sonography. Visual-evoked potentials were performed on the same day as the transorbital sonography and were evaluated by an expert neurophysiologist. Sonographers and the neurophysiologist were blinded to the status of the patient or control and to clinical information, including the side of the affected eye. RESULTS: The median optic nerve sheath diameter was thicker on the affected side (6.3 mm; interquartile range, 5.9–7.2 mm) compared with the nonaffected side (5.5 mm; interquartile range, 5.1–6.2 mm; P P P = not significant.). Both sides were thicker than those in controls (2.7 mm; interquartile range, 2.5–2.8 mm; P = .001 and .009). No correlation was found between optic nerve sheath diameter and optic nerve diameter and amplitude and latency of visual-evoked potentials in patients with optic neuritis. CONCLUSIONS: Transorbital sonography is a promising tool to support the clinical diagnosis of acute optic neuritis. Further studies are needed to define its specific role in the diagnosis and follow-up of optic neuritis

The reliability of commonly used electrophysiology measures

Background: Electrophysiological measures can help understand brain function both in healthy individuals and in the context of a disease. Given the amount of information that can be extracted from these measures and their frequent use, it is essential to know more about their inherent reliability. / Objective/Hypothesis: To understand the reliability of electrophysiology measures in healthy individuals. We hypothesized that measures of threshold and latency would be the most reliable and least susceptible to methodological differences between study sites. / Methods: Somatosensory evoked potentials from 112 control participants; long-latency reflexes, transcranial magnetic stimulation with resting and active motor thresholds, motor evoked potential latencies, input/output curves, and short-latency sensory afferent inhibition and facilitation from 84 controls were collected at 3 visits over 24 months at 4 Track-On HD study sites. Reliability was assessed using intra-class correlation coefficients for absolute agreement, and the effects of reliability on statistical power are demonstrated for different sample sizes and study designs. / Results: Measures quantifying latencies, thresholds, and evoked responses at high stimulator intensities had the highest reliability, and required the smallest sample sizes to adequately power a study. Very few between-site differences were detected. / Conclusions: Reliability and susceptibility to between-site differences should be evaluated for electrophysiological measures before including them in study designs. Levels of reliability vary substantially across electrophysiological measures, though there are few between-site differences. To address this, reliability should be used in conjunction with theoretical calculations to inform sample size and ensure studies are adequately powered to detect true change in measures of interest

Long-latency modulation of motor cortex excitability by ipsilateral posterior inferior frontal gyrus and pre-supplementary motor area

The primary motor cortex (M1) is strongly influenced by several frontal regions. Dual-site transcranial magnetic stimulation (dsTMS) has highlighted the timing of early (<40 ms) prefrontal/premotor influences over M1. Here we used dsTMS to investigate, for the first time, longer-latency causal interactions of the posterior inferior frontal gyrus (pIFG) and pre-supplementary motor area (pre-SMA) with M1 at rest. A suprathreshold test stimulus (TS) was applied over M1 producing a motor-evoked potential (MEP) in the relaxed hand. Either a subthreshold or a suprathreshold conditioning stimulus (CS) was administered over ipsilateral pIFG/pre-SMA sites before the TS at different CS-TS inter-stimulus intervals (ISIs: 40-150 ms). Independently of intensity, CS over pIFG and pre-SMA (but not over a control site) inhibited MEPs at an ISI of 40 ms. The CS over pIFG produced a second peak of inhibition at an ISI of 150 ms. Additionally, facilitatory modulations were found at an ISI of 60 ms, with supra-but not subthreshold CS intensities. These findings suggest differential modulatory roles of pIFG and pre-SMA in M1 excitability. In particular, the pIFG-but not the pre-SMA-exerts intensity-dependent modulatory influences over M1 within the explored time window of 40-150 ms, evidencing fine-tuned control of M1 output

Lake water quality monitoring tools

Lakes as ecosystems provide many goods and services. To benefit from them in long term we must assure sustainable management. SIMILE (informative System for the Integrated Monitoring of Insubric Lakes and their Ecosystems) project is focused on developing efficient monitoring of lake water quality since it gives the critical input for adequate management. The lakes of interest for SIMILE are the Insubric lakes Como, Lugano, and Maggiore. The paper is focused on describing which tools are used in the SIMILE project to exploit different sources of lake water quality data: in-situ high-frequency monitoring (HFM) through sensors, satellite observations, and data collected by citizens. Even though the paper is focused on the SIMILE project, and thus on tools and procedures for the Insubric lakes, it can serve as an example for other lakes too, especially because the tools developed in the project, such as a collaborative platform for sharing satellite-derived water quality parameters, and mobile application and web administrator interface for citizen science, are free and open-source, they can be easily adapted if needed. Moreover, the procedures for the processing of data coming from different sources are based on free (and often also open source) software and are well documented. The tools and procedures described in this paper might be a foundation for similar practice for lakes worldwide, and thus a step forward the 6th Sustainable Development Goal (SDG) of the United Nations (“Ensure availability and sustainable management of water and sanitation for all”)

Transcranial Direct Current Stimulation Effects on Single and Paired Flash Visual Evoked Potentials.

Transcranial direct current stimulation (tDCS) applied over the occipital cortex has a controversial effect on the visual cortex excitability. Paired flash visual evoked potentials (paired F-VEPs) offer a unique method to express neural inhibition within the visual system. However, no studies have explored the effects of tDCS on F-VEPs in humans. The aim of this study was to evaluate the changes of single- and paired-F-VEPs during and after tDCS in healthy humans. Twenty-six healthy volunteers participated. F-VEPs were recorded from occipital electrodes with closed eyes. Stimuli were single flashes, intermingled to flash pairs at the interstimulus interval of 125, 62.5, 50, 33.3, 16.6, and 11.1 ms (internal frequency of 8, 16, 20, 30, 60, and 90 Hz). The single F-VEP was split into a "main complex" and a "late response." As to paired stimuli, the "test" F-VEP emerged from electronic subtraction of the single-F-VEP to the paired-F-VEP. In experiment 1, the return electrode was located on the scalp and we studied changes in F-VEPs after anodal, cathodal (1 mA, 15 min) and sham stimulation. A second experiment was performed in which F-VEPs were recorded before, during and after tDCS stimulation (anodal and cathodal) with the return electrode on the neck. F-VEPs recorded in experiment 1 did not detect any significant change after tDCS. In experiment 2 anodal polarization significantly increased the P2 latency (P = .031) and reduced the amplitude of the "late response" of the single F-VEP (P = .008). As for the paired F-VEPs, no significant changes were detected. In conclusion, low-intensity anodal tDCS has weak inhibitory aftereffects on the single F-VEP and no effects on the paired F-VEPs. Further methodological studies are needed to improve polarization efficacy