Biomedical subjects
Publications and source records attributed to M Leandri.
The effects of high pass filters with cut-off frequencies of 160 and 320 Hz on computer-constructed potentials with known parameters were studied. It is concluded that high pass filtering using high cut-off frequencies introduces temporal and amplitude distortions and artefacts which may not be distinguished from true potentials.
The main features (amplitude, latency and shape) of the cervical activity evoked by stimulation of the median nerve, recorded throughout the cervical spine, have been concurrently investigated by monopolar, bipolar longitudinal and bipolar transverse recordings. In some subjects the derivation C7-Sn (suprasternal notch) has been employed as well. A comparative evaluation of the refractory period of each component of the cervical responses under investigation has been performed to differentiate presynaptic from postsynaptic events. Additional information has been obtained by cervical activity recorded by longitudinal and transverse bipolar derivations upon stimulation of the lower limb. It was thus demonstrated that both presynaptic and postsynaptic events were responsible for the cervical sensory evoked potential, as appearing when recorded against a cranial reference (that is the upper midfrontal region). The structures involved were the brachial plexus (N9), the cervical roots (P10 and a minor part of N11a), the dorsal columns both at caudal (N11a) and rostral (N11b) cervical levels, and the dorsal column nuclei (N13). However a contribution of the spinal segmental activity to the postsynaptic portion of the cervical response, more specifically to N13, should be considered as well, though direct evidence is still inadequate.
The sensitivity of the different parameters (absolute latency, interwave latency, latency asymmetry, amplitude) of both cervical and cerebral responses evoked by stimulation of the median nerve at the wrist was assessed in patients with multiple sclerosis by discriminant analysis. The peak latency of N13 or N20 SEP components or both was found to be more sensitive than their amplitude, provided that a preliminary covariation with the height of the subjects was performed. The measurement of latency asymmetry between the two sides increased the test's sensitivity, while amplitude asymmetry turned out to be of little diagnostic value. A linear discriminant function with four variates (that is mean amplitude, mean latency, latency asymmetry and height of the subject) was computed to summarise the information provided by the different parameters to give a rapid and exact method for the assessment of SEP abnormalities in multiple sclerosis patients.
Cervical responses evoked by stimulation of the median nerve have been concurrently recorded from C7--Fz and C7--Sn (suprasternal notch). The existence of two different waveforms (RI and RII) has been confirmed. RI (from C7--Fz) consists of four negative peaks (N9, N11, N13, N14) followed by a large positive deflection (P16). RII (from C7--Sn) is characterised by an early positive--negative spike (P1--N1a) followed by a slow negative--positive wave (N1b--P2). The study of the most relevant parameters (polarity, latency and refractory period) of each component of RI and RII did not indicate whether the generators underlying RI differ from those responsible for RII. However, stimulation of the lower limb, which does not involve segmental events at cervical level, showed a clearcut difference: no response was recorded from C7--Sn, while evoked activity equivalent to RI was obtained from C7--Fz. Therefore it is suggested that RII is entirely generated by segmentally evoked potentials while RI is mainly due to conducted potentials.
The central conduction time of the lemniscal pathway is not statistically different in the two sexes, while the peak latencies of both S13 and N20 components are significantly longer in males than in females. However, multivariate analysis of covariance of data showed that such a result is not related to sex, but to the difference in height between the two sexes.
The effect of hand muscle mechanical vibration on the somatosensory potential (SEP) evoked by median nerve stimulation, was investigated in 10 healthy subjects. A marked decrease in the amplitude of the N17, N20 and P25 components of the cerebral SEP was observed, while the S11 and S13 components of the cervical response did not change. The amplitude reduction of the SEP components was larger when low frequency vibration was used. Recordings performed after cooling the hand further suggest that the reduction of the amplitude of the SEP components induced by vibration is likely to depend on activation of muscle receptors. These findings could reflect an interaction between limniscal and spino-cerebellar inputs, possibly occurring at the thalamo-cortical levels, a concept compatible with the hypothesis that muscle spindle afferents do contribute to kinaesthesia or position-sense.
In six normal subjects cerebral somatosensory potentials evoked by median nerve stimulation at the wrist have been recorded in order to assess whether N20 and P25 components can be related to a single generator dipole. It was found that, at variance with the current literature, such components are due to separate generator dipoles, possibly related to the activity of different cortical structures. Moreover an additional component, chronologically occurring between N20 and P25, was consistently observed.
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A simple low cost stimulator for electroacupuncture is described. The stimulator can be used with needle electrodes or with surface electrodes.
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Responses evoked over the scalp and the neck by median nerve (or finger I) stimulation were concurrently recorded in 10 subjects. It was found that the first component of the cortical SEP consists of a small amplitude polyphasic wave (S wave) which could be recorded bilaterally upon unilateral stimulation. The polarity of the S wave varied according to the reference electrode position, at variance with the P15 component which remained constantly positive. It is therefore correct to assume that different generators are responsible for these two potentials. The synchrony between the S wave and the cervical response, which is largely spinal in origin, as well as some pertinent experimental data, suggest that the S wave is a far field reflection of activity generated mainly in the cervical dorsal columns. These findings might be relevant to the diagnosis of neurological disorders.
Two new components of the human SEP upon stimulation of the contralateral median nerve at the wrist have been identified. Such components have been called N16 and N17, according to their polarity and latency. N16 and N17, as well as the N14-P15 complex, are generated by separate subcortical dipoles. Particularly, they are supposed to be far-field reflections of the activity of the dorsal columns nuclei or the medial lemniscus (N14-P15), the thalamus (N16) and the thalamo-cortical radiation (N17). Moreover, it has been established that N14 is the very first intracranial component of the human SEP, the main peak of S wave and the preceding ones being extracranial in origin. A new classification of SEP intracranial components including early (N14 through N17), intermediate (N20 through P30) and late events is proposed.
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Normative data concerning the waves W1, W2, W3, P4, N5, P6 and N7 recorded from the scalp after stimulation of the infraorbital nerve have been collected from 96 healthy subjects, selected according to age and sex. Peak latency, inter-peak intervals, side-to-side asymmetry of inter-peak intervals, amplitude, amplitude ratio of some components versus W1 and side-to-side asymmetry of such ratio have been analysed as functions of age and sex. None of these parameters appeared to be affected by sex; computation of the correlation coefficient showed a significant (P less than 0.01), though slight, increase of value of the inter-peak intervals W1-W2 and W1-W3 with age. This increase was partially confirmed by analysis of variance. However, such differences are too small to be useful for practical applications, so only a single normative value is proposed for each parameter. The influence of stimulus strength on the amplitude of the W1 component has been studied in 10 more subjects; amplitude saturation of this wave has been found to take place at intensities between 4 and 6 times the sensory threshold. Increasing the stimulus rate from 1 to 3 pulses/sec did not affect any of the components. It is remarked that components W1, W2, W3 and, to a lesser extent, P4 are the ones to be considered useful in clinical practice.
Early scalp responses evoked by stimulation of the infraorbital nerve (W1, W2, W3) have been investigated in 23 patients affected by tumours of the base of the skull (parasellar area and cerebello-pontine angle) and in 38 patients suffering from 'idiopathic' trigeminal neuralgia. Differences in conduction times between healthy and affected side were evaluated and confronted with data obtained from 30 normal volunteers. Alterations of the response were found in all the patients with tumours of the base of the skull who had clinical signs in the trigeminal area and in 7 of the 12 cases without such signs. The usual pattern of alteration in cases with tumours of the parasellar area was a parallel involvement of W2 and W3 (both absent or delayed to the same extent), whereas in tumours of the cerebello-pontine angle W3 was more seriously affected than W2. Wave W1 was never altered. Pre- and post-operative recording sessions in 2 patients showed definite improvement of the responses after removal of the tumour. In 9 patients suffering from 'idiopathic' trigeminal neuralgia delays of conduction were found on the painful side, suggesting that damage to the trigeminal root, possibly at its entry zone into the pons, had taken place. Retrogasserian injection of glycerol was performed in 12 of the 38 patients with trigeminal neuralgia. Stimulation of the operated side showed disappearance of W2 and W3 in 9 cases, prolonged W1-W3 interval in 2 cases and no alterations in 1 case. The extent of response alteration usually paralleled the clinical results.
In 25 healthy volunteers the supraorbital nerve was stimulated and evoked potentials were recorded. Leads were placed on the scalp and along the ipsilateral eyebrow-mastoid line and were either referred to a non-cephalic reference (on the neck, or Cv7) or linked to form bipolar derivations. As template wave form was chosen the one obtained from derivation Cz-Cv7, which had an initial triphasic component with negative (SW1a), positive (SW1b), negative (SW1c) polarity (mean latencies 0.63, 0.95 and 1.43 msec), followed by 2 negative waves (SW2 and SW3, mean latencies of 2.20 and 2.89 msec). A final positive wave could be observed in most cases (SP4, mean latency of 4.08 msec). The records collected from the various derivations showed that each component (SW1, SW2, SW3 and SP4) had a different behaviour, thus suggesting separate origins. SW1 would originate from a volley travelling from the point of stimulation towards the mastoid, probably across the ophthalmic branch of the trigeminal nerve. The subsequent components would be generated by deeply situated structures: double pulse stimulation suggests that SW1, SW2 and SW3 are generated before the first synapse, whereas SP4 is a postsynaptic event. A strong similarity exists between the components evoked by stimulation of the supraorbital and the infraorbital nerves. Local anaesthetic block of the frontal nerve on the stimulated side and monitoring of the EMG activity of m. orbicularis oculi and m. frontalis ruled out any muscle contamination of the responses described in this paper.
We analyzed the possibility of assessing functional vasomotor changes by means of Arm-Brain Circulation Time (rABCT) and Vascular volume images (Vv) obtained with Angio-CT, in basal condition and following CO2 inhalation, in a sample of 48 patients with cluster headache. CO2 inhalation resulted in the appearance of local changes, which were detected in 28 regions. Analysis by indicator images of Vv-dependent rABCT distribution showed two main patterns: abnormal rABCT mostly evident at the smallest Vv pixels and abnormal rABCT dependent on abnormal Vv distribution. The former pattern was linked to abnormality at the circle of Willis; the latter to abnormal local vasomotor responses. Patients with cluster headache showed both patterns, which prompted us to conclude for the presence of low-degree stenosis in carotid arteries and vasomotor instability in peripheral brain vessels.