DOCSLIB.ORG

Translingual Neural Stimulation with the Portable Neuromodulation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Translingual Neural Stimulation with the Portable Neuromodulation Translingual Neural Stimulation With the Portable Neuromodulation Stimulator (PoNS®) Induces Structural Changes Leading to Functional Recovery In Patients With Mild-To-Moderate Traumatic Brain Injury Authors: Jiancheng Hou,1 Arman Kulkarni,2 Neelima Tellapragada,1 Veena Nair,1 Yuri Danilov,3 Kurt Kaczmarek,3 Beth Meyerand,2 Mitchell Tyler,2,3 *Vivek Prabhakaran1 1. Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA 2. Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA 3. Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA *Correspondence to [email protected] Disclosure: Dr Tyler, Dr Danilov, and Dr Kaczmarek are co-founders of Advanced Neurorehabilitation, LLC, which holds the intellectual property rights to the PoNS® technology. Dr Tyler is a board member of NeuroHabilitation Corporation, a wholly- owned subsidiary of Helius Medical Technologies, and owns stock in the corporation. The other authors have declared no conflicts of interest. Acknowledgements: Professional medical writing and editorial assistance were provided by Kelly M. Fahrbach, Ashfield Healthcare Communications, part of UDG Healthcare plc, funded by Helius Medical Technologies. Dr Tyler, Dr Kaczmarek, Dr Danilov, Dr Hou, and Dr Prabhakaran were being supported by NHC-TBI-PoNS-RT001. Dr Hou, Dr Kulkarni, Dr Nair, Dr Tellapragada, and Dr Prabhakaran were being supported by R01AI138647. Dr Hou and Dr Prabhakaran were being supported by P01AI132132, R01NS105646. Dr Kulkarni was being supported by the Clinical & Translational Science Award programme of the National Center for Research Resources, NCATS grant 1UL1RR025011. Dr Meyerand, Dr Prabhakaran, Dr Nair was being supported by U01NS093650. This study is a part of the long-term clinical trial (NCT02158494), which was completed to investigate the efficacy of translingual neural stimulation (cranial nerve noninvasive neuromodulation). The authors are willing sharing their data and analysis with other qualified investigators upon request. Received: 26.02.20 Accepted: 17.07.20 Keywords: Dynamic Gait Index (DGI), grey matter volume (GMV), Sensory Organization Test (SOT), translingual neural stimulation (TLNS), traumatic brain injuries. Citation: EMJ Radiol. 2020;1[1]:64-71. Abstract Traumatic brain injury (TBI) of varying severity can result in balance and movement disorders, for which the benefits of treatment with physical therapy has limits. In this study, patients with post- TBI balance issues received translingual neural stimulation (TLNS) in concert with physical therapy 64 RADIOLOGY • September 2020 EMJ and the effects on the grey matter volume (GMV) were evaluated. TBI-related balance and movement impairments were also assessed through Sensory Organization Test (SOT) and Dynamic Gait Index (DGI) scoring. When comparing pre- and post-intervention results, the most prominent GMV changes were increases within the cerebellum, and temporal regions, which are involved in automatic processing of gait, balance, motor control, and visual-motion. Decreases of GMV in frontal, occipital lobes (involved in less automatic processing or more conscious/effortful processing of gait, balance, motor control, and vision) positively correlated to increases in SOT/DGI scores. These results indicate that TLNS can produce brain plasticity changes leading to positive changes in functional assessments. Overall, these data indicate that TLNS delivered in conjunction with physical therapy, is a safe, effective, and integrative way to treat TBI. INTRODUCTION changes (i.e., brain regions of pons, brainstem, and cerebellum), reduce symptoms, and begin 13,14,16,17 The Centers for Disease Control and Prevention normalising function. In TLNS, stimulation (CDC) report that up to 5.3 million people in of the tongue can occur with either a high- the USA are living with a disability related to frequency (HFP) or low-frequency (LFP) pulse traumatic brain injury (TBI),1 resulting in $76.5 device. A long-term clinical trial was recently billion per year2 in medical and rehabilitation completed to investigate the efficacy of TLNS costs. The majority of TBI are considered mild- in patients with mmTBI symptoms and compare 18 to-moderate (mmTBI)3 and development of outcomes of the HFP and LFP devices. balance impairments after injury is common, To better understand the effects of TLNS, the 4 occurring in 30% to 65% of patients. Currently, substudy presented here was developed with the the main approach for treating mmTBI primary objective of using structural MRI (sMRI) symptoms is physical therapy (PT), but its effect to evaluate cortical and subcortical changes in has limits and improvements in function are the brains of patients before (pre-) and after 5 often lost if therapy is not sustained. Recent (post-) treatment. Specifically, the grey matter studies have demonstrated the effective volume (GMV) results before and after treatment outcomes with motor-behavioural interventions were compared to investigate if individuals 6-9 and cognitive skill training after injury, experienced a reduction in compensatory brain which support the development of a regions and, conversely, growth in deficient unified and multidisciplinary approach to automatic brain regions. These structural 10-12 mmTBI treatment. changes were then correlated to behavioural A treatment plan utilising translingual neural assessments of balance and gait before and stimulation (TLNS) combines electrical after treatment. stimulation of cranial nerves V (trigeminal) and VII (facial) with physical therapy mainly aimed METHODS AND MATERIALS at restoring balance and gait.13 TLNS can be provided via the Portable Neuromodulation Participants Stimulator (PoNS®, Helius Medical Technologies, Newtown, Pennsylvania, USA), an investigational Participants were recruited through print and medical device that delivers sequenced patterns radio advertising and were required to have mm of electrical stimulation on the tongue. These TBI that occurred 1 year before enrolment, stimuli then trigger the trigeminal and facial reached a functional plateau in their recovery nerves to excite a natural flow of neural impulses (as defined by a discharge note from their to the brainstem or cerebellum and promote physical therapist), and a NeuroComa Sensory changes in targeted brain structures.14-16 Results Organization Test (SOT) composite score 16 from pilot studies of TLNS treatment of patients points below normal after adjustment for age. after mmTBI suggest that, in the absence of Mild and moderate TBI diagnoses were made identifiable tissue damage, a combination of based on guidelines established by Veterans neurostimulation and rehabilitation that is both Affairs/Department of Defense.19 All participants targeted and challenging will induce neuroplastic had a nonremarkable neuroradiographic report Creative Commons Attribution-Non Commercial 4.0 September 2020 • RADIOLOGY 65 after their most recent TBI, meaning that the other than those attributed to their primary findings were not significant per the clinical diagnosis, history of treatment for cancer judgement of the neuroradiologist. Reports other than basal cell carcinoma within the past were reviewed to rule out refractory subdural year, a penetrating head injury, craniotomy, or haematomas, evidence of tumours, anatomical refractory subdural haematoma. Long-term use anomalies, or evidence of loss of grey matter. of psychoactive or psychostimulant medications Neuroradiographic reports and therapy that, in the opinion of the investigators, discharge notes were obtained through a would compromise the participant’s ability to medical records request; MRI prior to enrolment comprehend and perform study activities was was required if a participant lacked a also grounds for exclusion, as was the presence neuroradiographic report. Potential participants of a pacemaker or elevated risk for cardiovascular were excluded if they had oral or other health events. Individuals with a lower extremity problems that would preclude TLNS or, in the biomechanical prosthetic, history of seizures, or a opinion of the investigators, were unable to ‘severe’ score in any of the attention, memory, or successfully complete the stimulation intensity executive functions categories on the Cognitive level setting procedure for the device. Additional Linguistic Quick Test (CLQT) were also excluded.20 inclusion and exclusion criteria are available (please see next paragraph for the detailed Intervention criteria for inclusion and exclusion about all the The intervention TLNS training programme nine mmTBI participants who received HFP focussed on balance and gait, and consists of or LFP stimulation). Rolling recruitment was twice-daily in-lab training for 2-weeks (with at- used, and enrolled participants had a unique home training during the intervening weekend). 3-digit identifier that was used for double blinding The participants also received physical exercise and 1:1 randomisation by a clinical monitor. training to develop improved motor coordination Nine participants with mmTBI (at least 1 year and mobility as part of the TLNS training. post-injury) were involved (age range: 43–62 All participants returned to the clinic weekly years; mean age: 53.11; standard deviation: 6.60; 6 during the at-home phase for a single session of female and 3 male) in the study. The Institutional retraining and progression, and participated in Review
Load more

Recommended publications
  • The Reversal Sign Daniel Gaete,1 Antonio Lopez-Rueda2
    Images in… BMJ Case Reports: first published as 10.1136/bcr-2014-204419 on 16 May 2014. Downloaded from The reversal sign Daniel Gaete,1 Antonio Lopez-Rueda2 1Clinica Alemana de Santiago, DESCRIPTION Santiago, Chile A 75-year-old man with a history of chronic 2Hospital Clinic i Provincial de Barcelona, Barcelona, Spain obstructive pulmonary disease was found in cardio- pulmonary arrest. After successful resuscitation the Correspondence to patient was transferred to our institution. On Antonio Lopez-Rueda, arrival, a non-enhanced brain CT was performed to [email protected] assess brain damage, which showed signs of diffuse Accepted 18 April 2014 cerebral oedema, with effacement of the cerebral sulci, sulcal hyperdensity and decreased attenuation of deep and cortical grey matter which appears hypodense in comparison to the white matter, a finding referred to as the ‘reversal sign’ (figures 1 and 2). These injuries were secondary to global brain ischaemia. In less than 8 h, the patient devel- oped multiple organ dysfunction syndrome and was pronounced dead. Cardiopulmonary arrest may lead to diffuse hypoxic ischaemic brain injury. Initially, unen- hanced brain CT may show subtle hypodensity of Figure 2 Coronal reformatted image of the same the basal ganglia and insular cortex, with efface- patient showing the reversal sign, which is also present ment of the basal cisterns. When diffuse brain in the cerebellum. oedema develops, the findings become more obvious, with effacement of the sulci and cisterns, The reversal sign reflects a diffuse hypoxic and loss of the grey matter–white matter differenti- ischaemic cerebral injury, with irreversible brain ation.
    [Show full text]
  • Anatomy of the Temporal Lobe
    Hindawi Publishing Corporation Epilepsy Research and Treatment Volume 2012, Article ID 176157, 12 pages doi:10.1155/2012/176157 Review Article AnatomyoftheTemporalLobe J. A. Kiernan Department of Anatomy and Cell Biology, The University of Western Ontario, London, ON, Canada N6A 5C1 Correspondence should be addressed to J. A. Kiernan, [email protected] Received 6 October 2011; Accepted 3 December 2011 Academic Editor: Seyed M. Mirsattari Copyright © 2012 J. A. Kiernan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Only primates have temporal lobes, which are largest in man, accommodating 17% of the cerebral cortex and including areas with auditory, olfactory, vestibular, visual and linguistic functions. The hippocampal formation, on the medial side of the lobe, includes the parahippocampal gyrus, subiculum, hippocampus, dentate gyrus, and associated white matter, notably the fimbria, whose fibres continue into the fornix. The hippocampus is an inrolled gyrus that bulges into the temporal horn of the lateral ventricle. Association fibres connect all parts of the cerebral cortex with the parahippocampal gyrus and subiculum, which in turn project to the dentate gyrus. The largest efferent projection of the subiculum and hippocampus is through the fornix to the hypothalamus. The choroid fissure, alongside the fimbria, separates the temporal lobe from the optic tract, hypothalamus and midbrain. The amygdala comprises several nuclei on the medial aspect of the temporal lobe, mostly anterior the hippocampus and indenting the tip of the temporal horn. The amygdala receives input from the olfactory bulb and from association cortex for other modalities of sensation.
    [Show full text]
  • Histological Underpinnings of Grey Matter Changes in Fibromyalgia Investigated Using Multimodal Brain Imaging
    1090 • The Journal of Neuroscience, February 1, 2017 • 37(5):1090–1101 Neurobiology of Disease Histological Underpinnings of Grey Matter Changes in Fibromyalgia Investigated Using Multimodal Brain Imaging X Florence B. Pomares,1,2 Thomas Funck,3 Natasha A. Feier,1 XSteven Roy,1 X Alexandre Daigle-Martel,4 XMarta Ceko,5 Sridar Narayanan,3 XDavid Araujo,3 Alexander Thiel,6,7 Nikola Stikov,4,8 Mary-Ann Fitzcharles,9,10 and Petra Schweinhardt1,2,6,11 1Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 0C7, Canada, 2Faculty of Dentistry, McGill University, Montreal, Quebec H3A 0C7, Canada, 3McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, H3A 2B4, Canada, 4Institute for Biomedical Engineering, E´cole Polytechnique, Montreal, Quebec H3T 1J4, Canada, 5Institute of Cognitive Science, University of Colorado, Boulder, Colorado 80309, 6Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec H3A 0C7, Canada, 7Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada, 8Montreal Heart Institute, Montreal, Quebec, H1T 1C8, Canada, 9Division of Rheumatology, McGill University Health Centre, Montreal, Quebec H3G 1A4, Canada, 10Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec H3G 1A4, Canada, and 11Interdisciplinary Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, 8008 Zurich, Switzerland Chronic pain patients present with cortical gray matter alterations, observed with anatomical magnetic resonance (MR) imaging. Reduced regional gray matter volumes are often interpreted to reflect neurodegeneration, but studies investigating the cellular origin of gray matter changesarelacking.Weusedmultimodalimagingtocompare26postmenopausalwomenwithfibromyalgiawith25healthycontrols(agerange: 50–75 years) to test whether regional gray matter volume decreases in chronic pain are associated with compromised neuronal integrity.
    [Show full text]
  • Visual Cortex in Humans 251
    Author's personal copy Visual Cortex in Humans 251 Visual Cortex in Humans B A Wandell, S O Dumoulin, and A A Brewer, using fMRI, and we discuss the main features of the Stanford University, Stanford, CA, USA V1 map. We then summarize the positions and proper- ties of ten additional visual field maps. This represents ã 2009 Elsevier Ltd. All rights reserved. our current understanding of human visual field maps, although this remains an active field of investigation, with more maps likely to be discovered. Finally, we Human visua l cortex comprises 4–6 billion neurons that are organ ized into more than a dozen distinct describe theories about the functional purpose and functional areas. These areas include the gray matter organizing principles of these maps. in the occi pital lobe and extend into the temporal and parietal lobes . The locations of these areas in the The Size and Location of Human Visual intact human cortex can be identified by measuring Cortex visual field maps. The neurons within these areas have a variety of different stimulus response proper- The entirety of human cortex occupies a surface area 2 ties. We descr ibe how to measure these visual field on the order of 1000 cm and ranges between 2 and maps, their locations, and their overall organization. 4 mm in thickness. Each cubic millimeter of cortex contains approximately 50 000 neurons so that neo- We then consider how information about patterns, objects, color s, and motion is analyzed and repre- cortex in the two hemispheres contain on the order of sented in these maps.
    [Show full text]
  • Toward a Common Terminology for the Gyri and Sulci of the Human Cerebral Cortex Hans Ten Donkelaar, Nathalie Tzourio-Mazoyer, Jürgen Mai
    Toward a Common Terminology for the Gyri and Sulci of the Human Cerebral Cortex Hans ten Donkelaar, Nathalie Tzourio-Mazoyer, Jürgen Mai To cite this version: Hans ten Donkelaar, Nathalie Tzourio-Mazoyer, Jürgen Mai. Toward a Common Terminology for the Gyri and Sulci of the Human Cerebral Cortex. Frontiers in Neuroanatomy, Frontiers, 2018, 12, pp.93. 10.3389/fnana.2018.00093. hal-01929541 HAL Id: hal-01929541 https://hal.archives-ouvertes.fr/hal-01929541 Submitted on 21 Nov 2018 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. REVIEW published: 19 November 2018 doi: 10.3389/fnana.2018.00093 Toward a Common Terminology for the Gyri and Sulci of the Human Cerebral Cortex Hans J. ten Donkelaar 1*†, Nathalie Tzourio-Mazoyer 2† and Jürgen K. Mai 3† 1 Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands, 2 IMN Institut des Maladies Neurodégénératives UMR 5293, Université de Bordeaux, Bordeaux, France, 3 Institute for Anatomy, Heinrich Heine University, Düsseldorf, Germany The gyri and sulci of the human brain were defined by pioneers such as Louis-Pierre Gratiolet and Alexander Ecker, and extensified by, among others, Dejerine (1895) and von Economo and Koskinas (1925).
    [Show full text]
  • The Role of the Superior Temporal Sulcus and the Mirror Neuron System in Imitation
    r Human Brain Mapping 31:1316–1326 (2010) r The Role of the Superior Temporal Sulcus and the Mirror Neuron System in Imitation Pascal Molenberghs,* Christopher Brander, Jason B. Mattingley, and Ross Cunnington The University of Queensland, Queensland Brain Institute & School of Psychology, St Lucia, Queensland, Australia r r Abstract: It has been suggested that in humans the mirror neuron system provides a neural substrate for imitation behaviour, but the relative contributions of different brain regions to the imitation of manual actions is still a matter of debate. To investigate the role of the mirror neuron system in imita- tion we used fMRI to examine patterns of neural activity under four different conditions: passive ob- servation of a pantomimed action (e.g., hammering a nail); (2) imitation of an observed action; (3) execution of an action in response to a word cue; and (4) self-selected execution of an action. A net- work of cortical areas, including the left supramarginal gyrus, left superior parietal lobule, left dorsal premotor area and bilateral superior temporal sulcus (STS), was significantly active across all four con- ditions. Crucially, within this network the STS bilaterally was the only region in which activity was significantly greater for action imitation than for the passive observation and execution conditions. We suggest that the role of the STS in imitation is not merely to passively register observed biological motion, but rather to actively represent visuomotor correspondences between one’s own actions and the actions of others. Hum Brain Mapp 31:1316–1326, 2010. VC 2010 Wiley-Liss, Inc. Key words: fMRI; imitation; mirror neuron system r r INTRODUCTION ror neurons are visuomotor neurons that fire both when an action is performed and when a similar or identical Motor imitation involves observing the action of another action is passively observed [Rizzolatti and Craighero, individual and matching one’s own movements to those 2004].
    [Show full text]
  • Correction for Partial-Volume Effects on Brain Perfusion SPECT in Healthy Men
    Correction for Partial-Volume Effects on Brain Perfusion SPECT in Healthy Men Hiroshi Matsuda, MD1; Takashi Ohnishi, MD1; Takashi Asada, MD2; Zhi-jie Li, MD1,3; Hidekazu Kanetaka, MD1; Etsuko Imabayashi, MD1; Fumiko Tanaka, MD1; and Seigo Nakano, MD4 1Department of Radiology, National Center Hospital for Mental, Nervous, and Muscular Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan; 2Department of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan; 3Department of Nuclear Medicine, The Second Clinical Hospital of China Medical University, Shen-Yang City, China; and 4Department of Geriatric Medicine, National Center Hospital for Mental, Nervous, and Muscular Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan The limited spatial resolution of SPECT scanners does not allow Functional changes in the brains of healthy elderly people an exact measurement of the local radiotracer concentration in and patients with neurodegenerative disorders have been brain tissue because partial-volume effects (PVEs) underesti- studied widely by SPECT. However, due to the limited mate concentration in small structures of the brain. The aim of this study was to determine which brain structures show greater spatial resolution of SPECT, the accurate measurement of influence of PVEs in SPECT studies on healthy volunteers and to tracer concentration in brain structures depends on several investigate aging effects on SPECT after the PVE correction. physical limitations—particularly, the relation between ob- Methods: Brain perfusion SPECT using 99mTc-ethylcysteinate ject size and scanner spatial resolution. This relation, known dimer was performed in 52 healthy men, 18–86 y old. The as the partial-volume effect (PVE), biases the measured regional cerebral blood flow (rCBF) was noninvasively measured concentration in small structures by diminishing the true using graphical analysis.
    [Show full text]
  • Stimulus Arousal Drives Amygdalar Responses to Emotional
    www.nature.com/scientificreports OPEN Stimulus arousal drives amygdalar responses to emotional expressions across sensory modalities Huiyan Lin1,2,4*, Miriam Müller-Bardorf2,4, Bettina Gathmann2,4, Jaqueline Brieke2, Martin Mothes-Lasch2, Maximilian Bruchmann2, Wolfgang H. R. Miltner3 & Thomas Straube2 The factors that drive amygdalar responses to emotionally signifcant stimuli are still a matter of debate – particularly the proneness of the amygdala to respond to negatively-valenced stimuli has been discussed controversially. Furthermore, it is uncertain whether the amygdala responds in a modality-general fashion or whether modality-specifc idiosyncrasies exist. Therefore, the present functional magnetic resonance imaging (fMRI) study systematically investigated amygdalar responding to stimulus valence and arousal of emotional expressions across visual and auditory modalities. During scanning, participants performed a gender judgment task while prosodic and facial emotional expressions were presented. The stimuli varied in stimulus valence and arousal by including neutral, happy and angry expressions of high and low emotional intensity. Results demonstrate amygdalar activation as a function of stimulus arousal and accordingly associated emotional intensity regardless of stimulus valence. Furthermore, arousal-driven amygdalar responding did not depend on the visual and auditory modalities of emotional expressions. Thus, the current results are consistent with the notion that the amygdala codes general stimulus relevance across visual
    [Show full text]
  • The Human Brain Hemisphere Controls the Left Side of the Body and the Left What Makes the Human Brain Unique Is Its Size
    About the brain Cerebrum (also known as the The brain is made up of around 100 billion nerve cells - each one cerebral cortex or forebrain) is connected to another 10,000. This means that, in total, we The cerebrum is the largest part of the brain. It is split in to two have around 1,000 trillion connections in our brains. (This would ‘halves’ of roughly equal size called hemispheres. The two be written as 1,000,000,000,000,000). These are ultimately hemispheres, the left and right, are joined together by a bundle responsible for who we are. Our brains control the decisions we of nerve fibres called the corpus callosum. The right make, the way we learn, move, and how we feel. The human brain hemisphere controls the left side of the body and the left What makes the human brain unique is its size. Our brains have a hemisphere controls the right side of the body. The cerebrum is larger cerebral cortex, or cerebrum, relative to the rest of the The human brain is the centre of our nervous further divided in to four lobes: frontal, parietal, occipital, and brain than any other animal. (See the Cerebrum section of this temporal, which have different functions. system. It is the most complex organ in our fact sheet for further information.) This enables us to have abilities The frontal lobe body and is responsible for everything we do - such as complex language, problem-solving and self-control. The frontal lobe is located at the front of the brain.
    [Show full text]
  • Function of Cerebral Cortex
    FUNCTION OF CEREBRAL CORTEX Course: Neuropsychology CC-6 (M.A PSYCHOLOGY SEM II); Unit I By Dr. Priyanka Kumari Assistant Professor Institute of Psychological Research and Service Patna University Contact No.7654991023; E-mail- [email protected] The cerebral cortex—the thin outer covering of the brain-is the part of the brain responsible for our ability to reason, plan, remember, and imagine. Cerebral Cortex accounts for our impressive capacity to process and transform information. The cerebral cortex is only about one-eighth of an inch thick, but it contains billions of neurons, each connected to thousands of others. The predominance of cell bodies gives the cortex a brownish gray colour. Because of its appearance, the cortex is often referred to as gray matter. Beneath the cortex are myelin-sheathed axons connecting the neurons of the cortex with those of other parts of the brain. The large concentrations of myelin make this tissue look whitish and opaque, and hence it is often referred to as white matter. The cortex is divided into two nearly symmetrical halves, the cerebral hemispheres . Thus, many of the structures of the cerebral cortex appear in both the left and right cerebral hemispheres. The two hemispheres appear to be somewhat specialized in the functions they perform. The cerebral hemispheres are folded into many ridges and grooves, which greatly increase their surface area. Each hemisphere is usually described, on the basis of the largest of these grooves or fissures, as being divided into four distinct regions or lobes. The four lobes are: • Frontal, • Parietal, • Occipital, and • Temporal.
    [Show full text]
  • OBSERVATIONS on PARTIAL REMOVAL of the POST-CENTRAL GYRUS for PAIN by WALPOLE LEWIN and C
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.15.3.143 on 1 August 1952. Downloaded from J. Neurol. Neurosurg. Psychiat., 1952, 15, 143. OBSERVATIONS ON PARTIAL REMOVAL OF THE POST-CENTRAL GYRUS FOR PAIN BY WALPOLE LEWIN and C. G. PHILLIPS From the Nuffield Department ofSurgery and the University Laboratory ofPhysiology, Oxford The role of the cerebral cortex in the conscious one case where stimulation of the sensory cortex appreciation of pain has interested neurologists for produced pain in the phantom leg. many years. Head and Holmes (1911) considered In this paper we wish to record three cases in that pain entered consciousness at thalamic level, which partial resection of the post-central gyrus and more recently Penfleld (1947) stated that was undertaken for the relief of pain. In the first 6. .no removal of cortex anywhere can prevent patient the pain developed during an unusual, pain from being felt and only very rarely does a prolonged, sensory painful aura in traumatic patient use the word pain to describe the result of epilepsy, the second patient had intractable pain in cortical stimulation ", and, he goes on, " it is a phantom foot, and the third had a painful thigh obvious therefore that the pathway of pain conduc- stump. In all three, electrical stimulation of the Protected by copyright. tion reaches the thalamus and consciousness appropriate area of the post-central gyrus repro- without essential conduction to the cortex ". duced the pain complained of by the patient and Adrian (1941) found that no impulses reached the relief followed the removal of this area of cortex.
    [Show full text]
  • Neocortex: Consciousness Cerebellum
    Grey matter (chips) White matter (the wiring: the brain mainly talks to itself) Neocortex: consciousness Cerebellum: unconscious control of posture & movement brains 1. Golgi-stained section of cerebral cortex 2. One of Ramon y Cajal’s faithful drawings showing nerve cell diversity in the brain cajal Neuropil: perhaps 1 km2 of plasma membrane - a molecular reaction substrate for 1024 voltage- and ligand-gated ion channels. light to Glia: 3 further cell types 1. Astrocytes: trophic interface with blood, maintain blood brain barrier, buffer excitotoxic neurotransmitters, support synapses astros Oligodendrocytes: myelin insulation oligos Production persists into adulthood: radiation myelopathy 3. Microglia: resident macrophages of the CNS. Similarities and differences with Langerhans cells, the professional antigen-presenting cells of the skin. 3% of all cells, normally renewed very slowly by division and immigration. Normal Neurosyphilis microglia Most adult neurons are already produced by birth Peak synaptic density by 3 months EMBRYONIC POSTNATAL week: 0 6 12 18 24 30 36 Month: 0 6 12 18 24 30 36 Year: 4 8 12 16 20 24 Cell birth Migration 2* Neurite outgrowth Synaptogenesis Myelination 1* Synapse elimination Modified from various sources inc: Andersen SL Neurosci & Biobehav Rev 2003 Rakic P Nat Rev Neurosci 2002 Bourgeois Acta Pediatr Suppl 422 1997 timeline 1 Synaptogenesis 100% * Rat RTH D BI E A Density of synapses in T PUBERTY primary visual cortex H at different times post- 0% conception. 100% (logarithmic scale) RTH Cat BI D E A T PUBERTY H The density values equivalent 0% to 100% vary between species 100% but in Man the peak value is Macaque 6 3 RTH 350 x10 synapses per mm BI D E PUBERTY A T The peak rate of synapse H formation is at birth in the 0% macaque: extrapolating to 100% the entire cortex, this Man RTH BI amounts to around 800,000 D E synapses formed per sec.
    [Show full text]