Somatosensory-Evoked Potentials as a Marker of Functional Neuroplasticity in Athletes: A Systematic Review

BackgroundSomatosensory-evoked potentials (SEP) represent a non-invasive tool to assess neural responses elicited by somatosensory stimuli acquired via electrophysiological recordings. To date, there is no comprehensive evaluation of SEPs for the diagnostic investigation of exercise-induced functional neuroplasticity. This systematic review aims at highlighting the potential of SEP measurements as a diagnostic tool to investigate exercise-induced functional neuroplasticity of the sensorimotor system by reviewing studies comparing SEP parameters between athletes and healthy controls who are not involved in organized sports as well as between athlete cohorts of different sport disciplines.MethodsA systematic literature search was conducted across three electronic databases (PubMed, Web of Science, and SPORTDiscus) by two independent researchers. Three hundred and ninety-seven records were identified, of which 10 cross-sectional studies were considered eligible.ResultsDifferences in SEP amplitudes and latencies between athletes and healthy controls or between athletes of different cohorts as well as associations between SEP parameters and demographic/behavioral variables (years of training, hours of training per week & reaction time) were observed in seven out of 10 included studies. In particular, several studies highlight differences in short- and long-latency SEP parameters, as well as high-frequency oscillations (HFO) when comparing athletes and healthy controls. Neuroplastic differences in athletes appear to be modality-specific as well as dependent on training regimens and sport-specific requirements. This is exemplified by differences in SEP parameters of various athlete populations after stimulation of their primarily trained limb.ConclusionTaken together, the existing literature suggests that athletes show specific functional neuroplasticity in the somatosensory system. Therefore, this systematic review highlights the potential of SEP measurements as an easy-to-use and inexpensive diagnostic tool to investigate functional neuroplasticity in the sensorimotor system of athletes. However, there are limitations regarding the small sample sizes and inconsistent methodology of SEP measurements in the studies reviewed. Therefore, future intervention studies are needed to verify and extend the conclusions drawn here.

Habituation of Somatosensory Evoked Potentials in Patients with Alzheimer’s Disease and Those with Vascular Dementia

Background and Objectives: The most prevalent dementia are Alzheimer’s disease and vascular dementia. There is evidence that cortical synaptic function may differ in these two conditions. Habituation of cortical responses to repeated stimuli is a well-preserved phenomenon in a normal brain cortex, related to an underlying mechanism of synaptic efficacy regulation. Lack of habituation represents a marker of synaptic dysfunction. The purpose of this study was to assess the habituation of somatosensory evoked potentials (SEPs) in 29 patients affected by mild-to-moderate Alzheimer’s disease (AD-type) or vascular (VD-type) dementia. Materials and Methods: All patients underwent a clinical history interview, neuropsychological evaluation, and neuroimaging examination. SEPs were elicited by electrical stimulation of the right median nerve at the wrist. Six-hundred stimuli were delivered, and cortical responses divided in three blocks of 200. Habituation was calculated by measuring changes of N20 amplitude from block 1 to block 3. SEP variables recorded in patients were compared with those recorded in 15 age- and gender-matched healthy volunteers. Results: SEP recordings showed similar N20 amplitudes in AD-type and VD-type patients in block 1, that were higher than those recorded in controls. N20 amplitude decreased from block 1 to block 3 (habituation) in normal subjects and in VD-type patients, whereas in AD-type patients it remained unchanged (lack of habituation). Conclusions: The findings suggest that neurophysiologic mechanisms of synaptic efficacy that underneath habituation are impaired in patients with AD-type dementia but not in patients with VD-type dementia. SEPs habituation may contribute to early distinction of Alzheimer’s disease vs. vascular dementia.

Comparison of subjective peripheral sensation, F-waves, and somatosensory evoked potentials in response to a unilateral pinch task measured on the contractile and non-contractile sides

Depression of sensory input during voluntary muscle contractions has been demonstrated using electrophysiological methods in both animals and humans. However, the association between electrophysiological responses of the sensory system and subjective peripheral sensation (SPS) during a voluntary muscle contraction remains unclear. Our aim in this study was to describe the changes in SPS, spinal α-motoneuron excitability (F-wave to M-wave amplitude), and somatosensory evoked potentials (SEPs) during a unilateral pinch-grip task. Outcome variables were measured on the side ipsilateral and contralateral to the muscle contraction, and at rest (control). Participants were 8 healthy men, 20.9±0.8 years of age. The isometric pinch-grip task was performed at 30% of the maximum voluntary isometric force measured for the right and left hand separately. The appearance rate of the F-wave during the task was significantly higher for the ipsilateral (right) hand than for the contralateral (left) hand and control condition. Although there was no difference in F-wave latency between hands and the control condition, the amplitude of the F-wave was significantly higher for the ipsilateral (right) hand than for the contralateral (left) hand and the control condition. There was no difference in the amplitude of the SEP at N20. However, the amplitude at P25 was significantly lower for the ipsilateral (right) hand than for the contralateral (left) hand and the control condition. The accuracy rate of detecting tactile stimulation, evaluated for 20 repetitions using a Semmes–Weinstein monofilament at the sensory threshold for each participant, was significantly lower during the pinch-grip task for both the ipsilateral (right) and contralateral (left) hand compared to the control condition. Overall, our findings show that SPS and neurophysiological parameters were not modulated in parallel during the task, with changes in subjective sensation preceding changes in electrophysiological indices during the motor task. Our findings provide basic information on sensory-motor coordination.

Evoked potentials as biomarkers of hereditary spastic paraplegias: A case-control study

Introduction The Hereditary Spastic Paraplegias (HSP) are a group of genetic diseases that lead to slow deterioration of locomotion. Clinical scales seem to have low sensitivity in detecting disease progression, making the search for additional biomarkers a paramount task. This study aims to evaluate the role of evoked potentials (EPs) as disease biomarkers of HSPs. Methods A single center cross-sectional case-control study was performed, in which 18 individuals with genetic diagnosis of HSP and 21 healthy controls were evaluated. Motor evoked potentials (MEP) obtained with transcranial magnetic stimulation and somatosensory evoked potentials (SSEP) were performed in lower (LL) and upper limbs (UL). Results Central motor conduction time in lower limbs (CMCT-LL) was prolonged in HSP subjects, with marked reductions in MEP-LL amplitudes when compared to the control group (p<0.001 for both comparisons). CMCT-UL was 3.59ms (95% CI: 0.73 to 6.46; p = 0.015) prolonged and MEP-UL amplitudes were reduced (p = 0.008) in the HSP group. SSEP-LL latencies were prolonged in HSP subjects when compared to controls (p<0.001), with no statistically significant differences for upper limbs (p = 0.147). SSEP-UL and SSEP-LL latencies presented moderate to strong correlations with age at onset (Rho = 0.613, p = 0.012) and disease duration (Rho = 0.835, p<0.001), respectively. Similar results were obtained for the SPG4 subgroups of patients. Conclusion Motor and somatosensory evoked potentials can adequately differentiate HSP individuals from controls. MEP were severely affected in HSP subjects and SSEP-LL latencies were prolonged, with longer latencies being related to more severe disease. Future longitudinal studies should address if SSEP is a sensitive disease progression biomarker for HSP.

Effect of Neck Muscle Fatigue on Hand Muscle Motor Performance and Early Somatosensory Evoked Potentials

Even on pain free days, recurrent neck pain alters sensorimotor integration (SMI) measured via somatosensory evoked potentials (SEPs). Neck muscle fatigue decreases upper limb proprioception, and thus may interfere with upper limb motor task acquisition and SMI. This study aimed to determine the effect of cervical extensor muscle (CEM) fatigue on upper limb motor acquisition and retention; and SMI, measured via early SEPs. Twenty-four healthy right-handed individuals were randomly assigned to control or CEM fatigue. Baseline SEPs were elicited via median nerve stimulation at the wrist. Participants then lay prone on a padded table. The fatigue group supported a 2 kg weight until they could no longer maintain the position. The control group rested their neck in neutral for 5 min. Participants completed pre- and post-motor skill acquisition while seated, SEPs were again collected. Task retention was measured 24 h later. Accuracy improved post acquisition and at retention for both groups (p < 0.001), with controls outperforming the fatigue group (p < 0.05). The fatigue group had significantly greater increases in the N24 (p = 0.017) and N30 (p = 0.007) SEP peaks. CEM fatigue impaired upper limb motor learning outcomes in conjunction with differential changes in SEP peak amplitudes related to SMI.

Direct brainstem somatosensory evoked potentials for cavernous malformations

OBJECTIVE Brainstem cavernous malformations (CMs) often require resection due to their aggressive natural history causing hemorrhage and progressive neurological deficits. The authors report a novel intraoperative neuromonitoring technique of direct brainstem somatosensory evoked potentials (SSEPs) for functional mapping intended to help guide surgery and subsequently prevent and minimize postoperative sensory deficits. METHODS Between 2013 and 2019 at the Stanford University Hospital, intraoperative direct brainstem stimulation of primary somatosensory pathways was attempted in 11 patients with CMs. Stimulation identified nucleus fasciculus, nucleus cuneatus, medial lemniscus, or safe corridors for incisions. SSEPs were recorded from standard scalp subdermal electrodes. Stimulation intensities required to evoke potentials ranged from 0.3 to 3.0 mA or V. RESULTS There were a total of 1 midbrain, 6 pontine, and 4 medullary CMs—all with surrounding hemorrhage. In 7/11 cases, brainstem SSEPs were recorded and reproducible. In cases 1 and 11, peripheral median nerve and posterior tibial nerve stimulations did not produce reliable SSEPs but direct brainstem stimulation did. In 4/11 cases, stimulation around the areas of hemosiderin did not evoke reliable SSEPs. The direct brainstem SSEP technique allowed the surgeon to find safe corridors to incise the brainstem and resect the lesions. CONCLUSIONS Direct stimulation of brainstem sensory structures with successful recording of scalp SSEPs is feasible at low stimulation intensities. This innovative technique can help the neurosurgeon clarify distorted anatomy, identify safer incision sites from which to evacuate clots and CMs, and may help reduce postoperative neurological deficits. The technique needs further refinement, but could potentially be useful to map other brainstem lesions.

Amplitude of Somatosensory Evoked Potentials (SEPs) in Short-Latency SEPs Condition is 80% of that in Giant SEPs

The recording conditions of somatosensory evoked potentials (giant SEPs) are different from those of short-latency SEPs (SSEPs). We investigated the waveform characteristics obtained for each condition. Forty-eight upper limbs of 24 adult normal subjects (12 males, age 35.5 ± 9.7 years (mean ± SD)) were investigated. The main differences in recording conditions were reference electrodes (giant SEPs: the earlobe electrode ipsilateral to the stimulated limb, SSEPs: Fz), stimulus rate (1 Hz, 5 Hz), and bandpass filter (1 Hz–1 kHz, 20 Hz–3 kHz). SEPs were elicited by unilateral percutaneous electrical stimulation of the median nerve at the wrist. The amplitudes of N20o–N20 and N20–P25 were significantly larger in the giant SEP condition than in the SSEP condition (p<0.001). The mean + 3SD of N20–P25 amplitude was 10.0 µV in the giant SEP condition and 7.8 µV in the SSEP condition. The N20–P25 amplitude was significantly correlated between the giant SEP and SSEP conditions (R=0.64, p<0.001). Thus, the amplitude of SEPs in the SSEPs condition is equivalent to 80% of that in the giant SEPs condition. The information is useful for detecting cortical hyperexcitability in various neurological disorders including myoclonic epilepsy.