Isolating two sources of variability of subcortical stimulation to quantify fluctuations of corticospinal tract excitability. (June 2022)

• Record Type: Journal Article
• Authors: Goetz, Stefan M.; Howell, Bryan; Wang, Boshuo; Li, Zhongxi; Sommer, Marc A.; Peterchev, Angel V.; Grill, Warren M.
• Is Part Of: Clinical neurophysiology. Volume 138(2022)
• Page Start: 134
• Page End: 142
• Publication Date: 2022-06
• Subjects: Subcortical electrical stimulation -- Recruitment curve -- Input–output (IO) curve -- Dose–response curve -- Trial-to-trial variability -- Isolation of excitability -- Spinal contribution to short-term fluctuation of excitability; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2022.02.009
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Direct activation of pyramidal-tract fibers revealed two sources of trial-to-trial variability. Input-side variability downstream of cortical networks was present and similar in magnitude to that observed in previous TMS studies. Excitability fluctuations in the MEP more likely derived from stochastic activity in synapses rather than axonal ion channels. Abstract: Objective: Investigate the variability previously found with cortical stimulation and handheld transcranial magnetic stimulation (TMS) coils, criticized for its high potential of coil position fluctuations, bypassing the cortex using deep brain electrical stimulation (DBS) of the corticospinal tract with fixed electrodes where both latent variations of the coil position of TMS are eliminated and cortical excitation fluctuations should be absent. Methods: Ten input–output curves were recorded from five anesthetized cats with implanted DBS electrodes targeting the corticospinal tract. Goodness of fit of regressions with a conventional single variability source as well as a dual variability source model was quantified using a Schwarz Bayesian Information approach to avoid overfitting. Results: Motor evoked potentials (MEPs) through DBS of the corticospinal tract revealed short-term fluctuations in excitability of the targeted neuron pathway reflecting endogenous input-side variability at similar magnitude as TMS despite bypassing cortical networks. Conclusion: Input-side variability, i.e., variability resulting in changing MEP amplitudes as if the stimulation strength was modulated, also emerges in electrical stimulation at a similar degree and is not primarily a result of varying stimulation, such as minor coil movements in TMS. More importantly, this variability component is present, although the cortex is bypassed. Thus, it may be of spinal origin, which can include cortical input from spinal projections. Further, the nonlinearity of the compound variability entails complex heteroscedastic non-Gaussian distributions and typically does not allow simple linear averages in statistical analysis of MEPs. As the average is dominated by outliers, it risks bias. With appropriate regression, the net effects of excitatory and inhibitory inputs to the targeted neuron pathways become noninvasively observable and quantifiable. Significance: The neural responses evoked by artificial stimulation in the cerebral cortex are variable. For example, MEPs in response to repeated presentations of the same stimulus can vary from no response to saturation across trials. Several sources of such variability have been suggested, and most of them may be technical in nature, but localization is missing.