This study will provide information about changes that occur in the motor neurons of the
spinal cord (the nerve cells that control the muscles) when the motor cortex (the region of
the brain that controls movement) is unable to send messages to the spinal cord and muscles
in the normal way. This information will help elucidate how the nervous system adapts after
injury or disease of the motor cortex.
Healthy adult volunteers and adults with a spasticity disorder and moderate weakness may be
eligible for this study. Patients will be screened with a medical history, physical
examination and diagnostic studies as needed. Healthy volunteers will have a neurological
examination. Muscle weakness and spasticity will be evaluated in both groups of subjects.
All participants will have electromyography (measurement of electrical activity in muscles)
during nerve stimulation and transcranial magnetic stimulation, described below. (Some
patients, such as those with a pacemaker or implanted medication pumps, metal objects in the
eye, history of epilepsy and others, will not have magnetic stimulation.)
Electromyography - The electrical activity of muscles will be measured either by 1) using
metal electrodes taped to the skin overlying a muscle, or 2) using thin wires inserted into
the muscle through a needle.
Nerve stimulation - The nerves will be stimulated by applying a small electrical pulse
through metal disks on the skin of the arm or leg.
Transcranial magnetic stimulation - A brief electrical current is passed through a wire coil
placed on the scalp. This creates a magnetic pulse, which stimulates the brain. During the
test, the participant may be asked to tense certain muscles slightly or perform other simple
Nerve block - Some patients will have a nerve block of one of the nerves in the arm. For
this procedure, a local anesthetic is injected under the skin to produce numbness and
weakness in some arm muscles.
Objective: The purpose of this protocol is to characterize abnormalities in motoneuron
recruitment in adult patients with corticospinal tract dysfunction using electrophysiologic
measures. We wish to determine whether the intrinsic spinal mechanisms for recruitment are
abnormal or whether only inputs to motoneurons are changed. This information is pertinent
for assessing ways that can ultimately be used to enhance strength in patients with
corticospinal tract dysfunction using the existing spinal circuitry.
Study Design: Comparison of physiological observations in patients and age - matched control
Study Population: Adults with spastic paresis aged 21-80 and healthy volunteers.
Outcome Parameters: Measures of motor unit firing in response to peripheral nerve
stimulation and transcranial magnetic stimulation.
- INCLUSION CRITERIA:
Adult patients with selective corticospinal tract dysfunction
Minimum age 21 years; maximum age 80 years
Moderate severity of weakness (greater than or equal to MRC Grade 4)
Adult normal volunteers
Severe weakness with inability to maintain voluntary contractions
Significant sensory impairment
For TMS studies only: pregnancy, implanted devices such as pacemakers, medication pumps or
defibrillators, metal in the cranium except the mouth, intracardiac lines, history of