SUMMARY1. Using two magnetic stimulators, we investigated the effect of a conditioning magnetic stimulus over the motor cortex of one hemisphere on the size of EMG responses evoked in the first dorsal interosseous (FDI) muscle by a magnetic test stimulus given over the opposite hemisphere.2. A single conditioning shock to one hemisphere produced inhibition of the test response evoked from the opposite hemisphere when the conditioning-test interval was 5-6 ms or longer. We shall refer to this as interhemispheric inhibition. However, the minimum latency of inhibition observed using surface EMG responses may have underestimated the true interhemispheric conduction time. Single motor unit studies suggested values 4-7 ms longer than the minimum interval observed with surface EMG.3. Interhemispheric inhibition was seen when the test muscle was active or relaxed. Increasing the intensity of the conditioning stimulus increased the duration of inhibition: increasing the intensity of the test stimulus reduced the depth of inhibition.4. The conditioning coil had to be placed on the appropriate area of scalp for inhibition to occur. The effect of the conditioning stimulus was maximal when it was applied over the hand area of motor cortex, and decreased when the stimulus was moved medial or lateral to that point. A. FERBERT AND OTHERS 6. When the test muscle was relaxed, the amount of interhemispheric inhibition could be increased slightly by voluntary contraction of the muscles in the hand contralateral to the conditioning hemisphere. This effect disappeared if the test muscle was held active throughout the experiment.7. Magnetic conditioning stimuli over one hemisphere were also capable of affecting on-going voluntary EMG activity in the ipsilateral FDI. Inhibition began 10-15 ms after the minimum corticospinal conduction time to the muscle, and lasted for about 30 ms. The depth of inhibition was approximately proportional to the level of on-going EMG. A similar period of inhibition was also observed in the forearm flexor muscles, but in biceps it was less clear and sometimes preceded by excitation.8. The interhemispheric inhibition described in these experiments is probably produced via a transcallosal pathway.

Electromyograms (EMGs) were recorded from surface electrodes over the sternomastoid muscles and averaged in response to brief (0.1 ms) clicks played through headphones. In normal subjects, clicks 85 to 100 dB above our reference (45 dB SPL: close to perceptual threshold for normal subjects for such clicks) evoked reproducible changes in the averaged EMG beginning at a mean latency of 8-2 ms. The earliest potential change, a biphasic positive-negativity (p13-n23), occurred in all subjects and the response recorded from over the muscle on each side was predominantly generated by afferents originating from the ipsilateral ear. Later potentials (n34, p44), present in most but not all subjects, were generated bilaterally after unilateral ear stimulation. The amplitude of the averaged responses increased in direct proportion to the mean level of tonic muscle activation during the recording period. The p13-n23 response was abolished in patients who had undergone selective section of the vestibular nerve but was preserved in subjects with severe sensorineural hearing loss. It is proposed that the p13-n23 response is generated by activation of vestibular afferents, possibly those arising from the saccule, and transmitted via a rapidly conducting oligosynaptic pathway to anterior neck muscles. Conversely, the n34 and p44 potentials do not depend on the integrity of the vestibular nerve and probably originate from cochlear afferents. (7 Neurol Neurosurg Psychiatry 1994;57:190-197) The vestibular nuclei have powerful projections to the ocular motor nuclei, the cerebellum, the reticular formation, and the spinal cord.' In humans, the most accessible and best studied vestibular pathway is that between the semicircular canals and the ocular motor nuclei: the standard test of vestibular function, caloric induced nystagmus, measures the effect of horizontal canal activation on eye movements.2 The reflex effects resulting from activation of the otoliths and the function of the direct vestibular projections to the spinal cord in humans are difficult to study and poorly understood.3 The initial muscle excitation after an unexpected fall depends on otolith activation, possibly via connections to the reticular formation and thereby to the spinal cord." Detailed studies on a single patient who had an otolithic Tullio phenomenon (sound-evoked activation of the vestibular apparatus) showed shortlatency activation of leg muscles, probably via vestibulospinal pathways.7 The limitations of our knowledge of vestibular influences on the muscles of the trunk and limbs led us to reinvestigate earlier reports of activation of the vestibular apparatus in normal subjects by loud clicks.Bickford et al 8 described the characteristics of averaged responses to clicks with recordings with an active electrode just below the inion (the "inion response"). They concluded that the short latency potentials that they recorded were not, as they had first supposed, indicative of an auditory projection to the cerebellar vermis, but rather were gener...

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Regional cerebral blood flow was measured in normal subjects with positron emission tomography (PET) while they performed five different motor tasks. In all tasks they had to moved a joystick on hearing a tone. In the control task they always pushed it forwards (fixed condition), and in four other experimental tasks the subjects had to select between four possible directions of movement. These four tasks differed in the basis for movement selection. A comparison was made between the regional blood flow for the four tasks involving movement selection and the fixed condition in which no selection was required. When selection of a movement was made, significant increases in regional cerebral blood flow were found in the premotor cortex, supplementary motor cortex, and superior parietal association cortex. A comparison was also made between the blood flow maps generated when subjects performed tasks based on internal or external cues. In the tasks with internal cues the subjects could prepare their movement before the trigger stimulus, whereas in the tasks with external cues they could not. There was greater activation in the supplementary motor cortex for the tasks with internal cues. Finally a comparison was made between each of the selection conditions and the fixed condition; the greatest and most widespread changes in regional activity were generated by the task on which the subjects themselves made a random selection between the four movements.

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A recent technique of assessing vestibular function, the vestibular-evoked myogenic potential (VEMP), is an otolith-mediated, short-latency reflex recorded from averaged sternocleidomastoid electromyography in response to intense auditory clicks delivered via headphones. Since their first description 10 years ago, VEMPs are now being used by investigators worldwide, and characteristic changes observed with aging and in a variety of peripheral and central vestibulopathies have been described. Additional methods of evoking VEMPs, which use air- and bone-conducted short-tone bursts, forehead taps, and short-duration transmastoid direct current (DC) stimulation, have been described, and these complement the original technique. Click-evoked VEMPs are attenuated or absent in a proportion of patients with vestibular neuritis, herpes zoster oticus, late Meniere disease, and vestibular schwannomas; their amplitudes are increased and thresholds are pathologically lowered in superior semicircular canal dehiscence presenting with the Tullio phenomenon. VEMPs evoked by clicks and DC are useful when monitoring the efficacy of intratympanic gentamicin therapy used for chemical vestibular ablation. Prolonged p13 and n23 peak latencies and decreased amplitudes have been observed in association with central vestibulopathy. VEMPs evoked by clicks are a robust, reproducible screening test of otolith function. DC stimulation enables differentiation of labyrinthine from retrolabyrinthine lesions; bone-conducted stimuli permit VEMP recording despite conductive hearing loss and deliver a relatively larger vestibular stimulus for a given level of auditory perception.

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Summary: Positron emission tomographic (PET) images of regional cerebral blood flow (rCBF) from 30 normal, resting volunteers aged 30 to 85 years were analysed to identify areas where rCBF fell with age. Images were anatomically normalised, and a pixel-by-pixel linear re gression was performed to remove differences in global CBF between subjects. Pixels at which rCBF then showed a significant (p < 0.0 I) negative correlation with age were identified. They were displayed as a statistical parametric map (SPM) of correlations. We demonstrate an age-related decrease in adjusted rCBF in the cingulate,In the normal brain, local blood flow is coupled to metabolic demand (Greenberg et aI., 1979) probably by both chemical and neural mechanisms (Lou et aI., 1987). Positron emission tomography (PET) can measure the distribution within the brain of admin istered radionuclides. Such measurements may be converted into quantitative images of regional cere bral blood flow (rCBF) whose profile is taken to reflect neuronal activity (Frackowiak et aI., 1980;Fox, 1989).Many PET studies have looked for age-related changes in rCBF to investigate neural physiology in aging, and define normal values with which rCBF in