Brain Activity During Production of Movement
Brain Activity During Production of Movement
This study will use electroencephalography (EEG) to examine how the brain prepares for
 movement. It will look at 1) what changes occur in a person's brain just before voluntary
 movement, 2) when the changes occur, 3) how consistent the changes are, and 4) how the
 changes vary from person to person. The information from this study will be applied to other
 studies, such as exploring how brain changes that signal movement can be used to control
 prostheses in patients with spinal cord injuries or stroke.

 Healthy normal volunteers 18 years of age and older may be eligible for this study. People
 with neurologic or psychiatric disorders and people taking medicines that may affect brain
 signals (e.g., Valium) may not participate.

 Participants will come to the NIH Clinical Center on two separate days for testing sessions
 of 2 to 3 hours each. At each session, an EEG cap will be placed on the head to record brain
 signals, and electrodes will be placed on the arms to record movement. Subjects will perform
 simple movements during the EEG recording, such as flexing their arm of clenching their fist.
 Researchers will use the first recording to determine the pattern of how the brain prepares
 for movement. During the second recording, they will try to predict the subjects' movements,
 based on the patterns discerned in the first recording.
Human voluntary movement is associated with at least two distinct types of scalp
 electroencephalographic (EEG) changes. Event-related potentials are slow, with DC signals
 developing in the bifrontal region as early as 1.5 seconds prior to movement. They are
 detected by averaging multiple events in the time domain and generally require at least 40-50
 events to allow detection of the signal within the noise. Frequency changes however, are more
 robust and may be seen reliably on individual traces. The frequency changes occur in the
 alpha (8-13 Hz) range as well as beta (13-30 Hz) and may occur up to 2 seconds before
 movement. This leads to the notion that real-time analysis of the EEG may allow one to
 predict individual movement. If this could be done reliably, it may provide further insight
 about how the brain prepares for movement, as well as potential therapeutic options such as
 control of cortically based prosthetic device.

 Our initial study, henceforth Phase 1, is an exploratory study using real-time EEG to
 identify the factors that allow one to reliably predict normal human voluntary movement.
 Subjects will be normal volunteers, studied in the EEG lab in the Human Motor Control
 Section. Subjects will be asked to perform a simple motor task involving a sequence of finger
 movements while undergoing a routine EEG recording with surface electromyography. The EEG
 will then be processed using standard techniques to identify the location and time course of
 EEG signals in response to movement. Once this has occurred, subjects will return for a
 real-time study that will use their individually identified factors to predict their
 movement. The effects of training on the accuracy of prediction will also be explored by
 scheduling multiple real-time prediction sessions per subject over the course of several
 weeks. The rate of successful movement prediction will be the primary outcome measure.

 After we are able to accurately predict movement intention with healthy volunteers, i.e., the
 false positive rate is under 20% with the false negative rate under 50%, we will study
 whether we can achieve the same prediction accuracy with stroke patients and patients with
 primary lateral sclerosis (PLS) or amyotrophic lateral sclerosis (ALS). The stroke patients
 and ALS/PLS patients will perform the same procedure as the subjects in the Phase 1 part of
 the trial.

 Phase 2 of the investigation will extend to a different type of movement, reaching, and to an
 additional parameter, the spatial field of the intended target of the movement. In addition,
 Phase 2 will also include magnetoencephalography (MEG) as well as EEG methods to classify the
 spatiotemporal features of these movement parameters. Successful prediction of the intended
 goals of reaches to either ipsilateral or contralateral fields, prior to the onset of
 movement will be the main outcome measure of phase 2 of the study.

 In Phase 3 of the investigation, healthy volunteers will perform a simple finger movement
 task which will be analyzed with special attention given to the timing of the intention to
 move and to how the intention affects the EEG signal. In order to assess whether spontaneous
 movements without prior instruction are associated with different physiological markers from
 typical self-paced paradigms, a recording session will be performed after the EEG cap is
 placed without instructing the subject.

 Results from this study will then be used to design further protocols studying human
 voluntary movement and clinical applications as appropriate.
-  INCLUSION CRITERIA:

 HEALTHY VOLUNTEERS:

 Healthy volunteers will be over 18, and willing to participate, and able to give informed
 consent.

 STROKE PATIENTS:

 The stroke patients will have a clinically and radiologically documented stroke in the
 sub-acute (2 weeks to 6 months to after onset) or the chronic state (more than 6 months
 after onset), having a lesion in sub-cortical regions including the basal ganglia,
 thalamus, internal capsule, or a combination of these structures, or cerebellum
 unilaterally. These lesions can extend to the surrounding areas, however not including the
 cortical areas. Patients will be over 18 years of age.

 PLS/ALS PATIENTS:

 Patients must fulfill the diagnostic criteria proposed by Pringle (1992) for PLS and have
 been diagnosed with PLS for at least 3 years. Criteria include onset of spasticity alone in
 adulthood, slow progressive course, no family history, no lower motor neuron signs, and
 exclusion of known causes of spasticity. ALS patients should have probable or definite ALS
 by El Escorial criteria. Patients must have evidence of upper and lower motor neuron signs
 in two or more defined regions: cranial, arms, legs, or torso. Only the PLS/ALS patients
 who have recently participated in the study under protocol 06-N-0174 will be included. Some
 subjects will be studied as inpatients.

 EXCLUSION CRITERIA:

 HEALTHY VOLUNTEERS:

 Subjects who are unable to perform simple voluntary movement with both hands.

 Subjects who have any neurological or psychiatric conditions.

 Subjects who have any implanted metal in or on their bodies that cannot be removed prior to
 the MRI and MEG scans.

 STROKE PATIENTS:

 We are investigating a particular EEG pattern associated with voluntary movement that we
 believe may not be present in patients with multiple strokes that involve the cerebral
 cortex; therefore, we will exclude this population of stroke patients. We will, however,
 include patients with multiple strokes if the cerebral cortex was not involved because we
 hypothesize that the EEG pattern that we are looking for will be preserved in patients with
 sub-cortical stroke lesions.

 A. Patients with MRI findings consistent with brain tumors, trauma or AVMs will be
 excluded.

 B. Patients with multiple stroke lesions that involve the cerebral cortex will be excluded.

 C. Subjects with a pre-stroke history of schizophrenia or bipolar disorders will be
 excluded.

 D. Subjects with cancer will be excluded.

 E. Patients not capable of giving an informed consent will be excluded.

 PLS/ALS PATIENTS:

 PLS/ALS patients with a history or evidence of a coexisting or other neurological disorder,
 such as stroke, epilepsy, Parkinson's disease, polio, ataxia or neuropathy, or a history of
 traumatic brain injury, skull defects or neurosurgery will be excluded. PLS/ALS patients
 will have neuropsychological tests of frontal cortex function under protocol 06-N-0174.
 Patients with scores below 133 (out of 144) on the Mattis dementia rating scale will be
 classified as impaired patients who are unable to give their own informed consent and will
 be excluded. PLS/ALS patients who are unable to travel will be excluded. PLS/ALS patients
 who are respirator dependent will be excluded.