Subcortical, thalamic and cortical somatosensory evoked potentials to median nerve stimulation

Subcortical and cortical somatosensory evoked potentials (SEPs) to median nerve stimulation were studied in 16 normal controls, 3 patients with Parkinson's disease, and 2 patients with thalamic lesions. Multiple electrodes were placed over the scalp and cervical spines and connected with a hand electrode or Fz in grid II. Thalamic SEPs were recorded directly from the Vim nucleus in 3 patients with Parkinson's disease during the stereotaxic operation. SEPs recorded from the scalp-hand derivations were composed of 4 negative (N9, N11, N16, N18) and 3 positive potentials (P8, P10, P12), whereas, at the scalp-Fz electrode, only one negative peak was identified (N20). N18 is of higher amplitude on the parieto-occipital areas and corresponds to N20. On the other hand, N16 can be identified more clearly on the fronto-central areas at scalp-hand derivations because of intermixture with N18 on the posterior head areas and disappears at scalp-scalp derivation. This suggests that N16 represents a subcortical component that is picked up as a far-field potential at the scalp electrodes. Components preceding N16 at scalp-hand derivations are also interpreted as far-field potentials because of their short latency and wide distribution over the scalp. The peak latency of N16 is not significantly different from the major negativity recorded directly from the thalamus, whereas N18 (N20) occurs significantly later. From this we conclude that N16 is most probably generated in the thalamus with the potentials of shorter latency originating caudal to the thalamus and N18 rostral to the thalamus.