Frequency dependence of cortical somatosensory evoked response to peripheral nerve stimulation with controlled afferent excitation

Objective: H-reflex targeted neuroplasticity (HrTNP) protocols comprise a promising rehabilitation approach to improve motor function after brain or spinal injury. In this operant conditioning protocol, concurrent measurement of cortical responses, such as somatosensory evoked potentials (SEPs), would be useful for examining supraspinal involvement and neuroplasticity mechanisms. To date, this potential has not been exploited. However, the stimulation parameters used in the HrTNP protocol deviate from the classically recommended settings for SEP measurements. Most notably, it demands a much longer pulse width, higher stimulation intensity, and lower frequency than traditional SEP settings. In this paper, we report SEP measurements performed within the HrTNP stimulation parameter constraints, specifically characterizing the effect of stimulation frequency.
Approach: SEPs were acquired for tibial nerve stimulation at three stimulation frequencies (0.2, 1, and 2 Hz) in 13 subjects while maintaining the afferent volley by controlling the direct soleus muscle response via the Evoked Potential Operant Conditioning System. The amplitude and latency of the short-latency P40 and mid-latency N70 SEP components were measured at the central scalp region using non-invasive electroencephalography.
Main results: As frequency rose from 0.2 Hz, P40 amplitude and latency did not change. In contrast, N70 amplitude decreased significantly (39% decrease at 1 Hz, and 57% decrease at 2 Hz), presumably due to gating effects. N70 latency was not affected. Across all three frequencies, N70 amplitude increased significantly with stimulation intensity and correlated with M-wave amplitude.
Significance: We assess SEPs within an HrTNP protocol, focusing on P40 and N70, elicited with controlled afferent excitation at three stimulation frequencies. HrTNP conditioning protocols show promise for enhancing motor function after brain and spinal injuries. While SEPs offer valuable insights into supraspinal involvement, the stimulation parameters in HrTNP often differ from standard SEP measurement protocols. We address these deviations and provide recommendations for effectively integrating SEP assessments into HrTNP studies.