**5. Perspective of the application of somatosensory stimulation within the clinical environment**

In the studies of Gelnar, Harrington, and Stippich et al., brain activation within the postcentral gyrus and superior and inferior parietal lobule have been found (Gelnar et al., 1998a;Harrington et al., 2000a;Stippich et al., 1999a). Furthermore, brain activation within Brodmann area 3a was detected due to somatosensory stimulation (Geyer et al., 1999;Geyer et al., 2000;Kurth et al., 2000), which can be explained by the fact that Brodmann area 3a receives input from the deep and from the proprioceptive receptors (Ibanez et al., 1989;Iwamura et al., 1993;Kaas et al., 1979;Maldjian et al., 1999a;Recanzone et al., 1992;Tharin and Golby, 2007). BOLD response in the primary motor cortex due to vibrotactile stimulation is an important finding, because the stimulation does not require the collaboration of the subject under examination. In an fMRI study with mechanical vibration, BOLD response in primary sensorimotor cortex was found in all of the investigations (Golaszewski et al., 2002a,b). Motor cortical activation caused by vibration, is presumably based on the co-stimulation of cutaneous mechanoreceptors and muscle spindles that requires sufficient displacement amplitudes and vibration frequencies. Similar to the fingerto-thumb-tapping paradigm, vibration led to contralateral brain activity in postcentral gyrus in ten out of ten subjects. Vibration stimulation failed to consistently activate supplementary motor area and anterior cingular cortex since it represents a passive paradigm that does not involve motor cortical areas for planning of volitional movements. Vibratory stimuli are transmitted via the large afferents of the dorsal column to the thalamus and are relayed there to the brain cortex. This "information" originates from the extra personnel space that might be an explanation, why Brodmann area 9 in superior frontal gyrus responds with activation in some cases.

In functional brain imaging with certain somatosensory stimulation protocols the whole sensorimotor cortex can be addressed for functional brain mapping that offers the possibility of several clinical applications for somatosensory paradigms in Neuroradiology. Somatosensory paradigms can be used for preoperative functional brain mapping of the sensorimotor cortex in patients with perirolandic lesions. Further applications include the investigation of brain plasticity and reorganization (Pons et al., 1992) and investigation of patients in comatose and vegetative state (Kampfl et al., 1998).

#### **6. References**

346 Neuroimaging – Cognitive and Clinical Neuroscience

Fig. 5. Single subject analysis: fMRI maps of eight single subjects (1-8) applying pneumatic cuff somatosensory finger stimulation with fixed (fixed simulation FS, green) and random (random stimulation RS, red) presentation of vibrotactile stimuli with a mean frequency of 4 Hz over all blocks. Yellow spots represent activation overlap between FS and RS maps

Fig. 6. Patient in vegetative state 14 days post hypoxia. Vibration stimulation with a moving magnet actuator system delivered to the sole of the left foot (Gallasch et al., 2006;Golaszewski et al., 2006) elicits brain activation contra- and ipsilaterally within the primary and secondary sensorimotor cortex and especially within the premotor cortex, the center for predefined movement loops, and the supplementary motor area that represents the superior center for motor planning. Functional brain mapping in this patient proved an intact somatosensory channel to the sensorimotor system for a targeted therapeutic approach in neurorehabilitation.


Somatosensory Stimulation in Functional Neuroimaging: A Review 349

Gelnar, P.A., Krauss, B.R., Szeverenyi, N.M., and Apkarian, A.V. (1998a). Fingertip

Gelnar, P.A., Krauss, B.R., Szeverenyi, N.M., and Apkarian, A.V. (1998b). Fingertip

Gelnar, P.A., Krauss, B.R., Szeverenyi, N.M., and Apkarian, A.V. (1998c). Fingertip representation in the human somatosensory cortex: an fMRI study. Neuroimage *7*, 261-83. Geyer, S., Schleicher, A., and Zilles, K. (1999). Areas 3a, 3b, and 1 of human primary

Geyer, S., Schormann, T., Mohlberg, H., and Zilles, K. (2000). Areas 3a, 3b, and 1 of human

Giabbiconi, C.M., Trujillo-Barreto, N.J., Gruber, T., and Muller, M.M. (2007). Sustained

Golaszewski, S.M., Siedentopf, C.M., Baldauf, E., Koppelstaetter, F., Eisner, W., Unterrainer,

Golaszewski, S.M., Siedentopf, C.M., Baldauf, E., Koppelstaetter, F., Eisner, W., Unterrainer,

Golaszewski, S.M., Siedentopf, C.M., Koppelstaetter, F., Fend, M., Ischebeck, A., Gonzalez-

Golaszewski, S.M., Zschiegner, F., Siedentopf, C.M., Unterrainer, J., Sweeney, R.A., Eisner,

Golaszewski, S.M., Zschiegner, F., Siedentopf, C.M., Unterrainer, J., Sweeney, R.A., Eisner,

Graham, S.J., Staines, W.R., Nelson, A., Plewes, D.B., and McIlroy, W.E. (2001). New devices to deliver somatosensory stimuli during functional MRI. Magn Reson Med *46*, 436-42. Hamzei, F., Liepert, J., Dettmers, C., Adler, T., Kiebel, S., Rijntjes, M., and Weiller, C. (2001).

Harrington, G.S., Wright, C.T., and Downs, J.H. 3rd (2000a). A new vibrotactile stimulator

Magn Reson Imaging *24*, 1177-82. GE Medical Systems. MR safety and MR compatibility.

261-83.

261-83.

http://www.ge.com/medical/mr/iomri/safety.htm; 1997.

somatosensory cortex. Neuroimage *10*, 63-83.

space. Neuroimage *11*, 684-96.

stimulator. Neuroimage *17*, 421-30.

stimulator. Neuroimage *17*, 421-30.

sensorimotor cortex. Neurosci Lett *324*, 125-8.

sensorimotor cortex. Neurosci Lett *324*, 125-8.

during childhood. Neuroreport *12*, 957-62.

for functional MRI. Hum Brain Mapp *10*, 140-5.

Neuroimage *35*, 255-62.

vibrating probe for somatosensory mapping of plantar afferences with fMRI. J

representation in the human somatosensory cortex: an fMRI study. Neuroimage *7*,

representation in the human somatosensory cortex: an fMRI study. Neuroimage *7*,

primary somatosensory cortex. Part 2. Spatial normalization to standard anatomical

spatial attention to vibration is mediated in primary somatosensory cortex.

J., Guendisch, G.M., Mottaghy, F.M., and Felber, S.R. (2002b). Functional magnetic resonance imaging of the human sensorimotor cortex using a novel vibrotactile

J., Guendisch, G.M., Mottaghy, F.M., and Felber, S.R. (2002). Functional magnetic resonance imaging of the human sensorimotor cortex using a novel vibrotactile

Felipe, V., Haala, I., Struhal, W., Mottaghy, F.M., Gallasch, E., Felber, S.R., and Gerstenbrand, F. (2006). Human brain structures related to plantar vibrotactile stimulation: a functional magnetic resonance imaging study. Neuroimage *29*, 923-9.

W., Lechner-Steinleitner, S., Mottaghy, F.M., and Felber, S. (2002a). A new pneumatic vibrator for functional magnetic resonance imaging of the human

W., Lechner-Steinleitner, S., Mottaghy, F.M., and Felber, S. (2002). A new pneumatic vibrator for functional magnetic resonance imaging of the human

Structural and functional cortical abnormalities after upper limb amputation

positron emission tomography scanning: a comparison with intraoperative cortical stimulation. J Neurosurg *90*, 478-83.


Bittar, R.G., Olivier, A., Sadikot, A.F., Andermann, F., Pike, G.B., and Reutens, D.C. (1999b).

Briggs, R.W., Dy-Liacco, I., Malcolm, M.P., Lee, H., Peck, K.K., Gopinath, K.S., Himes, N.C.,

Burton, H., MacLeod, A.M., Videen, T.O., and Raichle, M.E. (1997). Multiple foci in parietal

Casey, K.L., Minoshima, S., Berger, K.L., Koeppe, R.A., Morrow, T.J., and Frey, K.A. (1994).

Casey, K.L., Minoshima, S., Morrow, T.J., and Koeppe, R.A. (1996). Comparison of human

Chinzei, K., Kikinis, R., and Jolesz, F. (1999). MR compatibility of mechanotronic devices, design criteria. In Proc MICCA 99, Lecture Notes in Computer Science *1679*, 1020-1031. Cramer, S.C., Moore, C.I., Finklestein, S.P., and Rosen, B.R. (2000). A pilot study of

Derbyshire, S.W., Jones, A.K., Gyulai, F., Clark, S., Townsend, D., and Firestone, L.L. (1997).

Disbrow, E., Roberts, T., and Krubitzer, L. (2000). Somatotopic organization of cortical fields in

Disbrow, E., Roberts, T., Poeppel, D., and Krubitzer, L. (2001). Evidence for interhemispheric processing of inputs from the hands in human S2 and PV. J Neurophysiol *85*, 2236-44. Drevets, W.C., Burton, H., Videen, T.O., Snyder, A.Z., Simpson, J.R. Jr, and Raichle, M.E.

Flor, H., Denke, C., Schaefer, M., and Grusser, S. (2001). Effect of sensory discrimination training on cortical reorganisation and phantom limb pain. Lancet *357*, 1763-4. Fox, P.T., Burton, H., and Raichle, M.E. (1987). Mapping human somatosensory cortex with

Francis, S.T., Kelly, E.F., Bowtell, R., Dunseath, W.J., Folger, S.E., and McGlone, F. (2000). fMRI of the responses to vibratory stimulation of digit tips. Neuroimage *11*, 188-202. Gallasch, E., Fend, M., Rafolt, D., Nardone, R., Kunz, A., Kronbichler, M., Beisteiner, R., and

Gallasch, E., Golaszewski, S.M., Fend, M., Siedentopf, C.M., Koppelstaetter, F., Eisner, W.,

stimulation device for fMRI. Magn Reson Med *51*, 640-3.

by repetitive noxious heat stimuli. J Neurophysiol *71*, 802-7.

somatotopic mapping after cortical infarct. Stroke *31*, 668-71.

positron emission tomography. J Neurosurg *67*, 34-43.

evoked responses with fMRI. Neuroimage *50*, 1067-73.

stimulation. J Neurosurg *90*, 478-83.

pain. J Neurophysiol *76*, 571-81.

stimulation. Nature *373*, 249-52.

patterns of central activity. Pain *73*, 431-45.

*122 ( Pt 9)*, 1651-65.

positron emission tomography scanning: a comparison with intraoperative cortical

Presurgical motor and somatosensory cortex mapping with functional magnetic resonance imaging and positron emission tomography. J Neurosurg *91*, 915-21. Boecker, H., Ceballos-Baumann, A., Bartenstein, P., Weindl, A., Siebner, H.R., Fassbender,

T., Munz, F., Schwaiger, M., and Conrad, B. (1999). Sensory processing in Parkinson's and Huntington's disease: investigations with 3D H(2)(15)O-PET. Brain

Soltysik, D.A., Browne, P., and Tran-Son-Tay, R. (2004). A pneumatic vibrotactile

and frontal cortex activated by rubbing embossed grating patterns across fingerpads: a positron emission tomography study in humans. Cereb Cortex *7*, 3-17.

Positron emission tomographic analysis of cerebral structures activated specifically

cerebral activation pattern during cutaneous warmth, heat pain, and deep cold

Pain processing during three levels of noxious stimulation produces differential

the lateral sulcus of Homo sapiens: evidence for SII and PV. J Comp Neurol *418*, 1-21.

(1995). Blood flow changes in human somatosensory cortex during anticipated

Golaszewski, S. (2010). Cuff-type pneumatic stimulator for studying somatosensory

Gerstenbrand, F., and Felber, S.R. (2006). Contact force- and amplitude-controllable

vibrating probe for somatosensory mapping of plantar afferences with fMRI. J Magn Reson Imaging *24*, 1177-82.

GE Medical Systems. MR safety and MR compatibility.

http://www.ge.com/medical/mr/iomri/safety.htm; 1997.


Somatosensory Stimulation in Functional Neuroimaging: A Review 351

Laureys, S., Faymonville, M.E., Peigneux, P., Damas, P., Lambermont, B., Del Fiore, G.,

Lee, C.C., Jack, C.R. Jr, and Riederer, S.J. (1998). Mapping of the central sulcus with functional MR: active versus passive activation tasks. AJNR Am J Neuroradiol *19*, 847-52. Maldjian, J.A., Gottschalk, A., Patel, R.S., Detre, J.A., and Alsop, D.C. (1999a). The sensory somatotopic map of the human hand demonstrated at 4 Tesla. Neuroimage *10*, 55-62. Maldjian, J.A., Gottschalk, A., Patel, R.S., Pincus, D., Detre, J.A., and Alsop, D.C. (1999b).

Mima, T., Sadato, N., Yazawa, S., Hanakawa, T., Fukuyama, H., Yonekura, Y., and

Moore, C.I., Stern, C.E., Corkin, S., Fischl, B., Gray, A.C., Rosen, B.R., and Dale, A.M. (2000).

Nelson, A.J., Staines, W.R., Graham, S.J., and McIlroy, W.E. (2004). Activation in SI and SII:

Ogawa, S., Lee, T.M., Kay, A.R., and Tank, D.W. (1990). Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci U S A *87*, 9868-72. Ogawa, S., Tank, D.W., Menon, R., Ellermann, J.M., Kim, S.G., Merkle, H., and Ugurbil, K.

Peyron, R., Laurent, B., and Garcia-Larrea, L. (2000). Functional imaging of brain responses to pain. A review and meta-analysis (2000). Neurophysiol Clin *30*, 263-88.

Piza, H. (2000). [Transplantation of hands in Innsbruck]. Wien Klin Wochenschr *112*, 563-5. Polonara, G., Fabri, M., Manzoni, T., and Salvolini, U. (1999). Localization of the first and

Pons, T.P., Garraghty, P.E., and Mishkin, M. (1992). Serial and parallel processing of tactual

Rausch, M., Spengler, F., and Eysel, U.T. (1998). Proprioception acts as the main source of input in human S-I activation experiments: a functional MRI study. Neuroreport *9*, 2865-8. Recanzone, G.H., Merzenich, M.M., and Jenkins, W.M. (1992). Frequency discrimination

Riener, R., Villgrattner, T., Kleiser, R., Nef, T., and Kollias, S. (2005). fMRI compatible

response zone in cortical area 3a. J Neurophysiol *67*, 1057-70.

vegetative state. Neuroimage *17*, 732-41.

stimulation: an fMRI study. Brain Res *824*, 291-5.

movements in man. Brain *122 ( Pt 10)*, 1989-97.

stimulation. Brain Res Cogn Brain Res *19*, 174-84.

Piezomechanik Gmbh (ed). (2002). Piezoelectric bending actuators.

imaging. AJNR Am J Neuroradiol *20*, 199-205.

man as studied by electrical stimulation. Brain *60*, 389-443.

Neurophysiol *84*, 558-69.

http://www.piezomechanik.com.

Proceedings 7024-7027.

Mazziotta, J.C.a.T.A.W. (2000). Brain Mapping: The methods. Academic Press).

Degueldre, C., Aerts, J., Luxen, A., Franck, G., Lamy, M., Moonen, G., and Maquet, P. (2002). Cortical processing of noxious somatosensory stimuli in the persistent

Mapping of secondary somatosensory cortex activation induced by vibrational

Shibasaki, H. (1999). Brain structures related to active and passive finger

Segregation of somatosensory activation in the human rolandic cortex using fMRI. J

the influence of vibrotactile amplitude during passive and task-relevant

(1992). Intrinsic signal changes accompanying sensory stimulation: functional brain mapping with magnetic resonance imaging. Proc Natl Acad Sci U S A *89*, 5951-5. Penfield, W.a.B.E. (1937). Somatic motor and sensory representation in the cerebral cortex of

second somatosensory areas in the human cerebral cortex with functional MR

information in somatosensory cortex of rhesus monkeys. J Neurophysiol *68*, 518-27.

training engaging a restricted skin surface results in an emergence of a cutaneous

electromagnetic haptic device. Conf Proc IEEE Eng Med Soc 2005. Conf


Harrington, G.S., Wright, C.T., and Downs, J.H. 3rd (2000b). A new vibrotactile stimulator

Hodge, C.J. Jr, Huckins, S.C., Szeverenyi, N.M., Fonte, M.M., Dubroff, J.G., and Davuluri, K.

Hoeller, M., Krings, T., Reinges, M.H., Hans, F.J., Gilsbach, J.M., and Thron, A. (2002). Movement

Ibanez, V., Deiber, M.P., and Mauguiere, F. (1989). Interference of vibrations with input

Ibanez, V., Deiber, M.P., Sadato, N., Toro, C., Grissom, J., Woods, R.P., Mazziotta, J.C., and

Iwamura, Y., Tanaka, M., Sakamoto, M., and Hikosaka, O. (1993). Rostrocaudal gradients in

Kaas, J.H., Nelson, R.J., Sur, M., Lin, C.S., and Merzenich, M.M. (1979). Multiple

Kampfl, A., Schmutzhard, E., Franz, G., Pfausler, B., Haring, H.P., Ulmer, H., Felber, S.,

Koppelstaetter, F., Siedentopf, C.M., Rhomberg, P., Lechner-Steinleitner, S., Eisner, W., and

Korvenoja, A., Huttunen, J., Salli, E., Pohjonen, H., Martinkauppi, S., Palva, J.M., Lauronen, L.,

and functional magnetic resonance imaging. Hum Brain Mapp *8*, 13-27. Krause, T., Kurth, R., Ruben, J., Schwiemann, J., Villringer, K., Deuchert, M., Moosmann, M.,

on electrical stimulus intensity: an fMRI study. Brain Res *899*, 36-46. Kurth, R., Villringer, K., Curio, G., Wolf, K.J., Krause, T., Repenthin, J., Schwiemann, J.,

by electrical finger stimulation. Neuroreport *9*, 207-12.

sensorimotor cortex. Acta Neurochir (Wien) *144*, 279-84; discussion 284. Huang, R.S. and Sereno, M.I. (2007). Dodecapus: An MR-compatible system for

(1998). Patterns of lateral sensory cortical activation determined using functional

artefacts and MR BOLD signal increase during different paradigms for mapping the

transmission in dorsal horn and cuneate nucleus in man: a study of somatosensory evoked potentials (SEPs) to electrical stimulation of median nerve and fingers. Exp

Hallett, M. (1995). Effects of stimulus rate on regional cerebral blood flow after

the neuronal receptive field complexity in the finger region of the alert monkey's

representations of the body within the primary somatosensory cortex of primates.

Golaszewski, S., and Aichner, F. (1998). Prediction of recovery from post-traumatic vegetative state with cerebral magnetic-resonance imaging. Lancet *351*, 1763-7. Kassubek, J., Juengling, F.D., Els, T., Spreer, J., Herpers, M., Krause, T., Moser, E., and

Lucking, C.H. (2003). Activation of a residual cortical network during painful stimulation in long-term postanoxic vegetative state: a 15O-H2O PET study. J

Golaszewski, S.M. (2007). FMRT vor Motorkortexstimulation bei Phantomschmerz:

Virtanen, J., Ilmoniemi, R.J., and Aronen, H.J. (1999). Activation of multiple cortical areas in response to somatosensory stimulation: combined magnetoencephalographic

Brandt, S., Wolf, K., Curio, G., and Villringer, A. (2001). Representational overlap of adjacent fingers in multiple areas of human primary somatosensory cortex depends

Deuchert, M., and Villringer, A. (2000). fMRI shows multiple somatotopic digit representations in human primary somatosensory cortex. Neuroreport *11*, 1487-91. Kurth, R., Villringer, K., Mackert, B.M., Schwiemann, J., Braun, J., Curio, G., Villringer, A.,

and Wolf, K.J. (1998). fMRI assessment of somatotopy in human Brodmann area 3b

for functional MRI. Hum Brain Mapp *10*, 140-5.

magnetic resonance imaging. J Neurosurg *89*, 769-79.

somatosensory stimulation. Neuroimage *34*, 1060-73.

median nerve stimulation. Brain *118 ( Pt 5)*, 1339-51.

postcentral gyrus. Exp Brain Res *92*, 360-8.

Brain Res *75*, 599-610.

Science *204*, 521-3.

Neurol Sci *212*, 85-91.

Ein Fallbericht. Nervenarzt.


**18** 

**Neuroimaging Studies in** 

*1Department of Neurology,* 

*2Nuclear Medicine,* 

*3Radiology,* 

*Taiwan* 

**Carbon Monoxide Intoxication** 

*Chang Gung Memorial Hospital, Kaohsiung Medical Center* 

*4Department of Biological Science, National Sun Yet-sen University* 

 *and Chang Gung University College of Medicine,* 

Ya-Ting Chang1, Wen-Neng Chang1, Shu-Hua Huang2, Chun-Chung Lui3,

CO is a tasteless, odorless and colorless gas. The existence of endogenous CO in the human body arises from heme catabolism (Meredith and Vale 1988; Ernst and Zibrak 1998) and oxidation of organic molecules (Marilena 1997). Endogenous CO acts as a neurotransmitter for long-term potentiation, consequently playing a key role in memory and learning (Marilena 1997). It also plays a role in modulating inflammation, apoptosis, cell proliferation, mitochondrial biogenesis (Weaver 2009) and vascular relaxation

Exogenous sources of CO intoxication include smoking, forest fires, pollutants, and improper usage of heaters or furnaces (Weaver 2009; Kumar, Prakash et al. 2010). CO intoxication usually indicates exposure to exogenous sources and is considered one of the most common causes of poisoning worldwide (Prockop and Chichkova 2007; Weaver 2009), with 1000 deaths annually in Britain (Meredith and Vale 1988), and 4000-6000 deaths annually in the United States (Tibbles and Perrotta 1994; Ernst and Zibrak 1998; Weaver 1999). In Asia, the exact epidemiology remains unclear. In Japan, Hong Kong and Taiwan, a common CO etiology of intoxication is charcoal burning suicide (Lee, Chan et al. 2002). In Japan, poisoning by charcoal burning is the most lethal form of suicide and is a highly prevalent method among men aged 25-64 years of age (Kamizato, Yoshitome et al. 2009), in contrast to a high rate of drug poisoning as a method of suicide in women. In Hong Kong, the risk factors of suicide by charcoal burning are male and living alone with financial stress (Lee and Leung 2009). In Taiwan, charcoal burning was not a common method of suicide before 1998, with a rate of only 0.14 per 105 people per year (Lin and Lu 2008). With the dissemination of media and the internet, the rate of charcoal burning suicides dramatically increased by 40-fold, reaching a rate of 5.38 per 105 people per year

**1. Introduction** 

(Marilena 1997).

in 2005 (Lin and Lu 2008).

Chen-Chang Lee3, Nai-Ching Chen1 and Chiung-Chih Chang1,4

