EXAMINATION OF THE DESCENDING PATHWAY TO THE EXTERNAL ANAL-SPHINCTER AND PELVIC FLOOR MUSCLES BY TRANSCRANIAL CORTICAL STIMULATION

In 26 neurologically normal patients and 9 healthy volunteers EMG responses after transcranial cortical stimulation (TCCS) were recorded from the external anal sphincter (EAS), the anterior tibial muscle (TA), the bulbocavernosus muscle (BC) and the rectus abdominis muscle (RA). Electrical TCCS was used in 29 subjects and magnetic TCCS in 6 subjects. Response patterns in the different muscles in relation to the strength of the stimulus were analyzed. It was found that the response patterns related to the strength of stimulation differed totally between the TA and the EAS. When the stimulus strength was increased stepwise, a response with a latency of 31.9 ± 2.5 msec was first recorded in the TA, followed at higher strength by a secondary response with a latency of approximately 100 msec. In contrast, a response with a latency of 105.5 ± 23.9 msec was first recorded in the EAS. The latency of this response gradually shortened with increasing stimulus strength until a response with a constant latency of 36.1 ± 6.1 was obtained. In some subjects the response pattern in the BC was similar to that in the TA, and in others it was similar to that in the EAS. Responses in the TA, RA and EAS were all facilitated during voluntary contraction of the EAS. Both responses in the TA and in the EAS were facilitated by voluntary contraction of the TA. During voluntary contraction of the TA an inhibitory period was always recorded, while in the EAS no inhibitory periods were observed during either contraction or relaxation. The hypothesis that the fastest cortico-motoneuronal pathway to the EAS is polysynaptic is proposed. © 1990.