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Am J Physiol Gastrointest Liver Physiol 274: G419-G423, 1998;
0193-1857/98 $5.00
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Vol. 274, Issue 2, G419-G423, February 1998

Spinal and pudendal nerve modulation of human corticoanal motor pathways

Shaheen Hamdy1, Paul Enck2, Qasim Aziz1, John C. Rothwell3, Samet Uengoergil2, Anthony Hobson1, and David G. Thompson1

1 University Department of Gastroenterology, Hope Hospital, Salford M6 8HD; 3 Medical Research Council Human Movement and Balance Unit, Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom; and 2 Department of Gastroenterology, Heinrich Heine University, 40225 Dusseldorf, Germany

We investigated the effects of lumbosacral and pudendal nerve stimulation on the corticofugal pathways to the human external anal sphincter. In 11 healthy subjects, anal sphincter electromyographic responses, evoked to transcranial magnetic stimulation of the motor cortex, were recorded 5-500 ms after lumbosacral root or pudendal nerve stimulation. Lumbosacral and pudendal nerve stimulation alone evoked responses with amplitudes of 293 ± 73 and 401 ± 153 µV and latencies of 3.2 ± 0.2 and 2.2 ± 0.2 ms, respectively. Cortical stimulation also evoked responses with amplitudes of 351 ± 104 µV and latencies of 20.9 ± 1.1 ms. When lumbosacral or pudendal nerve stimulation preceded cortical stimulation, the cortically evoked responses were facilitated (P < 0.01), with the effect appearing greatest at 5-20 ms after both lumbosacral and pudendal excitation and at 50-100 ms after lumbosacral excitation alone. Our results demonstrate that cortical pathways to the external anal sphincter are facilitated by prior lumbosacral and pudendal nerve stimulation, indicating that sensorimotor interactions are important in the central neural control of sphincter function.

cerebral cortex; electromyography; external anal sphincter; magnetic stimulation


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