Coherent cortical and muscle discharge in cortical myoclonus.

There is increasing evidence in man that the cortical drive to motor neurons is rhythmic. This oscillatory drive may be exaggerated in patients with cortical myoclonus. Spectral analysis of surface bipolar EEG and EMG activity was performed in eight such patients. Only three cases had evidence of giant cortical evoked potentials or a cortical correlate on back-averaging at the time of study. In six subjects, significant coherence between contralateral and vertex EEG and EMG was observed in ranges similar to that previously reported for normal subjects (15-30 and 30-60 Hz). Three out of these six subjects also had significant coherence at higher frequencies (up to 175 Hz). All eight patients had a correlate in the cumulant density estimate between EEG and contralateral EMG. EMG lagged EEG by about 14, 25 and 35 ms for the muscles of the forearm, hand and foot, respectively. These delays were estimated from the slope of the phase curves and the timing of the peaks in the cumulant density estimates, and are appropriate for conduction in fast pyramidal pathways. The results provide clear evidence of a cortical drive synchronizing muscle discharge over a broad range of frequencies in patients with cortical myoclonus. Fourier analysis is a promising technique in the diagnosis and investigation of such patients.