That animals and humans can accomplish the same goal using different effectors and different goals using the same effectors attests to the remarkable flexibility of the central nervous system. This phenomenon has been termed 'motor equivalence', an example being the writing of a name with a pencil held between the toes or teeth. The idea of motor equivalence has reappeared because single-cell studies in monkeys have shown that parameters of voluntary movement (such as direction) may be specified in the brain, relegating muscle activation to spinal interneuronal systems. Using a novel experimental paradigms and a full-head SQUID (for superconducting quantum interference device) array to record magnetic fields corresponding to ongoing brain activity, we demonstrate: (1), a robust relationship between time-dependent activity in sensorimotor cortex and movement velocity, independent of explicit task requirements; and (2) neural activations that are specific to task demands alone. It appears, therefore, that signatures of motor equivalence in humans may be found in dynamic patterns of cortical activity.

Neuromagnetic fields accompanying voluntary flexions of the right index finger were studied in five subjects. In all subjects, slow magnetic fields were observed over the central scalp beginning about 1 second prior to movement onset. These fields displayed a similar time course to the electrically recorded "readiness potential", but with reversals of field direction over regions of the rolandic fissure over both hemispheres. Least-squares fitting of two current dipole sources for the pre-movement fields resulted in a consistent localization of one source in the region of the rolandic fissure contralateral to the side of movement in four subjects. Ipsilateral dipole sources fitted inconsistently at deeper locations or outside the head indicating the inability of a single dipole source to account for the ipsilateral fields. A large field reversal was also observed over the contralateral (left) hemisphere, 90-130 ms after onset of EMG activity in the active muscles. In some subjects, single dipole sources could be fitted to this "movement-evoked" field at locations slightly deeper and posterior to the pre-movement source locations in the contralateral hemisphere, possibly indicating unilateral activation of somatosensory cortex related to sensory feedback during the onset of this movement. Subtraction of pre-movement field activity from post-movement fields improved the ability to fit a single contralateral rolandic source for all subjects suggesting that pre-movement sources continue to be active during movement onset. These findings confirm previous reports that voluntary finger movements are preceded by slow magnetic fields.(ABSTRACT TRUNCATED AT 250 WORDS)

Moderate-dose daily prednisone for 4 to 6 weeks, followed by low-dose alternate-day therapy as needed, can control the diplopia in patients with ocular myasthenia gravis. The frequency of deterioration to generalized myasthenia gravis at 2 years may be reduced; 9.4% in this study compared with more than 40% previously reported frequency. Corticosteroids may be useful even when ocular motor dysfunction is not normalized.

Prior reports of neuroleptic malignant syndrome (NMS) concerned patients with psychiatric disorders, usually schizophrenia, who were taking dopamine receptor blocking agents. We report the syndrome in a patient with Huntington disease who was treated with dopamine-depleting agents. He had a negative evaluation for malignant hyperthermia (MH), and we suggest that NMS differs from MH. The occurrence of NMS caused by dopamine-depleting agents suggests that anticholinergic properties of phenotiazines are not the only cause. Central dopaminergic systems probably participate in thermoregulation, and dopamine depletion probably plays a pathogenetic role in this syndrome.

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