Changes in pattern electroretinograms to equiluminant red-green and blue-yellow gratings in patients with early Parkinson's disease.

In Parkinson's disease (PD), the luminance pattern electroretinogram (PERG) is reported to be abnormal, indicating dysfunction of retinal ganglion cells (RGCs). To determine the vulnerability of different subpopulations of RGCs in PD patients, the authors recorded the PERG to stimuli of chromatic (red-green [R-G] and blue-yellow [B-Y]) and achromatic (yellow-black [Y-Bk]) contrast, known to emphasize the contribution of parvocellular, koniocellular, and magnocellular RGCs, respectively. Subjects were early PD patients (n = 12; mean age, 60.1 +/- 8.3 years; range, 46 to 74 years) not undergoing treatment with levodopa and age-sex-matched controls (n = 12). Pattern electroretinograms were recorded monocularly in response to equiluminant R-G, B-Y, and Y-Bk horizontal gratings of 0.3 c/deg and 90% contrast, reversed at 1Hz, and presented at a viewing distance of 24 cm (59.2 x 59 degree field). In PD patients, the PERG amplitude was significantly reduced (by 40 to 50% on average) for both chromatic and luminance stimuli. Pattern electroretinogram latency was significantly delayed (by about 15 ms) for B-Y stimuli only. Data indicate that, in addition to achromatic PERGs, chromatic PERGs are altered in PD before levodopa therapy. Overall, chromatic PERGs to B-Y equiluminant stimuli exhibited the largest changes. Data are consistent with previous findings in PD, showing that visual evoked potentials (VEP) to B-Y chromatic stimuli are more delayed than VEPs to R-G and achromatic stimuli. The results suggest that the koniocellular subpopulation of RGCs may be particularly vulnerable in early stages of Parkinson's disease.     

Equiluminant red-green and blue-yellow VEPs in multiple sclerosis.

The primate visual system is composed by two color-opponent pathways--red-green (R-G) and blue-yellow (B-Y)--subserved by the so-called parvo- and koniocellular streams respectively. The authors' aim was to compare the relative involvement of chromatic visual subsystems in multiple sclerosis (MS). In 30 MS patients with different forms of MS they recorded visual evoked potentials (VEPs) to onset (300 msec) and offset (700 msec) of equiluminant R-G and B-Y sinusoidal gratings of different contrast (90% and 25%). Equiluminance was established psychophysically by establishing the R-G and the B-Y color ratio at which chromatic gratings alternating at 15 and 10 Hz respectively had minimum visibility. The negative wave at stimulus onset with a peak latency of 120 to 160 msec was evaluated. Ordinary VEPs to luminance (LUM) contrast (black-white reversing checkerboards of 15' check size and 50% contrast) were also recorded for comparison. Latencies of R-G VEPs were abnormal in 53.3% and 58.3% of patients at 90% and 25% contrast respectively, whereas abnormal B-Y VEPs were 56.6% and 48.3%. Latencies of LUM VEPs were abnormal in 45% of patients. Interocular latency asymmetries were abnormal in 59.2% and 33.3% of patients for R-G, and 51.8% and 62.9% for B-Y. Latency asymmetries for LUM VEP were abnormal in 46.4% of patients. The higher rate of VEP abnormalities found with equiluminant chromatic stimuli compared with achromatic stimuli confirms the general vulnerability of color-opponent visual pathways in MS, even if the number of patients with abnormal findings was not significantly different when both test conditions were compared. VEPs to R-G and B-Y equiluminant stimuli appear to be involved approximately to the same extent.     

Chromatic pattern-reversal electroretinograms (ChPERGs) are spared in multiple system atrophy compared with Parkinson’s disease

Abstract Idiopathic Parkinson’s disease (IPD) patients have abnormal visual evoked potentials (VEPs) and pattern electroretinograms (PERGs), attributed to dopaminergic transmission deficiency in visual pathway, probably the retina. VEP abnormalities are not reported in multiple system atrophy (MSA). The aim of this study was to investigate and compare chromatic (Ch) red-green (R-G) and blue-yellow (B-Y), and luminance yellow-black (Y-Bk) PERGs in patients with MSA and IPD. We investigated 6 MSA patients (mean age: 62±7.4 years) not undergoing any pharmacological treatment, as well as 12 early IPD patients (mean age: 60.1±8.3 years) and 12 age-matched normal observers. ChPERGs were recorded monocularly in response to full-field equiluminant R-G, B-Y and Y-Bk horizontal gratings. In MSA only responses to R-G stimuli showed minimal insignificant changes (slight but not significant amplitude reduction without any significant latency delay); no significant abnormality was detected for B-Y and luminance Y-Bk stimuli. By contrast, in IPD all responses were reduced in amplitude and delayed in latency, above all for B-Y stimuli. Present data indicate that both chromatic and achromatic PERGs are virtually unaffected in MSA, whereas in early IPD they are clearly impaired, suggesting different pathogenic retinal mechanisms and a useful simple tool for distinguishing MSA from IPD.     

The effect of spatial frequency on chromatic and achromatic steady-state visual evoked potentials.

OBJECTIVE: Little is known about the physiological properties of the major components of steady-state visual evoked potentials (VEPs). Based on the hypothesis that isoluminant color and high contrast pattern differentially activate the parvo- and magnocellular pathways, we studied difference in spatial frequency function between chromatic and achromatic VEPs to sinusoidal gratings. METHODS: Steady-state VEPs to isoluminant chromatic (red-green) and high contrast (90%) achromatic (black-white) sinusoidal gratings with nine spatial frequencies (0.5 to 8.0 cycles/degrees (cpd)) at 4 Hz (8 reversals/s) were recorded in 13 normal subjects. VEPs were Fourier analyzed to obtain phase and amplitude of the second (2F) and fourth (4F) harmonic responses. RESULTS: The 2F amplitude of chromatic VEPs decreased above 4.0 cpd in a low-pass function while that of achromatic VEPs showed a band-pass function with a peak at 4.0 cpd. The 4F amplitude of chromatic VEPs was not affected significantly by spatial frequency whereas that of achromatic VEPs exhibited a high-pass function. The phases of 2F and 4F showed a non-monotonic function of spatial frequency in both chromatic and achromatic stimuli with peaks at middle spatial frequencies. CONCLUSION: Chromatic and achromatic visual stimuli differently affected 2F and 4F components, which thus suggests that 2F and 4F components are generated from different neuronal subgroups largely in the parvocellular pathway.     

Parvocellular pathway impairment in autism spectrum disorder: Evidence from visual evoked potentials

In humans, visual information is processed via parallel channels: the parvocellular (P) pathway analyzes color and form information, whereas the magnocellular (M) stream plays an important role in motion analysis. Individuals with autism spectrum disorder (ASD) often show superior performance in processing fine detail, but impaired performance in processing global structure and motion information. To date, no visual evoked potential (VEP) studies have examined the neural basis of atypical visual performance in ASD. VEPs were recorded using 128-channel high density EEG to investigate whether the P and M pathways are functionally altered in ASD. The functioning of the P and M pathways within primary visual cortex (V1) were evaluated using chromatic (equiluminant red–green sinusoidal gratings) and achromatic (low contrast black–white sinusoidal gratings) stimuli, respectively. Unexpectedly, the N1 component of VEPs to chromatic gratings was significantly prolonged in ASD patients compared to controls. However, VEP responses to achromatic gratings did not differ significantly between the two groups. Because chromatic stimuli preferentially stimulate the P-color but not the P-form pathway, our findings suggest that ASD is associated with impaired P-color pathway activity. Our study provides the first electrophysiological evidence for P-color pathway impairments with preserved M function at the V1 level in ASD.     

Early visual processing in neglect patients: A study with steady-state VEPs

Reliable steady-state visual evoked potentials (VEPs) were recorded in a group of 19 right brain-damaged patients with visuospatial hemineglect (Neglect), and two control groups: 15 left brain-damaged (LBD) patients and 12 right brain-damaged (RBD) patients without neglect. Moreover, VEPs were recorded in two rare cases of left brain damage and right visuospatial hemineglect. Stimuli were gratings phase-reversed at various temporal frequencies presented in the left and right visual field. In the Neglect group, VEPs to stimuli displayed in the left visual field (contralesional stimuli) had longer latencies. The delay was not present for the two control groups. As regards the VEP amplitudes, the Neglect group data showed a less distinctive pattern than in the case of latency. VEPs to stimuli contralateral to the lesion were smaller than those recorded for stimuli ipsilateral to the lesion in both Neglect and RBD groups. On the contrary, the VEP amplitudes for the two hemifields were comparable in the LBD group. In the case of left brain damage and neglect, VEPs to right visual field stimuli had longer latencies and lower amplitudes compared to the ipsilesional responses in both patients. Overall, the data support the view that, in most cases, early visual processing is not intact in the neglected hemifield.     

Neural basis of photo/chromatic sensitivity in adolescence

Purpose: To determine a psychophysiological basis for age visual sensitivity to chromatic and achromatic stimuli. Methods: We investigated the effects of achromatic and four isoluminant color combinations (blue/red, blue/green, green/red, and blue/yellow), luminance ratio changes in color combinations (blue/red; 1:1, 3:4, 4:3) and contrast changes (3 to 100%) on steady‐state electroretinograms (ERGs) and visual evoked potentials (VEPs) in 32 healthy teenagers and 30 young adults. Results: We found that (1) dual peaks at 9 and 18 Hz with a dip at 12 Hz were observed in VEPs with all isoluminant color combinations, (2) VEP responses were significantly enhanced and the 12‐Hz dip became unclear with luminance ratio changes between two colors with a nonantagonistic relationship (blue/red), and (3) VEP amplitudes were significantly increased when the contrast was increased. These characteristics were more evident in teenagers than young adults; however, ERGs were qualitatively similar between the two groups. Discussion: The visual cortex is differently modulated by different color‐luminance combinations, and higher sensitivity to color‐luminance combinations in the visual cortex in teenagers is responsible for the high prevalence of photo/chromatic sensitivity in adolescence.     

Chromatic modulation of luminance visual evoked potential latencies in healthy subjects and patients with mild vision disorders.

OBJECTIVE: To study whether and how color modulates luminance visual evoked potentials (VEPs). METHODS: We studied pattern-reversal luminance VEPs to red/black and blue/black checkerboards with identical luminance contrast values (mixed luminance and chromatic components) (isocontrast color VEP, in brief, IVEPs) in 25 healthy subjects and two groups of patients with mild vision disorders (23 with glaucoma and 25 with optic neuritis). We then compared these with the standard color VEPs to pure chromatic contrast red/green and blue/yellow gratings (CVEPs). RESULTS: In healthy subjects, VEPs to red/black checkerboards and red/green gratings were slower than those obtained with blue/black checkerboards and blue/yellow gratings. Both procedures (IVEPs and CVEPs) differentiated patients with vision disorders from healthy subjects and distinguished between the two different vision disorders. Red/black checkerboards and red-green gratings elicited slower VEPs in patients with optic neuritis and blue/black checkerboards and blue/yellow gratings elicited slower VEPs in patients with glaucoma. IVEPs appeared more stable and ample than CVEPs. The contrast indices normalized CVEP and IVEP latencies in the same subject and showed a positive correlation between CVEP and IVEP latencies in healthy subjects and in patients with optic neuritis, but not in patients with glaucoma. CONCLUSIONS: Our study confirms the usefulness of CVEPs in detecting and differentiating mild vision disorders. IVEPs to colored pattern-reversal luminance checkerboards are equally effective in distinguishing between various vision disorders possibly because colors can modulate VEP latencies to luminance contrast stimuli. SIGNIFICANCE: IVEPs can be useful in differentiating the various vision disorders and are easier than CVEPs to test in a routine clinical setting.     

Visual evoked potentials in idiopathic intracranial hypertension

Objective

Visual evoked potentials (VEPs) are sensitive indicators of optic nerve dysfunction. Since visual loss is a serious complication of idiopathic intracranial hypertension (IIH), we measured VEP in an attempt to evaluate quantitatively the optic nerve damage in patients with chronic IIH.

Methods

We examined 20 consecutive IIH patients fulfilling modified Dandy criteria. VEPs were recorded bilaterally and at midline from occipital electrodes using pattern reversal stimuli to each eye separately. The results were compared to norm values used in our laboratory.

Results

VEP response latencies were usually similar in both eyes. They were delayed in nine patients (45%) bilaterally and in two additional patients unilaterally (55% of patients had abnormal responses in at least one eye). VEP amplitudes were not affected. All three patients with reduced visual acuity in both eyes had prolonged VEP latencies, but abnormal records were seen frequently also in cases with normal visual acuity. Repeated examinations 6–12 months later revealed similar results in clinically stable patients and improvement of VEP latency in parallel to clinical improvement in one.

Conclusions

Clinical visual impairment in IIH is probably preceded by prolongation of VEP responses and the latter may be evidence of optic nerve dysfunction due to demyelination.     

Visual evoked potentials in neurosyphilis.

The visual evoked potential (VEP) to pattern reversal was recorded in 79 patients with neurosyphilis. Sixteen patients (20%) had abnormal VEP latencies with a predominance of pathological VEP values in the group of tabes dorsalis (50%) as compared to general paresis (18%) or meningovascular forms (13%). A comparison of the frequency of abnormal VEPs with that of other ophthalmological tests (visual acuity, visual field, central campimetry, pupillary reactions, dark adaptation, optic fundus) yielded no diagnostic superiority of VEP.     

Alteration of visual evoked potentials and electroretinograms in Parkinson's disease

A group of 24 patients with Parkinson's disease (PD) with normal fundi and normal visual acuities was examined electrophysiologically. Checkerboard reversal VEPs and ERGs (P-ERGs) at various contrast levels as well as photopic and scotopic luminance ERGs were recorded and compared with an age-matched group of controls. Earlier reported latency increases of the VEPs of the patients were confirmed for patterns of high contrast only. Scotopic and photopic luminance ERGs of the patients showed normal latencies, but at all light intensities the amplitudes of the scotopic and photopic b wave, as well as the amplitudes of the photopic a waves, were significantly reduced, P-ERG amplitudes were reduced at 50% contrast. Identical results were obtained in patients under dopaminergic treatment (n = 17) and in patients who did not receive any treatment (n = 7). These results suggest that alterations occur already at the retinal level where dopamine receptors have been found. Thus the reported changes of the VEP are not caused by the visual cortex alone.     

Visual hallucinosis: The major clinical determinant of distorted chromatic contour perception in Parkinson's disease

Summary Recently distorted chromatic contour perception has been demonstrated in Parkinson's disease (PD). The aim of our study is to determine the clinical factors which influence chromatic contour perception in PD. Chromatic and achromatic contour perception, colour discrimination and clinical data were evaluated in 73 patients with PD. We used a computer-aided method to determine the chromatic fusion time (CFT) which indicates the acuity of monochromatic contour perception. Chromatic CFT was generally shortened in patients as compared to controls (p < 0.01), whereas achromatic CFT was not significantly different. Variance analysis revealed the ability of colour discrimination and the risk of visual hallucinations as statistically significant (p < 0.05) variables influencing contour perception of certain stimuli. In contrast, disease stage, disease duration and disease severity have no relevant effect on chromatic contour perception in Parkinson's disease. On the basis of those properties one may suggest that distorted chromatic contour perception is due to an impairment at a central stage of visual processing in PD and an imbalance of the serotonergic system. Whether CFT is a reliable method to predict the individual risk of hallucinosis in PD has to be evaluated.     

Spatial attention has different effects on the magno- and parvocellular pathways.

Attention was directed to the left or to the right of the fixation point by the lateral presentation of a target on which the subject had to perform an attention demanding task. A (task-irrelevant) grating displayed in the left visual field was the visual evoked potential (VEP) stimulus. Gratings modulated either in luminance or colour contrast at various temporal frequencies were used in order to maximise the activation of magno- or parvocellular pathways. VEPs recorded in attended and unattended conditions were compared. For luminance stimuli, both latency and amplitude of VEPs were modified by attention. For chromatic stimuli, attention affected the amplitude but not the latency of VEPs. Spatial attention uses different mechanisms when magno- or parvocellular systems are involved.     

Luminance and chromatic visual evoked potentials in type I and type II diabetes: relationships with peripheral neuropathy

Abstract The objective of the study was to investigate the subclinical visual deficit in type I and II diabetes, and its relationship with peripheral neuropathy. Thirty-two healthy volunteers, 20 patients with type I diabetes and 30 patients with type II diabetes were studied in a clinical neurophysiology setting. Luminance (VEPs) and chromatic visual evoked potentials (CVEPs) were recorded, with white-black, grey-black, red-green and blue-yellow sinusoidal gratings. The peak latencies of the VEP positive wave and CVEP negative wave were recorded. Ten patients with type I and 8 with type II diabetes had peripheral neuropathy. VEPs were slower in patients with type II diabetes and CVEPs were slower in patients with type I and type II diabetes than in controls. Blue-yellow CVEPs were slower in type II than in type I diabetes. VEPs and red-green CVEPs were slower in patients with diabetes with neuropathy than in those without. In conclusion, we found that visual system impairment differs in diabetes with and without peripheral neuropathy.     

Visual Evoked Potentials in Parkinson's Disease and Multiple Lacunar Infarction

Abstract: To clarify the underlying mechanism of abnormality in visual evoked potentials (VEPs) in Parkinson's disease (PD), pattern reversal VEPs were examined in PD as compared with multiple cerebral infarction in the subcortical regions (multiple lacunar infarction: MCI). In particular, the relationship between the VEPs and dementia was investigated. The patients with PD and MCI were divided into 4 groups; PD without dementia (nD-PD: n=20), PD with dementia (D-PD: n=13), MCI without dementia (nD-MCI: n=18), and MCI with dementia (D-MCI: n=12). Sixteen normal subjects were employed as control. There was no significant difference in age among the 5 groups. The D-PD patients showed significantly longer P100 latencies compared to the other 4 groups (p<0.05). In the PD patients, the P100 latencies were significantly correlated with illness duration (p<0.05). A significant negative correlation was found between the P100 latencies and scores on Mini-Mental State Examination (MMSE) in the PD patients (p<0.01). The MMSE score did not correlate with illness duration (p>0.1). The MCI patients showed no significant difference in the VEPs findings compared to the control subjects. These findings suggest that the abnormal VEPs in the D-PD patients may be related to the dementing process and that subcortical lesions make a little contribution to the VEPs delay.     

Assessment of visual functions following prenatal exposure to organic solvents

Prenatal exposure to organic solvents has been previously associated with increased risk of color vision deficits and reduced visual acuity in young children. These findings prompted us to evaluate visual functioning in solvent-exposed infants using more sensitive non-invasive visual evoked potential (VEP) techniques. VEP techniques are described in the context of an ongoing prospective longitudinal cohort study of infants exposed to organic solvents in utero. VEPs are recorded via three active electrodes fitted over the occipital cortex while infants view changing visual stimuli. The sweep VEP is used to assess contrast detection and visual acuity by presenting sinusoidal gratings that "sweep" across a range of contrasts and spatial frequencies. Transient VEPs are used to assess responses to equiluminant chromatic- and luminance-modulated sinusoidal gratings presented in pattern onset-offset format. A single case study is presented showing abnormal chromatic responses and reduced contrast sensitivity in a 2.5-year-old boy following prenatal exposure to perchloroethylene (PCE). These VEP techniques therefore appear promising for the clinical assessment of visual toxicity in pediatric populations.     

Impaired early visual response modulations to spatial information in chronic schizophrenia

Early visual processing stages have been demonstrated to be impaired in schizophrenia patients and their first-degree relatives. The amplitude and topography of the P1 component of the visual evoked potential (VEP) are both affected; the latter of which indicates alterations in active brain networks between populations. At least two issues remain unresolved. First, the specificity of this deficit (and suitability as an endophenotype) has yet to be established, with evidence for impaired P1 responses in other clinical populations. Second, it remains unknown whether schizophrenia patients exhibit intact functional modulation of the P1 VEP component; an aspect that may assist in distinguishing effects specific to schizophrenia. We applied electrical neuroimaging analyses to VEPs from chronic schizophrenia patients and healthy controls in response to variation in the parafoveal spatial extent of stimuli. Healthy controls demonstrated robust modulation of the VEP strength and topography as a function of the spatial extent of stimuli during the P1 component. By contrast, no such modulations were evident at early latencies in the responses from patients with schizophrenia. Source estimations localized these deficits to the left precuneus and medial inferior parietal cortex. These findings provide insights on potential underlying low-level impairments in schizophrenia.     

Subclinical VEP abnormalities in patients on chronic deferoxamine therapy: longitudinal studies

As deferoxamine (DFO) appeared to have certain toxic effects on the sensory pathways in some of our patients on nightly subcutaneous deferoxamine (DFO) for transfusion-dependent anemia, treatment was stopped in all of these patients to obtain a comprehensive baseline assessment of sensory function. Visual evoked potentials (VEPs) were studied in all patients; the 77 described in this report all had normal ophthalmological examinations. Abnormally prolonged VEP latencies were found in 21%. The patients remained off DFO for 2-6 months, and most of those with abnormal VEPs who were retested showed improvement in their VEPs over this period with the VEPs returning to within normal range in half the cases; two showed no change. Since restarting DFO, VEP latencies in 10 of these patients have increased again beyond normal limits, as have the VEPs in 7 who had previously normal VEPs. Although most of the 77 patients have VEPs that are currently normal and stable while on DFO, a significant sub-group have abnormal VEPs that appear sensitive to the administration of DFO and may reflect a vulnerability to DFO neurotoxicity. These data suggest that the VEPs can detect subclinical toxic effects of DFO on the visual system and should be considered as a monitor for patients receiving chronic DFO therapy.     

Visually evoked potentials in respiratory chain disorders

OBJECTIVES: Little is known about the frequency of abnormal visually evoked potentials (VEPs) in patients with respiratory chain disorders (RCDs). We thus wanted to investigate the frequency of abnormal VEPs in RCDs, how often VEPs are abnormal despite normal visual acuity, and which of the VEP variables are most often abnormal. MATERIAL AND METHODS: Reversal checkerboard VEPs of 26 patients with RCDs, aged 32-74 years, were evaluated. RESULTS: VEPs were abnormal in 17 of the 26 cases (65%). The P100 latency was prolonged at least unilaterally in 16 patients. The P100/N145 amplitude was decreased in a single patient. VEPs were abnormal without visual impairment in 9 cases (53%). CONCLUSION: VEPs prove useful to detect clinical or subclinical impairment of the optical tract in patients with RCDs. In the majority of the cases, the P100 latencies are prolonged while the P100/N145 amplitude remains normal.     

Motion-onset and pattern-reversal visual evoked potentials in diagnostics of neuroborreliosis.

Neuroborreliosis is a form of borreliosis that affects the central and/or peripheral nervous system. Although it can mimic neurologic and ophthalmologic disorders such as multiple sclerosis and optic neuritis, visual evoked potential (VEP) examination is usually not used in neuroborreliosis diagnostics. Combined VEP testing (pattern-reversal VEPs and VEPs produced in response to linear and radial motion) was performed in 81 patients with neuroborreliosis verified by laboratory results (positive polymerase chain reaction or intrathecal antibodies production). Thirty-four patients reported diplopia or blurred vision related to borreliosis. In 33 (40%) patients the VEPs were delayed: motion-onset VEPs were pathologic in 22 (27%) patients, reversal VEPs in 5 (6%) patients, and both VEP types in 6 (7%) patients. The findings suggest that VEP testing (especially the motion-onset VEP testing) can confirm CNS involvement. Much higher sensitivity of motion-onset VEPs in comparison with reversal VEPs can result from rather selective (earlier) involvement of the magnocellular system or the dorsal stream of the visual pathway.