Can electrophysiological assessments of brain function be useful to the intensive care physician in daily clinical practice?

Changes in electroencephalogram parameters and auditory event-related potentials, induced by interruption to propofol sedation in intensive care patients, provide a number of electrophysiological measures that can be used to assess neurological function accurately. Studies of electroencephalogram parameters suggest that power spectral estimation, as root mean square power, is more useful and precise than spectral edge frequency 95% in evaluating the functional integrity of the brain. When such parameters are used to evaluate neurological function, in particular the N100 and mismatch negativity components, a precise assessment of a patient's readiness to awaken from a pharmacologically induced coma (such as sedation) can be obtained. In terms of ease of use, however, it is more difficult to establish whether N100 or mismatch negativity is superior.     

P50 and acoustic startle gating are not related in healthy participants

Although P50 event-related potential (ERP) suppression and acoustic startle prepulse inhibition are conceptualized as measures of sensory and sensorimotor gating, respectively, the relationship between these measures is unclear. In the present study, P50 and prepulse inhibition trials were interleaved in a single testing session to determine their relationship. Thirty-one healthy participants were presented with startle- and P50-eliciting stimuli across six trial blocks. Lead stimuli (i.e., the prepulse to the acoustic startle and the first click in the dual click ERP paradigm) resulted in significant gating, or amplitude attenuation, of responses to the startle probe and second paired click. There were no meaningful correlations between the P50 and prepulse inhibition variables, indicating that P50 suppression and acoustic startle prepulse inhibition measure distinct neural mechanisms. The implications of these findings for operationally defining the psychological construct of gating with these psychophysiological measures are discussed.     

Newborn human brain identifies repeated auditory feature conjunctions of low sequential probability

Natural environments are usually composed of multiple sources for sounds. The sounds might physically differ from one another only as feature conjunctions, and several of them might occur repeatedly in the short term. Nevertheless, the detection of rare sounds requires the identification of the repeated ones. Adults have some limited ability to effortlessly identify repeated sounds in such acoustically complex environments, but the developmental onset of this finite ability is unknown. Sleeping newborn infants were presented with a repeated tone carrying six frequent (P = 0.15 each) and six rare (P approximately 0.017 each) conjunctions of its frequency, intensity and duration. Event-related potentials recorded from the infants' scalp were found to shift in amplitude towards positive polarity selectively in response to rare conjunctions. This finding suggests that humans are relatively hard-wired to preattentively identify repeated auditory feature conjunctions even when such conjunctions occur rarely among other similar ones.     

Tryptophan depletion effects on EEG and MEG responses suggest serotonergic modulation of auditory involuntary attention in humans

Involuntary attention shifting, i.e., detecting and orienting to unexpected stimulus changes, may be altered at low brain serotonin (5-hydroxytryptamine; 5-HT) levels. This was studied in 13 healthy subjects (21–30 years old; 6 females) by using a dietary challenge, acute tryptophan depletion (ATD), which decreases 5-HT synthesis in the brain. Five hours after ingestion of either ATD or control mixture (randomized, double-blinded, crossover design), brain responses indexing involuntary attention were measured with simultaneous 64-channel electroencephalography (EEG) and 122-channel magnetoencephalography (MEG). During the measurement, the subjects were instructed to discriminate equiprobable 200- and 400-ms tones by pressing one of two buttons rapidly. Occasionally, the frequency of the tones changed (10% increase/decrease), causing involuntary attention shifting. ATD significantly lowered plasma tryptophan concentrations (total tryptophan decreased by 75%, free tryptophan decreased by 35%). As compared to the control condition, ATD reduced the amplitude of the deviant-tone N2 wave, including the overlapping mismatch negativity (MMN) and N2b subcomponents, which are suggested to reflect change detection in the brain. The EEG results were accompanied by a significant increase in the peak latency of the magnetic counterpart of MMN. However, no ATD effects were observed in P3 to task-irrelevant frequency change. Reaction time (RT) to deviants per se was not significantly affected, but RT in trials succeeding the deviant-frequency tones was increased by ATD, which suggested impaired reorienting to the task-relevant activity. In conclusion, the results suggest that decreased level of central 5-HT function after ATD may decrease involuntary attention shifting to task-irrelevant sound changes and thus modulate resource allocation to the task-relevant activity.     

Sound presentation rate is represented logarithmically in human cortex

The encoding of temporal information is critical to auditory processing. Since the mismatch negativity component of the auditory event-related brain potential is thought to reflect properties of auditory sensory memory, we used it to examine the representation of acoustic time intervals in the human cortex. The mismatch negativity occurs in response to deviations in acoustic regularities, which are stored in sensory memory. We used 16 stimulus conditions, randomly presenting short trains of tones with fixed onset-to-onset intervals of 100, 200, 300 or 400 ms (all tones in the study were identical). The first four intervals between the tones established the acoustic regularity on each train (i.e. the 'standard'). The fifth tone in each train was preceded by an interval that varied randomly among the same four intervals. If this interval was different from the standard for that trial, it violated the acoustic regularity (i.e. it was a 'deviant'). The mismatch response to the fifth tone differed significantly among stimulus conditions and was proportional to the absolute value of the logarithm of the deviant/standard interval ratio. This indicates that short acoustic time intervals are represented with a ratio scale in the human cortex. When the fifth tone occurred 100 ms after the fourth, it elicited a somewhat different, although proportional response, supporting the hypothesis that a special integration mechanism may exist for very short time intervals.     

Subthalamic stimulation influences postmovement cortical somatosensory processing in Parkinson's disease

In Parkinson's disease, poor motor performance (resulting primarily from abnormal cortical activation during movement preparation and execution) may also be due to impaired sensorimotor integration and defective cortical activity termination of the ongoing movement, thus delaying preparation of the following one. Reduced movement-related synchronization of the beta rhythm in Parkinson's disease compared to controls has been put forward as evidence for impaired postmovement cortical deactivation. We assessed the effects of subthalamic deep brain stimulation and l-dopa on beta rhythm synchronization over the premotor and primary sensorimotor cortex. Ten advanced patients performed self-paced wrist flexion in four conditions according to the presence or not of stimulation and l-dopa. Compared to without treatment, the motor score improved by approximately 60%; the beta synchronization was present over the contralateral frontocentral region and increased significantly over the contralateral central region under stimulation and under l-dopa, with a maximal effect when both treatments were associated. Our advanced patients displayed very focused and attenuated beta rhythm synchronization which, under stimulation, increased over the contralateral premotor and primary sensorimotor cortex. Stimulation and l-dopa both partly restored postmovement cortical deactivation in advanced Parkinson's disease, although the respective mechanisms probably differ. They may improve bradykinesia and cortical deactivation by reestablishing movement-related somatosensory processing at the end of the movement through the basal ganglia into the cortex.     

Do P1 and N1 evoked by the ERP task reflect primary visual processing in Parkinson's disease?

To evaluate whether P1 and N1 evoked by ERP tasks could appropriatelyreflect primary visual processing in Parkinson's disease (PD). Methods: We recorded ERPs in 13 PD patients with duration of illness less than 5 years and 18 age-matched normal control subjects. P1 and N1 from Oz were evoked by a visual oddball and a delayed matching S1-S2 task. The effect of different events on P1 and N1 was studied. All patients were given an ECD-SPECT examination, and the SPECT images were overlaid on the 3D-MRI. The correlation of P1 or N1 to the regional cerebral blood flow (rCBF) was studied. Results: P1 was not influenced by different events. There was no significant P1 differences between the PD and the normal group. N1 was significantly shorter and smaller in the patients than that in the normal group. N1 amplitude after the waveform subtraction (target-frequent) in the PD group did not show significant difference with that in the normal controls, nor with the N1 before the subtraction. Nd, the subcomponent of N1 after the subtraction in the patients was significantlyearlier and smaller than that in the normal controls. P1 only weakly correlated with the rCBF in the occipital lobe. N1 was correlated with the rCBF in a global region. Conclusions: The results provided some evidence that P1 might reflect the primary visual processing, and N1 might be involved in both primary and cognitive visual processing. The altered N1 in the PD patients might be due to the deformed Nd.     

Prolonged latencies of the N2 and P3 of the auditory event-related potential in children at risk for schizophrenia

Summary In previous studies investigating long latency components of the event-related potential (ERP), schizophrenic patients generally showed reduced P3 amplitudes and in some studies prolonged N2 or P3 latencies. As there is a higher risk of offspring of schizophrenics than of mentally healthy parents developing this disease, the present study was intended to clarify whether ERP components (in particular the N2 and P3) differ between these two groups of children. Twelve high-risk and 12 age-matched control children (aged 9–16 years) performed an auditory oddball task in order to assess late ERP components. This task required the subject to covertly count rare target tone pips (P = 0.2) irregularly interspersed among frequent standard tone pips (P = 0.8) in two series of 400 pips. ERPs were recorded from midline electrodes (Fz, Cz, Pz). The results indicated distinctly prolonged N2 and P3 latencies in ERPs to target stimuli in children of schizophrenic patients. These findings suggest a slowed target classification in these children.     

The role of devaluing and discounting in performance monitoring: a neurophysiological study of minorities under threat

Psychological disengagement allows stigmatized individuals to cope with negative outcomes in stereotype-relevant domains, but its role in online performance monitoring and adjustment is unknown. This study examined how two forms of disengagement (devaluing and discounting) predict performance monitoring at an early (motivational) and later (interpretational) stage of error processing. Among minority college students, event-related brain activity was measured in response to errors on tasks described neutrally or as diagnostic of intelligence. Results found dissociable effects for error-related negativity (ERN) and later positivity (Pe). When the task was linked to intelligence, valuing academics predicted larger ERNs. Unexpectedly, discounting tendencies predicted smaller Pes when the task was described neutrally, a relationship that was attenuated and somewhat reversed when explicitly linking the task to intelligence. In the diagnostic condition, valuing also predicted more efficient behavioral responses to errors, whereas discounting predicted more negative task construals. Results suggest that among stereotype threatened minority students, devaluing has implications for early stage motivational processes involved in monitoring and responding to errors, whereas discounting may have implications for later construal processes.     

Event-Related Potentials in Posttraumatic Headache

OBJECTIVES: To assess impairment of cognitive functions occurring in patients with posttraumatic headache as a consequence of a minor cranial trauma in the absence of organic damage involving the central nervous system. BACKGROUND: The term posttraumatic syndrome defines a stereotypic set of symptoms following traumatic brain injury that are subjective and varied. A deficit of cognitive function and impairment of the rapid processes of learning, attention, and short-term memory have frequently been identified. Moreover, headache is the most frequent symptom reported by the patients. Due to the nature of the symptoms, a great limitation in defining the posttraumatic syndrome is represented by the lack of methods and diagnostic tools that allow quantification of the subjective disturbances and evidence of the signs indicative of central nervous system involvement in this pathological condition. METHODS: Twenty-five subjects (16 women, 9 men; mean age, 28 +/- 9 years) were examined between 3 and 6 months after the traumatic event. The P300 event-related potential was recorded by an odd-ball paradigm with an acoustic modality. The patients underwent electroencephalography and brain stem auditory evoked potentials; magnetic resonance imaging was performed to exclude the presence of cerebral lesions. RESULTS: The mean latency of P300 was increased in both central electrodes (Cz and Pz) in patients with posttraumatic syndrome compared with controls (P<.001); assuming the value of mean +/- 2 SD was the cutoff point between normal and abnormal results, the P300 latency results were altered in 13 patients (52%). In the patient group, a significant correlation was demonstrated between Zung Depression Scale score and P3 and N2 wave latencies (r = 0.54, P <.004; r = 0.56, P<.003) and between Zung Anxiety Scale scores and P3 wave latencies (r = 0.46, P<.02). CONCLUSIONS: These data suggest the usefulness of the P300 event-related potential in evaluating cognitive disturbances in patients affected by posttraumatic syndrome. Alteration of cognitive potential in such patients, even in the absence of lesions detectable by neuroimaging, indicate the functional impairment of specific cerebral areas that can occur after a traumatic event.