Cognitive Processing in Non-Communicative Patients: What Can Event-Related Potentials Tell Us?

Event-related potentials (ERP) have been proposed to improve the differential diagnosis of non-responsive patients. We investigated the potential of the P300 as a reliable marker of conscious processing in patients with locked-in syndrome (LIS). Eleven chronic LIS patients and 10 healthy subjects (HS) listened to a complex-tone auditory oddball paradigm, first in a passive condition (listen to the sounds) and then in an active condition (counting the deviant tones). Seven out of nine HS displayed a P300 waveform in the passive condition and all in the active condition. HS showed statistically significant changes in peak and area amplitude between conditions. Three out of seven LIS patients showed the P3 waveform in the passive condition and five of seven in the active condition. No changes in peak amplitude and only a significant difference at one electrode in area amplitude were observed in this group between conditions. We conclude that, in spite of keeping full consciousness and intact or nearly intact cortical functions, compared to HS, LIS patients present less reliable results when testing with ERP, specifically in the passive condition. We thus strongly recommend applying ERP paradigms in an active condition when evaluating consciousness in non-responsive patients.

Information processing in patients in vegetative and minimally conscious states.

OBJECTIVE: Evaluation of a short two-tone oddball paradigm to discriminate between the vegetative state (VS) and minimal consciousness state (MCS) in a sample of patients with severe disorders of consciousness (DOC). METHOD: EEG was recorded from 45 DOC patients and 14 healthy participants while listening to an auditory oddball paradigm presented in a passive - just listen - and an active - count the odd tones - condition. In patients, the experiment was repeated after a minimum of one week. RESULTS: Prevalence of the P300 was higher in healthy participants (71%) than in patients, but did not discriminate between VS (T1: ∼10%; T2: ∼11%) and MCS (T1: ∼13%; T2: 25%) patients. CONCLUSION: Results cast doubt on whether this simple auditory stimulation paradigm, which requires cognitive action from the listener, is sensitive enough to discriminate between patients with DOC. SIGNIFICANCE: The sensitivity of the P300 ERP obtained in a short two-tone oddball paradigm presented in a passive and an active condition appears to be too low for routine application in a clinical setting aiming at distinguishing between VS and MCS patients.

A combination strategy based brain-computer interface for two-dimensional movement control.

OBJECTIVE: Two-dimensional (2D) movement control is an important issue in brain-computer interfaces (BCIs) research because being able to move, for example, a cursor with the brain will enable patients with motor disabilities to control their environment. However, it is still a challenge to continuously control 2D movement with a non-invasive BCI system. In this paper, we developed a 2D cursor control with motor imagery BCI tasks allowing users to move a cursor to any position by using a combination strategy. With this strategy, a user can combine multiple motor imagery tasks, alternatively or simultaneously, to control 2D movements. APPROACH: After a training session, six participants took part in the first control strategy experiment (the center-out experiment) to verify the effectiveness of the cursor control. Three of the six participants performed an additional experiment, in which they were required to move the cursor to hit five targets in a given sequence. MAIN RESULTS: The average hit rate was more than [Formula: see text] and the trajectories were close to the shortest path. The average hit rate was more than 95.6% and the trajectories were close to the shortest path in the center-out experiment. In the additional experiment, three participants achieved a 100% hit rate with a short trajectory. SIGNIFICANCE: The results demonstrated that users were able to effectively control the 2D movement using the proposed strategy. The present system may be used as a tool to interact with the external world.

Task instructions modulate the attentional mode affecting the auditory MMN and the semantic N400.

Event-related potentials (ERPs) have been proven to be a useful tool to complement clinical assessment and to detect residual cognitive functions in patients with disorders of consciousness. These ERPs are often recorded using passive or unspecific instructions. Patient data obtained this way are then compared to data from healthy participants, which are usually recorded using active instructions. The present study investigates the effect of attentive modulations and particularly the effect of active vs. passive instruction on the ERP components mismatch negativity (MMN) and N400. A sample of 18 healthy participants listened to three auditory paradigms: an oddball, a word priming, and a sentence paradigm. Each paradigm was presented three times with different instructions: ignoring auditory stimuli, passive listening, and focused attention on the auditory stimuli. After each task, the participants indicated their subjective effort. The N400 decreased from the focused task to the passive task, and was extinct in the ignore task. The MMN exhibited higher amplitudes in the focused and passive task compared to the ignore task. The data indicate an effect of attention on the supratemporal component of the MMN. Subjective effort was equally high in the passive and focused tasks but reduced in the ignore task. We conclude that passive listening during EEG recording is stressful and attenuates ERPs, which renders the interpretation of the results obtained in such conditions difficult.

True or false? Activations of language-related areas in patients with disorders of consciousness.

Twenty-nine patients with Unresponsive Wakefulness Syndrome (UWS), 26 patients in Minimally Conscious State (MCS), and 21 healthy control individuals matched in age and social environment (patients' relatives) were presented with 80 short sentences half of which were factually correct, and the other half factually incorrect. The diagnosis was made on the basis of repeated neurological examinations as well as the standardized assessment using a Coma Recovery Scale-Revised (CRS-R). fMRI blood oxygen level dependent signal was recorded in an event-related design time-locked to the end word of the sentences. In the contrast "incorrect-minus-correct" significant activations in the relevant brain regions were obtained in 17 (81%) controls and in 16 (29%) patients. Among patients, the 16 responders had a significantly longer time since accident than the 39 non-responders. Responders and non-responders did not differ in terms of the diagnosis (UWS vs. MCS), age, CRS-R score, or the degree of brain atrophy. The data concur with the results of several earlier studies on UWS/MCS patients, with the difference that the critical stimuli in those studies were semantically incongruent or ambiguous propositions rather than factually false ones in the present experiment. The hypothesis is discussed that the differential response of brain language areas to factually correct and incorrect statements does not require conscious perception of the statements.

Hypersensitivity in borderline personality disorder during mindreading.

BACKGROUND: One of the core symptoms of borderline personality disorder (BPD) is the instability in interpersonal relationships. This might be related to existent differences in mindreading between BPD patients and healthy individuals. METHODS: We examined the behavioural and neurophysiological (fMRI) responses of BPD patients and healthy controls (HC) during performance of the 'Reading the Mind in the Eyes' test (RMET). RESULTS: Mental state discrimination was significantly better and faster for affective eye gazes in BPD patients than in HC. At the neurophysiological level, this was manifested in a stronger activation of the amygdala and greater activity of the medial frontal gyrus, the left temporal pole and the middle temporal gyrus during affective eye gazes. In contrast, HC subjects showed a greater activation in the insula and the superior temporal gyri. CONCLUSION: These findings indicate that BPD patients are highly vigilant to social stimuli, maybe because they resonate intuitively with mental states of others.

On the role of attention in binocular rivalry: electrophysiological evidence.

During binocular rivalry visual consciousness fluctuates between two dissimilar monocular images. We investigated the role of attention in this phenomenon by comparing event-related potentials (ERPs) when binocular-rivalry stimuli were attended with when they were unattended. Stimuli were dichoptic, orthogonal gratings that yielded binocular rivalry and dioptic, identically oriented gratings that yielded binocular fusion. Events were all possible orthogonal changes in orientation of one or both gratings. We had two attention conditions: In the attend-to-grating condition, participants had to report changes in perceived orientation, focussing their attention on the gratings. In the attend-to-fixation condition participants had to report changes in a central fixation target, taking attention away from the gratings. We found, surprisingly, that attending to rival gratings yielded a smaller ERP component (the N1, from 160-210 ms) than attending to the fixation target. To explain this paradoxical effect of attention, we propose that rivalry occurs in the attend-to-fixation condition (we found an ERP signature of rivalry in the form of a sustained negativity from 210-300 ms) but that the mechanism processing the stimulus changes is more adapted in the attend-to-grating condition than in the attend-to-fixation condition. This is consistent with the theory that adaptation gives rise to changes of visual consciousness during binocular rivalry.

Early correlates of visual awareness following orientation and colour rivalry.

Binocular rivalry occurs when dissimilar images are presented to corresponding retinal regions of the two eyes: visibility alternates irregularly between the two images, interspersed by brief transitions when parts of both may be visible. We measured event-related potentials (ERPs) following binocular rivalry by changing the stimulus viewed by one eye to be identical to that in the other eye, eliciting binocular fusion. Because of the rivalry, observers either saw the change, when it happened to the visible stimulus, or did not see the change, when it happened to the invisible stimulus. The earliest ERP differences between visible and invisible changes occurred after about 100 ms (P1) when the rivalry was between stimuli differing in orientation, and after about 200 ms (N1) when the rivalry was between stimuli differing in colour. These differences originated from ventro-lateral temporal and prefrontal areas. We conclude that the rivalling stimulus property influences the timing of modulation of correlates of visual awareness in a property-independent cortical network.