Desflurane is risk factor for postoperative delirium in older patients' independent from intraoperative burst suppression duration.

Background: Postoperative Delirium (POD) is the most frequent neurocognitive complication after general anesthesia in older patients. The development of POD is associated with prolonged periods of burst suppression activity in the intraoperative electroencephalogram (EEG). The risk to present burst suppression activity depends not only on the age of the patient but is also more frequent during propofol anesthesia as compared to inhalative anesthesia. The aim of our study is to determine, if the risk to develop POD differs depending on the anesthetic agent given and if this correlates with a longer duration of intraoperative burst suppression. Methods: In this secondary analysis of the SuDoCo trail [ISRCTN 36437985] 1277 patients, older than 60 years undergoing general anesthesia were included. We preprocessed and analyzed the raw EEG files from each patient and evaluated the intraoperative burst suppression duration. In a logistic regression analysis, we assessed the impact of burst suppression duration and anesthetic agent used for maintenance on the risk to develop POD. Results: 18.7% of patients developed POD. Burst suppression duration was prolonged in POD patients (POD 27.5 min ± 21.3 min vs. NoPOD 21.4 ± 16.2 min, p < 0.001), for each minute of prolonged intraoperative burst suppression activity the risk to develop POD increased by 1.1% (OR 1.011, CI 95% 1.000-1.022, p = 0.046). Burst suppression duration was prolonged under propofol anesthesia as compared to sevoflurane and desflurane anesthesia (propofol 32.5 ± 20.3 min, sevoflurane 17.1 ± 12.6 min and desflurane 20.1 ± 16.0 min, p < 0.001). However, patients receiving desflurane anesthesia had a 1.8fold higher risk to develop POD, as compared to propofol anesthesia (OR 1.766, CI 95% 1.049-2.974, p = 0.032). Conclusion: We found a significantly increased risk to develop POD after desflurane anesthesia in older patients, even though burst suppression duration was shorter under desflurane anesthesia as compared to propofol anesthesia. Our finding might help to explain some discrepancies in studies analyzing the impact of burst suppression duration and EEG-guided anesthesia on the risk to develop POD.

Machine-learning model predicting postoperative delirium in older patients using intraoperative frontal electroencephalographic signatures.

Objective: In older patients receiving general anesthesia, postoperative delirium (POD) is the most frequent form of cerebral dysfunction. Early identification of patients at higher risk to develop POD could provide the opportunity to adapt intraoperative and postoperative therapy. We, therefore, propose a machine learning approach to predict the risk of POD in elderly patients, using routine intraoperative electroencephalography (EEG) and clinical data that are readily available in the operating room. Methods: We conducted a retrospective analysis of the data of a single-center study at the Charité-Universitätsmedizin Berlin, Department of Anesthesiology [ISRCTN 36437985], including 1,277 patients, older than 60 years with planned surgery and general anesthesia. To deal with the class imbalance, we used balanced ensemble methods, specifically Bagging and Random Forests and as a performance measure, the area under the ROC curve (AUC-ROC). We trained our models including basic clinical parameters and intraoperative EEG features in particular classical spectral and burst suppression signatures as well as multi-band covariance matrices, which were classified, taking advantage of the geometry of a Riemannian manifold. The models were validated with 10 repeats of a 10-fold cross-validation. Results: Including EEG data in the classification resulted in a robust and reliable risk evaluation for POD. The clinical parameters alone achieved an AUC-ROC score of 0.75. Including EEG signatures improved the classification when the patients were grouped by anesthetic agents and evaluated separately for each group. The spectral features alone showed an AUC-ROC score of 0.66; the covariance features showed an AUC-ROC score of 0.68. The AUC-ROC scores of EEG features relative to patient data differed by anesthetic group. The best performance was reached, combining both the EEG features and the clinical parameters. Overall, the AUC-ROC score was 0.77, for patients receiving Propofol it was 0.78, for those receiving Sevoflurane it was 0.8 and for those receiving Desflurane 0.73. Applying the trained prediction model to an independent data set of a different clinical study confirmed these results for the combined classification, while the classifier on clinical parameters alone did not generalize. Conclusion: A machine learning approach combining intraoperative frontal EEG signatures with clinical parameters could be an easily applicable tool to early identify patients at risk to develop POD.

Electrocorticography is superior to subthalamic local field potentials for movement decoding in Parkinson's disease.

Brain signal decoding promises significant advances in the development of clinical brain computer interfaces (BCI). In Parkinson's disease (PD), first bidirectional BCI implants for adaptive deep brain stimulation (DBS) are now available. Brain signal decoding can extend the clinical utility of adaptive DBS but the impact of neural source, computational methods and PD pathophysiology on decoding performance are unknown. This represents an unmet need for the development of future neurotechnology. To address this, we developed an invasive brain-signal decoding approach based on intraoperative sensorimotor electrocorticography (ECoG) and subthalamic LFP to predict grip-force, a representative movement decoding application, in 11 PD patients undergoing DBS. We demonstrate that ECoG is superior to subthalamic LFP for accurate grip-force decoding. Gradient boosted decision trees (XGBOOST) outperformed other model architectures. ECoG based decoding performance negatively correlated with motor impairment, which could be attributed to subthalamic beta bursts in the motor preparation and movement period. This highlights the impact of PD pathophysiology on the neural capacity to encode movement vigor. Finally, we developed a connectomic analysis that could predict grip-force decoding performance of individual ECoG channels across patients by using their connectomic fingerprints. Our study provides a neurophysiological and computational framework for invasive brain signal decoding to aid the development of an individualized precision-medicine approach to intelligent adaptive DBS.

Cognitive Workload of Tugboat Captains in Realistic Scenarios: Adaptive Spatial Filtering for Transfer Between Conditions.

Changing and often class-dependent non-stationarities of signals are a big challenge in the transfer of common findings in cognitive workload estimation using Electroencephalography (EEG) from laboratory experiments to realistic scenarios or other experiments. Additionally, it often remains an open question whether actual cognitive workload reflected by brain signals was the main contribution to the estimation or discriminative and class-dependent muscle and eye activity, which can be secondary effects of changing workload levels. Within this study, we investigated a novel approach to spatial filtering based on beamforming adapted to changing settings. We compare it to no spatial filtering and Common Spatial Patterns (CSP). We used a realistic maneuvering task, as well as an auditory n-back secondary task on a tugboat simulator as two different conditions to induce workload changes on professional tugboat captains. Apart from the typical within condition classification, we investigated the ability of the different classification methods to transfer between the n-back condition and the maneuvering task. The results show a clear advantage of the proposed approach over the others in the challenging transfer setting. While no filtering leads to lowest within-condition normalized classification loss on average in two scenarios (22 and 10%), our approach using adaptive beamforming (30 and 18%) performs comparably to CSP (33 and 15%). Importantly, in the transfer from one to another setting, no filtering and CSP lead to performance around chance level (45 to 53%), while our approach in contrast is the only one capable of classifying in all other scenarios (34 and 35%) with a significant difference from chance level. The changing signal composition over the scenarios leads to a need to adapt the spatial filtering in order to be transferable. With our approach, the transfer is successful due to filtering being optimized for the extraction of neural components and additional investigation of their scalp patterns revealed mainly neural origin. Interesting findings are that rather the patterns slightly change between conditions. We conclude that the approaches with low normalized loss depend on eye and muscle activity which is successful for classification within conditions, but fail in the classifier transfer since eye and muscle contributions are highly condition-specific.

Suppress Me if You Can: Neurofeedback of the Readiness Potential.

Voluntary movements are usually preceded by a slow, negative-going brain signal over motor areas, the so-called readiness potential (RP). To date, the exact nature and causal role of the RP in movement preparation have remained heavily debated. Although the RP is influenced by several motorical and cognitive factors, it has remained unclear whether people can learn to exert mental control over their RP, for example, by deliberately suppressing it. If people were able to initiate spontaneous movements without eliciting an RP, this would challenge the idea that the RP is a necessary stage of the causal chain leading up to a voluntary movement. We tested the ability of participants to control the magnitude of their RP in a neurofeedback experiment. Participants performed self-initiated movements, and after every movement, they were provided with immediate feedback about the magnitude of their RP. They were asked to find a strategy to perform voluntary movements such that the RPs were as small as possible. We found no evidence that participants were able to to willfully modulate or suppress their RPs while still eliciting voluntary movements. This suggests that the RP might be an involuntary component of voluntary action over which people cannot exert conscious control.

Integrating neurophysiologic relevance feedback in intent modeling for information retrieval.

The use of implicit relevance feedback from neurophysiology could deliver effortless information retrieval. However, both computing neurophysiologic responses and retrieving documents are characterized by uncertainty because of noisy signals and incomplete or inconsistent representations of the data. We present the first-of-its-kind, fully integrated information retrieval system that makes use of online implicit relevance feedback generated from brain activity as measured through electroencephalography (EEG), and eye movements. The findings of the evaluation experiment (N = 16) show that we are able to compute online neurophysiology-based relevance feedback with performance significantly better than chance in complex data domains and realistic search tasks. We contribute by demonstrating how to integrate in interactive intent modeling this inherently noisy implicit relevance feedback combined with scarce explicit feedback. Although experimental measures of task performance did not allow us to demonstrate how the classification outcomes translated into search task performance, the experiment proved that our approach is able to generate relevance feedback from brain signals and eye movements in a realistic scenario, thus providing promising implications for future work in neuroadaptive information retrieval (IR).

A large scale screening study with a SMR-based BCI: Categorization of BCI users and differences in their SMR activity.

Brain-Computer Interfaces (BCIs) are inefficient for a non-negligible part of the population, estimated around 25%. To understand this phenomenon in Sensorimotor Rhythm (SMR) based BCIs, data from a large-scale screening study conducted on 80 novice participants with the Berlin BCI system and its standard machine-learning approach were investigated. Each participant performed one BCI session with resting state Encephalography, Motor Observation, Motor Execution and Motor Imagery recordings and 128 electrodes. A significant portion of the participants (40%) could not achieve BCI control (feedback performance > 70%). Based on the performance of the calibration and feedback runs, BCI users were stratified in three groups. Analyses directed to detect and elucidate the differences in the SMR activity of these groups were performed. Statistics on reactive frequencies, task prevalence and classification results are reported. Based on their SMR activity, also a systematic list of potential reasons leading to performance drops and thus hints for possible improvements of BCI experimental design are given. The categorization of BCI users has several advantages, allowing researchers 1) to select subjects for further analyses as well as for testing new BCI paradigms or algorithms, 2) to adopt a better subject-dependent training strategy and 3) easier comparisons between different studies.

Toward Electrophysiology-Based Intelligent Adaptive Deep Brain Stimulation for Movement Disorders.

Deep brain stimulation (DBS) represents one of the major clinical breakthroughs in the age of translational neuroscience. In 1987, Benabid and colleagues demonstrated that high-frequency stimulation can mimic the effects of ablative neurosurgery in Parkinson's disease (PD), while offering two key advantages to previous procedures: adjustability and reversibility. Deep brain stimulation is now an established therapeutic approach that robustly alleviates symptoms in patients with movement disorders, such as Parkinson's disease, essential tremor, and dystonia, who present with inadequate or adverse responses to medication. Currently, stimulation electrodes are implanted in specific target regions of the basal ganglia-thalamic circuit and stimulation pulses are delivered chronically. To achieve optimal therapeutic effect, stimulation frequency, amplitude, and pulse width must be adjusted on a patient-specific basis by a movement disorders specialist. The finding that pathological neural activity can be sampled directly from the target region using the DBS electrode has inspired a novel DBS paradigm: closed-loop adaptive DBS (aDBS). The goal of this strategy is to identify pathological and physiologically normal patterns of neuronal activity that can be used to adapt stimulation parameters to the concurrent therapeutic demand. This review will give detailed insight into potential biomarkers and discuss next-generation strategies, implementing advances in artificial intelligence, to further elevate the therapeutic potential of DBS by capitalizing on its modifiable nature. Development of intelligent aDBS, with an ability to deliver highly personalized treatment regimens and to create symptom-specific therapeutic strategies in real-time, could allow for significant further improvements in the quality of life for movement disorders patients with DBS that ultimately could outperform traditional drug treatment.

Characterizing Regularization Techniques for Spatial Filter Optimization in Oscillatory EEG Regression Problems : Guidelines Derived from Simulation and Real-World Data.

We report on novel supervised algorithms for single-trial brain state decoding. Their reliability and robustness are essential to efficiently perform neurotechnological applications in closed-loop. When brain activity is assessed by multichannel recordings, spatial filters computed by the source power comodulation (SPoC) algorithm allow identifying oscillatory subspaces. They regress to a known continuous trial-wise variable reflecting, e.g. stimulus characteristics, cognitive processing or behavior. In small dataset scenarios, this supervised method tends to overfit to its training data as the involved recordings via electroencephalogram (EEG), magnetoencephalogram or local field potentials generally provide a low signal-to-noise ratio. To improve upon this, we propose and characterize three types of regularization techniques for SPoC: approaches using Tikhonov regularization (which requires model selection via cross-validation), combinations of Tikhonov regularization and covariance matrix normalization as well as strategies exploiting analytical covariance matrix shrinkage. All proposed techniques were evaluated both in a novel simulation framework and on real-world data. Based on the simulation findings, we saw our expectations fulfilled, that SPoC regularization generally reveals the largest benefit for small training sets and under severe label noise conditions. Relevant for practitioners, we derived operating ranges of regularization hyperparameters for cross-validation based approaches and offer open source code. Evaluating all methods additionally on real-world data, we observed an improved regression performance mainly for datasets from subjects with initially poor performance. With this proof-of-concept paper, we provided a generalizable regularization framework for SPoC which may serve as a starting point for implementing advanced techniques in the future.

Classifying the mental representation of word meaning in children with Multivariate Pattern Analysis of fNIRS.

This study presents the implementation of a within-subject neural decoder, based on Support Vector Machines, and its application for the classification of distributed patterns of hemodynamic activation, measured with Functional Near Infrared Spectroscopy (fNIRS) on children, in response to meaningful and meaningless auditory stimuli. Classification accuracy nominally exceeds chance level for the majority of the participants, but fails to reach statistical significance. Future work should investigate whether individual differences in classification accuracy may relate to other characteristics of the children, such as their cognitive, speech or reading abilities.

Improving the analysis of near-infrared spectroscopy data with multivariate classification of hemodynamic patterns: a theoretical formulation and validation.

OBJECTIVE: The statistical analysis of functional near infrared spectroscopy (fNIRS) data based on the general linear model (GLM) is often made difficult by serial correlations, high inter-subject variability of the hemodynamic response, and the presence of motion artifacts. In this work we propose to extract information on the pattern of hemodynamic activations without using any a priori model for the data, by classifying the channels as 'active' or 'not active' with a multivariate classifier based on linear discriminant analysis (LDA). APPROACH: This work is developed in two steps. First we compared the performance of the two analyses, using a synthetic approach in which simulated hemodynamic activations were combined with either simulated or real resting-state fNIRS data. This procedure allowed for exact quantification of the classification accuracies of GLM and LDA. In the case of real resting-state data, the correlations between classification accuracy and demographic characteristics were investigated by means of a Linear Mixed Model. In the second step, to further characterize the reliability of the newly proposed analysis method, we conducted an experiment in which participants had to perform a simple motor task and data were analyzed with the LDA-based classifier as well as with the standard GLM analysis. MAIN RESULTS: The results of the simulation study show that the LDA-based method achieves higher classification accuracies than the GLM analysis, and that the LDA results are more uniform across different subjects and, in contrast to the accuracies achieved by the GLM analysis, have no significant correlations with any of the demographic characteristics. Findings from the real-data experiment are consistent with the results of the real-plus-simulation study, in that the GLM-analysis results show greater inter-subject variability than do the corresponding LDA results. SIGNIFICANCE: The results obtained suggest that the outcome of GLM analysis is highly vulnerable to violations of theoretical assumptions, and that therefore a data-driven approach such as that provided by the proposed LDA-based method is to be favored.

Implicit relevance feedback from electroencephalography and eye tracking in image search.

OBJECTIVE: Methods from brain-computer interfacing (BCI) open a direct access to the mental processes of computer users, which offers particular benefits in comparison to standard methods for inferring user-related information. The signals can be recorded unobtrusively in the background, which circumvents the time-consuming and distracting need for the users to give explicit feedback to questions concerning the individual interest. The obtained implicit information makes it possible to create dynamic user interest profiles in real-time, that can be taken into account by novel types of adaptive, personalised software. In the present study, the potential of implicit relevance feedback from electroencephalography (EEG) and eye tracking was explored with a demonstrator application that simulated an image search engine. APPROACH: The participants of the study queried for ambiguous search terms, having in mind one of the two possible interpretations of the respective term. Subsequently, they viewed different images arranged in a grid that were related to the query. The ambiguity of the underspecified search term was resolved with implicit information present in the recorded signals. For this purpose, feature vectors were extracted from the signals and used by multivariate classifiers that estimated the intended interpretation of the ambiguous query. MAIN RESULT: The intended interpretation was inferred correctly from a combination of EEG and eye tracking signals in 86% of the cases on average. Information provided by the two measurement modalities turned out to be complementary. SIGNIFICANCE: It was demonstrated that BCI methods can extract implicit user-related information in a setting of human-computer interaction. Novelties of the study are the implicit online feedback from EEG and eye tracking, the approximation to a realistic use case in a simulation, and the presentation of a large set of photographies that had to be interpreted with respect to the content.

Assessing the Depth of Cognitive Processing as the Basis for Potential User-State Adaptation.

Objective: Decoding neurocognitive processes on a single-trial basis with Brain-Computer Interface (BCI) techniques can reveal the user's internal interpretation of the current situation. Such information can potentially be exploited to make devices and interfaces more user aware. In this line of research, we took a further step by studying neural correlates of different levels of cognitive processes and developing a method that allows to quantify how deeply presented information is processed in the brain. Methods/Approach: Seventeen participants took part in an EEG study in which we evaluated different levels of cognitive processing (no processing, shallow, and deep processing) within three distinct domains (memory, language, and visual imagination). Our investigations showed gradual differences in the amplitudes of event-related potentials (ERPs) and in the extend and duration of event-related desynchronization (ERD) which both correlate with task difficulty. We performed multi-modal classification to map the measured correlates of neurocognitive processing to the corresponding level of processing. Results: Successful classification of the neural components was achieved, which reflects the level of cognitive processing performed by the participants. The results show performances above chance level for each participant and a mean performance of 70-90% for all conditions and classification pairs. Significance: The successful estimation of the level of cognition on a single-trial basis supports the feasibility of user-state adaptation based on ongoing neural activity. There is a variety of potential use cases such as: a user-friendly adaptive design of an interface or the development of assistance systems in safety critical workplaces.

A low-dimensional representation for individual head geometries.

In the estimation of individual head geometries for source localization and electrical stimulation in neuroelectric investigations and application, mostly complex geometrical models are directly extracted from anatomical images. We present a novel method that uses a dimensionality reduction from thousands down to the range of tens of parameters to successfully represent an individual 4-shell Boundary Element Method (BEM) head model, which can successively be fitted to any kind of data from an individual head (e.g. headshape, impedances) and then used for individual head model creation. The results show, that around 15 - 20 components can lead to satisfactory results.

Weighted spatial based geometric scheme as an efficient algorithm for analyzing single-trial EEGS to improve cue-based BCI classification.

There is a growing interest in analyzing the geometrical behavior of electroencephalogram (EEG) covariance matrix in the context of brain computer interface (BCI). The bottleneck of the current Riemannian framework is the bias of the mean vector of EEG signals to the noisy trials, which deteriorates the covariance matrix in the manifold space. This study presents a spatial weighting scheme to reduce the effect of noisy trials on the mean vector. To assess the proposed method, dataset IIa from BCI competition IV, containing the EEG trials of 9 subjects performing four mental tasks, was utilized. The performance of the proposed method is compared to the classical Riemannian method along with Common Spatial Pattern (CSP) on the dataset. The results show that when considering just two imagery classes, the proposed method performs on par with CSP method, whereas in the multi class scenario, the proposed algorithm outperforms the CSP approach on seven out of nine subjects. Incidentally, the proposed method obtains better accuracy for the majority of subjects compared to the classical Riemannian method.

Open Access Dataset for EEG+NIRS Single-Trial Classification.

We provide an open access dataset for hybrid brain-computer interfaces (BCIs) using electroencephalography (EEG) and near-infrared spectroscopy (NIRS). For this, we con-ducted two BCI experiments (left vs. right hand motor imagery; mental arithmetic vs. resting state). The dataset was validated using baseline signal analysis methods, with which classification performance was evaluated for each modality and a combination of both modalities. As already shown in previous literature, the capability of discriminating different mental states can be en-hanced by using a hybrid approach, when comparing to single modality analyses. This makes the provided data highly suitable for hybrid BCI investigations. Since our open access dataset also comprises motion artifacts and physiological data, we expect that it can be used in a wide range of future validation approaches in multimodal BCI research.

The Berlin Brain-Computer Interface: Progress Beyond Communication and Control.

The combined effect of fundamental results about neurocognitive processes and advancements in decoding mental states from ongoing brain signals has brought forth a whole range of potential neurotechnological applications. In this article, we review our developments in this area and put them into perspective. These examples cover a wide range of maturity levels with respect to their applicability. While we assume we are still a long way away from integrating Brain-Computer Interface (BCI) technology in general interaction with computers, or from implementing neurotechnological measures in safety-critical workplaces, results have already now been obtained involving a BCI as research tool. In this article, we discuss the reasons why, in some of the prospective application domains, considerable effort is still required to make the systems ready to deal with the full complexity of the real world.

Is Neural Activity Detected by ERP-Based Brain-Computer Interfaces Task Specific?

OBJECTIVE: Brain-computer interfaces (BCIs) that are based on event-related potentials (ERPs) can estimate to which stimulus a user pays particular attention. In typical BCIs, the user silently counts the selected stimulus (which is repeatedly presented among other stimuli) in order to focus the attention. The stimulus of interest is then inferred from the electroencephalogram (EEG). Detecting attention allocation implicitly could be also beneficial for human-computer interaction (HCI), because it would allow software to adapt to the user's interest. However, a counting task would be inappropriate for the envisaged implicit application in HCI. Therefore, the question was addressed if the detectable neural activity is specific for silent counting, or if it can be evoked also by other tasks that direct the attention to certain stimuli. APPROACH: Thirteen people performed a silent counting, an arithmetic and a memory task. The tasks required the subjects to pay particular attention to target stimuli of a random color. The stimulus presentation was the same in all three tasks, which allowed a direct comparison of the experimental conditions. RESULTS: Classifiers that were trained to detect the targets in one task, according to patterns present in the EEG signal, could detect targets in all other tasks (irrespective of some task-related differences in the EEG). SIGNIFICANCE: The neural activity detected by the classifiers is not strictly task specific but can be generalized over tasks and is presumably a result of the attention allocation or of the augmented workload. The results may hold promise for the transfer of classification algorithms from BCI research to implicit relevance detection in HCI.

Multiscale temporal neural dynamics predict performance in a complex sensorimotor task.

Ongoing neuronal oscillations are pivotal in brain functioning and are known to influence subjects' performance. This modulation is usually studied on short time scales whilst multiple time scales are rarely considered. In our study we show that Long-Range Temporal Correlations (LRTCs) estimated from the amplitude of EEG oscillations over a range of time-scales predict performance in a complex sensorimotor task, based on Brain-Computer Interfacing (BCI). Our paradigm involved eighty subjects generating covert motor responses to dynamically changing visual cues and thus controlling a computer program through the modulation of neuronal oscillations. The neuronal dynamics were estimated with multichannel EEG. Our results show that: (a) BCI task accuracy may be predicted on the basis of LRTCs measured during the preceding training session, and (b) this result was not due to signal-to-noise ratio of the ongoing neuronal oscillations. Our results provide direct empirical evidence in addition to previous theoretical work suggesting that scale-free neuronal dynamics are important for optimal brain functioning.