Brain Activity Characteristics of Patients With Disorders of Consciousness in the EEG Resting State Paradigm: A Review.

The assessment of the level of consciousness in disorders of consciousness (DoC) is still one of the most challenging problems in contemporary medicine. Nevertheless, based on the multitude of studies conducted over the last 20 years on resting states based on electroencephalography (EEG) in DoC, it is possible to outline the brain activity profiles related to both patients without preserved consciousness and minimally conscious ones. In the case of patients without preserved consciousness, the dominance of low, mostly delta, frequency, and the marginalization of the higher frequencies were observed, both in terms of the global power of brain activity and in functional connectivity patterns. In turn, the minimally conscious patients revealed the opposite brain activity pattern-the characteristics of higher frequency bands were preserved both in global power and in functional long-distance connections. In this short review, we summarize the state of the art of EEG-based research in the resting state paradigm, in the context of providing potential support to the traditional clinical assessment of the level of consciousness.

Assessment of Statistically Significant Command-Following in Pediatric Patients with Disorders of Consciousness, Based on Visual, Auditory and Tactile Event-Related Potentials.

Disorders of consciousness (DOC) are among the major challenges of contemporary medicine, mostly due to the high rates of misdiagnoses in clinical assessment, based on behavioral scales. This turns our attention to potentially objective neuroimaging methods. Paradigms based on electroencephalography (EEG) are most suited for bedside applications, but sensitive to artifacts. These problems are especially pronounced in pediatric patients. We present the first study on the assessment of pediatric DOC patients by means of command-following procedures and involving long-latency cognitive event-related potentials. To deal with the above mentioned challenges, we construct a specialized signal processing scheme including artifact correction and rejection, parametrization, classification and final assessment of the statistical significance. To compensate for the possible bias of the tests involved in the final diagnosis, we propose the Monte Carlo evaluation of the processing pipeline. To compensate for possible sensory impairments of DOC patients, for each subject we check command-following responses to the stimuli in the major modalities: visual, tactile, and audio (words and sounds). We test the scheme on 20 healthy volunteers and present results for 15 patients from a hospital for children with severe brain damage, in relation to their behavioral diagnosis on the Coma Recovery Scale-Revised (CRS-R).

Event-related potentials in the odd-ball paradigm and behavioral scales for the assessment of children and adolescents with disorders of consciousness: A proof of concept study.

OBJECTIVE: Quantification of signatures of conscious processing in children with disorders of consciousness (DoC) using odd-ball paradigms in multiple modalities. METHOD: We review the diagnostic approaches available in the field, from clinical scales to neuroimaging methods, and concentrate upon measures derived from electroencephalographic event related potentials. RESULTS: Evoked potentials were recorded in five procedures, encompassing visual, auditory and tactile modalities, from ten pediatric DoC patients-six in a minimally conscious state (MCS), three in unresponsive wakefulness syndrome (UWS) and one who emerged from MCS (eMCS)-and the control group of 10 healthy children. In almost all the eMCS and MCS patients, higher amplitude of P300 was observed and the effect was statistically significant in at least one out of the five performed procedures. Additionally, signs of conscious information processing were detected in one UWS patient. CONCLUSION: The presented results provide a proof of concept for the possibility of applying ERP-derived electrophysiological measures as an aid in the assessment of children and adolescents in DoC.

Parametric Description of EEG Profiles for Assessment of Sleep Architecture in Disorders of Consciousness.

We propose a fully parametric approach to the assessment of sleep architecture, based upon the classical electroencephalographic criteria, applicable also to the recordings of patients with disorders of consciousness (DOC). Sleep spindles and slow waves are automatically detected from the matching pursuit decomposition of overnight EEG recordings. Their evolution can be presented in the form of EEG profiles, yielding a continuous description of sleep architecture, compatible with the classical criteria used in sleep staging. We propose assessment of these EEG profiles by five parameters, which can be combined by a linear classifier, assessing the quality of sleep architecture. Proposed methodology is evaluated on 59 overnight EEG recordings from 19 patients from a hospital for children with severe brain damage, in relation to their behavioral diagnosis according to the Coma Recovery Scale-Revised. Presented results indicate robustness of the proposed approach, which may serve as a valuable aid in diagnosis of DOC patients. Complete software environment for computing and presentation of EEG profiles is freely available from http://svarog.pl .

Complex Modulation Method for Measuring Cross-Frequency Coupling of Neural Oscillations.

There is growing evidence from human intracranial electrocorticography (ECoG) studies that interactions between cortical frequencies are important for sensory perception, cognition and inter-regional neuronal communication. Recent studies have focused mainly on the strength of phase-amplitude coupling in cross-frequency interactions. Here, we introduce a complex modulation method based on measures of coherence to investigate cross-frequency coupling in the neural time series. This novel approach uses complex demodulation transform and coherence measures from the transformed signals. We used this method to quantify power coupling between two cortical frequency bands: theta (47 Hz) and high gamma (70-150 Hz) in ECoG signals recorded during an auditory task. We compared complex modulation results with traditional phase-amplitude coupling measures (PAC) derived from the same ECoG dataset. Our results suggest that cross-frequency coupling may involve changes in both phase-amplitude and power relationships between frequencies, reflecting the complexity of neuronal oscillatory interactions.

Integrated trimodal SSEP experimental setup for visual, auditory and tactile stimulation.

OBJECTIVE: Steady-state evoked potentials (SSEPs), the brain responses to repetitive stimulation, are commonly used in both clinical practice and scientific research. Particular brain mechanisms underlying SSEPs in different modalities (i.e. visual, auditory and tactile) are very complex and still not completely understood. Each response has distinct resonant frequencies and exhibits a particular brain topography. Moreover, the topography can be frequency-dependent, as in case of auditory potentials. However, to study each modality separately and also to investigate multisensory interactions through multimodal experiments, a proper experimental setup appears to be of critical importance. The aim of this study was to design and evaluate a novel SSEP experimental setup providing a repetitive stimulation in three different modalities (visual, tactile and auditory) with a precise control of stimuli parameters. Results from a pilot study with a stimulation in a particular modality and in two modalities simultaneously prove the feasibility of the device to study SSEP phenomenon. APPROACH: We developed a setup of three separate stimulators that allows for a precise generation of repetitive stimuli. Besides sequential stimulation in a particular modality, parallel stimulation in up to three different modalities can be delivered. Stimulus in each modality is characterized by a stimulation frequency and a waveform (sine or square wave). We also present a novel methodology for the analysis of SSEPs. MAIN RESULTS: Apart from constructing the experimental setup, we conducted a pilot study with both sequential and simultaneous stimulation paradigms. EEG signals recorded during this study were analyzed with advanced methodology based on spatial filtering and adaptive approximation, followed by statistical evaluation. SIGNIFICANCE: We developed a novel experimental setup for performing SSEP experiments. In this sense our study continues the ongoing research in this field. On the other hand, the described setup along with the presented methodology is a considerable improvement and an extension of methods constituting the state-of-the-art in the related field. Device flexibility both with developed analysis methodology can lead to further development of diagnostic methods and provide deeper insight into information processing in the human brain.

Spindles in Svarog: framework and software for parametrization of EEG transients.

We present a complete framework for time-frequency parametrization of EEG transients, based upon matching pursuit (MP) decomposition, applied to the detection of sleep spindles. Ranges of spindles duration (>0.5 s) and frequency (11-16 Hz) are taken directly from their standard definitions. Minimal amplitude is computed from the distribution of the root mean square (RMS) amplitude of the signal within the frequency band of sleep spindles. Detection algorithm depends on the choice of just one free parameter, which is a percentile of this distribution. Performance of detection is assessed on the first cohort/second subset of the Montreal Archive of Sleep Studies (MASS-C1/SS2). Cross-validation performed on the 19 available overnight recordings returned the optimal percentile of the RMS distribution close to 97 in most cases, and the following overall performance measures: sensitivity 0.63 ± 0.06, positive predictive value 0.47 ± 0.08, and Matthews coefficient of correlation 0.51 ± 0.04. These concordances are similar to the results achieved on this database by other automatic methods. Proposed detailed parametrization of sleep spindles within a universal framework, encompassing also other EEG transients, opens new possibilities of high resolution investigation of their relations and detailed characteristics. MP decomposition, selection of relevant structures, and simple creation of EEG profiles used previously for assessment of brain activity of patients in disorders of consciousness are implemented in a freely available software package Svarog (Signal Viewer, Analyzer and Recorder On GPL) with user-friendly, mouse-driven interface for review and analysis of EEG. Svarog can be downloaded from http://braintech.pl/svarog.