Children with a history of atypical febrile seizures show abnormal steady state visual evoked potential brain responses.

Atypical febrile seizures (FSs) are considered a risk factor for the onset of epilepsy in later life as well as for potential cognitive impairment. However, distinctive characteristics defining the group of children at risk for negative outcomes are not well established. In the following study, children from 6 to 59 months with a history of atypical FSs were investigated using steady state visual evoked potentials (ssVEP), a brain response known to increase with age. Abnormally, low theta and alpha ssVEP brain responses were found in children with a history of atypical FSs.

Detection of hemodynamic responses to epileptic activity using simultaneous Electro-EncephaloGraphy (EEG)/Near Infra Red Spectroscopy (NIRS) acquisitions.

Simultaneous recordings of Electro-EncephaloGraphy (EEG) with Near InfraRed Spectroscopy (NIRS) allow measuring hemodynamic changes (changes in the concentration of oxy- and deoxyhemoglobin) at the time of epileptic discharges detected on scalp EEG. Two NIRS detection methods based on the General Linear Model (GLM) respectively in the time domain and in the time-frequency domain are investigated in this study using realistic simulations of spontaneous interictal epileptic activity. We evaluated the sensitivity at different Signal to Noise Ratios (SNR), the effect of either a large or a small number of discharges and the impact of model misspecification (e.g. omission or false detection of epileptic discharges). We also explored the effect on the estimation of key parameters, which set the model order. Simulations showed that both methods become inaccurate in lower SNR conditions, leading to many false positive detections. However, the time-frequency estimator showed better performance than the time-domain one. Key parameters for each algorithm were identified and results suggest to model confounds in the GLM differently for oxy- and deoxyhemoglobin. We also demonstrated that an inaccurate marking of epileptic events has a small impact on the detection statistics whereas an inaccurate specification of the hemodynamic response function delay decreases drastically the detection abilities. Finally, we illustrated the two methods on clinical EEG/NIRS data of one patient with focal epilepsy, showing an increase of regional Cerebral Blood Volume (rCBV) spatially concordant with the presumed epileptogenic focus.

Functional reorganization of the auditory pathways following late callosotomy.

Injuries at various levels of the auditory system have been shown to lead to functional reorganization of the auditory pathways. In particular, it has recently been shown that such reorganization can occur in callosal agenesis. The pattern of cortical activity following callosotomy is however still unknown, but behavioral results suggest that it could be significantly different from that observed in callosal agenesis. We aimed to confirm this hypothesis by investigating fMRI responses to complex sounds presented binaurally and monaurally in a callosotomized patient. In the binaural condition, the callosotomized subject showed patterns of auditory cortical activation that were similar to those of neurologically intact individuals. However, in both monaural conditions, the callosotomized individual showed a significant increase of the asymmetries favoring the contralateral pathways. Such patterns of cortical responses are only partially consistent with the results obtained from callosal agenesis subjects using the exact same procedure. Indeed, the latter show differences compared with normals in both binaural and monaural conditions. These findings provide neurological evidence that callosotomy could lead to distinctive functional reorganization of the human auditory pathways.

Functional reorganization of the human auditory pathways following hemispherectomy: an fMRI demonstration.

The present study investigated the functional reorganization of ipsilateral and contralateral auditory pathways in hemispherectomized subjects. Functional reorganization was assessed using functional Magnetic Resonance Imaging (fMRI) and stimulation with complex sounds presented binaurally and monaurally. For neurologically intact control subjects, results showed that binaural stimulations evoked balanced activity in both hemispheres while monaural stimulations induced strong contralateral activity and weak ipsilateral activity. The results obtained from hemispherectomized subjects were substantially different from those obtained from control subjects. Specifically, activity in the intact hemisphere showed a significant decrease in response to contralateral stimulation but, concomitantly, an increase in response to ipsilateral stimulation. The present findings suggest that a substantial functional reorganization takes place in the auditory pathways following an early hemispherectomy. The exact nature of this functional reorganization remains to be specified.

Cross-modal reorganization and speech perception in cochlear implant users.

Recent work suggests that once the auditory cortex of deaf persons has been reorganized by cross-modal plasticity, it can no longer respond to signals from a cochlear implant (CI) installed subsequently. To further examine this issue, we compared the evoked potentials involved in the processing of visual stimuli between CI users and hearing controls. The stimuli were concentric circles replaced by a different overlapping shape, inducing a shape transformation, known to activate the ventral visual pathway in human adults. All CI users had their device implanted for >1 year, but obtained different levels of auditory performance following training to establish language comprehension. Seven of the 13 patients showed good capacities for speech recognition with the CI (good performers) while the six others demonstrated poor speech recognition abilities (poor performers). The evoked potentials of all patients showed larger amplitudes, with different distributions of scalp activations between the two groups. The poor performers exhibited broader, anteriorly distributed, high P2 amplitudes over the cortex whereas the good performers showed significantly higher P2 amplitudes over visual occipital areas. These results suggest the existence of a profound cross-modal reorganization in the poor performers and an intramodal reorganization in the good performers. We interpret these data on the basis of enhanced audiovisual coupling as the key to a long-term functional improvement in speech discrimination in CI users.

Interaction between the flash evoked SSVEPs and the spontaneous EEG activity in children and adults.

OBJECTIVE: To evaluate the interaction between the steady-state visual evoked potentials (SSVEPs) recorded during the intermittent photic stimulation (IPS) and the spontaneous EEG activities both in children and adults. METHODS: EEG was recorded during the rest and under 5, 7.5, 10 and 12.5 Hz IPS in 41 children between 3 and 16 years and 10 adults. We distinguished between the spontaneous resting EEG spectra, SSVEPs (1st harmonic) and undriven (ongoing) EEG spectra recorded during the IPS. RESULTS: We show that IPS influences spontaneous EEG activity by specifically suppressing or desynchronizing individual posterior dominant resting EEG frequencies (DF) in both children and adults. Further, this highly significant and consistent suppressing effect positively correlates with the SSVEPs amplitude. CONCLUSIONS: Our data suggest that the desynchronization of the spontaneous EEG activity under IPS and the SSVEPs are related to each other. SIGNIFICANCE: These relationships could be interesting to study in pathological conditions where the neural synchronization and the responses to IPS have been shown to be affected, such as epilepsy and schizophrenia.

The effect of visors on head and facial injury in National Hockey League players.

There has been an increase in the number of concussions sustained by players in the National Hockey League (NHL). While wearing a helmet is now required by the NHL, the face visor remains optional. It is unknown to what degree face visors influence concussion, other head injury and eye-injury rates at the professional level. Data from the 2001-2002 NHL season were examined. It was found that wearing a face visor did not significantly influence the prevalence of concussion. Visor protection did, however, minimise eye-injuries and other, non-concussion head injuries. These data suggest that, while a visor may prevent some head and eye-injuries, other measures may be necessary to reduce the number of concussions.

Enhanced EEG connectivity in children with febrile seizures.

BACKGROUND: Epilepsy is currently conceptualized as a disturbance of neuronal networks with altered connectivity that persists into the interictal phase. Febrile seizures are sometimes a precursor in childhood of lifelong epilepsy. We investigated whether studying functional connectivity in children with febrile seizures could help understand the mechanisms underlying their long-term seizure susceptibility. METHODS: EEG was recorded during rest and intermittent photic stimulation (IPS) in 12 FS patients, 5 siblings and 15 control children between 6 and 36 months of age. Original EEG data were transformed into source space using a multiple regional source model. Source coherence values were calculated for the interfrontal, interoccipital and occipito-frontal connections for the delta, theta, alpha, beta and gamma frequency bands. RESULTS: Our results suggest enhanced delta and theta frequency EEG source coherence in patients with FSs compared to siblings and control children, both under resting conditions and during IPS, more consistent for the theta band and the occipito-frontal connections. CONCLUSIONS: Enhanced connectivity in patients with FSs could indicate a seizure-prone state and interfere with the maturation of cerebral networks. Further prospective studies are needed to assess whether hyperconnectivity is a risk factor for epileptogenesis and neurodevelopmental disorders.

Corpus callosotomy for control of intractable epilepsy in children.

Cerebral commissurotomy has often been reported to control seizures in patients suffering from intractable epilepsy. However, in adults, division of the corpus callosum alone has been shown to be equally effective while considerably reducing the surgical morbidity. The present study of nine epileptic callosotomized patients suggests that callosal section can also be performed successfully and safely in children. Neurologic and concomitant psychological improvements are described.

Somesthetic discrimination thresholds in the absence of the corpus callosum.

The aim of this study was to investigate how the absence of the corpus callosum affects somesthetic sensation on the axial midline and in proximal and distal body regions. For this purpose, two-point discrimination ability was evaluated in four acallosal subjects, four callosotomized subjects, six IQ-matched subjects and 10 control subjects with average and above average IQ. Sensory thresholds were established in the distal (index, palm), proximal (forearm), cranio-axial (forehead) and axial (dorsal trunk) body regions. The threshold was defined as the smallest separation at which the two points were perceived at a 70% accuracy level. Results showed that the thresholds of the acallosal and the callosotomized subjects were not significantly different from those of the IQ-matched control groups in the distal, proximal and cranio-axial body regions. However, thresholds in the dorsal trunk were significantly higher in the two experimental groups. It thus appears that the axial regions of the body that are normally densely represented in the corpus callosum function abnormally when this structure is absent or transected. Moreover, compensatory mechanisms normally seen in cases of early brain injury do not seem to apply in the present case since the acallosals showed the same impairments as the callosotomized subjects.

Interhemispheric depth judgement.

Interhemispheric depth comparisons were studied by requiring subjects to align in depth two textured plates, one presented to the left hemifield and the other to the right. Callosal agenesis subjects and neurologically-normal control subjects adjusted the plates so that they appeared to be at the same distance. Subjects viewed the plates monocularly or binocularly while keeping their head still, moving it side-to-side or moving it up and down. Subjects fixated a target located between the two plates while performing the task. For all subjects, the results showed that the deviations from veridical settings were significantly smaller for the binocular than for the monocular viewing conditions. Moreover, there were no significant differences among the three binocular viewing conditions (horizontal, vertical or no head movement), indicating that neither vertical nor horizontal motion parallax improves the precision of depth judgement when binocular disparity is available. These results further suggest that the precision of interhemispheric comparison for binocular depth is not affected by the absence of the corpus callosum. Looking at the plates monocularly, the control subjects judge the relative depth between the plates more precisely when they moved their head than when they kept it still. These results show that motion parallax is a useful depth cue when relative motion is extracted from different hemifields. Unlike the control subjects, the callosal agenesis subjects did not judge the relative depth between the plates more precisely when they moved their head than when they kept it still. These results show that interhemispheric comparison of depth using relative motion is not possible without the corpus callosum.

Intra- and interhemispheric processing of visual information in callosal agenesis.

Two siblings with total callosal agenesis were compared with two control groups on a number of tachistoscopic tasks involving unilateral and bilateral presentation of verbal and nonverbal stimuli. Acallosals were able to effect intra- and interhemispheric comparisons and to correctly identify all kinds of stimuli in either visual field. However, they responded more slowly, especially in the bilateral condition where they also made more errors than the controls. The results are interpreted in terms of increased use of extra-callosal commissures.

Influence of anatomical factors and spatial compatibility on the stimulus-response relationship in the absence of the corpus callosum.

Simple and choice reaction times (RTs) to lateralized flashes of light were measured in two acallosal subjects, a callosotomized patient with sparing of the splenium, six IQ-matched controls and six controls with above average IQ. The aim of the study was to investigate the influence of stimulus-response factors on visuomotor integration in the absence of the corpus callosum. The results showed that simple-RTs are faster for all groups when sensory input and motor output are coordinated in the same hemisphere, regardless of the spatial relationship between stimulus (S) and response (R). The difference between ipsilateral and contralateral RTs, taken as a measure of interhemispheric transmission time (ITT), was more than three times longer in the patients lacking the corpus callosum than in the controls. In the choice-RT paradigm, the main determinant of the response speed was S-R spatial compatibility rather than the anatomical relationship between the neural structures receiving the visual input and those controlling the motor output. Spatially compatible S-R pairings were always faster than incompatible pairings. The compatibility effect was present in all subjects but it was significantly larger in the callosum-deprived patients and their IQ-matched controls with respect to the high-IQ controls. The latter finding suggests that cognitive factors may be involved in the production of the spatial compatibility effect.

Extent and limits of callosal plasticity: presence of disconnection symptoms in callosal agenesis.

Although earlier studies have emphasized the absence of 'split-brain' symptoms in callosal agenesis patients, the notion of an 'asymptomatic' acallosal brain has lately been challenged. We report a number of findings that are indicative of an interruption of interhemispheric communication and integration in individuals lacking the corpus callosum. Several groups of patients with callosal pathology (acallosals, patients with commissurotomy or callosotomy, either complete or partial) were compared to matched controls. Interhemispheric transfer was tested in two different experiments involving pointing to a light source while maintaining central fixation. In the first experiment, a learning paradigm was used to measure transfer of a motor skill from the trained to the untrained hand. In the second experiment, subjects pointed to visual targets at different locations on a perimeter. Midline fusion, a recurrent theme when describing callosal function, was assessed using tasks which included depth perception with binocular and/or monocular cues, two-point discrimination thresholds and sound localization in the peri-central and lateral fields. Subjects with callosal pathology were impaired on all tasks involving transfer of motor and visuo-spatial skills and on some of the tasks requiring sensory integration of visual and tactile information across the body midline. We conclude that these functions require an intact corpus callosum since none of these deficits were seen in controls equated for IQ.

Absence of disconnexion syndrome in callosal agenesis and early callosotomy: brain reorganization or lack of structural specificity during ontogeny?

Four acallosal subjects, one child, aged 5, and three adults, as well as five epileptic patients who underwent callosotomy between the ages of 6-21 years, were tested on a variety of intra- and intermanual tasks in a study aimed at elucidating the developmental aspects of callosal plasticity. The performance of the clinical sample was compared to that of 48 normal children, aged 5-12 years, an age span generally considered to coincide with the final stages of callosal maturation. As previously reported, interhemispheric integration improved with increasing age in the normal sample. The two patients having undergone callosotomy in childhood performed as well as their normal peers, whereas the three others who had the operation in late adolescence or adulthood showed the typical disconnexion deficits reported in the literature. The acallosal subjects, including the youngest one, outperformed all groups. We speculate that the remarkable plasticity seen in the acallosals and the young callosotomized patients may be related to a critical period in development coinciding with a phase of synaptic overproduction and redundancy that would favor the reinforcement of alternative neural pathways. The compensatory mechanisms appear to become more limited in late adolescence when synaptic distribution presumably assumes adult patterns.

Sound localization in hemispherectomized patients.

In order to precisely evaluate the consequences of cortical damage on free-field sound localization in humans, the present study examined response accuracy to auditory targets in three hemispherectomized patients and IQ-matched controls. Listeners reported sound location by pointing with their dominant hand to the apparent sound location in an anechoic chamber. Two conditions were tested: (i) localization of a fixed-sound source and (ii) localization of the beginning and the end of a simulated moving stimulus. In both conditions, the responses of the patients were less accurate than those of the controls in the hemifield contralateral to their removed hemisphere. Moreover, the single-case analyses revealed that the performances obtained with fixed sources were generally more precise than those obtained with moving sources. This result is discussed in terms of a differential involvement of cortical and subcortical pathways in the processing of stationary and moving sounds. Finally, the age at surgery and the post-surgical interval were related with the magnitude of the deficits, suggesting the possible influences of functional reorganization and cerebral plasticity.

Unilateral and bilateral temperature comparisons in acallosal and split-brain subjects.

Therapeutic section of the corpus callosum in adult epileptic patients typically results in their incapacity to carry out interhemispheric comparisons of lateralized information. The fact that acallosal and early split-brain subjects display few of these symptoms when tested in the tactile modality has led to the suggestion that these patients may use ipsilateral projections of the somatosensory system more effectively. Compensation, however, is limited by the fact that the lemniscal pathway is strongly lateralized, especially for the distal parts of the body, where few ipsilaterally projecting fibres have been demonstrated. The pathway carrying temperature information has a larger ipsilateral component. Bilateral comparisons within the same hemisphere in subjects who are lacking the corpus callosum should be more common and the development of compensatory mechanisms in early-sectioned or acallosal subjects should be more likely. The objective of the present experiment was to evaluate differential thresholds for thermal stimuli applied on a number of regions either on the same side or on corresponding sites on opposite sides of the body. One subject callosotomized as an adult and one split-brain subject who underwent callosotomy in childhood, as well as three acallosal subjects, were compared to IQ-matched and normal-IQ control subjects. The fingers, forearm and trunk were tested. The comparison temperature was 30 degrees C and the other was varied in an ascending or descending fashion using a modified method of limits. Differential thresholds were similar for within- and between-side comparisons, and comparable to those of the IQ-matched subjects. The results indicate that comparisons involving temperature discrimination for stimuli applied to the two sides of the body do not require the integrity of the corpus callosum.

Divided visuo-spatial attention systems with total and anterior callosotomy.

The role of the corpus callosum in the inter-hemispheric integration of the visuo-spatial attention system, was investigated in patients with a total callosotomy or with an anterior callosal section. Subjects produced simple reaction times (RTs) to visual targets shown to the left or right visual hemifield. Preceding the target by an interval of 500 ms, arrow cues predicting the target location were shown left and right of the point of ocular fixation. For a majority of total and anterior callosotomy patients, results with valid focused cues (both arrows pointing to the target location) and with divided-attention cues (arrows pointing away from fixation) did not differ and both conditions produced shorter RTs than with neutral cues (equal signs). In contrast, neurologically intact subjects showed equal RTs with divided-attention and neutral cues, whereas valid focused cues produced reduced RTs relative to neutral cues. These results indicate that most split-brains, in contrast to normal observers, are capable of directing their attention to left and right visual field locations simultaneously, and therefore that each cerebral hemisphere controls its own visuo-spatial attention mechanism.

Concussions in athletes produce brain dysfunction as revealed by event-related potentials.

We have used event-related potentials (ERP) to assess cerebral activity following mild traumatic brain injuries in 20 college athletes practising contact sports. Concussion victims showed a striking decrease in P300 amplitude, an effect presumed to reflect alterations in attentional-cognitive processes. Moreover, the degree of impairment was strongly related to the severity of post-concussion symptoms. Our data suggest that concussions cause objectively measurable changes in the electrophysiological markers of brain activity and hence in the functions of the structures from which they originate. ERPs may thus constitute a reliable method to accurately monitor the clinical course and recovery of head injuries in athletes.

Brain functional reorganization in early blind humans revealed by auditory event-related potentials.

Visually challenged individuals often compensate for their handicap by developing supra-normal abilities in their remaining sensory systems. Here, we examined the scalp distribution of components N1 and P3 of auditory evoked potentials during a sound localization task in four totally blind subjects who had previously shown better performance than sighted subjects. Both N1 and P3 waves peaked at their usual positions while blind and sighted individuals performed the task. However, in blind subjects these two components were also found to be robust over occipital regions while in sighted individuals this pattern was not seen. We conclude that deafferented posterior visual areas in blind individuals are recruited to carry out auditory functions, enabling these individuals to compensate for their lack of vision.