Transcutaneous auricular VNS applied to experimental pain: A paired behavioral and EEG study using thermonociceptive CO2 laser.

BACKGROUND: Transcutaneous auricular Vagal Nerve Stimulation (taVNS) is a non-invasive neurostimulation technique with potential analgesic effects. Several studies based on subjective behavioral responses suggest that taVNS modulates nociception differently with either pro-nociceptive or anti-nociceptive effects. OBJECTIVE: This study aimed to characterize how taVNS alters pain perception, by investigating its effects on event-related potentials (ERPs) elicited by different types of spinothalamic and lemniscal somatosensory stimuli, combined with quantitative sensory testing (detection threshold and intensity ratings). METHODS: We performed 3 experiments designed to study the time-dependent effects of taVNS and compare with standard cervical VNS (cVNS). In Experiment 1, we assessed the effects of taVNS after 3 hours of stimulation. In Experiment 2, we focused on the immediate effects of the duty cycle (OFF vs. ON phases). Experiments 1 and 2 included 22 and 15 healthy participants respectively. Both experiments consisted of a 2-day cross-over protocol, in which subjects received taVNS and sham stimulation sequentially. In addition, subjects received a set of nociceptive (thermonociceptive CO2 laser, mechanical pinprick) and non-nociceptive (vibrotactile, cool) stimuli, for which we recorded detection thresholds, intensity of perception and ERPs. Finally, in Experiment 3, we tested 13 epileptic patients with an implanted cVNS by comparing OFF vs. ON cycles, using a similar experimental procedure. RESULTS: Neither taVNS nor cVNS appeared to modulate the cerebral and behavioral aspects of somatosensory perception. CONCLUSION: The potential effect of taVNS on nociception requires a cautious interpretation, as we found no objective change in behavioral and cerebral responses to spinothalamic and lemniscal somatosensory stimulations.

Anodal Transcutaneous Spinal Direct Current Stimulation (tsDCS) Selectively Inhibits the Synaptic Efficacy of Nociceptive Transmission at Spinal Cord Level.

Recently studies have aimed at developing transcutaneous spinal direct current stimulation (tsDCS) as a non-invasive technique to modulate spinal function in humans. Independent studies evaluating its after-effects on nociceptive or non-nociceptive somatosensory responses have reported comparable effects suggesting that tsDCS impairs axonal conduction of both the spino-thalamic and the medial lemniscus tracts. The present study aimed to better understand how tsDCS affects, in humans, the spinal transmission of nociceptive and non-nociceptive somatosensory inputs. We compared the after-effects of anodal low-thoracic, anodal cervical and sham tsDCS on the perception and brain responses elicited by laser stimuli selectively activating Aδ-thermonociceptors of the spinothalamic system and vibrotactile stimuli selectively activating low-threshold Aß-mechanoreceptors of the lemniscal system, delivered to the hands and feet. Low-thoracic tsDCS selectively and significantly affected the LEP-N2 wave elicited by nociceptive stimulation of the lower limbs, without affecting the LEP-N2 wave elicited by nociceptive stimulation of the upper limbs, and without affecting the SEP-N2 wave elicited by vibrotactile stimulation of either limb. This selective and segmental effect indicates that the neuromodulatory after-effects of tsDCS cannot be explained by anodal blockade of axonal conduction and, instead, are most probably due to a segmental effect on the synaptic efficacy of the local processing and/or transmission of nociceptive inputs in the dorsal horn.

EEG Frequency-Tagging and Input-Output Comparison in Rhythm Perception.

The combination of frequency-tagging with electroencephalography (EEG) has recently proved fruitful for understanding the perception of beat and meter in musical rhythm, a common behavior shared by humans of all cultures. EEG frequency-tagging allows the objective measurement of input-output transforms to investigate beat perception, its modulation by exogenous and endogenous factors, development, and neural basis. Recent doubt has been raised about the validity of comparing frequency-domain representations of auditory rhythmic stimuli and corresponding EEG responses, assuming that it implies a one-to-one mapping between the envelope of the rhythmic input and the neural output, and that it neglects the sensitivity of frequency-domain representations to acoustic features making up the rhythms. Here we argue that these elements actually reinforce the strengths of the approach. The obvious fact that acoustic features influence the frequency spectrum of the sound envelope precisely justifies taking into consideration the sounds used to generate a beat percept for interpreting neural responses to auditory rhythms. Most importantly, the many-to-one relationship between rhythmic input and perceived beat actually validates an approach that objectively measures the input-output transforms underlying the perceptual categorization of rhythmic inputs. Hence, provided that a number of potential pitfalls and fallacies are avoided, EEG frequency-tagging to study input-output relationships appears valuable for understanding rhythm perception.

Intracerebral evidence of rhythm transform in the human auditory cortex.

Musical entrainment is shared by all human cultures and the perception of a periodic beat is a cornerstone of this entrainment behavior. Here, we investigated whether beat perception might have its roots in the earliest stages of auditory cortical processing. Local field potentials were recorded from 8 patients implanted with depth-electrodes in Heschl's gyrus and the planum temporale (55 recording sites in total), usually considered as human primary and secondary auditory cortices. Using a frequency-tagging approach, we show that both low-frequency (<30 Hz) and high-frequency (>30 Hz) neural activities in these structures faithfully track auditory rhythms through frequency-locking to the rhythm envelope. A selective gain in amplitude of the response frequency-locked to the beat frequency was observed for the low-frequency activities but not for the high-frequency activities, and was sharper in the planum temporale, especially for the more challenging syncopated rhythm. Hence, this gain process is not systematic in all activities produced in these areas and depends on the complexity of the rhythmic input. Moreover, this gain was disrupted when the rhythm was presented at fast speed, revealing low-pass response properties which could account for the propensity to perceive a beat only within the musical tempo range. Together, these observations show that, even though part of these neural transforms of rhythms could already take place in subcortical auditory processes, the earliest auditory cortical processes shape the neural representation of rhythmic inputs in favor of the emergence of a periodic beat.

Unirhinal Olfactory Testing for the Diagnostic Workup of Mild Cognitive Impairment.

BACKGROUND: Olfactory dysfunction is associated with Alzheimer's disease (AD), and already present at pre-dementia stage. OBJECTIVES: Based on the assumption that early neurodegeneration in AD is asymmetrical and that olfactory input is primarily processed in the ipsilateral hemisphere, we assessed whether unirhinal psychophysical and electrophysiological assessment of olfactory function can contribute to the diagnostic workup of mild cognitive impairment (MCI). METHODS: Olfactory function of 13 MCI patients with positive amyloid PET, 13 aged-matched controls (AC) with negative amyloid PET and 13 patients with post-infectious olfactory loss (OD) was assessed unirhinally using (1) psychophysical testing of olfactory detection, discrimination and identification performance and (2) the recording of olfactory event-related brain potentials. Time-frequency analysis was used to enhance the signal-to-noise ratio of the electrophysiological responses. Psychophysical and electrophysiological assessment of auditory and trigeminal chemosensory function served as controls. RESULTS: As compared to AC and OD, MCI patients exhibited a significant asymmetry of olfactory performance. This asymmetry efficiently discriminated between MCI and AC (sensitivity: 85% , specificity: 77% ), as well as MCI and OD (sensitivity: 85% , specificity: 70% ). There was also an asymmetry of the electrophysiological responses, but not specific for MCI. In both MCI and OD, olfactory stimulation of the best nostril elicited significantly more activity than stimulation of the worse nostril, between 3-7.5 Hz and 1.2-2.0 s after stimulus onset. Trigeminal and auditory psychophysical testing did not show any difference between groups. CONCLUSION: MCI patients exhibit a marked asymmetry of behavioral olfactory function, which could be useful for the diagnostic workup of MCI.

Capturing with EEG the neural entrainment and coupling underlying sensorimotor synchronization to the beat.

Synchronizing movements with rhythmic inputs requires tight coupling of sensory and motor neural processes. Here, using a novel approach based on the recording of steady-state-evoked potentials (SS-EPs), we examine how distant brain areas supporting these processes coordinate their dynamics. The electroencephalogram was recorded while subjects listened to a 2.4-Hz auditory beat and tapped their hand on every second beat. When subjects tapped to the beat, the EEG was characterized by a 2.4-Hz SS-EP compatible with beat-related entrainment and a 1.2-Hz SS-EP compatible with movement-related entrainment, based on the results of source analysis. Most importantly, when compared with passive listening of the beat, we found evidence suggesting an interaction between sensory- and motor-related activities when subjects tapped to the beat, in the form of (1) additional SS-EP appearing at 3.6 Hz, compatible with a nonlinear product of sensorimotor integration; (2) phase coupling of beat- and movement-related activities; and (3) selective enhancement of beat-related activities over the hemisphere contralateral to the tapping, suggesting a top-down effect of movement-related activities on auditory beat processing. Taken together, our results are compatible with the view that rhythmic sensorimotor synchronization is supported by a dynamic coupling of sensory and motor related activities.

Enhanced brain responses to C-fiber input in the area of secondary hyperalgesia induced by high-frequency electrical stimulation of the skin.

High-frequency electrical stimulation (HFS) of the human skin induces an increase in both mechanical and heat pain sensitivity in the surrounding unconditioned skin. The aim of this study was to investigate the effect of HFS on the intensity of perception and brain responses elicited by the selective activation of C fibers. HFS was applied to the ventral forearm of 15 healthy volunteers. Temperature-controlled CO2 laser stimulation was used to activate selectively low-threshold C-fiber afferents without concomitantly activating Aδ-fiber afferents. These stimuli were detected with reaction times compatible with the conduction velocity of C fibers. The intensity of perception and event-related brain potentials (ERPs) elicited by thermal stimuli delivered to the surrounding unconditioned skin were recorded before (T0) and after HFS (T1: 20 min after HFS; T2: 45 min after HFS). The contralateral forearm served as a control. Mechanical hyperalgesia following HFS was confirmed by measuring the change in the intensity of perception elicited by mechanical punctate stimuli. HFS resulted in increased intensity of perception to mechanical punctate stimulation and selective C-fiber thermal stimulation at both time points. In contrast, the N2 wave of the ERP elicited by C-fiber stimulation (679 ± 88 ms; means ± SD) was enhanced at T1 but not at T2. The P2 wave (808 ± 105 ms) was unaffected by HFS. Our results suggest that HFS enhances the sensitivity to thermal C-fiber input in the area of secondary hyperalgesia. However, there was no significant enhancement of the magnitude of the C-fiber ERPs at T2, suggesting that quickly adapting C fibers do not contribute to this enhancement.

Selective neuronal entrainment to the beat and meter embedded in a musical rhythm.

Fundamental to the experience of music, beat and meter perception refers to the perception of periodicities while listening to music occurring within the frequency range of musical tempo. Here, we explored the spontaneous building of beat and meter hypothesized to emerge from the selective entrainment of neuronal populations at beat and meter frequencies. The electroencephalogram (EEG) was recorded while human participants listened to rhythms consisting of short sounds alternating with silences to induce a spontaneous perception of beat and meter. We found that the rhythmic stimuli elicited multiple steady state-evoked potentials (SS-EPs) observed in the EEG spectrum at frequencies corresponding to the rhythmic pattern envelope. Most importantly, the amplitude of the SS-EPs obtained at beat and meter frequencies were selectively enhanced even though the acoustic energy was not necessarily predominant at these frequencies. Furthermore, accelerating the tempo of the rhythmic stimuli so as to move away from the range of frequencies at which beats are usually perceived impaired the selective enhancement of SS-EPs at these frequencies. The observation that beat- and meter-related SS-EPs are selectively enhanced at frequencies compatible with beat and meter perception indicates that these responses do not merely reflect the physical structure of the sound envelope but, instead, reflect the spontaneous emergence of an internal representation of beat, possibly through a mechanism of selective neuronal entrainment within a resonance frequency range. Taken together, these results suggest that musical rhythms constitute a unique context to gain insight on general mechanisms of entrainment, from the neuronal level to individual level.

Tagging the neuronal entrainment to beat and meter.

Feeling the beat and meter is fundamental to the experience of music. However, how these periodicities are represented in the brain remains largely unknown. Here, we test whether this function emerges from the entrainment of neurons resonating to the beat and meter. We recorded the electroencephalogram while participants listened to a musical beat and imagined a binary or a ternary meter on this beat (i.e., a march or a waltz). We found that the beat elicits a sustained periodic EEG response tuned to the beat frequency. Most importantly, we found that meter imagery elicits an additional frequency tuned to the corresponding metric interpretation of this beat. These results provide compelling evidence that neural entrainment to beat and meter can be captured directly in the electroencephalogram. More generally, our results suggest that music constitutes a unique context to explore entrainment phenomena in dynamic cognitive processing at the level of neural networks.

Dishabituation of laser-evoked EEG responses: dissecting the effect of certain and uncertain changes in stimulus modality.

The repetition of nociceptive stimuli of identical modality, intensity, and location at short and constant interstimulus intervals (ISIs) determines a strong habituation of the corresponding EEG responses, without affecting the subjective perception of pain. To understand what determines this response habituation, we (i) examined the effect of introducing a change in the modality of the repeated stimulus, and (ii) dissected the relative contribution of bottom-up, stimulus-driven changes in modality and top-down, cognitive expectations of such a change, on both laser-evoked and auditory-evoked EEG responses. Multichannel EEG was recorded while participants received trains of three stimuli (S1-S2-S3, a triplet) delivered to the hand dorsum at 1-sec ISI. S3 belonged either to the same modality as S1 and S2 or to the other modality. In addition, participants were either explicitly informed or not informed of the modality of S3. We found that introducing a change in stimulus modality produced a significant dishabituation of the laser-evoked N1, N2, and P2 waves; the auditory N1 and P2 waves; and the laser- and auditory-induced event-related synchronization and desynchronization. In contrast, the lack of explicit knowledge of a possible change in the sensory modality of the stimulus (i.e., uncertainty) only increased the ascending portion of the laser-evoked and auditory-evoked P2 wave. Altogether, these results indicate that bottom-up novelty resulting from the change of stimulus modality, and not top-down cognitive expectations, plays a major role in determining the habituation of these brain responses.

A multisensory investigation of the functional significance of the "pain matrix".

Functional neuroimaging studies in humans have shown that nociceptive stimuli elicit activity in a wide network of cortical areas commonly labeled as the "pain matrix" and thought to be preferentially involved in the perception of pain. Despite the fact that this "pain matrix" has been used extensively to build models of where and how nociception is processed in the human brain, convincing experimental evidence demonstrating that this network is specifically related to nociception is lacking. The aim of the present study was to determine whether there is at least a subset of the "pain matrix" that responds uniquely to nociceptive somatosensory stimulation. In a first experiment, we compared the fMRI brain responses elicited by a random sequence of brief nociceptive somatosensory, non-nociceptive somatosensory, auditory and visual stimuli, all presented within a similar attentional context. We found that the fMRI responses triggered by nociceptive stimuli can be largely explained by a combination of (1) multimodal neural activities (i.e., activities elicited by all stimuli regardless of sensory modality) and (2) somatosensory-specific but not nociceptive-specific neural activities (i.e., activities elicited by both nociceptive and non-nociceptive somatosensory stimuli). The magnitude of multimodal activities correlated significantly with the perceived saliency of the stimulus. In a second experiment, we compared these multimodal activities to the fMRI responses elicited by auditory stimuli presented using an oddball paradigm. We found that the spatial distribution of the responses elicited by novel non-target and novel target auditory stimuli resembled closely that of the multimodal responses identified in the first experiment. Taken together, these findings suggest that the largest part of the fMRI responses elicited by phasic nociceptive stimuli reflects non nociceptive-specific cognitive processes.

The enhancement of the N1 wave elicited by sensory stimuli presented at very short inter-stimulus intervals is a general feature across sensory systems.

BACKGROUND: A paradoxical enhancement of the magnitude of the N1 wave of the auditory event-related potential (ERP) has been described when auditory stimuli are presented at very short (< 400 ms) inter-stimulus intervals (ISI). Here, we examined whether this enhancement is specific for the auditory system, or whether it also affects ERPs elicited by stimuli belonging to other sensory modalities. METHODOLOGY AND PRINCIPAL FINDINGS: We recorded ERPs elicited by auditory and somatosensory stimuli in 13 healthy subjects. For each sensory modality, 4800 stimuli were presented. Auditory stimuli consisted in brief tones presented binaurally, and somatosensory stimuli consisted in constant-current electrical pulses applied to the right median nerve. Stimuli were delivered continuously, and the ISI was varied randomly between 100 and 1000 ms. We found that the ISI had a similar effect on both auditory and somatosensory ERPs. In both sensory modalities, ISI had an opposite effect on the magnitude of the N1 and P2 waves: the magnitude of the auditory and the somatosensory N1 was significantly increased at ISI < or = 200 ms, while the magnitude of the auditory and the somatosensory P2 was significantly decreased at ISI < or = 200 ms. CONCLUSION AND SIGNIFICANCE: The observation that both the auditory and the somatosensory N1 are enhanced at short ISIs indicates that this phenomenon reflects a physiological property that is common across sensory systems, rather than, as previously suggested, unique for the auditory system. Two of the hypotheses most frequently put forward to explain this observation, namely (i) the decreased contribution of inhibitory postsynaptic potentials to the recorded scalp ERPs and (ii) the decreased contribution of 'latent inhibition', are discussed. Because neither of these two hypotheses can satisfactorily account for the concomitant reduction of the auditory and the somatosensory P2, we propose a third, novel hypothesis, consisting in the modulation of a single neural component contributing to both the N1 and the P2 waves.