Edge detection and surface 'filling in' as shown by texture visual evoked potentials.

OBJECTIVES: We designed a stimulation paradigm that was designed to ascertain whether specific components of the texture visual evoked potentials were attributable to edge detection or to surface 'filling-in' processes. METHODS: The stimuli were textures of parallel line elements, which were either uniform (all horizontal or vertical lines) or segregated (checkerboards in which texture line elements of neighbor checks were oriented orthogonally). A sequence of 4 stimuli, two uniform followed by two segregated stimuli, was repeated cyclically. Accordingly, segregation could appear from a uniform display; it could also be maintained, with the checkerboard illusory margin location unchanged but with alteration in the orientation of all line elements. Each stimulus was presented for 487 ms and instantly replaced by the following one. RESULTS: Segregation-related components for segregation-appearance (Sa) and for segregation-maintenance (Sm) conditions were obtained separately by subtraction. In both conditions, a negative component was obtained with a peak latency of about 140-150 ms. However, the onset of Sa was earlier than that of Sm, whereas the respective offsets were almost identical. CONCLUSIONS: We hypothesize that the segregation component in VEPs is composed of two subcomponents: an early part, which is related to the segregation of edges, and a final part, which is related to the 'filling-in' of the homogeneous texture surface within the boundary defined by these edges.

Circadian and hypothermia-induced effects on visual and auditory evoked potentials in multiple sclerosis.

OBJECTIVES: Body cooling has been proposed as a symptomatic treatment for multiple sclerosis. This study aimed to assess the effects of body cooling and of circadian variations on clinical parameters and on visual and auditory evoked potential measures in multiple sclerosis patients. METHODS: Clinical status was assessed and VEPs, BAEPs and MLAEPs (all with two stimulus frequencies) were recorded a total of 4 times on two separate days (two times per day at 08:30 and 15:00 h each day) in 10 multiple sclerosis patients and 10 controls. On one of these days, the subjects were submitted to body cooling before the afternoon session. RESULTS: Tympanic temperature was significantly higher in the afternoon. Cooling lowered the temperature by 1.4 degrees C. No clinical effects were observed. Circadian effects were detected on VEP amplitude, which increased both in controls and in patients at low stimulus frequency (P<0.01), and increased in controls and decreased in patients at high stimulus frequency (interaction: P<0.01). Cooling determined an increase in BAEP I-V peak-to-peak time in controls, and a reduction in patients at high stimulus frequency (interaction: P<0.01). In patients, cooling also determined a great increase in MLAEP amplitude (interaction: P<0.001). We did not find cooling effects on VEP measures. CONCLUSIONS: Visual and auditory evoked potentials showed differences in circadian and cooling effects between controls and multiple sclerosis patients. These differences are consistent with the hypothesis of temperature-dependent conduction blocks in demyelinated fibers. Cooling may have a clinical effect in selected patients only.

Periodic alternating nystagmus and vestibulo-spinal system facilitating activity.

OBJECTIVE: Periodic alternating nystagmus has been associated with the instability of the velocity storage mechanism, which is known to play an important role in both the vestibulo-oculomotor and the optokinetic systems. In the present study we looked for a possible spinal equivalent to PAN. METHODS AND RESULTS: In 3 PAN patients, the H-reflex amplitude proved to be slightly but significantly influenced by nystagmus direction, in that it was greater when the nystagmus was beating toward the stimulation side. CONCLUSIONS: This finding suggests that projections from velocity storage may play a role not only in the ocular motor but also in assisting postural stability through the vestibulo-spinal system.

Amodal completion in texture visual evoked potentials.

Amodal completion refers to the phenomenological finding of perceiving partly occluded objects as continuing uninterrupted behind an occluder. The outlying problem is how the visual system processes such non-local stimuli because the known processes of early vision are spatially restricted operations which segregate local differences in the visual image, and little is known about their interactions in producing the segmentation of the image into functionally coherent, or global, objects. We recorded human visual evoked potentials (VEPs) to texture stimuli and addressed local/non-local relationships in comparing a condition in which local edges were present, due to texture segregation, with a condition in which, in addition to local edges, textures appeared to continue as surfaces behind gray stripes due to non-local amodal completion. Subtraction of offset from onset responses showed: (1) a difference component due to texture segregation characterized by a negativity with onset at about 95 ms and lasting up to about 280 ms; (2) a further negativity, specifically elicited by amodal completion, with onset at about 142 ms, peaking at 175 ms, and lasting up to about 188 ms. Therefore, amodal completion occurs at an early processing stage of image analysis and the difference component in VEPs can be related to figure-ground perception.

Somatosensory evoked potentials in Charcot-Marie-Tooth disease.

SEPs by median nerve stimulation have been performed in 18 adult patients (12 males and 6 females) affected by CMTD (type I, 13 patients; type II, 5 patients). All patients underwent MCV studies (median, ulnar, peroneal nerve), SCV studies (median and sural nerve), VEP, BAEP. N9 and N13 peaks were not detectable in 7/13 and 5/13 cases (HMSN type I) while cortical N19 were always recorded. Latency values of all responses were moderately or markedly delayed in all cases with HMSN type I, but proved normal or slightly delayed in HMSN type II cases. The prolonged latencies were mainly related to slowing of peripheral conduction. N9-N13 inter-peak was abnormally prolonged in 2 cases and N13-N19 in 2 other cases; both were prolonged in another case. In another 3 cases an abnormal BAEP was recorded. The few patients with abnormal CCT and BAEP probably belong to a borderline form between HMSN and hereditary ataxias.

Multimodal evoked potentials in myotonic dystrophy (MyD).

By means of multimodal evoked potentials (EPs), we evaluated the central nervous system (CNS) involvement in 25 subjects suffering from myotonic dystrophy: brainstem auditory evoked potentials (BAEPs), middle-latency auditory evoked potentials (MLAEPs) and somatosensory evoked potentials (SEPs) from the upper limb were performed on all subjects, whereas only the 19 patients, whose clinical ocular abnormalities were slight, underwent pattern-electretinograms (PERGs) and pattern visual-evoked potentials (VEPs) in order to identify the site of lesion among visual pathways (retinal and/or retroretinal). PERGs were abnormal in 8/19 subjects, VEPs in 8/19 subjects (the two techniques were simultaneously abnormal in 8 eyes), BAEPs in 7/25 subjects, MLAEPs in 4/25 subjects (in one subject both BAEps and MLAEPs were abnormal) and SEPs were abnormal in 1/25 subjects. 13/25 of our subjects showed at least one EP that revealed a CNS involvement. The electrophysiological alterations were not correlated either with subject age or with disease duration. Multimodal EPs enabled us to demonstrate that CNS involvement in myotonic dystrophy is important and mainly affects the visual and auditory system.

Vestibular evoked myogenic potentials: test-retest reliability.

Vestibular evoked myogenic potentials (VEMPs) are myogenic responses induced by stimulation of the saccular macula by intense sound stimuli. The responses are recordable from the sternocleidomastoid (SCM) muscles. We recorded VEMPs from normal subjects (up to three times in each subject) to identify: i) the best recording procedures, ii) the reliability, and iii) the normal limits for both individual point and test-retest evaluation. We adopted a recording setting in which the subjects were asked to simultaneously activate both SCM muscles by pushing their forehead against a load cell during a bilateral acoustic stimulation. This system enabled subjects to monitor their intensity of SCM activation and to keep intensity constant; us to record VEMPs from both sides simultaneously, and thus to minimize the duration of the recording session. For each subject we considered the mean and the difference (divided by the mean) of the values derived from the two SCM muscles of the latency of the P13 and N23 components and of the P13-N23 peak-to-peak amplitude. Reliability was evaluated by estimate of the intraclass correlation coefficient, and was good or excellent for all parameters, with the exception of the P13-N23 amplitude side-difference. To take advantage of all the data available, we computed the normal limits for both individual point and test-retest evaluation by means of the variability indices used for the evaluation of reliability. In this system, VEMP recording is simple, inexpensive and rapid. It is well tolerated by subjects, and easily implemented in laboratories equipped for evoked potential recording.

Visual evoked potential abnormalities in dyslexic children.

Developmental reading disability (dyslexia) has traditionally been attributed to impaired linguistic skills. Recent psychophysical data suggest that dyslexia may be related to a visual perceptual deficit. A few visual evoked potential (VEP) studies have addressed this hypothesis, but their results are far from consistent. We submitted 9 dyslexic subjects and 9 age- and sex-matched normal controls to checkerboard pattern reversal VEPs. The main experimental variables were: large (0.5 cycles per degree; cpd) and small (2 cpd) checks and two reversal frequencies (2.1 Hz and 8 Hz); mean luminance and contrast (60 cd/m2 and 50%, respectively) were kept constant in all four conditions. Transient VEP (2.1 Hz) parameters did not differ between controls and dyslexics at 2 cpd. At 0.5 cpd, N70 amplitude was significantly smaller and N70 latency significantly shorter in dyslexics. Amplitudes for the fundamental frequency (8 Hz), as well as for the second and third harmonics of the steady-state VEPs were smaller in dyslexics for both stimulus sizes. A discriminant analysis correctly classified each subject. Our data confirm the hypothesis of a perceptual deficit in dyslexic subjects. The abnormalities are related to spatial and temporal stimulus frequencies: they appear when large stimuli are presented, or when the stimulation frequency is high. These data support the hypothesis of selective magnocellular dysfunction in dyslexia.

Trigeminal evoked potentials in man: a new olfactory stimulation device.

The recording of olfactory evoked potentials in healthy humans, using a continuous flow olfactory stimulator, is described. A stimulator pushed inert gas (N2) in a continuous flow through the nose at a rate of 4 l/min. At fixed 30-second intervals, (32 times) the flow was replaced by an equal amount of CO2, a trigeminal stimulant. Each pulse lasted 200 ms. An electronic timing circuit triggered both the stimulator and the recorder. Signal acquisition was performed using an Evoked Potential Recorder (Nicolet Compact Four by Nicolet Biomedical Instruments), triggered by the stimulator. Using this stimulator device reliable olfactory evoked potentials can be recorded in a clinical setting. Since this is a non invasive technique which can be used to test olfactory function whether or not the patient cooperates, it is expected to become widely used, particularly in non collaborating patients and in those suspected of malingering.

[Parameters of somatosensory evoked potentials in normal subjects in relation to age and height]. / Parametri del potenziale evocato somatosensitivo (PES) in soggetti normali in rapporto ad eta' e statura.

Cortical SEPs by stimulation of median nerve at wrist (159 measurements; 144 subjects, 63 M - 81 F; mean age 39.7, range 11-70; mean height 162.5, range 134-190) and cortical SEPs by stimulation of posterior tibial nerve at ankle (100 measurements; 81 subjects, 37 M - 44 F; mean age 34.7, range 11-60; mean height 161.1, range 134-180 cm) have been performed. The latencies of N1 of median SEPs and of N1 and P1 of tibial SEPs significantly increase with the height of subjects. The statistical evaluation of latency values of each subject normalized at a height of 165 cm show a little increase of latency according to the age of the subjects; this increase is quite evident for the latency of P1 of tibial SEP.

Prestimulus spectral EEG patterns and the evoked auditory vertex response.

A vigilance-related index (slow wave index, SWI) representing the relative delta + theta amplitude of the 1 sec prestimulus EEG spectrum has been related to latencies and amplitudes of the auditory cortical evoked response (EP) in 12 volunteers. Stimuli were 70 dB SL tone bursts delivered at 10 sec ISI. Four selective averages were obtained for each subject according to the subdivision of the SWI into quartiles. The subjects were divided into 2 groups having individual mean SWI values above or below the group's median SWI. Repeated measures MANOVA showed that N1 latency increased within subjects from the first to the fourth SWI quartile and that it was longer in subjects with high mean SWIs. N1-P2 amplitude decreased within subjects from the first to the fourth SWI quartile, but only in the group with high mean SWI.

[Visual evoked potential in multiple sclerosis]. / Il potenziale evocato visivo nella sclerosi multipla.

Visual Evoked Responses (VER) by binocular flash stimulation were carried out in 30 cases of "definite" (15 cases-Group I) and of "probable" (15 cases-Group II) Multiple Sclerosis (MS). VER were recorded bilaterally by reference occiput-mastoid. Averaging of 50 responses (time base 200-500-1000 msec) was considered; measures were made by registration on X-Y Plotter. Abnormal VER by increased latencies of III and/or IV peak (Ciganek) were present uni- or bilaterally in most of the subjects (73,3% of the I Group; 66,6% of the II Group). Percentage of abnormal VER is quite higher than clinical involvement of visual pathways; it is present in 3 out of 5 patients also, in whom clinical findings were confined to spinal cord. The results are discussed with reference to the previous literature. Recording of VER seems useful in detecting involvement of visual pathways without clinical evidence.

Brainstem impairment in multiple sclerosis: an assessment by multimodal evoked potentials.

The usefulness of multimodal evoked potentials for the diagnosis of Multiple Sclerosis (MS) is established. Our purpose was to try to set of 3 EPs (BAEP, median SEP and trigeminal SEP) in the evaluation of brainstem dysfunction. 53 definite and probable MS patients have been examined; they were allotted to 3 groups according to the duration of the disease. Our results showed that median SEP is the most sensitive investigation, while BAEP and trigeminal SEP were abnormal in a smaller number of cases. The combined use of median and trigeminal SEPs supplied sufficient information on brainstem function, without using the complete set of EPs. No significant relation between EP abnormalities and duration of the disease was found.

[Visual evoked potentials from different unpatterned stimuli in normal subjects and subjects with multiple sclerosis]. / Potenziali evocati visivi (PEV) da differenti stimoli non strutturati in soggetti normali e con sclerosi multipla (SM).

A study of VEP was carried out by stimulation with white and red flashes in 20 normal subjects and 58 patients with definite or possible Multiple Sclerosis (MS). In normal subjects, the VEP obtained with the red flash exhibited a simplified waveform and a significantly higher latency of the III and IV peaks than with the white flash. This is due to the different spectral component of the stimulation, which specifically excites foveal receptors whose fibers have a smaller diameter and therefore a lower conduction velocity. The subjects with definite or probable MS showed average VEP latencies which were significantly higher than those of normal subjects. A comparison of the results obtained with the two types of stimulation demonstrates that the red flash reveals a higher number of modified VEPs, thus pointing out even subclinical impairments of the visual pathways.

Acute effects of levodopa plus carbidopa on evoked potentials in Parkinson's disease.

Visual evoked potentials by flash (VEP-f) and pattern reversal (VEP-p) stimulation and BAEPs were performed in parkinsonian patients before and after 1 and 4 hours levodopa + Carbidopa administration in two separate experiments. In the first experiment (9 patients and 9 controls) an increase of latencies of peaks III and IV of VEP-f was observed in parkinsonian patients but not in controls. In the second experiment (6 patients) an increase of latencies of peaks N70 and P100 of VEP-p and an increase of latency of peak III and of III-V interval of BAEPs was observed. The results confirm the influence of dopaminergic systems on visual pathways and suggest that the effects of acute 1-DOPA administration may differ from those of chronic treatment. Moreover some evidence exists that dopaminergic systems are involved also in acoustic pathways.

Evoked potentials monitoring of a cerebral focal ischemia model.

A model of cerebral ischemia by microsphere embolization in the rabbit was monitored with somatosensory evoked potentials by median nerve stimulation (SEPs) and by flash visual evoked potential (VEPs). The degree of SEP alterations paralleled the type of lesions (focal or multifocal ischemia or diffuse oedema). Alterations present at the first hour after ischemia were generally unchanged during the follow-up, which ended at the 24th hour. The prevalence of VEP alterations was low (only 16% in focal ischemia). These results are compared to EEG modifications performed in the same animals.

Prestimulus EEG influence on late ERP components.

Ten healthy volunteers were submitted to an auditory oddball event related potentials (ERP) paradigm. Single trial 500 ms poststimulus ERPs (Pz, Cz, Fz--linked earlobes) along with the correspondent 1000 ms prestimulus EEG (O1-Cz) were stored. EEG epochs were submitted to spectral analysis and a slow wave index (SWI = delta + theta/total) was computed. Three selective ERP averages corresponding to low, medium and high SWI were computed. N2 latency was longer and P3a amplitude was lower in high SWI averages as compared to low SWI averages.

Somatosensory evoked potentials in amyotrophic lateral sclerosis.

Forty five patients with amyotrophic lateral sclerosis were investigated, by means of somatosensory evoked potentials, in order to detect the presence of subclinical sensory changes. Cervical SEPs from the median nerve and cortical SEPs from the median and tibial nerve were recorded, showing a delay of N13 and subsequent components; the latency of the first constant cortical potential was also increased in many patients. Only the SEPs from the tibial nerve showed a decrease of amplitude. These results suggest a pathological slowing of conduction along the central sensory pathways in amyotrophic lateral sclerosis.

One-week test-retest reliability of spinal and cortical somatosensory evoked potentials by tibial nerve stimulation.

Spinal (Th12) and cortical somatosensory evoked potentials by right and left posterior tibial nerve stimulation at the ankle were performed in 20 healthy volunteers (10 females and 10 males) aged 23-50 years. The procedure was repeated after one week to assess the reliability of the parameters and to establish upper normal variability limits. Reliability was measured by the intraclass correlation coefficient and was excellent for all absolute latencies and at least good for amplitudes and for the spinal-cortical conduction time. Upper variability limits were calculated using a method based on the within-subject mean square, which can be also applied in the case of more than two repetitions.