Twenty-four-hour rhythmicities in disorders of consciousness are associated with a favourable outcome.

Fluctuations of consciousness and their rhythmicities have been rarely studied in patients with a disorder of consciousness after acute brain injuries. 24-h assessment of brain (EEG), behaviour (eye-opening), and circadian (clock-controlled hormones secretion from urine) functions was performed in acute brain-injured patients. The distribution, long-term predictability, and rhythmicity (circadian/ultradian) of various EEG features were compared with the initial clinical status, the functional outcome, and the circadian rhythmicities of behaviour and clock-controlled hormones. Here we show that more physiological and favourable patterns of fluctuations are associated with a higher 24 h predictability and sharp up-and-down shape of EEG switches, reminiscent of the Flip-Flop model of sleep. Multimodal rhythmic analysis shows that patients with simultaneous circadian rhythmicity for brain, behaviour, and hormones had a favourable outcome. Finally, both re-emerging EEG fluctuations and homogeneous 24-h cycles for EEG, eye-opening, and hormones appeared as surrogates for preserved functionality in brainstem and basal forebrain, which are key prognostic factors for later improvement. While the recovery of consciousness has previously been related to a high short-term complexity, we suggest in this exploratory study the importance of the high predictability of the 24 h long-term generation of brain rhythms and highlight the importance of circadian body-brain rhythms in awakening.

Self-processing in coma, unresponsive wakefulness syndrome and minimally conscious state.

Introduction: Behavioral and cerebral dissociation has been now clearly established in some patients with acquired disorders of consciousness (DoC). Altogether, these studies mainly focused on the preservation of high-level cognitive markers in prolonged DoC, but did not specifically investigate lower but key-cognitive functions to consciousness emergence, such as the ability to take a first-person perspective, notably at the acute stage of coma. We made the hypothesis that the preservation of self-recognition (i) is independent of the behavioral impairment of consciousness, and (ii) can reflect the ability to recover consciousness. Methods: Hence, using bedside Electroencephalography (EEG) recordings, we acquired, in a large cohort of 129 severely brain damaged patients, the brain response to the passive listening of the subject's own name (SON) and unfamiliar other first names (OFN). One hundred and twelve of them (mean age ± SD = 46 ± 18.3 years, sex ratio M/F: 71/41) could be analyzed for the detection of an individual and significant discriminative P3 event-related brain response to the SON as compared to OFN ('SON effect', primary endpoint assessed by temporal clustering permutation tests). Results: Patients were either coma (n = 38), unresponsive wakefulness syndrome (UWS, n = 30) or minimally conscious state (MCS, n = 44), according to the revised version of the Coma Recovery Scale (CRS-R). Overall, 33 DoC patients (29%) evoked a 'SON effect'. This electrophysiological index was similar between coma (29%), MCS (23%) and UWS (34%) patients (p = 0.61). MCS patients at the time of enrolment were more likely to emerged from MCS (EMCS) at 6 months than coma and UWS patients (p = 0.013 for comparison between groups). Among the 72 survivors' patients with event-related responses recorded within 3 months after brain injury, 75% of the 16 patients with a SON effect were EMCS at 6 months, while 59% of the 56 patients without a SON effect evolved to this favorable behavioral outcome. Discussion: About 30% of severely brain-damaged patients suffering from DoC are capable to process salient self-referential auditory stimuli, even in case of absence of behavioral detection of self-conscious processing. We suggest that self-recognition covert brain ability could be an index of consciousness recovery, and thus could help to predict good outcome.

Impairment of central language processing in critically ill coronavirus disease 2019 patients with delirium.

Accumulating evidence indicates that coronavirus disease 2019 is a major cause of delirium. Given the global dimension of the current pandemic and the fact that delirium is a strong predictor of cognitive decline for critically ill patients, this raises concerns regarding the neurological cost of coronavirus disease 2019. Currently, there is a major knowledge gap related to the covert yet potentially incapacitating higher-order cognitive impairment underpinning coronavirus disease 2019 related delirium. The aim of the current study was to analyse the electrophysiological signatures of language processing in coronavirus disease 2019 patients with delirium by using a specifically designed multidimensional auditory event-related potential battery to probe hierarchical cognitive processes, including self-processing (P300) and semantic/lexical priming (N400). Clinical variables and electrophysiological data were prospectively collected in controls subjects (n = 14) and in critically ill coronavirus disease 2019 patients with (n = 19) and without (n = 22) delirium. The time from intensive care unit admission to first clinical sign of delirium was of 8 (3.5-20) days, and the delirium lasted for 7 (4.5-9.5) days. Overall, we have specifically identified in coronavirus disease 2019 patients with delirium, both a preservation of low-level central auditory processing (N100 and P200) and a coherent ensemble of covert higher-order cognitive dysfunctions encompassing self-related processing (P300) and sematic/lexical language priming (N400) (spatial-temporal clustering, P-cluster ≤ 0.05). We suggest that our results shed new light on the neuropsychological underpinnings of coronavirus disease 2019 related delirium, and may constitute a valuable method for patient's bedside diagnosis and monitoring in this clinically challenging setting.

Atypical beta power fluctuation while listening to an isochronous sequence in dyslexia.

OBJECTIVE: Developmental dyslexia is a reading disorder that features difficulties in perceiving and tracking rhythmic regularities in auditory streams, such as speech and music. Studies on typical healthy participants have shown that power fluctuations of neural oscillations in beta band (15-25 Hz) reflect an essential mechanism for tracking rhythm or entrainment and relate to predictive timing and attentional processes. Here we investigated whether adults with dyslexia have atypical beta power fluctuation. METHODS: The electroencephalographic activities of individuals with dyslexia (n = 13) and typical control participants (n = 13) were measured while they passively listened to an isochronous tone sequence (2 Hz presentation rate). The time-frequency neural activities generated from auditory cortices were analyzed. RESULTS: The phase of beta power fluctuation at the 2 Hz stimulus presentation rate differed and appeared opposite between individuals with dyslexia and controls. CONCLUSIONS: Atypical beta power fluctuation might reflect deficits in perceiving and tracking auditory rhythm in dyslexia. SIGNIFICANCE: These findings extend our understanding of atypical neural activities for tracking rhythm in dyslexia and could inspire novel methods to objectively measure the benefits of training, and predict potential benefit of auditory rhythmic rehabilitation programs on an individual basis.

Virtually spatialized sounds enhance auditory processing in healthy participants and patients with a disorder of consciousness.

Neuroscientific and clinical studies on auditory perception often use headphones to limit sound interference. In these conditions, sounds are perceived as internalized because they lack the sound-attributes that normally occur with a sound produced from a point in space around the listener. Without the spatial attention mechanisms that occur with localized sounds, auditory functional assessments could thus be underestimated. We hypothesize that adding virtually externalization and localization cues to sounds through headphones enhance sound discrimination in both healthy participants and patients with a disorder of consciousness (DOC). Hd-EEG was analyzed in 14 healthy participants and 18 patients while they listened to self-relevant and irrelevant stimuli in two forms: diotic (classic sound presentation with an "internalized" feeling) and convolved with a binaural room impulse response (to create an "externalized" feeling). Convolution enhanced the brains' discriminative response as well as the processing of irrelevant sounds itself, in both healthy participants and DOC patients. For the healthy participants, these effects could be associated with enhanced activation of both the dorsal (where/how) and ventral (what) auditory streams, suggesting that spatial attributes support speech discrimination. Thus, virtually spatialized sounds might "call attention to the outside world" and improve the sensitivity of assessment of brain function in DOC patients.

Sharing an Open Stimulation System for Auditory EEG Experiments Using Python, Raspberry Pi, and HifiBerry.

In auditory behavioral and EEG experiments, the variability of stimulation solutions, for both software and hardware, adds unnecessary technical constraints. Currently, there is no easy to use, inexpensive, and shareable solution that could improve collaborations and data comparisons across different sites and contexts. This article outlines a system composed by a Raspberry Pi coupled with Python programming and associated with a HifiBerry sound card. We compare its sound performances with those of a wide variety of materials and configurations. This solution achieves the high timing accuracy and sound quality important in auditory cognition experiments, while being simple to use and open source. The present system shows high performances and results along with excellent feedback from users. It is inexpensive, easy to build, share, and improve on. Working with such low-cost, powerful, and collaborative hardware and software tools allows people to create their own specific, adapted, and shareable system that can be standardized across different collaborative sites, while being extremely simple and robust in use.

Personal familiarity of music and its cerebral effect on subsequent speech processing.

Despite the obvious personal relevance of some musical pieces, the cerebral mechanisms associated with listening to personally familiar music and its effects on subsequent brain functioning have not been specifically evaluated yet. We measured cerebral correlates with functional magnetic resonance imaging (fMRI) while composers listened to three types of musical excerpts varying in personal familiarity and self (familiar own/composition, familiar other/favorite or unfamiliar other/unknown music) followed by sequences of names of individuals also varying in personal familiarity and self (familiar own/own name, familiar other/close friend and unfamiliar other/unknown name). Listening to music with autobiographical contents (familiar own and/or other) recruited a fronto-parietal network including mainly the dorsolateral prefrontal cortex, the supramarginal/angular gyri and the precuneus. Additionally, while listening to familiar other music (favorite) was associated with the activation of reward and emotion networks (e.g. the striatum), familiar own music (compositions) engaged brain regions underpinning self-reference (e.g. the medial prefrontal cortex) and visuo-motor imagery. The present findings further suggested that familiar music with self-related reference (compositions) leads to an enhanced activation of the autobiographical network during subsequent familiar name processing (as compared to music without self-related reference); among these structures, the precuneus seems to play a central role in personally familiar processing.

Regular rhythmic primes boost P600 in grammatical error processing in dyslexic adults and matched controls.

Regular musical rhythms orient attention over time and facilitate processing. Previous research has shown that regular rhythmic stimulation benefits subsequent syntax processing in children with dyslexia and specific language impairment. The present EEG study examined the influence of a rhythmic musical prime on the P600 late evoked-potential, associated with grammatical error detection for dyslexic adults and matched controls. Participants listened to regular or irregular rhythmic prime sequences followed by grammatically correct and incorrect sentences. They were required to perform grammaticality judgments for each auditorily presented sentence while EEG was recorded. In addition, tasks on syntax violation detection as well as rhythm perception and production were administered. For both participant groups, ungrammatical sentences evoked a P600 in comparison to grammatical sentences and its mean amplitude was larger after regular than irregular primes. Peak analyses of the P600 difference wave confirmed larger peak amplitudes after regular primes for both groups. They also revealed overall a later peak for dyslexic participants, particularly at posterior sites, compared to controls. Results extend rhythmic priming effects on language processing to underlying electrophysiological correlates of morpho-syntactic violation detection in dyslexic adults and matched controls. These findings are interpreted in the theoretical framework of the Dynamic Attending Theory (Jones, 1976, 2019) and the Temporal Sampling Framework for developmental disorders (Goswami, 2011).

Boosting Cognition With Music in Patients With Disorders of Consciousness.

BACKGROUND: Music listening conveys beneficial effects on cognitive processes in both normal and pathologic cerebral functioning. Surprisingly, no quantitative study has evaluated the potential effects of music on cognition and consciousness in patients with disorders of consciousness. OBJECTIVE: The aim of the present study was to evaluate the effect of music on cerebral processing in patients with disorders of consciousness. METHODS: Using bedside electroencephalographic recording, we acquired in 13 patients with disorders of consciousness event-related potentials to the patient's first name after either an excerpt of the patient's preferred music (music condition) or a continuous sound (control condition). RESULTS: The cerebral response to the patient's first name was more often observed in the music condition, than in the control condition. Furthermore, the presence or absence of a discriminative response in the music condition seemed to be associated with a favorable or unfavorable outcome, respectively. CONCLUSIONS: These findings demonstrate for the first time that music has a beneficial effect on cognitive processes of patients with disorders of consciousness. The autobiographical characteristics of music, that is, its emotional and personal relevance, probably increase arousal and/or awareness.

Unsupervised online classifier in sleep scoring for sleep deprivation studies.

STUDY OBJECTIVE: This study was designed to evaluate an unsupervised adaptive algorithm for real-time detection of sleep and wake states in rodents. DESIGN: We designed a Bayesian classifier that automatically extracts electroencephalogram (EEG) and electromyogram (EMG) features and categorizes non-overlapping 5-s epochs into one of the three major sleep and wake states without any human supervision. This sleep-scoring algorithm is coupled online with a new device to perform selective paradoxical sleep deprivation (PSD). SETTINGS: Controlled laboratory settings for chronic polygraphic sleep recordings and selective PSD. PARTICIPANTS: Ten adult Sprague-Dawley rats instrumented for chronic polysomnographic recordings. MEASUREMENTS: The performance of the algorithm is evaluated by comparison with the score obtained by a human expert reader. Online detection of PS is then validated with a PSD protocol with duration of 72 hours. RESULTS: Our algorithm gave a high concordance with human scoring with an average κ coefficient > 70%. Notably, the specificity to detect PS reached 92%. Selective PSD using real-time detection of PS strongly reduced PS amounts, leaving only brief PS bouts necessary for the detection of PS in EEG and EMG signals (4.7 ± 0.7% over 72 h, versus 8.9 ± 0.5% in baseline), and was followed by a significant PS rebound (23.3 ± 3.3% over 150 minutes). CONCLUSIONS: Our fully unsupervised data-driven algorithm overcomes some limitations of the other automated methods such as the selection of representative descriptors or threshold settings. When used online and coupled with our sleep deprivation device, it represents a better option for selective PSD than other methods like the tedious gentle handling or the platform method.

Metrical presentation boosts implicit learning of artificial grammar.

The present study investigated whether a temporal hierarchical structure favors implicit learning. An artificial pitch grammar implemented with a set of tones was presented in two different temporal contexts, notably with either a strongly metrical structure or an isochronous structure. According to the Dynamic Attending Theory, external temporal regularities can entrain internal oscillators that guide attention over time, allowing for temporal expectations that influence perception of future events. Based on this framework, it was hypothesized that the metrical structure provides a benefit for artificial grammar learning in comparison to an isochronous presentation. Our study combined behavioral and event-related potential measurements. Behavioral results demonstrated similar learning in both participant groups. By contrast, analyses of event-related potentials showed a larger P300 component and an earlier N2 component for the strongly metrical group during the exposure phase and the test phase, respectively. These findings suggests that the temporal expectations in the strongly metrical condition helped listeners to better process the pitch dimension, leading to improved learning of the artificial grammar.