Modeling the Test-Retest Statistics of a Localization Experiment in the Full Horizontal Plane.

HYPOTHESIS: Two approaches to model the test-retest statistics of a localization experiment basing on Gaussian distribution and on surrogate data are introduced. Their efficiency is investigated using different measures describing directional hearing ability. BACKGROUND: A localization experiment in the full horizontal plane is a challenging task for hearing impaired patients. In clinical routine, we use this experiment to evaluate the progress of our cochlear implant (CI) recipients. Listening and time effort limit the reproducibility. METHODS: The localization experiment consists of a 12 loudspeaker circle, placed in an anechoic room, a "camera silens". In darkness, HSM sentences are presented at 65 dB pseudo-erratically from all 12 directions with five repetitions. This experiment is modeled by a set of Gaussian distributions with different standard deviations added to a perfect estimator, as well as by surrogate data. Five repetitions per direction are used to produce surrogate data distributions for the sensation directions. To investigate the statistics, we retrospectively use the data of 33 CI patients with 92 pairs of test-retest-measurements from the same day. RESULTS: The first model does not take inversions into account, (i.e., permutations of the direction from back to front and vice versa are not considered), although they are common for hearing impaired persons particularly in the rear hemisphere. The second model considers these inversions but does not work with all measures. CONCLUSION: The introduced models successfully describe test-retest statistics of directional hearing. However, since their applications on the investigated measures perform differently no general recommendation can be provided. The presented test-retest statistics enable pair test comparisons for localization experiments.

Effect of changing pulse rate on profile parameters of perceptual thresholds and loudness comfort levels and relation to ECAP thresholds in recipients of the Nucleus CI24RE device.

The Nucleus CI24RE 'Freedom' device offers higher stimulation rates and lower noise levels in action potential measurements (ECAPs) than previous devices. A study including ten European implant teams showed that the effect of changes in rate from 250 to 3500 pulses per second on tilt and curvature of the T and C profiles is insignificant. When changing rate one may change the levels at all electrodes by the same amount. Using an automated procedure ECAPs could be measured quickly and reliably at a noise level of only 1 microV, this did not result in improved correlations between the tilt and curvature parameters of the ECAP profiles and those of the T and C profiles. Average C levels appear to differ markedly among implant centers; a better assessment protocol is required. When increasing stimulus rate one should take into account that this requires higher pulse charges per second and more power consumption.

Clinical results of AutoNRT, a completely automatic ECAP recording system for cochlear implants.

OBJECTIVE: AutoNRT is the completely automatic electrically evoked compound action potential (ECAP) measuring algorithm in the recently released Nucleus Freedom cochlear implant system. AutoNRT allows clinicians to automatically record T-NRT profiles that in turn can be used as a guide for initial fitting. The algorithm consists of a pattern recognition part that judges if the traces contain an ECAP and an intelligent flow that optimizes the measurement parameters and finds the ECAP threshold (T-NRT). The objective of this study was to determine how accurate, reliable, and fast the automatic measurements are. DESIGN: Data on more than 400 electrodes were collected as part of the multicenter clinical trial of the Nucleus Freedom cochlear implant system. T-NRT values determined by the algorithm were compared with T-NRT determinations on the same data by different human observers. Also, the time the measurements took was analyzed. RESULTS: In 90% of the cases, the absolute difference between the AutoNRT and the human observer determined T-NRT was less than 9 CL; the median absolute difference was 3 CL. A second experiment, in which a group of human observers were asked to analyze NRT data, showed high variability in T-NRT; in some cases, two experienced clinicians disagreed by more than 30 current levels. Compared with the group, AutoNRT performed as well as the "average" clinician, with the advantage that the AutoNRT threshold determinations are objective. Analysis of the timing data showed an average intraoperative measurement time of less than 20 sec per electrode with a standard deviation of 5 sec, suggesting that the total array of 22 electrodes can be measured intraoperatively in about 7 minutes on average. CONCLUSIONS: AutoNRT provides comparable accuracy to an average clinician but with the added benefit of significant time savings over manual recordings. This makes it a valuable tool for clinical measurement of ECAP threshold in cochlear implant recipients.

Kinematic analysis of thalamic versus subthalamic neurostimulation in postural and intention tremor.

Deep brain stimulation of the thalamus (thalamic DBS) is an established therapy for medically intractable essential tremor and tremor caused by multiple sclerosis. In both disorders, motor disability results from complex interaction between kinetic tremor and accompanying ataxia with voluntary movements. In clinical studies, the efficacy of thalamic DBS has been thoroughly assessed. However, the optimal anatomical target structure for neurostimulation is still debated and has never been analysed in conjunction with objective measurements of the different aspects of motor impairment. In 10 essential tremor and 11 multiple sclerosis patients, we analysed the effect of thalamic DBS through each contact of the quadripolar electrode on the contralateral tremor rating scale, accelerometry and kinematic measures of reach-to-grasp-movements. These measures were correlated with the anatomical position of the stimulating electrode in stereotactic space and in relation to nuclear boundaries derived from intraoperative microrecording. We found a significant impact of the stereotactic z-coordinate of stimulation contacts on the TRS, accelerometry total power and spatial deviation in the deceleration and target period of reach-to-grasp-movements. Most effective contacts clustered within the subthalamic area (STA) covering the posterior Zona incerta and prelemniscal radiation. Stimulation within this region led to a mean reduction of the lateralized tremor rating scale by 15.8 points which was significantly superior to stimulation within the thalamus (P < 0.05, student's t-test). STA stimulation resulted in reduction of the accelerometry total power by 99%, whereas stimulation at the ventral thalamic border (68%) or within the thalamus proper (2.5%) was significantly less effective (P < 0.01). Concomitantly, STA stimulation led to a significantly higher increase of tremor frequency and decrease in EMG synchronization compared to stimulation within the thalamus proper (P < 0.001). In reach-to-grasp movements, STA stimulation reduced the spatial variability of the movement path in the deceleration period by 28.9% and in the target period by 58.4%, whereas stimulation within the thalamus was again significantly less effective (P < 0.05), with a reduction in the deceleration period between 6.5 and 21.8% and in the target period between 1.2 and 11.3%. An analysis of the nuclear boundaries from intraoperative microrecording confirmed the anatomical impression that most effective electrodes were located within the STA. Our data demonstrate a profound effect of deep brain stimulation of the thalamic region on tremor and ataxia in essential tremor and tremor caused by multiple sclerosis. The better efficacy of stimulation within the STA compared to thalamus proper favours the concept of a modulation of cerebello-thalamic projections underlying the improvement of these symptoms.

Measuring the refractoriness of the electrically stimulated auditory nerve.

Intracochlear recordings in cochlear implant recipients provide access to the electrically evoked compound action potential (ECAP). ECAP thresholds are potential predictors of speech processor map's threshold and comfortable loudness levels. The auditory nerve's refractory properties can influence these levels due to high-rate stimulation with interpulse intervals within the relative refractory period. Recovery functions were investigated at 84 stimulation sites in 14 Nucleus CI24 recipients using neural response telemetry and a modified forward masking technique. This technique introduces a reference masker-probe interval (MPI). In our study, an appropriate value between 300 and 375 micro s was determined for this reference MPI, and the use of a reference MPI of 300 micro s is suggested for recovery and amplitude growth functions. A median absolute refractory period of about 390 micro s and a median time constant of about 425 micro s were obtained by fitting an exponential model to the data. Hence, the auditory nerve is usually in relative refractory state when standard neural response telemetry forward masking is selected because of its default MPI of 500 micro s. This can bias the measurement of ECAP thresholds. Additionally, the shape of standard forward masking recovery functions was explained by the influence of latency shift of the neural response.

Most effective stimulation site in subthalamic deep brain stimulation for Parkinson's disease.

The optimal stimulation site in subthalamic deep brain stimulation (STN-DBS) was evaluated by correlation of the stereotactic position of the stimulation electrode with the electrophysiologically specified dorsal STN border. In a series of 25 electrodes, best clinical results with least energy consumption were found in contacts located in the dorsolateral border zone, whereas contacts within the subthalamic white matter, e.g., zona incerta, were significantly less effective. We suggest that the dorsolateral STN border should be covered by STN-DBS.

Is the rhythm of physiological tremor involved in cortico-cortical interactions?

The function of low-frequency oscillations as correlates of physiological tremor in supplementary motor area (SMA) and M1 remains unclear. In epicortical recordings from M1 and SMA and surface electromyographic (EMG) recordings in an epileptic patient we found reproducibly significant coherence between all three recording sites in the 6- to 15-Hz band. The partial coherence between SMA and muscle, however, was not significant. There was a constant phase shift between SMA and M1 indicating synchronized activity. We conclude that the cortical correlates of physiological tremor may be involved in linking different cortical motor centers and might therefore play a role in cortical motor planning.