Direct estimation of evoked hemoglobin changes by multimodality fusion imaging

In the last two decades, both diffuse optical tomography (DOT) and blood oxygen level dependent (BOLD)-based functional magnetic resonance imaging (fMRI) methods have been developed as noninvasive tools for imaging evoked cerebral hemodynamic changes in studies of brain activity. Although these two technologies measure functional contrast from similar physiological sources, i.e., changes in hemoglobin levels, these two modalities are based on distinct physical and biophysical principles leading to both limitations and strengths to each method. In this work, we describe a unified linear model to combine the complimentary spatial, temporal, and spectroscopic resolutions of concurrently measured optical tomography and fMRI signals. Using numerical simulations, we demonstrate that concurrent optical and BOLD measurements can be used to create cross-calibrated estimates of absolute micromolar deoxyhemoglobin changes. We apply this new analysis tool to experimental data acquired simultaneously with both DOT and BOLD imaging during a motor task, demonstrate the ability to more robustly estimate hemoglobin changes in comparison to DOT alone, and show how this approach can provide cross-calibrated estimates of hemoglobin changes. Using this multimodal method, we estimate the calibration of the 3 tesla BOLD signal to be -0.55%+/-0.40% signal change per micromolar change of deoxyhemoglobin.

Coupling between somatosensory evoked potentials and hemodynamic response in the rat

We studied the relationship between somatosensory evoked potentials (SEP) recorded with scalp electroencephalography (EEG) and hemoglobin responses recorded non-invasively with diffuse optical imaging (DOI) during parametrically varied electrical forepaw stimulation in rats. Using these macroscopic techniques we verified that the hemodynamic response is not linearly coupled to the somatosensory evoked potentials, and that a power or threshold law best describes the coupling between SEP and the hemoglobin response, in agreement with the results of most invasive studies. We decompose the SEP response in three components (P1, N1, and P2) to determine which best predicts the hemoglobin response. We found that N1 and P2 predict the hemoglobin response significantly better than P1 and the input stimuli (S). Previous electrophysiology studies reported in the literature show that P1 originates in layer IV directly from thalamocortical afferents, while N1 and P2 originate in layers I and II and reflect the majority of local cortico-cortical interactions. Our results suggest that the evoked hemoglobin response is driven by the cortical synaptic activity and not by direct thalamic input. The N1 and P2 components, and not P1, need to be considered to correctly interpret neurovascular coupling.

Assessment of infant brain development with frequency-domain near-infrared spectroscopy

This is the first report to demonstrate quantitative monitoring of infant brain development with frequency-domain near-infrared spectroscopy (FD-NIRS). Regionally specific increases in blood volume and oxygen consumption were measured in healthy infants during their first year. The results agree with prior PET and SPECT reports; but, unlike these methods, FD-NIRS is portable and uses nonionizing radiation. Further, new information includes the relatively constant tissue oxygenation with age and location, suggesting a tight control between local oxygen delivery and consumption in healthy infants during brain development. FD-NIRS could become the preferred clinical tool for quantitatively assessing infant brain development.

Near-infrared spectroscopy measurement of the pulsatile component of cerebral blood flow and volume from arterial oscillations

We describe a near-infrared spectroscopy (NIRS) method to noninvasively measure relative changes in the pulsate components of cerebral blood flow (pCBF) and volume (pCBV) from the shape of heartbeat oscillations. We present a model that is used and data to show the feasibility of the method. We use a continuous-wave NIRS system to measure the arterial oscillations originating in the brains of piglets. Changes in the animals' CBF are induced by adding CO(2) to the breathing gas. To study the influence of scalp on our measurements, comparative, invasive measurements are performed on one side of the head simultaneously with noninvasive measurements on the other side. We also did comparative measurements of CBF using a laser Doppler system to validate the results of our method. The results indicate that for sufficient source-detector separation, the signal contribution of the scalp is minimal and the measurements are representative of the cerebral hemodynamics. Moreover, good correlation between the results of the laser Doppler system and the NIRS system indicate that the presented method is capable of measuring relative changes in CBF. Preliminary results show the potential of this NIRS method to measure pCBF and pCBV relative changes in neonatal pigs.

Diffuse optical imaging of the whole head

Near-Infrared Spectroscopy (NIRS) and diffuse optical imaging (DOI) are increasingly used to detect hemodynamic changes in the cerebral cortex induced by brain activity. Until recently, the small number of optodes in NIRS instruments has hampered measurement of optical signals from diverse brain regions. Our new DOI system has 32 detectors and 32 sources; by arranging them in a specific pattern, we can cover most of the adult head. With the increased number of optodes, we can collect optical data from prefrontal, sensorimotor, and visual cortices in both hemispheres simultaneously. We describe the system and report system characterization measurements on phantoms as well as on human subjects at rest and during visual, motor, and cognitive stimulation. Taking advantage of the system's larger number of sources and detectors, we explored the spatiotemporal patterns of physiological signals during rest. These physiological signals, arising from cardiac, respiratory, and blood-pressure modulations, interfere with measurement of the hemodynamic response to brain stimulation. Whole-head optical measurements, in addition to providing maps of multiple brain regions' responses to brain activation, will enable better understandings of the physiological signals, ultimately leading to better signal processing algorithms to distinguish physiological signal clutter from brain activation signals.

A temporal comparison of BOLD, ASL, and NIRS hemodynamic responses to motor stimuli in adult humans

In this study, we have preformed simultaneous near-infrared spectroscopy (NIRS) along with BOLD (blood oxygen level dependent) and ASL (arterial spin labeling)-based fMRI during an event-related motor activity in human subjects in order to compare the temporal dynamics of the hemodynamic responses recorded in each method. These measurements have allowed us to examine the validity of the biophysical models underlying each modality and, as a result, gain greater insight into the hemodynamic responses to neuronal activation. Although prior studies have examined the relationships between these two methodologies through similar experiments, they have produced conflicting results in the literature for a variety of reasons. Here, by employing a short-duration, event-related motor task, we have been able to emphasize the subtle temporal differences between the hemodynamic parameters with a high contrast-to-noise ratio. As a result of this improved experimental design, we are able to report that the fMRI measured BOLD response is more correlated with the NIRS measure of deoxy-hemoglobin (R = 0.98; P < 10(-20)) than with oxy-hemoglobin (R = 0.71), or total hemoglobin (R = 0.53). This result was predicted from the theoretical grounds of the BOLD response and is in agreement with several previous works [Toronov, V.A.W., Choi, J.H., Wolf, M., Michalos, A., Gratton, E., Hueber, D., 2001. "Investigation of human brain hemodynamics by simultaneous near-infrared spectroscopy and functional magnetic resonance imaging." Med. Phys. 28 (4) 521-527.; MacIntosh, B.J., Klassen, L.M., Menon, R.S., 2003. "Transient hemodynamics during a breath hold challenge in a two part functional imaging study with simultaneous near-infrared spectroscopy in adult humans". NeuroImage 20 1246-1252.; Toronov, V.A.W., Walker, S., Gupta, R., Choi, J.H., Gratton, E., Hueber, D., Webb, A., 2003. "The roles of changes in deoxyhemoglobin concentration and regional cerebral blood volume in the fMRI BOLD signal" Neuroimage 19 (4) 1521-1531]. These data have also allowed us to examine more detailed measurement models of the fMRI signal and comment on the roles of the oxygen saturation and blood volume contributions to the BOLD response. In addition, we found high correlation between the NIRS measured total hemoglobin and ASL measured cerebral blood flow (R = 0.91; P < 10(-10)) and oxy-hemoglobin with flow (R = 0.83; P < 10(-05)) as predicted by the biophysical models. Finally, we note a significant amount of cross-modality, correlated, inter-subject variability in amplitude change and time-to-peak of the hemodynamic response. The observed co-variance in these parameters between subjects is in agreement with hemodynamic models and provides further support that fMRI and NIRS have similar vascular sensitivity.

Ocular counterrolling differs in dynamic and static stimulation

In the past, the majority of ocular counterrolling (OCR) studies were performed with subjects tilted and held statically. Studies in our laboratory have focused on dynamic rotation below the threshold of the semicircular canals. The present study compares OCR in both static and dynamic modes. Ten normal subjects, mean age 50.9 years (SD 16.2 years), underwent rotation about their naso-occipital axis to 90 degrees to the right and left, at a constant velocity of 3 degrees/s and an acceleration of 0.2 degree/s2. Subsequently, they were tilted at the same acceleration and velocity to 30 degrees, 60 degrees, 90 degrees, 60 degrees, 30 degrees and 0 degree to both sides and held in each position for 1 min. The results showed that OCR varied substantially in the two protocols. The most dramatic difference was disconjugacy in the static mode, with the two eyes differing by as much as 4 degrees, in contrast to the generally conjugate OCR in the dynamic mode. Amplitudes also tended to differ, some subjects having greater and others lesser OCR in one mode vis-à-vis the other. Possible explanations for these differences may be found in the work of Hudspeth and colleagues, who found that mechanical deflection of the bullfrog saccula resulted in gradated responses in the underlying hair cells. Further, hair cells in the process of active bending led to different responses than those in a fixed position. Possibly in humans, too, the otoconia do not maintain a fixed relation to the underlying hair cells. Additionally, this study confirms our earlier finding of independent control in the two eyes.

Near-infrared spiroximetry: noninvasive measurements of venous saturation in piglets and human subjects

We present a noninvasive method to measure the venous oxygen saturation (Sv(O(2))) in tissues using near-infrared spectroscopy (NIRS). This method is based on the respiration-induced oscillations of the near-infrared absorption in tissues, and we call it spiroximetry (the prefix spiro means respiration). We have tested this method in three piglets (hind leg) and in eight human subjects (vastus medialis and vastus lateralis muscles). In the piglet study, we compared our NIRS measurements of the Sv(O(2)) (Sv(O(2))-NIRS(resp)) with the Sv(O(2)) of blood samples. Sv(O(2))-NIRS(resp) and Sv(O(2)) of blood samples agreed well over the whole range of Sv(O(2)) considered (20-95%). The two measurements showed an average difference of 1.0% and a standard deviation of the difference of 5.8%. In the human study, we found a good agreement between Sv(O(2))-NIRS(resp) and the Sv(O(2)) values measured with the NIRS venous occlusion method. Finally, in a preliminary test involving muscle exercise, Sv(O(2))-NIRS(resp) showed an expected postexercise decrease from the initial baseline value and a subsequent recovery to baseline.

Parabolic flight reveals independent binocular control of otolith-induced eye torsion

To examine otolith-governed ocular torsion in hyper- and hypogravity, eight subjects, including two astronauts, underwent parabolic flight while seated upright with head fixed. A mask fitted with two video cameras provided synchronized images of both eyes at a rate of 25/sec during 15 parabolas, the individual parabolas separated by a few minutes of level 1 G flight. Three main findings emerged: 1) After the first parabola, most subjects showed differential torsional offset of the two eyes in the 1 G portions between parabolas, compared to the conjugate baseline position of the eyes prior to the first parabola. 2) Changes in binocular torsion in the 0 G and 1.8 G portions of parabolic flight revealed in most subjects systematic reversal of direction. The reversal was consistent within, but not across subjects. 3) Disconjugacy defined as the moment-to-moment difference in the movements of the two eyes, and evaluated without the contribution of the differential offset, found two subjects with relatively high disconjugacy scores, and the remaining six with low scores. On the basis of prior studies (9, 20), we would predict the first two would be subject to SMS, the remainder not. The two astronauts, who did not have SMS on their space missions, fell into the low scoring group. We propose that the disconjugacies may be due to intrinsic asymmetries in the otolith receptors on the two sides of the head, which appear to be independently linked to the extraocular muscles of the two eyes, a phenomenon masked in normal 1 G states by adaptation. The apparently independent control of the two sides cannot be detected by the simpler and more common monocular studies.

The effect of space missions on gravity-responsive torsional eye movements

Three astronauts underwent preflight, inflight, and postflight testing of spontaneous ocular torsion and of ocular counterrolling (OCR), reflexes governed by the gravity-responsive otolith organs in the inner ear. One astronaut, A, had a 30-day space mission on Euromir '94 and was examined monocularly with SensoMotoric Instruments video-oculography (VOG). The other two astronauts, B and C, were studied with a binocular VOG and flew an 180-day mission on Euromir '95. In space, spontaneous eye torsion in the upright position was found to be substantially offset from baseline Earth-based recordings in all three subjects for the duration of the flights. In addition, the binocular studies showed a marked torsional disconjugacy. On return to Earth, offset and torsional disconjugacy persisted for many days. OCR in response to 30 degrees right and left tilt was examined preflight and postflight. Compared to preflight, Astronaut A showed reduced OCR immediately postflight, which increased over the next few days. Both Astronauts B and C had increased OCR postflight, which gradually approached but did not achieve the preflight values over 13 days postflight. The adaptation of ocular torsion in space in one astronaut and not in the other two, and slow adaptation postflight, may reflect the lack of visual feed-back and the open loop nature of the otolith-ocular torsion reflex.

Four-year follow-up of adrenal-to-brain transplants in Parkinson's disease

OBJECTIVE

Evaluate long-term efficacy of autologous adrenal-to-caudate transplants in idiopathic Parkinson's disease refractory to medical treatment.

DESIGN

Subjects underwent evaluations several times preoperatively on the University of California-Los Angeles Parkinson's Disease Disability Scale and the Hoehn and Yahr stage of disease. Postoperatively, they were also repeatedly rated on the Unified Parkinson's Disease Rating Scale.

SETTING

Clinical visits and surgery took place at the University of California-Los Angeles Center for the Health Sciences.

PATIENTS

Three men and one woman, ages 44 to 55 years, were followed up for several years preoperatively. At surgery, disease durations ranged from 7 to 16 years. Originally, all patients had a good response to levodopa, but for several years preoperatively, they had had fluctuating responses and a short duration of drug action.

INTERVENTION

Right adrenalectomy was performed through a midline abdominal incision. Open craniotomy exposed the head of the right caudate into which pieces of adrenal medulla, 1 to 2 mm in size, were implanted.

MAIN OUTCOME MEASURES

Scores on the three major scales (see "Design") were augmented with the number of hours "off" per day and severity of abnormal involuntary movements. Disease progression of each patient was compared with his own preoperative course and with those of a cohort of patients with Parkinson's disease followed up for 14 years who had received medical treatment without transplant surgery.

RESULTS

After 4 years, transplants continued to be beneficial to three patients and had been of brief transient benefit to the fourth. The course of disease was more benign postoperatively than preoperatively and was more slowly progressive than that in the cohort.

CONCLUSION

Improvement was not sufficient to justify adrenal transplants as routine therapy but does point the way to the use of other dopamine tissue transplantation.

Transplantation of fetal mesencephalic tissue in Parkinson's patients

Patients with idiopathic Parkinson's disease who had become refractory to medical treatment underwent unilateral stereotactic transplantation of mesencephalic tissue obtained from 7- to 9-week-old postconception fetuses. Small pieces of tissue, less than 1 mm, were deposited in 9 sites in the putamen and 3 in the caudate. Patients were 4 men and 3 women and aged from 42 to 59 years (mean 50). Symptom durations were from 9 to 21 years (mean 14). The examinations were done at 3- to 4-month intervals pre- and postoperatively. Patients were examined for a minimum of 1 year postoperatively. The examinations consisted of neurological and general physical examinations, UCLA Parkinson's Disability Scale, Hoehn and Yahr rating and United Parkinson's Disease Rating Scale (PDRS), all in both 'on' and 'off' states. Video recordings and timed tests of a number of motor tests were performed. Patients also completed 7 consecutive days of hourly self-assessments prior to each visit. Fluorodopa PET scans were obtained pre- and 6 and 15 months postoperatively. The operations took place from mid-July 1992 to January 1993. Postoperative states have been free of complications. All have been on immunosuppressants. Levodopa was transiently decreased in the postoperative period, but raised to approximately the preoperative level thereafter. In late March 1993, 3 patients appeared to show modest improvement in the UCLA and UPDRS scales and in the patients' self-assessments.

Ocular torsion as a test of the asymmetry hypothesis of space motion sickness

Disconjugate eye torsion induced by 0 G and 1.8 G during parabolic flight was studied in nine former astronauts in 1990 and eight in 1991, four of whom were included in the previous experiment. The astronauts could be divided into two statistically significant groups on the basis of low and high scores of disconjugacy. When their histories of space motion sickness (SMS) were later revealed, all of the low scorers had not been sick on previous space flights; all the high scorers had had SMS. These data give support to the hypothesis that SMS in one-half or two-thirds of astronauts is due to an otolith, probably utricular, asymmetry in those persons.

Further evidence to support disconjugate eye torsion as a predictor of space motion sickness

Disconjugate eye torsion in hypo- and hypergravity of parabolic flight was examined in four former astronauts and four previously tested ex-astronauts to replicate an earlier study and to further test the asymmetry hypothesis of otolith function. Results in the new subjects supported the asymmetry hypothesis and confirmed previous findings that those with low scores of torsional disconjugacy on the KC-135 did not suffer space motion sickness in their prior Shuttle missions while those with high scores did. Tilting subjects with high disconjugacy scores slightly to one side and the other failed to find a position that decreased disconjugacy in hypergravity, leading to the conclusion that a simple planar asymmetry about the y-axis was probably not the cause of the observed torsional differences in the two eyes. Disconjugacy increased at 0 G with increasing parabolas, much more so in subjects who had suffered SMS. Because of this, 10 to 20 parabolas were deemed to be a more certain discriminator than a fewer number.

Prediction of space motion sickness susceptibility by disconjugate eye torsion in parabolic flight

The hypothesis of asymmetric otolith function asserts that physiological or anatomical differences in the two sides of the bilateral gravity-sensing otolith apparatus of the inner ear may be well compensated on Earth, but when exposed to novel gravitational states, the prior compensatory stratagems may be ineffective, leading to unstable vestibular responses and causing the phenomenon of space motion sickness. To investigate this hypothesis, spontaneous eye torsion, a reflex governed by the otolith organs, was examined in the upright position during the hypo- and hypergravity of parabolic flight aboard NASA's KC-135 aircraft in nine former astronauts whose history of space motion sickness was revealed after data analysis had been completed. Results showed that astronauts who had been sick in space had significantly higher scores of disconjugate eye torsion in parabolic flight, and that their responses were consistently different in 1.8 G relative to 0 G compared to astronauts who had not been sick in space. In 1 G, there were no differences in disconjugate eye torsion between the subjects. The results support the asymmetry hypothesis and offer a possible predictive test of space motion sickness.

Instability of ocular torsion in zero gravity: possible implications for space motion sickness

Inherent asymmetries of the gravity-sensitive otolith organs of the inner ear may be well-compensated in ordinary 1 G, but rendered unstable in novel gravitational states. Several aspects of ocular counterrolling and spontaneous eye torsion, reflexes governed by the otoliths, were examined during the hypo- and hypergravity in parabolic flight on the NASA KC-135 aircraft. Among the subjects were two astronauts, one who had suffered space motion sickness during his mission and one who had not. Using an observed separation of scores of torsional instability at 0 G as the criterion, we divided our 10 subjects into the 5 highest and 5 lowest scorers, reminiscent of the approximately 50% who do and the 50% who do not experience space motion sickness (SMS). The astronaut who had had SMS was in the high group; and the one who had not was in the low group. At 1.8 G, the groups defined at 0 G were significantly different in the instability measure. They were also significantly different at both 0 G and 1.8 G in another measure, that of torsional variability. There were no differences between the groups in amplitude of eye torsion in 0 G or 1.8 G. None of the tests were significantly different in 1 G. The results suggest that these tests of eye torsion on the KC-135 might differentiate those who would experience SMS from those who would not. Proof of this speculation awaits replication of the study using only astronaut subjects.

An examination of male-female differences in progression and mortality of Parkinson's disease

We conducted disability and mortality studies to determine if the male preponderance usually found in Parkinson's disease (PD) was reflected in different courses of the diseases in the 2 sexes. We analyzed longitudinal disability score in 47 men and 23 women with PD followed for 6 years at UCLA. We found no significant differences between the sexes in mean disability scores in any of the 6 years. Mean dopa dosage was significantly higher in men, possibly reflecting their generally larger body mass. Choreoathetosis, dementia, or other side effects did not differ between the 2 groups. We obtained observed to expected mortality ratios in 239 men and 132 women followed for 3,831 person-years from records of 4 medical centers. Using the sex-specific US Life Tables to calculate expected mortality, we found the observed to expected ratio for the men was 1.7457 and for the women 2.4740, a significantly greater excess in female mortality. Analyses of mortality using tables which are not sex-specific will fail to uncover the decreased longevity in women with PD. We conclude that, despite the male preponderance in PD, men and women acquire it at the same age, have the same progression and duration of disease, and die at the same age; whereas, in the general population, women have a longer life expectancy than men. It is not known what factors protect women from incurring PD and what lowers their life expectancy to that of men when they do have the disease.

Effect of age at onset on progression and mortality in Parkinson's disease

We examined longitudinal disability scores in 54 patients with Parkinson's disease followed for 6 years at UCLA. We sorted data into 3 groups based on age at onset of symptoms: group A, onset under 50 years; group B, 50 to 59 years; group C, 60 years or older. There were no significant differences between groups initially. All 3 groups improved dramatically when levodopa was given, but group A showed significantly less disability in years 4, 5, and 6 than did group C. The groups did not differ with respect to side effects. To determine if age at onset affected mortality, we sorted records from 4 geographically diverse centers into the same 3 groups. Results on 359 patients followed for 3,314 person-years, covering a period of 17 years after onset of symptoms, showed that group A had the most favorable observed-to-expected mortality ratio, 1.82, compared with 2.17 and 2.20 for groups B and C respectively, but the difference was not statistically significant. Results from the disability analyses indicate that patients with onset of Parkinson's disease under 50 years of age may have a more favorable prognosis than those whose symptoms begin in later years.

Ocular torsion in upright and tilted positions during hypo- and hypergravity of parabolic flight

Four subjects considered resistant to motion sickness were tested in KC-135 parabolic flight to examine ocular torsion at hypo- and hypergravity. Three of these showed no significant torsion at zero G in either the upright position or when tilted 30 degrees to right or left. At 1.8 G in the tilted positions they showed greater ocular counterrolling than at 1 G. None of these three subjects became motion sick. The fourth subject showed eye torsion toward his left in all positions at zero G. This leftward bias could also be seen at 1.8 G when tilted left ear down, the side that induces rightward counterrolling. There he had less eye torsion than at 1 G. This subject became motion sick. All subjects had normal counterrolling in ground-based testing. These results support the hypothesis that asymmetry of the utricular system may be well compensated in the normal 1 G environment, but unmasked in unaccustomed gravitational situations, suggesting a possible predictive test for space adaptation syndrome.