Effect of reference point on visual evoked potentials: clinical relevance

Normative values of visual evoked potential in adults

PURPOSE

Visual evoked potentials (VEP) are used to determine the function of visual pathway from the optic nerve to visual cortex. Various factors may affect VEP response, viz., technical and environmental. The aim of this study is to obtain the normative value of VEP latency and amplitude parameters in adulthood in Indonesia, as well as the relationship of height, weight, body mass index (BMI), head circumference, and visual acuity with the variety of latency and amplitude values of VEP parameters.

METHODS

It is a cross-sectional study on 120 healthy subjects consisting of 60 males and 60 females between 18 and 65 years old. Height, weight, BMI, head circumference, and visual acuity were measured and continued with VEP examination using a 26' checkerboard pattern on the left and right eyes alternately. All data were collected and analyzed with the Shapiro-Wilk test using statistical software R version 3.5.2.

RESULTS

Mean value of P100 latency (interocular latency) of left and right eye were 104.6 ± 3.4 ms and 104.1 ± 3.4 ms, respectively, as well as 9.8 ± 4.7 μV and 10.3 ± 5.4 μV for the amplitude. There was no significant difference between the male and female group, as well as on the age group. Female significantly exhibited a higher P100 amplitude than male. The greater the age, the lower amplitude of P100 significantly.

CONCLUSION

Gender and age do not affect the P100 latency value but only affect P100 amplitude. Height, weight, BMI, head circumference, and visual acuity also do not affect the P100 latency and amplitude.

Effect of Different References on Auditory-Evoked Potentials in Children with Cochlear Implants

Background: Nose reference (NR), mastoid reference (MR), and montage average reference (MAR) are usually used in auditory event-related potential (AEP) studies with a recently developed reference electrode standardization technique (REST), which may reduce the reference effect. For children with cochlear implants (CIs), auditory deprivation may hinder normal development of the auditory cortex, and the reference effect may be different between CIs and a normal developing group.

Methods: Thirteen right-side-CI children were recruited, comprising 7 males and 6 females, ages 2–5 years, with CI usage of ~1 year. Eleven sex- and age-matched healthy children were recruited for normal controls; 1,000 Hz pure tone evoked AEPs were recorded, and the data were re-referenced to NR, left mastoid reference (LMR, which is the opposite side of the implanted cochlear), MAR, and REST. CI artifact and P1–N1 complex (latency, amplitudes) at Fz were analyzed.

Results: Confirmed P1–N1 complex could be found in Fz using NR, LMR, MAR, and REST with a 128-electrode scalp. P1 amplitude was larger using LMR than MAR and NR, while no statistically significant difference was found between NR and MAR in the CI group; REST had no significant difference with the three other references. In the control group, no statistically significant difference was found with different references. Group difference of P1 amplitude could be found when using MR, MAR, and REST. For P1 latency, no significant difference among the four references was shown, whether in the CI or control group. Group difference in P1 latency could be found in MR and MAR. N1 amplitude in LMR was significantly lower than NR and MAR in the control group. LMR, MAR, and REST could distinguish the difference in the N1 amplitude between the CI and control group. Contralateral MR or MAR was found to be better in differentiating CI children versus controls. No group difference was found for the artifact component.

Conclusions: Different references for AEP studies do not affect the CI artifact. In addition, contralateral MR is preferable for P1–N1 component studies involving CI children, as well as methodology-like studies.

Relative value of the inion and mid-parietal locations as additional recording sites in pattern reversal visual evoked potentials

Although the P100 response of pattern reversal visual evoked potentials (PRVEPs) is most commonly recorded from the midline occipital site (MO), the response at this location can occasionally be absent or poorly defined due to anatomical variability of the visual cortex. In these cases, the American Electroencephalographic Society Evoked Potential Guidelines recommends recording from the mid-parietal (MP) and Inion electrode sites. In this study, we compared the amplitude of the P100 component recorded simultaneously from MO, MP and the Inion. PRVEPs obtained following stimulation with 30' check sizes from 155 consecutive patients (310 eyes) over a 2 year period were analyzed. At each of the 3 recording sites, the peak amplitude of P100 was calculated as N75-P100, P100-N145, and the sum of N75-P100 and P100-N145. There was a statistically significant difference between the electrode sites for all 3 methods of amplitude measurement (one-way ANOVA; P < 0.0001). For each method of measurement, there was no significant difference between P100 amplitude at MO or the Inon, but a significantly reduced amplitude at MP compared to both the MO and Inion electrode sites (post hoc Scheffe, P < 0.05). The P100 amplitude was highest at the Inion in 18% of responses, including cases where the amplitude at that site was at least twice that at MO. In no case was the amplitude highest at MP. Our results indicate that the Inion is a better recording site compared to MP when acquiring PRVEPs, is often complementary to MO, and should be the first additional site to be used when extra channels are available.

Frontal negativity of pattern-reversal visual evoked potentials in humans

We investigated the nature of negative potential in the frontal region with an approximate latency of 100 ms ('frontal negativity') as a component of pattern-reversal visual evoked potential (PVEP) in healthy human subjects. It was recorded by stimulation of one-half of the visual field, with different reference electrodes and with experimental manipulations of the stimulating visual field ('central scotomata' and 'peripheral constriction'). A negative potential field was demonstrated to be localized in the frontal region, and its physiological properties detected by the visual field manipulations were shown to be different from those of the occipital positive (P100) and negative (N105) components of PVEP. We conclude, therefore, that frontal negativity of PVEP is an actual electrical event generated in the frontal region, independent of P100 and N105.

The clinical significance of the bifid or "W" pattern reversal visual evoked potential

Although the visual evoked potential (VEP) to an alternating checkerboard stimulus is usually recorded from the occipital midline as an N-P-N complex with a major positive deflection at 100 ms (P100), a wave form exhibiting a P-N-P or "W" morphology is occasionally encountered and its interpretation is the source of some controversy. A retrospective chart review identified 15 patients exhibiting the "W" VEP. This represented 7.6 percent of 197 VEP studies and 5.1 percent of 394 eyes. The response was encountered in 1.7 percent of 57 normal patients and 21.4 percent of 56 patients with definite, probable or possible multiple sclerosis (P less than .001). The "W" response was considered normal in only one patient. Of the remaining 14 cases, 13 had definite, probable or possible MS and one had ischemic optic neuropathy. It is concluded that the "W" VEP is an aberrant response that is rarely seen in normals and may have the same significance as a delayed P100 latency.

Power spectrum and optimal filtering for visual evoked potentials to pattern reversal

The optimal bandwidth for recording the visual evoked potential (VEP) to pattern reversal was investigated in 8 normal subjects by re-analyzing off-line data recorded on tape using an open bandwidth of 0.1 Hz-3 kHz. Power spectral analysis of the VEP revealed little energy above 50 Hz. With digital filtering, the amplitude N70-P100 was significantly attenuated only when the low-pass filter was reduced to 50 Hz or when the high-pass filter was raised to 8 Hz. With analogue filtering, there was significant prolongation of latency of P100 when the low-pass filter (12 dB/octave) was reduced to 250 Hz and a significant decrease in latency when the high-pass filter (6 dB/octave) exceeded 3 Hz. However, the effects of analogue filtering were not uniform across subjects: in 2 subjects the latency of P100 was prolonged using a low-pass filter of 600 Hz and in 2 other subjects the latency was shortened when the 1 Hz high-pass filter was introduced. If a restricted bandwidth is used, non-uniform distortion of latency could make a significant contribution to the variability in latency of P100. The optimal bandwidth is one which minimises this contribution to the variability, 0.3 Hz to greater than 600 Hz.

ERP study of the development of the holistic and analytic modes of processing between 6 and 8 years

Event-related potentials (ERPs) were recorded (01, 02, Fcz, Cpz leads) from 32 normal children aged from 6 to 8 years during a categorisation task performed with 4 types of stimuli that allowed for a holistic and/or an analytic development to modify information processing according to the child's age. Whatever age, derivation or stimulus, the individual ERPs showed a large negative N2 wave (mean latency: 230 ms) made up of two widely overlapping components. In order to separate these components, an initial principal component analysis (PCA) was performed on the waveforms; this PCA provided a principal component that accounted for the amplitude difference between the first negative peak of the N2 wave (180 ms after stimulus onset) and the subsequent slope change. A second PCA was then carried out on the corresponding individual component scores; this second PCA provided two factors according to whether the stimuli were holistically or analytically processed. Regarding the pre- and post-vertex data (Fcz and Cpz), these two factors accounted for the same ERP effect for the 6-year-old children but opposite effects after the age of seven. We interpreted this change as reflecting the differentiation of specific - holistic and analytic - modes of processing from a non-specific mode after the establishment of the concrete operation period.