Event-Related Potentials as Biomarkers of Behavior Change Mechanisms in Substance Use Disorder Treatment

Evaluation of Event-Related Potentials in Somatic Diseases - Systematic Review

Many somatic illnesses (e.g. hypertension, diabetes, pulmonary and cardiac diseases, hepatitis C, kidney and heart failure, HIV infection, Sjogren's disease) may impact central nervous system functions resulting in emotional, sensory, cognitive or even personality impairments. Event-related potential (ERP) methodology allows for monitoring neurocognitive processes and thus can provide a valuable window into these cognitive processes that are influenced, or brought about, by somatic disorders. The current review aims to present published studies on the relationships between somatic illness and brain function as assessed with ERP methodology, with the goal to discuss where this field of study is right now and suggest future directions.

Updated Perspectives on the Neurobiology of Substance Use Disorders Using Neuroimaging

Substance use problems impair social functioning, academic achievement, and employability. Psychological, biological, social, and environmental factors can contribute to substance use disorders. In recent years, neuroimaging breakthroughs have helped elucidate the mechanisms of substance misuse and its effects on the brain. Functional magnetic resonance imaging (MRI), positron emission tomography (PET), single-photon emission computed tomography (SPECT), and magnetic resonance spectroscopy (MRS) are all examples. Neuroimaging studies suggest substance misuse affects executive function, reward, memory, and stress systems. Recent neuroimaging research attempts have provided clinicians with improved tools to diagnose patients who misuse substances, comprehend the complicated neuroanatomy and neurobiology involved, and devise individually tailored and monitorable treatment regimens for individuals with substance use disorders. This review describes the most recent developments in drug misuse neuroimaging, including the neurobiology of substance use disorders, neuroimaging, and substance use disorders, established neuroimaging techniques, recent developments with established neuroimaging techniques and substance use disorders, and emerging clinical neuroimaging technology.

Machine learning in biosignals processing for mental health: A narrative review

Machine Learning (ML) offers unique and powerful tools for mental health practitioners to improve evidence-based psychological interventions and diagnoses. Indeed, by detecting and analyzing different biosignals, it is possible to differentiate between typical and atypical functioning and to achieve a high level of personalization across all phases of mental health care. This narrative review is aimed at presenting a comprehensive overview of how ML algorithms can be used to infer the psychological states from biosignals. After that, key examples of how they can be used in mental health clinical activity and research are illustrated. A description of the biosignals typically used to infer cognitive and emotional correlates (e.g., EEG and ECG), will be provided, alongside their application in Diagnostic Precision Medicine, Affective Computing, and brain-computer Interfaces. The contents will then focus on challenges and research questions related to ML applied to mental health and biosignals analysis, pointing out the advantages and possible drawbacks connected to the widespread application of AI in the medical/mental health fields. The integration of mental health research and ML data science will facilitate the transition to personalized and effective medicine, and, to do so, it is important that researchers from psychological/ medical disciplines/health care professionals and data scientists all share a common background and vision of the current research.

Acute sensitization of the P3 event-related potential response to beverage images and the risk for alcohol use disorder

Previous research suggests the amplitude of the P3 event-related potential (ERP) response reflects the incentive value of the eliciting stimulus, and that individuals with trait-like lower sensitivity (LS) to the acute effects of alcohol, a potent risk factor for alcohol use disorder (AUD), tend to show exaggerated P3 ERP responses to alcohol beverage cues (compared to their peers with higher sensitivity; HS). No prior research has examined trajectories of the cue-elicited P3 response across repeated trials of nonreinforced cue presentations. Characterizing these trajectories can be informative as to potential mechanisms linking LS with increased AUD risk. Here, we tested whether individual differences in alcohol sensitivity are associated with different trial-by-trial trajectories of the P3 elicited by alcohol and nonalcohol reward cues (infrequent oddball/target stimuli) using a large sample of emerging adults (M _age = 19.53; N = 287; 55% female; 86% White; 90% right-handed) stratified for alcohol sensitivity. Multilevel models adjusted for age, sex, handedness, and alcohol use indicated that: (i) the P3 response to alcohol and nonalcohol reward cues alike sensitized (i.e., increased) across trials; (ii) across the task, the P3 response to alcohol cues was larger for the LS than the HS phenotype; and (iii) the P3 difference score (alcohol - nonalcohol) was larger for the LS than HS phenotype only across the first half of task. Findings suggest that whereas incentive value attribution may be a mechanism for alcohol cue-triggered attentional biases for both LS and HS individuals, LS individuals more consistently over-attribute incentive value to alcohol cues.

A scoping review of electroencephalographic (EEG) markers for tracking neurophysiological changes and predicting outcomes in substance use disorder treatment

Substance use disorders (SUDs) constitute a growing global health crisis, yet many limitations and challenges exist in SUD treatment research, including the lack of objective brain-based markers for tracking treatment outcomes. Electroencephalography (EEG) is a neurophysiological technique for measuring brain activity, and although much is known about EEG activity in acute and chronic substance use, knowledge regarding EEG in relation to abstinence and treatment outcomes is sparse. We performed a scoping review of longitudinal and pre-post treatment EEG studies that explored putative changes in brain function associated with abstinence and/or treatment in individuals with SUD. Following PRISMA guidelines, we identified studies published between January 2000 and March 2022 from online databases. Search keywords included EEG, addictive substances (e.g., alcohol, cocaine, methamphetamine), and treatment related terms (e.g., abstinence, relapse). Selected studies used EEG at least at one time point as a predictor of abstinence or other treatment-related outcomes; or examined pre- vs. post-SUD intervention (brain stimulation, pharmacological, behavioral) EEG effects. Studies were also rated on the risk of bias and quality using validated instruments. Forty-four studies met the inclusion criteria. More consistent findings included lower oddball P3 and higher resting beta at baseline predicting negative outcomes, and abstinence-mediated longitudinal decrease in cue-elicited P3 amplitude and resting beta power. Other findings included abstinence or treatment-related changes in late positive potential (LPP) and N2 amplitudes, as well as in delta and theta power. Existing studies were heterogeneous and limited in terms of specific substances of interest, brief times for follow-ups, and inconsistent or sparse results. Encouragingly, in this limited but maturing literature, many studies demonstrated partial associations of EEG markers with abstinence, treatment outcomes, or pre-post treatment-effects. Studies were generally of good quality in terms of risk of bias. More EEG studies are warranted to better understand abstinence- or treatment-mediated neural changes or to predict SUD treatment outcomes. Future research can benefit from prospective large-sample cohorts and the use of standardized methods such as task batteries. EEG markers elucidating the temporal dynamics of changes in brain function related to abstinence and/or treatment may enable evidence-based planning for more effective and targeted treatments, potentially pre-empting relapse or minimizing negative lifespan effects of SUD.

Electrophysiological responses to emotional and cocaine cues reveal individual neuroaffective profiles in cocaine users

Smokers with stronger neuroaffective responses to drug-related cues compared to nondrug-related pleasant images (C > P) are more vulnerable to compulsive smoking than individuals with the opposite brain reactivity profile (P > C). However, it is unknown if these neurobehavioral profiles exist in individuals abusing other drugs. We tested whether individuals with cocaine use disorder (CUD) show similar neuroaffective profiles to smokers. We also monitored eye movements to assess attentional bias toward cues and we further performed exploratory analyses on demographics, personality, and drug use between profiles. Participants with CUD (n = 43) viewed pleasant, unpleasant, cocaine, and neutral images while we recorded electroencephalogram. For each picture category, we computed the amplitude of the late positive potential (LPP), an event-related potential component that reflects motivational relevance. k-means clustering classified participants based on their LPP responses. In line with what has been observed in smokers, clustering participants using LPP responses revealed the presence of two groups: one with larger LPPs to pleasant images compared to cocaine images (P > C) and one group with larger LPPs to cocaine images compared to pleasant images (C > P). Individuals with the C > P reactivity profile also had higher attentional bias toward drug cues. The two groups did not differ on demographic and drug use characteristics, however individuals with the C > P profile reported lower distress tolerance, higher anhedonia, and higher posttraumatic stress symptoms compared to the P > C group. This is the first study to report the presence of these neuroaffective profiles in individuals with CUD, indicating that this pattern may cut across addiction populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A review of functional brain differences predicting relapse in substance use disorder: Actionable targets for new methods of noninvasive brain stimulation

Neuroimaging studies have identified a variety of brain regions whose activity predicts substance use (i.e., relapse) in patients with substance use disorder (SUD), suggesting that malfunctioning brain networks may exacerbate relapse. However, this knowledge has not yet led to a marked improvement in treatment outcomes. Noninvasive brain stimulation (NIBS) has shown some potential for treating SUDs, and a new generation of NIBS technologies offers the possibility of selectively altering activity in both superficial and deep brain structures implicated in SUDs. The goal of the current review was to identify deeper brain structures involved in relapse to SUD and give an account of innovative methods of NIBS that might be used to target them. Included studies measured fMRI in currently abstinent SUD patients and tracked treatment outcomes, and fMRI results were organized with the framework of the Addictions Neuroclinical Assessment (ANA). Four brain structures were consistently implicated: the anterior and posterior cingulate cortices, ventral striatum and insula. These four deeper brain structures may be appropriate future targets for the treatment of SUD using these innovative NIBS technologies.

Topiramate decreases the salience of motivationally relevant visual cues among smokers with alcohol use disorder

BACKGROUND

There is preliminary evidence that the anticonvulsant topiramate increases the likelihood of both smoking and alcohol abstinence among smokers with alcohol use disorder (AUD), but its therapeutic mechanism has not been determined. We used event-related potentials (ERPs) to evaluate topiramate's effect on the salience of drug-related, emotional, and neutral pictorial cues to identify whether one of its potential therapeutic mechanisms involves reduction of the salience of motivationally relevant cues.

METHODS

Participants enrolled in a multisite clinical trial treating smokers with AUD were randomly assigned to receive placebo, low-dose topiramate (up to 125 mg/day), or high-dose topiramate (up to 250 mg/day), along with brief behavioral compliance enhancement treatment. A subsample (n = 101) completed ERP assessments at baseline (1 week pre-medication) and week 5 (5 weeks on medication; 1 week pre-quit). We assessed the salience of pleasant, unpleasant, cigarette-related, alcohol-related, and neutral pictorial cues using the late positive potential (LPP) ERP component and measured self-reported substance use, reinforcement, craving, and withdrawal.

RESULTS

Five weeks of high-dose topiramate treatment decreased LPP amplitudes in response to both emotional (pleasant and unpleasant) and drug-related cues (alcohol and cigarette), but not to neutral cues. However, results showed that the LPPs were not significant mediators of the relationship between topiramate dose and post-quit measures of substance use, reinforcement, craving, or withdrawal.

CONCLUSIONS

These findings suggest that high-dose topiramate (up to 250 mg/day) decreases the motivational salience of both drug-related and emotional cues among smokers with AUD. However, the nonsignificant mediation analyses preclude any firm conclusions about whether this effect represents one of topiramate's therapeutic mechanisms of action.

Test-Retest Reliability of Event-Related Potentials Across Three Tasks

Abstract. Event-related potentials (ERPs) constitute a useful and cost-effective method to assess the neural underpinnings of multiple cognitive processes. ERPs have been used to track changes in cognitive processes in longitudinal and clinical studies. However, few studies have assessed their test-retest reliability (i.e., their consistency across time). Therefore, in the current study, we aimed to assess the test-retest reliability of ERPs (P100, N100, P200, N200, P3b, lateralized readiness potentials) across three tasks. In two assessments separated by approximately 4 months, ERPs were recorded in 26 healthy participants, during two oddball tasks (motor and counting) and a stimulus-response compatibility paradigm. Pearson’s correlations and intraclass correlations were used to assess the test-retest reliability of ERPs. Correlations between ERPs elicited by the three tasks were assessed with Pearson’s correlations. Our analyses revealed moderate to very strong test-retest reliability for most ERP components across the three tasks. Test-retest reliability did not differ between the motor and counting oddball tasks. Most ERPs were also correlated across paradigms. Therefore, these results confirm that ERPs have the potential to be reliable markers to serve as robust assessment tools in longitudinal or clinical studies.

Response inhibition alterations in migraine: evidence from event-related potentials and evoked oscillations

BACKGROUND

Migraine is characterized by a hypersensitivity to environmental stimulation which climaxes during headache attacks but persists during attack-free period. Despite ongoing debates about the nature of the mechanisms giving rise to this abnormality, the presence of deficient inhibitory cortical processes has been proposed to be one possible mechanism underlying its pathogenesis. Empirical evidence supporting this claim is mainly based on previous accounts showing functional cortical disexcitability in the sensory domain. Considering that a general inhibitory control process can play an important role across early to later stage of information processing, this may indicate the important role other dimensions of inhibitory control can play in migraine disability. The present study examined the pathophysiological features of inhibitory control that takes place during suppression of prepotent responses in migraineurs.

METHODS

Twenty-two patients with migraine without aura (mean age = 30.86 ± 5.69 years; 19 females) during the interictal period and 25 healthy controls (mean age = 30.24 ± 3.52 years; 18 females) were recruited. We used a stop signal task in combination with event-related potentials (ERPs) to examine participants' neural activity supporting response inhibition.

RESULTS

Behaviorally, migraineurs exhibited prolonged stop signal reaction times relative to healthy controls. At the neural level, the amplitude of the stop-N2 over fronto-central, central and centro-parietal scalp regions, a component of the ERPs related to conflict monitoring during early, non-motoric stages of inhibition, was significantly increased in migraineurs. Meanwhile, the amplitude of the stop-P3 over central and centro-parietal scalp regions, a component of the ERPs reflecting late-stage inhibition of the motor system and cognitive evaluation of motor inhibition, was also significantly increased in migraineurs. Ultimately, our time-frequency analysis further revealed increased delta activity in migraineurs.

CONCLUSIONS

Consistent with the theory that alterations in cognitive cortical processes are a key signature of migraine, our findings revealed an abnormal state of suppressing prepotent responses in migraineurs, which can be attributed to cortical disexcitability of the pre-frontal executive network and centro-parietal sensorimotor network. These novel findings extend to show the existence of dysfunctional inhibition control that occurs during suppression of prepotent responses in migraneurs.

Predictors of chronicity in alcohol use disorder: an evoked response potential study

INTRODUCTION

Evoked response potentials (ERP) can reliably map key neurocognitive processes which are putatively responsible for chronic alcohol use disorder (AUD). Aim of the present study was to study P300 auditory odd ball and N400 visual semantic incongruity paradigm mapping executive functions rubric as a potential biomarker predicting chronicity in AUDs. Methodology: 60 right handed 18 to 54 years age subjects were divided into chronic "CAD" and non chronic alcohol dependence "NAD" in addition to healthy control "HC" (N = 30). Subjects were assessed by Addiction Severity Index (ASI), P300 auditory odd ball paradigm in midline region and visual N400 semantic incongruity task in centro-parietal region in a cross sectional design. Results: All the three groups differed significantly for P300 and N400 amplitude in all the leads with maximum attenuation seen in CAD. On discriminant function analysis (DFA), P300 Pz and N 400 C2 amplitude values could accurately classified 78.3% subjects. Composite sensitivity and specificity of the two predictor variables differentiating CAD subjects from NAD were 79.31 and 77.41%. receiver operating characteristic curve generated an area under the curve of .758 and .847 i.e., "fair to good" ability to predict CAD from NAD. Conclusion: We conclude that specific ERP paradigm can be used as a state marker to map the cognitive deficits and as a biomarker to detect chronic AUDs.

Modeling neuroaffective biomarkers of drug addiction: A Bayesian nonparametric approach using dirichlet process mixtures

BACKGROUND

The properties of neurophysiological processes related to addiction have received much attention in the literature. However, empirical evidence of meaningful and useful characterization of these processes is limited. Recent studies have found that electrophysiological responses to emotional and drug-related cues can be used to create profiles that reliably predict smoking relapse.

NEW METHOD

This paper evaluates the validity of classifying electrophysiological responses into distinct profiles using a Bayesian dirichlet process mixture (DPM) model. The DPM is a Bayesian nonparametric (BNP) method to modeling unknown number of profiles characterized by uncertainty in cluster membership and in cluster number.

RESULTS

The DPM model confirmed previously identified neuroaffective reactivity profiles, but also revealed a finer level of granularity in the clustering. Specifically, in addition to the two clusters previously identified in the literature, the BNP methods identified a cluster of individuals showing similar responses to smoking, pleasant, neutral and unpleasant cues.

COMPARISON WITH EXISTING METHODS

BNP models provide an alternative to the k-mean clustering approach to modeling EEG-based neuroaffective profiles. Unlike k-means clustering, BNP models compute the probability that a subject belongs to a cluster while taking into consideration uncertainty in the number of clusters.

CONCLUSIONS

Our results confirm the reliability of the two clusters previously identified in these data, but also provide new insights by revealing a cluster that presented similar responses to stimuli with different contents. This finding may be related to the uncertainty in classification or overlapping brain-reactivity profiles.

Can we boost attention and inhibition in binge drinking? Electrophysiological impact of neurocognitive stimulation

RATIONALE

Binge drinking (i.e. excessive episodic alcohol consumption) among young adults has been associated with deleterious consequences, notably at the cognitive and brain levels. These behavioural impairments and brain alterations have a direct impact on psychological and interpersonal functioning, but they might also be involved in the transition towards severe alcohol use disorders. Development of effective rehabilitation programs to reduce these negative effects as they emerge thus constitutes a priority in subclinical populations.

OBJECTIVES

The present study tested the behavioural and electrophysiological impact of neurocognitive stimulation (i.e. transcranial direct current stimulation (tDCS) applied during a cognitive task) to improve attention and inhibition abilities in young binge drinkers.

METHODS

Two groups (20 binge drinkers and 20 non-binge drinkers) performed two sessions in a counterbalanced order. Each session consisted of an inhibition task (i.e. Neutral Go/No-Go) while participants received left frontal tDCS or sham stimulation, immediately followed by an Alcohol-related Go/No-Go task, while both behavioural and electrophysiological measures were recorded.

RESULTS

No significant differences were observed between groups or sessions (tDCS versus sham stimulation) at the behavioural level. However, electrophysiological measurements during the alcohol-related inhibition task revealed a specific effect of tDCS on attentional resource mobilization (indexed by the N2 component) in binge drinkers, whereas later inhibition processes (indexed by the P3 component) remained unchanged in this population.

CONCLUSIONS

The present findings indicate that tDCS can modify the electrophysiological correlates of cognitive processes in binge drinking. While the impact of such brain modifications on actual neuropsychological functioning and alcohol consumption behaviours remains to be determined, these results underline the potential interest of developing neurocognitive stimulation approaches in this population.

Biomarkers and neuromodulation techniques in substance use disorders

Addictive disorders are a severe health concern. Conventional therapies have just moderate success and the probability of relapse after treatment remains high. Brain stimulation techniques, such as transcranial Direct Current Stimulation (tDCS) and Deep Brain Stimulation (DBS), have been shown to be effective in reducing subjectively rated substance craving. However, there are few objective and measurable parameters that reflect neural mechanisms of addictive disorders and relapse. Key electrophysiological features that characterize substance related changes in neural processing are Event-Related Potentials (ERP). These high temporal resolution measurements of brain activity are able to identify neurocognitive correlates of addictive behaviours. Moreover, ERP have shown utility as biomarkers to predict treatment outcome and relapse probability. A future direction for the treatment of addiction might include neural interfaces able to detect addiction-related neurophysiological parameters and deploy neuromodulation adapted to the identified pathological features in a closed-loop fashion. Such systems may go beyond electrical recording and stimulation to employ sensing and neuromodulation in the pharmacological domain as well as advanced signal analysis and machine learning algorithms. In this review, we describe the state-of-the-art in the treatment of addictive disorders with electrical brain stimulation and its effect on addiction-related neurophysiological markers. We discuss advanced signal processing approaches and multi-modal neural interfaces as building blocks in future bioelectronics systems for treatment of addictive disorders.

Neuropsychophysiological Measures of Alcohol Dependence: Can We Use EEG in the Clinical Assessment?

Addiction management is complex, and it requires a bio-psycho-social perspective, that ought to consider the multiple etiological and developmental factors. Because of this, a large amount of resources has been allocated to assess the vulnerability to dependence, i.e., to identify the processes underlying the transition from substance use to dependence, as well as its course, in order to determine the key points in its prevention, treatment, and recovery. Consequently, knowledge \from neuroscience must be taken into account, which is why different initiatives have emerged with this objective, such as the "Research Domain Criteria" (RDoC), and the "Addiction Neuroclinical Assessment" (ANA). Particularly, neuropsychophysiological measures could be used as markers of cognitive and behavioral attributes or traits in alcohol dependence, and even trace clinical change. In this way, the aim of this narrative review is to provide an overview following ANA clinical framework, to the most robust findings in neuropsychophysiological changes in alcohol dependence, that underlie the main cognitive domains implicated in addiction: incentive salience, negative emotionality, and executive functioning. The most consistent results have been found in event-related potential (ERP) analysis, especially in the P3 component, that could show a wide clinical utility, mainly for the executive functions. The review also shows the usefulness of other components, implicated in affective and substance-related processing (P1, N1, or the late positive potential LPP), as well as event-related oscillations, such as theta power, with a possible use as vulnerability or clinical marker in alcohol dependence. Finally, new tools emerging from psychophysiology research, based on functional connectivity or brain graph analysis could help toward a better understanding of altered circuits in alcohol dependence, as well as communication efficiency and effort during mental operations. This review concludes with an examination of these tools as possible markers in the clinical field and discusses methodological differences, the need for more replicability studies and incipient lines of work. It also uses consistent findings in psychophysiology to draw possible treatment targets and cognitive profiles in alcohol dependence.

The Electrical Aftermath: Brain Signals of Posttraumatic Stress Disorder Filtered Through a Clinical Lens

This review aims to identify patterns of electrical signals identified using electroencephalography (EEG) linked to posttraumatic stress disorder (PTSD) diagnosis and symptom dimensions. We filter EEG findings through a clinical lens, evaluating nuances in findings according to study criteria and participant characteristics. Within the EEG frequency domain, greater right than left parietal asymmetry in alpha band power is the most promising marker of PTSD symptoms and is linked to exaggerated physiological arousal that may impair filtering of environmental distractors. The most consistent findings within the EEG time domain focused on event related potentials (ERPs) include: 1) exaggerated frontocentral responses (contingent negative variation, mismatch negativity, and P3a amplitudes) to task-irrelevant distractors, and 2) attenuated parietal responses (P3b amplitudes) to task-relevant target stimuli. These findings suggest that some individuals with PTSD suffer from attention dysregulation, which could contribute to problems concentrating on daily tasks and goals in lieu of threatening distractors. Future research investigating the utility of alpha asymmetry and frontoparietal ERPs as diagnostic and predictive biomarkers or intervention targets are recommended.

The Neural Correlates of Implicit Cognitive Bias Toward Internet-Related Cues in Internet Addiction: An ERP Study

Internet addiction is a sort of non-psychoactive substance dependence. The Implicit Association Test (IAT) is used to measure implicit cognition. Event-related potential (ERP) is one of the most widely used methods in cognitive neuroscience research to investigate the physiological correlates of cognitive activity associated with processing information. Further investigating the ERP characteristics of implicit cognitive bias in Internet addiction would be helpful in understanding the nature of Internet addiction. This study investigated the ERP characteristics of implicit cognitive bias in Internet addiction. The participants included 60 Internet-addicted individuals (IAG) and 60 normal controls (NCG). All participants were measured with ERPs using the IAT. The results showed that there was a significant difference in the Internet-related IAT effect for reaction times between IAG and NCG, and there were stronger positive implicit associations toward Internet related cues in IAG than NCG. Using P1, N2, P3, and N4 as dependent variables, a mixed repeated-measures analysis of variance (ANOVA) on the mean latencies and mean amplitudes revealed a significant interaction between the groups (IAG vs. NCG) and stimulus condition (compatible trials vs. incompatible trials) for the N2 and P3 amplitudes; the simple effects analysis showed that the N2 and P3 amplitudes were larger under the IAG-compatible trial conditions than under the IAG-incompatible trial conditions. In the IAG group, the positive implicit associations with Internet-related cues elicited larger N2 and P3 amplitudes at the occipital lobe sites. These results indicated that Internet addictive individuals show stronger positive implicit associations toward Internet-related cues, and the positive implicit associations toward Internet-related cues elicited ERP changes at occipital lobe sites.