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Zhang H, Yao J, Xu C, Wang C. Targeting electroencephalography for alcohol dependence: A narrative review. CNS Neurosci Ther 2023; 29:1205-1212. [PMID: 36890659 PMCID: PMC10068473 DOI: 10.1111/cns.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/26/2023] [Accepted: 02/16/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Electroencephalography (EEG)-based electrophysiological techniques have made progress in diagnosing and treating alcohol dependence in recent years. AIMS The article reviews the latest literature in this field. MATERIALS AND METHODS Alcohol dependence, which is common and prone to relapsing, poses a serious threat to individuals, families, and society. At present, the objective detection methods for alcohol dependence in clinic are not enough. As electrophysiological techniques developed in psychiatry, some researches on EEG-based monitoring methods are of great significance in the diagnosis and treatment of alcohol dependence. DISCUSSION As electrophysiological techniques developed in psychiatry, some researches on EEG-based monitoring methods such as resting electroencephalography (REEG), event-related potentials (ERP), event-related oscillations (ERO), and polysomnography (PSG), was reported. CONCLUSION In this paper, the status of electrophysiological researches on EEG in alcoholics are reviewed in detail.
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Affiliation(s)
- Huiwen Zhang
- Department of Anaesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China.,Department of Anaesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiahui Yao
- Department of Anaesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Cheng Xu
- Department of Anaesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chengyu Wang
- Department of Anaesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
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2
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Shen M, Wen P, Song B, Li Y. Detection of alcoholic EEG signals based on whole brain connectivity and convolution neural networks. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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3
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Mugruza-Vassallo CA, Granados-Domínguez JL, Flores-Benites V, Córdova-Berríos L. Different Markov chains modulate visual stimuli processing in a Go-Go experiment in 2D, 3D, and augmented reality. Front Hum Neurosci 2022; 16:955534. [PMID: 36569471 PMCID: PMC9769205 DOI: 10.3389/fnhum.2022.955534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022] Open
Abstract
The introduction of Augmented Reality (AR) has attracted several developments, although the people's experience of AR has not been clearly studied or contrasted with the human experience in 2D and 3D environments. Here, the directional task was applied in 2D, 3D, and AR using simplified stimulus in video games to determine whether there is a difference in human answer reaction time prediction using context stimulus. Testing of the directional task adapted was also done. Research question: Are the main differences between 2D, 3D, and AR able to be predicted using Markov chains? Methods: A computer was fitted with a digital acquisition card in order to record, test and validate the reaction time (RT) of participants attached to the arranged RT for the theory of Markov chain probability. A Markov chain analysis was performed on the participants' data. Subsequently, the way certain factors influenced participants RT amongst the three tasks time on the accuracy of the participants was sought in the three tasks (environments) were statistically tested using ANOVA. Results: Markov chains of order 1 and 2 successfully reproduced the average reaction time by participants in 3D and AR tasks, having only 2D tasks with the variance predicted with the current state. Moreover, a clear explanation of delayed RT in every environment was done. Mood and coffee did not show significant differences in RTs on a simplified videogame. Gender differences were found in 3D, where endogenous directional goals are in 3D, but no gender differences appeared in AR where exogenous AR buttons can explain the larger RT that compensate for the gender difference. Our results suggest that unconscious preparation of selective choices is not restricted to current motor preparation. Instead, decisions in different environments and gender evolve from the dynamics of preceding cognitive activity can fit and improve neurocomputational models.
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Affiliation(s)
| | | | - Victor Flores-Benites
- Facultad de Ingeniería y Arquitectura, Universidad de Lima, Lima, Peru
- Universidad de Ingeniería y Tecnología (UTEC), Lima, Peru
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4
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Liu Y, Chen Y, Fraga-González G, Szpak V, Laverman J, Wiers RW, Richard Ridderinkhof K. Resting-state EEG, Substance use and Abstinence After Chronic use: A Systematic Review. Clin EEG Neurosci 2022; 53:344-366. [PMID: 35142589 DOI: 10.1177/15500594221076347] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Resting-state EEG reflects intrinsic brain activity and its alteration represents changes in cognition that are related to neuropathology. Thereby, it provides a way of revealing the neurocognitive mechanisms underpinning chronic substance use. In addition, it is documented that some neurocognitive functions can recover following sustained abstinence. We present a systematic review to synthesize how chronic substance use is associated with resting-state EEG alterations and whether these spontaneously recover from abstinence. A literature search in Medline, PsycINFO, Embase, CINAHL, Web of Science, and Scopus resulted in 4088 articles, of which 57 were included for evaluation. It covered the substance of alcohol (18), tobacco (14), cannabis (8), cocaine (6), opioids (4), methamphetamine (4), and ecstasy (4). EEG analysis methods included spectral power, functional connectivity, and network analyses. It was found that long-term substance use with or without substance use disorder diagnosis was associated with broad intrinsic neural activity alterations, which were usually expressed as neural hyperactivation and decreased neural communication between brain regions. Some studies found the use of alcohol, tobacco, cocaine, cannabis, and methamphetamine was positively correlated with these changes. These alterations can partly recover from abstinence, which differed between drugs and may reflect their neurotoxic degree. Moderating factors that may explain results inconsistency are discussed. In sum, resting-state EEG may act as a potential biomarker of neurotoxic effects of chronic substance use. Recovery effects awaits replication in larger samples with prolonged abstinence. Balanced sex ratio, enlarged sample size, advanced EEG analysis methods, and transparent reporting are recommended for future studies.
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Affiliation(s)
- Yang Liu
- 12544Department of Psychology, School of Education, Shanghai Normal University, Shanghai, China
| | - Yujie Chen
- 12544Department of Psychology, School of Education, Shanghai Normal University, Shanghai, China
| | - Gorka Fraga-González
- 27217Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Veronica Szpak
- 1234Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Judith Laverman
- 1234Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Reinout W Wiers
- 1234Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology and Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
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5
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Martínez-Maldonado A, Rubio G, Sion A, Jurado-Barba R. Brain oscillatory functioning after long-term alcohol abstinence. Int J Psychophysiol 2022; 177:240-248. [PMID: 35662565 DOI: 10.1016/j.ijpsycho.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
The heterogeneity of the population with alcohol use disorder (AUD) sometimes makes the knowledge generated in areas such as neuroscience appear to be contradictory. One aspect that may help elucidate this apparent contradiction is controlling for certain variables that are not usually controlled, such as the abstinence time in people with AUD. This research aims to study the neuroelectrical oscillations in people with AUD with longer and shorter abstinence time in comparison with healthy individuals. We recruited twenty-nine individuals with AUD with abstinence time longer than fifteen days and shorter than six months (STA), twenty-six individuals with AUD with abstinence time longer than six months and shorter than thirteen months (LTA), and sixteen healthy individuals (HC). All participants underwent electroencephalographic recording in resting-state with eyes closed. The oscillatory activity obtained was analyzed to obtain the spectral power and phase synchronization level. Regarding the obtained spectral power results, these revealed that the STA group showed higher theta band power and lower alpha band power than the LTA and HC groups. The obtained results at the phase synchronization level also show two main results. On the one hand, the STA group showed lower alpha band phase synchronization than the LTA and HC groups. On the other hand, the HC group showed higher beta band phase synchronization than the STA and LTA groups. In conclusion, the obtained results reflect that abstinence maintenance for six or more months appears to produce an important oscillatory brain functioning normalization in people with AUD.
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Affiliation(s)
- Andrés Martínez-Maldonado
- Biomedical Research Institute Hospital 12 de Octubre, Av. Cordoba, no number, 28041 Madrid, Spain; Psychology Department, Faculty of Education & Health, Camilo José Cela University, Urb. Villafranca del Castillo, Rd. Castillo de Alarcón, 49, 28692 Villanueva de la Cañada, Madrid, Spain.
| | - Gabriel Rubio
- Biomedical Research Institute Hospital 12 de Octubre, Av. Cordoba, no number, 28041 Madrid, Spain; Faculty of Medicine, The Complutense University of Madrid, Rd. Ramón y Cajal, no number, 28040 Madrid, Spain; Addictive Diseases Network, Carlos III Health Institute, Rd. Sinesio Delgado, 4, 28029 Madrid, Spain
| | - Ana Sion
- Addictive Diseases Network, Carlos III Health Institute, Rd. Sinesio Delgado, 4, 28029 Madrid, Spain; Psychobiology and Behavioral Sciences Department, Faculty of Psychology, The Complutense University of Madrid, The Somosaguas Campus, Pozuelo de Alarcón, no number, 28223 Madrid, Spain
| | - Rosa Jurado-Barba
- Biomedical Research Institute Hospital 12 de Octubre, Av. Cordoba, no number, 28041 Madrid, Spain; Psychology Department, Faculty of Education & Health, Camilo José Cela University, Urb. Villafranca del Castillo, Rd. Castillo de Alarcón, 49, 28692 Villanueva de la Cañada, Madrid, Spain
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6
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Khan DM, Yahya N, Kamel N, Faye I. Effective Connectivity in Default Mode Network for Alcoholism Diagnosis. IEEE Trans Neural Syst Rehabil Eng 2021; 29:796-808. [PMID: 33900918 DOI: 10.1109/tnsre.2021.3075737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Alcohol Use Disorder (AUD) is a chronic relapsing brain disease characterized by excessive alcohol use, loss of control over alcohol intake, and negative emotional states under no alcohol consumption. The key factor in successful treatment of AUD is the accurate diagnosis for better medical and therapy management. Conventionally, for individuals to be diagnosed with AUD, certain criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) should be met. However, this process is subjective in nature and could be misleading due to memory problems and dishonesty of some AUD patients. In this paper, an assessment scheme for objective diagnosis of AUD is proposed. For this purpose, EEG recording of 31 healthy controls and 31 AUD patients are used for the calculation of effective connectivity (EC) between the various regions of the brain Default Mode Network (DMN). The EC is estimated using partial directed coherence (PDC) which are then used as input to a 3D Convolutional Neural Network (CNN) for binary classification of AUD cases. Using 5-fold cross validation, the classification of AUD vs. HC effective connectivity matrices using the proposed 3D-CNN gives an accuracy of 87.85 ± 4.64 %. For further validation, 32 and 30 subjects are randomly selected for training and testing, respectively, giving 100% correct classification of all the testing subjects.
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7
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Kim BM, Kim MS, Kim JS. Alterations of Functional Connectivity During the Resting State and Their Associations With Visual Memory in College Students Who Binge Drink. Front Hum Neurosci 2021; 14:600437. [PMID: 33424567 PMCID: PMC7793784 DOI: 10.3389/fnhum.2020.600437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022] Open
Abstract
This study investigated the characteristics of neural oscillation and functional connectivity (FC) in college students engaging in binge drinking (BD) using resting-state electroencephalography (EEG). Also, the associations of visual memory, evaluated by the Rey-Osterrieth Complex Figure Test (RCFT), and neural oscillation with FC during the resting state were investigated. The BD (n = 35) and non-BD (n = 35) groups were selected based on scores of the Korean version of the Alcohol use disorders (AUDs) Identification Test and the Alcohol Use Questionnaire. EEG was performed for 6 min while the participants rested with eyes closed. The theta, lower-alpha, and upper alpha powers did not differ between the BD and non-BD groups. Concerning FC, the BD group exhibited stronger theta coherence than that of the non-BD group, and in the lower and upper alpha bands, the BD group showed stronger coherence in some areas but weaker coherence in others compared with the non-BD group. However, these significant results were not observed after Bonferroni correction. The BD group showed significantly lower delayed recall scores on the RCFT than did the non-BD group. A positive correlation between the left prefrontal-parietal-occipital midline connection and performance on the delayed recall of the RCFT was observed in the BD group. The present results could suggest that binge drinkers have alterations in brain FC, which may be related to their visual memory deficits.
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Affiliation(s)
- Bo-Mi Kim
- Department of Psychology, Sungshin Women's University, Seoul, South Korea
| | - Myung-Sun Kim
- Department of Psychology, Sungshin Women's University, Seoul, South Korea
| | - June Sic Kim
- Research Institute of Basic Sciences, Seoul National University, Seoul, South Korea
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8
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The Role of Gamma Oscillations in the Pathophysiology of Substance Use Disorders. J Pers Med 2020; 11:jpm11010017. [PMID: 33379187 PMCID: PMC7824040 DOI: 10.3390/jpm11010017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/17/2022] Open
Abstract
Substance use disorders (SUDs) are a major public health problem—with over 200 million people reporting drug use in 2016. Electroencephalography (EEG) is a powerful tool that can provide insights into the impact of SUDs on cognition. Specifically, modulated gamma activity may provide an index of the pathophysiology of SUDs. Thus, the purpose of this review was to investigate the impact of alcohol, tobacco, cannabis, cocaine, and amphetamine on gamma activity, among pre-clinical and clinical populations during acute and chronic exposure and withdrawal states. We searched multiple databases for key terms related to SUDs, EEG, and gamma and ensured rigorous methods by using a standardized review reporting tool. We included 30 studies in this review and found that all substances were associated with modulation of gamma activity, across states and in both preclinical and clinical populations. Gamma oscillations appeared to be differentially modulated in clinical versus preclinical populations and had the most complex relationship with alcohol, indicating that it may act differently than other substances. The findings of this review offer insights into the pathophysiology of SUDs, providing a potential window into novel treatments for SUDs via modulation of gamma activity.
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9
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COMT Inhibition Alters Cue-Evoked Oscillatory Dynamics during Alcohol Drinking in the Rat. eNeuro 2018; 5:eN-NWR-0326-18. [PMID: 30406194 PMCID: PMC6220588 DOI: 10.1523/eneuro.0326-18.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022] Open
Abstract
Alterations in the corticostriatal system have been implicated in numerous substance use disorders, including alcohol use disorder (AUD). Adaptations in this neural system are associated with enhanced drug-seeking behaviors following exposure to cues predicting drug availability. Therefore, understanding how potential treatments alter neural activity in this system could lead to more refined and effective approaches for AUD. Local field potentials (LFPs) were acquired simultaneously in the prefrontal cortex (PFC) and nucleus accumbens (NA) of both alcohol preferring (P) and Wistar rats engaged in a Pavlovian conditioning paradigm wherein a light cue signaled the availability of ethanol (EtOH). On test days, the catechol-o-methyl-transferase (COMT) inhibitor tolcapone was administered prior to conditioning. Stimulus-evoked voltage changes were observed following the presentation of the EtOH cue in both strains and were most pronounced in the PFC of P rats. Phase analyses of LFPs in the θ band (5–11 Hz) revealed that PFC-NA synchrony was reduced in P rats relative to Wistars but was robustly increased during drinking. Presentation of the cue resulted in a larger phase reset in the PFC of P rats but not Wistars, an effect that was attenuated by tolcapone. Additionally, tolcapone reduced cued EtOH intake in P rat but not Wistars. These results suggest a link between corticostriatal synchrony and genetic risk for excessive drinking. Moreover, inhibition of COMT within these systems may result in reduced attribution of salience to reward paired stimuli via modulation of stimulus-evoked changes to cortical oscillations in genetically susceptible populations.
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10
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Affan RO, Huang S, Cruz SM, Holcomb LA, Nguyen E, Marinkovic K. High-intensity binge drinking is associated with alterations in spontaneous neural oscillations in young adults. Alcohol 2018; 70:51-60. [PMID: 29778070 DOI: 10.1016/j.alcohol.2018.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/04/2018] [Accepted: 01/04/2018] [Indexed: 01/07/2023]
Abstract
Heavy episodic alcohol consumption (also termed binge drinking) contributes to a wide range of health and cognitive deficits, but the associated brain-based indices are poorly understood. The current study used electroencephalography (EEG) to examine spontaneous neural oscillations in young adults as a function of quantity, frequency, and the pattern of their alcohol consumption. Sixty-one young adults (23.4 ± 3.4 years of age) were assigned to binge drinking (BD) and light drinking (LD) groups that were equated on gender, race/ethnic identity, age, educational background, and family history of alcoholism. EEG activity was recorded during eyes-open and eyes-closed resting conditions. Each participant's alpha peak frequency (APF) was used to calculate absolute power in individualized theta and alpha frequency bands, with a canonical frequency range used for beta. APF was slower by 0.7 Hz in BD, especially in individuals engaging in high-intensity drinking, but there were no changes in alpha power. BD also exhibited higher frontal theta and beta power than LD. Alpha slowing and increased theta power in BD remained after accounting for depression, anxiety, and personality characteristics, while elevated beta power covaried with sensation seeking. Furthermore, APF slowing and theta power correlated with various measures of alcohol consumption, including binge episodes and blackouts, but not with measures of working and episodic memory, cognitive flexibility, processing speed, or personality variables, suggesting that these physiological changes may be modulated by high-intensity alcohol intake. These results are consistent with studies of alcohol-use disorder (AUD) and support the hypothesis that binge drinking is a transitional stage toward alcohol dependence. The observed thalamocortical dysrhythmia may be indicative of an excitatory-inhibitory imbalance in BD and may potentially serve as an index of the progressive development of AUD, with a goal of informing possible interventions to minimize alcohol's deleterious effects on the brain.
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11
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An EEG-based functional connectivity measure for automatic detection of alcohol use disorder. Artif Intell Med 2018; 84:79-89. [DOI: 10.1016/j.artmed.2017.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/15/2017] [Accepted: 11/10/2017] [Indexed: 01/29/2023]
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12
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Mumtaz W, Vuong PL, Malik AS, Rashid RBA. A review on EEG-based methods for screening and diagnosing alcohol use disorder. Cogn Neurodyn 2017; 12:141-156. [PMID: 29564024 DOI: 10.1007/s11571-017-9465-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/20/2017] [Accepted: 11/29/2017] [Indexed: 01/28/2023] Open
Abstract
The screening test for alcohol use disorder (AUD) patients has been of subjective nature and could be misleading in particular cases such as a misreporting the actual quantity of alcohol intake. Although the neuroimaging modality such as electroencephalography (EEG) has shown promising research results in achieving objectivity during the screening and diagnosis of AUD patients. However, the translation of these findings for clinical applications has been largely understudied and hence less clear. This study advocates the use of EEG as a diagnostic and screening tool for AUD patients that may help the clinicians during clinical decision making. In this context, a comprehensive review on EEG-based methods is provided including related electrophysiological techniques reported in the literature. More specifically, the EEG abnormalities associated with the conditions of AUD patients are summarized. The aim is to explore the potentials of objective techniques involving quantities/features derived from resting EEG, event-related potentials or event-related oscillations data.
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Affiliation(s)
- Wajid Mumtaz
- 1Department of Electrical and Electronic Engineering, Center for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS, 32610 Seri Iskandar, Perak Malaysia
| | - Pham Lam Vuong
- 1Department of Electrical and Electronic Engineering, Center for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS, 32610 Seri Iskandar, Perak Malaysia
| | - Aamir Saeed Malik
- 1Department of Electrical and Electronic Engineering, Center for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS, 32610 Seri Iskandar, Perak Malaysia
| | - Rusdi Bin Abd Rashid
- 2Universiti Malaya, Aras 21, Wisma R&D Universiti Malaya, Jalan Pantai Bharu, 59200 Kuala Lumpur, Malaysia
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Zanin M, Papo D. Detecting switching and intermittent causalities in time series. CHAOS (WOODBURY, N.Y.) 2017; 27:047403. [PMID: 28456157 DOI: 10.1063/1.4979046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
During the last decade, complex network representations have emerged as a powerful instrument for describing the cross-talk between different brain regions both at rest and as subjects are carrying out cognitive tasks, in healthy brains and neurological pathologies. The transient nature of such cross-talk has nevertheless by and large been neglected, mainly due to the inherent limitations of some metrics, e.g., causality ones, which require a long time series in order to yield statistically significant results. Here, we present a methodology to account for intermittent causal coupling in neural activity, based on the identification of non-overlapping windows within the original time series in which the causality is strongest. The result is a less coarse-grained assessment of the time-varying properties of brain interactions, which can be used to create a high temporal resolution time-varying network. We apply the proposed methodology to the analysis of the brain activity of control subjects and alcoholic patients performing an image recognition task. Our results show that short-lived, intermittent, local-scale causality is better at discriminating both groups than global network metrics. These results highlight the importance of the transient nature of brain activity, at least under some pathological conditions.
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Affiliation(s)
| | - David Papo
- SCALab, UMR CNRS 9193, University of Lille, Villeneuve d'Ascq, France
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Mumtaz W, Vuong PL, Xia L, Malik AS, Rashid RBA. An EEG-based machine learning method to screen alcohol use disorder. Cogn Neurodyn 2017; 11:161-171. [PMID: 28348647 PMCID: PMC5350086 DOI: 10.1007/s11571-016-9416-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 09/30/2016] [Accepted: 10/14/2016] [Indexed: 01/19/2023] Open
Abstract
Screening alcohol use disorder (AUD) patients has been challenging due to the subjectivity involved in the process. Hence, robust and objective methods are needed to automate the screening of AUD patients. In this paper, a machine learning method is proposed that utilized resting-state electroencephalography (EEG)-derived features as input data to classify the AUD patients and healthy controls and to perform automatic screening of AUD patients. In this context, the EEG data were recorded during 5 min of eyes closed and 5 min of eyes open conditions. For this purpose, 30 AUD patients and 15 aged-matched healthy controls were recruited. After preprocessing the EEG data, EEG features such as inter-hemispheric coherences and spectral power for EEG delta, theta, alpha, beta and gamma bands were computed involving 19 scalp locations. The selection of most discriminant features was performed with a rank-based feature selection method assigning a weight value to each feature according to a criterion, i.e., receiver operating characteristics curve. For example, a feature with large weight was considered more relevant to the target labels than a feature with less weight. Therefore, a reduced set of most discriminant features was identified and further be utilized during classification of AUD patients and healthy controls. As results, the inter-hemispheric coherences between the brain regions were found significantly different between the study groups and provided high classification efficiency (Accuracy = 80.8, sensitivity = 82.5, and specificity = 80, F-Measure = 0.78). In addition, the power computed in different EEG bands were found significant and provided an overall classification efficiency as (Accuracy = 86.6, sensitivity = 95, specificity = 82.5, and F-Measure = 0.88). Further, the integration of these EEG feature resulted into even higher results (Accuracy = 89.3 %, sensitivity = 88.5 %, specificity = 91 %, and F-Measure = 0.90). Based on the results, it is concluded that the EEG data (integration of the theta, beta, and gamma power and inter-hemispheric coherence) could be utilized as objective markers to screen the AUD patients and healthy controls.
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Affiliation(s)
- Wajid Mumtaz
- Center for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, 32610 Bandar Seri Iskandar, Perak Malaysia
| | - Pham Lam Vuong
- Center for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, 32610 Bandar Seri Iskandar, Perak Malaysia
| | - Likun Xia
- Beijing Institute of Technology, Beijing, 100081 China
| | - Aamir Saeed Malik
- Center for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, 32610 Bandar Seri Iskandar, Perak Malaysia
| | - Rusdi Bin Abd Rashid
- University Malaya Centre of Addiction Sciences (UMCAS), Faculty of Medicine, Department of Psychological Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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15
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An integrated alcoholic index using tunable-Q wavelet transform based features extracted from EEG signals for diagnosis of alcoholism. Appl Soft Comput 2017. [DOI: 10.1016/j.asoc.2016.11.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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16
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Mumtaz W, Vuong PL, Xia L, Malik AS, Rashid RBA. Automatic diagnosis of alcohol use disorder using EEG features. Knowl Based Syst 2016. [DOI: 10.1016/j.knosys.2016.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Herrera-Díaz A, Mendoza-Quiñones R, Melie-Garcia L, Martínez-Montes E, Sanabria-Diaz G, Romero-Quintana Y, Salazar-Guerra I, Carballoso-Acosta M, Caballero-Moreno A. Functional Connectivity and Quantitative EEG in Women with Alcohol Use Disorders: A Resting-State Study. Brain Topogr 2015; 29:368-81. [PMID: 26660886 DOI: 10.1007/s10548-015-0467-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 11/24/2015] [Indexed: 12/13/2022]
Abstract
This study was aimed at exploring the electroencephalographic features associated with alcohol use disorders (AUD) during a resting-state condition, by using quantitative EEG and Functional Connectivity analyses. In addition, we explored whether EEG functional connectivity is associated with trait impulsivity. Absolute and relative powers and Synchronization Likelihood (SL) as a measure of functional connectivity were analyzed in 15 AUD women and fifteen controls matched in age, gender and education. Correlation analysis between self-report impulsivity as measured by the Barratt impulsiveness Scale (BIS-11) and SL values of AUD patients were performed. Our results showed increased absolute and relative beta power in AUD patients compared to matched controls, and reduced functional connectivity in AUD patients predominantly in the beta and alpha bands. Impaired connectivity was distributed at fronto-central and occipito-parietal regions in the alpha band, and over the entire scalp in the beta band. We also found that impaired functional connectivity particularly in alpha band at fronto-central areas was negative correlated with non-planning dimension of impulsivity. These findings suggest that functional brain abnormalities are present in AUD patients and a disruption of resting-state EEG functional connectivity is associated with psychopathological traits of addictive behavior.
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Affiliation(s)
| | | | - Lester Melie-Garcia
- LREN, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Eduardo Martínez-Montes
- Department of Neuroinformatics, Cuban Neuroscience Center, Havana, Cuba.,Politecnico di Torino, Turin, Italy
| | - Gretel Sanabria-Diaz
- LREN, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Correas A, Rodriguez Holguín S, Cuesta P, López-Caneda E, García-Moreno LM, Cadaveira F, Maestú F. Exploratory Analysis of Power Spectrum and Functional Connectivity During Resting State in Young Binge Drinkers: A MEG Study. Int J Neural Syst 2015; 25:1550008. [PMID: 25753601 DOI: 10.1142/s0129065715500082] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Binge Drinking (BD) is a pattern of intermittent intensive alcohol intake which has spread among young adults over the last decades. Adolescence constitutes a critical neuromaturation period in which the brain is particularly sensitive to the effects of alcohol. However, little is known about how BD affects the brain activity. This study aimed to characterize the brain's functional organization in BD and non-BD young population by means of analyzing functional connectivity (FC) and relative power spectra (PS) profiles measured with magnetoencephalography (MEG) during eyes-closed resting state. Our sample composed 73 first-year university students (35 BDs and 38 controls). Results showed that the BD subjects displayed a decreased alpha FC in frontal-parietal regions, and conversely, an enhanced FC in the delta, theta and beta bands in fronto-temporal networks. Besides the FC differences, the BD group showed a decreased PS within alpha range and an increased PS within theta range in the brain's occipital region. These differences in FC and PS measurements provide new evidence of the neurophysiological alterations related to the alcohol neurotoxicity and could represent an initial sign of an anomalous neural activity caused by a BD pattern of alcohol consumption during youth.
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Affiliation(s)
- A Correas
- Laboratory of Cognitive and Computational Neuroscience, Centre of Biomedical Technology (CTB), Campus Montegancedo s/n, 28223, Madrid, Spain
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19
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Computer-aided diagnosis of alcoholism-related EEG signals. Epilepsy Behav 2014; 41:257-63. [PMID: 25461226 DOI: 10.1016/j.yebeh.2014.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 09/28/2014] [Accepted: 10/03/2014] [Indexed: 02/05/2023]
Abstract
Alcoholism is a severe disorder that affects the functionality of neurons in the central nervous system (CNS) and alters the behavior of the affected person. Electroencephalogram (EEG) signals can be used as a diagnostic tool in the evaluation of subjects with alcoholism. The neurophysiological interpretation of EEG signals in persons with alcoholism (PWA) is based on observation and interpretation of the frequency and power in their EEGs compared to EEG signals from persons without alcoholism. This paper presents a review of the known features of EEGs obtained from PWA and proposes that the impact of alcoholism on the brain can be determined by computer-aided analysis of EEGs through extracting the minute variations in the EEG signals that can differentiate the EEGs of PWA from those of nonaffected persons. The authors advance the idea of automated computer-aided diagnosis (CAD) of alcoholism by employing the EEG signals. This is achieved through judicious combination of signal processing techniques such as wavelet, nonlinear dynamics, and chaos theory and pattern recognition and classification techniques. A CAD system is cost-effective and efficient and can be used as a decision support system by physicians in the diagnosis and treatment of alcoholism especially those who do not specialize in alcoholism or neurophysiology. It can also be of great value to rehabilitation centers to assess PWA over time and to monitor the impact of treatment aimed at minimizing or reversing the effects of the disease on the brain. A CAD system can be used to determine the extent of alcoholism-related changes in EEG signals (low, medium, high) and the effectiveness of therapeutic plans.
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20
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Knapp CM, Ciraulo DA, Datta S. Mechanisms underlying sleep-wake disturbances in alcoholism: focus on the cholinergic pedunculopontine tegmentum. Behav Brain Res 2014; 274:291-301. [PMID: 25151622 DOI: 10.1016/j.bbr.2014.08.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 12/24/2022]
Abstract
Sleep-wake (S-W) disturbances are frequently associated with alcohol use disorders (AUD), occurring during periods of active drinking, withdrawal, and abstinence. These S-W disturbances can persist after months or even years of abstinence, suggesting that chronic alcohol consumption may have enduring negative effects on both homeostatic and circadian sleep processes. It is now generally accepted that S-W disturbances in alcohol-dependent individuals are a significant cause of relapse in drinking. Although significant progress has been made in identifying the socio-economic burden and health risks of alcohol addiction, the underlying neurobiological mechanisms that lead to S-W disorders in AUD are poorly understood. Marked progress has been made in understanding the basic neurobiological mechanisms of how different sleep stages are normally regulated. This review article in seeking to explain the neurobiological mechanisms underlying S-W disturbances associated with AUD, describes an evidence-based, easily testable, novel hypothesis that chronic alcohol consumption induces neuroadaptive changes in the cholinergic cell compartment of the pedunculopontine tegmentum (CCC-PPT). These changes include increases in N-methyl-d-aspartate (NMDA) and kainate receptor sensitivity and a decrease in gamma-aminobutyric acid (GABAB)-receptor sensitivity in the CCC-PPT. Together these changes are the primary pathophysiological mechanisms that underlie S-W disturbances in AUD. This review is targeted for both basic neuroscientists in alcohol addiction research and clinicians who are in search of new and more effective therapeutic interventions to treat and/or eliminate sleep disorders associated with AUD.
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Affiliation(s)
- Clifford M Knapp
- Laboratory of Sleep and Cognitive Neuroscience, Boston University Psychiatry Associates Clinical Studies Unit, Department of Psychiatry, Boston University School of Medicine, 85 East Newton Street, Boston, MA 02118, USA
| | - Domenic A Ciraulo
- Laboratory of Sleep and Cognitive Neuroscience, Boston University Psychiatry Associates Clinical Studies Unit, Department of Psychiatry, Boston University School of Medicine, 85 East Newton Street, Boston, MA 02118, USA
| | - Subimal Datta
- Laboratory of Sleep and Cognitive Neuroscience, Boston University Psychiatry Associates Clinical Studies Unit, Department of Psychiatry, Boston University School of Medicine, 85 East Newton Street, Boston, MA 02118, USA.
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21
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Rangaswamy M, Porjesz B. Understanding alcohol use disorders with neuroelectrophysiology. HANDBOOK OF CLINICAL NEUROLOGY 2014; 125:383-414. [PMID: 25307587 DOI: 10.1016/b978-0-444-62619-6.00023-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neurocognitive deficits associated with impairments in various brain regions and neural circuitries, particularly involving frontal lobes, have been associated with chronic alcoholism, as well as with a predisposition to develop alcohol use and related disorders (AUDs). AUD is a multifactorial disorder caused by complex interactions between behavioral, genetic, and environmental liabilities. Neuroelectrophysiologic techniques are instrumental in understanding brain and behavior relationships and have also proved very useful in evaluating the genetic diathesis of alcoholism. This chapter describes findings from neuroelectrophysiologic measures (electroencephalogram, event-related potentials, and event-related oscillations) related to acute and chronic effects of alcohol on the brain and those that reflect underlying deficits related to a predisposition to develop AUDs and related disorders. The utility of these measures as effective endophenotypes to identify and understand genes associated with brain electrophysiology, cognitive networks, and AUDs has also been discussed.
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Affiliation(s)
- Madhavi Rangaswamy
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Bernice Porjesz
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, NY, USA.
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22
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Vuong PL, Xia L, Malik AS, Abd Rashid RB. Biomarker Development on Alcohol Addiction Using EEG. NEURAL INFORMATION PROCESSING 2013:199-206. [DOI: 10.1007/978-3-642-42054-2_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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23
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KARUNGARU STEPHEN, YOSHIDA TOSHIHIRO, SEO TORU, FUKUMI MINORU, TERADA KENJI. MONOTONOUS TASKS AND ALCOHOL CONSUMPTION EFFECTS ON THE BRAIN BY EEG ANALYSIS USING NEURAL NETWORKS. INTERNATIONAL JOURNAL OF COMPUTATIONAL INTELLIGENCE AND APPLICATIONS 2012. [DOI: 10.1142/s1469026812500150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An analysis of the Electroencephalogram (EEG) signals while performing a monotonous task and drinking alcohol using principal component analysis (PCA), linear discriminant analysis (LDA) for feature extraction and Neural Networks (NNs) for classification is proposed. The EEG is captured while performing a monotonous task that can adversely affect the brain and possibly cause stress. Moreover, we investigate the effects of alcohol on the brain by capturing the data continuously after consumption of equal amounts of alcohol. We hope that our work will shed more light on the relationship between such actions and EEG, and investigate if there is any relation between the tasks and mental stress. EEG signals offers a rare look at brain activity, while, monotonous activities are well known to cause irritation which may contribute to mental stress. We apply PCA and LDA to characterize the change in each component, extract it and discriminate using a NN. After experiments, it was found that PCA and LDA are effective analysis methods in EEG signal analysis.
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Affiliation(s)
- STEPHEN KARUNGARU
- University of Tokushima, 2-1 Minami Josanjima, Tokushima 770-8506, Japan
| | - TOSHIHIRO YOSHIDA
- University of Tokushima, 2-1 Minami Josanjima, Tokushima 770-8506, Japan
| | - TORU SEO
- University of Tokushima, 2-1 Minami Josanjima, Tokushima 770-8506, Japan
| | - MINORU FUKUMI
- University of Tokushima, 2-1 Minami Josanjima, Tokushima 770-8506, Japan
| | - KENJI TERADA
- University of Tokushima, 2-1 Minami Josanjima, Tokushima 770-8506, Japan
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24
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Pandey AK, Kamarajan C, Rangaswamy M, Porjesz B. Event-Related Oscillations in Alcoholism Research: A Review. ACTA ACUST UNITED AC 2012; Suppl 7. [PMID: 24273686 DOI: 10.4172/2155-6105.s7-001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Alcohol dependence is characterized as a multi-factorial disorder caused by a complex interaction between genetic and environmental liabilities across development. A variety of neurocognitive deficits/dysfunctions involving impairments in different brain regions and/or neural circuitries have been associated with chronic alcoholism, as well as with a predisposition to develop alcoholism. Several neurobiological and neurobehavioral approaches and methods of analyses have been used to understand the nature of these neurocognitive impairments/deficits in alcoholism. In the present review, we have examined relatively novel methods of analyses of the brain signals that are collectively referred to as event-related oscillations (EROs) and show promise to further our understanding of human brain dynamics while performing various tasks. These new measures of dynamic brain processes have exquisite temporal resolution and allow the study of neural networks underlying responses to sensory and cognitive events, thus providing a closer link to the physiology underlying them. Here, we have reviewed EROs in the study of alcoholism, their usefulness in understanding dynamical brain functions/dysfunctions associated with alcoholism as well as their utility as effective endophenotypes to identify and understand genes associated with both brain oscillations and alcoholism.
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Affiliation(s)
- Ashwini K Pandey
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
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25
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Zhu G, Li Y, Wen P(P. Evaluating Functional Connectivity in Alcoholics Based on Maximal Weight Matching. JOURNAL OF ADVANCED COMPUTATIONAL INTELLIGENCE AND INTELLIGENT INFORMATICS 2011. [DOI: 10.20965/jaciii.2011.p1221] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
EEG-based applications have faced the challenge of multi-modal integrated analysis problems. In this paper, a greedy maximal weight matching approach is used to measure the functional connectivity in alcoholics datasets with EEG and EOG signals. The major discovery is that the processing of the repeated and unrepeated stimuli in the γ band in control drinkers is significantly more different than that in alcoholic subjects. However, the EOGs are always stable in the case of visual tasks, except for a weakly wave when subjects make an error response to the stimuli.
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26
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Sanz-Martin A, Guevara MÁ, Amezcua C, Santana G, Hernández-González M. Effects of red wine on the electrical activity and functional coupling between prefrontal–parietal cortices in young men. Appetite 2011; 57:84-93. [DOI: 10.1016/j.appet.2011.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 03/23/2011] [Accepted: 04/09/2011] [Indexed: 11/26/2022]
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27
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Kamarajan C, Rangaswamy M, Manz N, Chorlian DB, Pandey AK, Roopesh BN, Porjesz B. Topography, power, and current source density of θ oscillations during reward processing as markers for alcohol dependence. Hum Brain Mapp 2011; 33:1019-39. [PMID: 21520344 DOI: 10.1002/hbm.21267] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 12/06/2010] [Accepted: 12/22/2010] [Indexed: 11/10/2022] Open
Abstract
Recent studies have linked alcoholism with a dysfunctional neural reward system. Although several electrophysiological studies have explored reward processing in healthy individuals, such studies in alcohol-dependent individuals are quite rare. The present study examines theta oscillations during reward processing in abstinent alcoholics. The electroencephalogram (EEG) was recorded in 38 abstinent alcoholics and 38 healthy controls as they performed a single outcome gambling task, which involved outcomes of either loss or gain of an amount (10 or 50¢) that was bet. Event-related theta band (3.0-7.0 Hz) power following each outcome stimulus was computed using the S-transform method. Theta power at the time window of the outcome-related negativity (ORN) and positivity (ORP) (200-500 ms) was compared across groups and outcome conditions. Additionally, behavioral data of impulsivity and task performance were analyzed. The alcoholic group showed significantly decreased theta power during reward processing compared to controls. Current source density (CSD) maps of alcoholics revealed weaker and diffuse source activity for all conditions and weaker bilateral prefrontal sources during the Loss 50 condition when compared with controls who manifested stronger and focused midline sources. Furthermore, alcoholics exhibited increased impulsivity and risk-taking on the behavioral measures. A strong association between reduced anterior theta power and impulsive task-performance was observed. It is suggested that decreased power and weaker and diffuse CSD in alcoholics may be due to dysfunctional neural reward circuitry. The relationship among alcoholism, theta oscillations, reward processing, and impulsivity could offer clues to understand brain circuitries that mediate reward processing and inhibitory control.
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Affiliation(s)
- Chella Kamarajan
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA.
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28
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Courtney KE, Polich J. Binge drinking effects on EEG in young adult humans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:2325-36. [PMID: 20623027 PMCID: PMC2898052 DOI: 10.3390/ijerph7052325] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 04/01/2010] [Accepted: 05/07/2010] [Indexed: 11/16/2022]
Abstract
Young adult (N = 96) university students who varied in their binge drinking history were assessed by electroencephalography (EEG) recording during passive viewing. Groups consisted of male and female non-binge drinkers (>1 to 5/4 drinks/ounces in under two hours), low-binge drinkers (5/4-7/6 drinks/ounces in under two hours), and high-binge drinkers (>or= 10 drinks/ounces in under two hours), who had been drinking alcohol at their respective levels for an average of 3 years. The non- and low-binge drinkers exhibited less spectral power than the high-binge drinkers in the delta (0-4 Hz) and fast-beta (20-35 Hz) bands. Binge drinking appears to be associated with a specific pattern of brain electrical activity in young adults that may reflect the future development of alcoholism.
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Affiliation(s)
- Kelly E Courtney
- The Scripps Research Institute, Molecular and Integrative Neurosciences Department, La Jolla, CA 92037, USA.
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29
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Abstract
There is no specialized alcohol addiction area in the brain; rather, alcohol acts on a wide range of excitatory and inhibitory nervous networks to modulate neurotransmitters actions by binding with and altering the function of specific proteins. With no hemato-encephalic barrier for alcohol, its actions are strongly related to the amount of intake. Heavy alcohol intake is associated with both structural and functional changes in the central nervous system with long-term neuronal adaptive changes contributing to the phenomena of tolerance and withdrawal. The effects of alcohol on the function of neuronal networks are heterogeneous. Because ethanol affects neural activity in some brain sites but is without effect in others, its actions are analyzed in terms of integrated connectivities in the functional circuitry of neuronal networks, which are of particular interest because of the cognitive interactions discussed in the manuscripts contributing to this review. Recent molecular data are reviewed as a support for the other contributions dealing with cognitive disturbances related to alcohol acute and addicted consumption.
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Affiliation(s)
- Claude Tomberg
- Brain Research Unit, Faculty of Medicine and CENOLI, Free University of Brussels, Belgium
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Kramer G, van der Flier WM, de Langen C, Blankenstein MA, Scheltens P, Stam CJ. EEG functional connectivity and ApoE genotype in Alzheimer's disease and controls. Clin Neurophysiol 2008; 119:2727-32. [PMID: 18848805 DOI: 10.1016/j.clinph.2008.08.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 08/18/2008] [Accepted: 08/23/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We examined the relation between Apolipoprotein E epsilon4 allele (ApoE epsilon4) genotype and functional connectivity measured by Electroencephalography (EEG) in patients with Alzheimer's disease (AD) and patients with subjective complaints (SC). METHODS We included 43 patients with AD (age (SD)=74.2 (4.0), m/f=22/21; 30 of ApoE epsilon4 carriers) and 21 patients with SC (age (SD)=73.2 (5.2), m/f=13/8; 7 ApoE epsilon4 carriers) for this study. Resting state EEGs were recorded in all subjects. Synchronisation likelihood (SL) between local cortical areas was compared in the alpha and beta band according to ApoE epsilon4 status and diagnosis. RESULTS ApoE epsilon4 carriers had higher SL values in lower and upper alpha band, in both diagnostic groups. In upper alpha band and beta band AD patients had lower SL than patients with SC, was irrespective of ApoE status. CONCLUSION The effects of AD and ApoE epsilon4 on functional connectivity are opposite and independent. SIGNIFICANCE The observed increase in SL in both AD and patients with SC carrying ApoE epsilon4 suggests a strong genetic impact of ApoE epsilon4 on brain function.
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Affiliation(s)
- Gerdien Kramer
- Department of Neurology, Alzheimer Centre, VU University Medical Center, PO Box 7057, De Boelelaan 1118, 1007 MB Amsterdam, Noord Holland, The Netherlands
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31
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Cannon R, Lubar J, Baldwin D. Self-perception and Experiential Schemata in the Addicted Brain. Appl Psychophysiol Biofeedback 2008; 33:223-38. [DOI: 10.1007/s10484-008-9067-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 09/17/2008] [Indexed: 11/25/2022]
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32
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Sokhadze TM, Cannon RL, Trudeau DL. EEG Biofeedback as a Treatment for Substance Use Disorders: Review, Rating of Efficacy and Recommendations for Further Research. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/10874200802219855] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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33
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Olde Dubbelink KTE, Felius A, Verbunt JPA, van Dijk BW, Berendse HW, Stam CJ, Delemarre-van de Waal HA. Increased resting-state functional connectivity in obese adolescents; a magnetoencephalographic pilot study. PLoS One 2008; 3:e2827. [PMID: 18665257 PMCID: PMC2474698 DOI: 10.1371/journal.pone.0002827] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 07/09/2008] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Obesity is not only associated with metabolic abnormalities, but also with cognitive dysfunction and changes in the central nervous system. The present pilot study was carried out to investigate functional connectivity in obese and non-obese adolescents using magnetoencephalography (MEG). METHODOLOGY/PRINCIPAL FINDINGS Magnetoencephalographic recordings were performed in 11 obese (mean BMI 38.8+/-4.6 kg/m(2)) and 8 lean (mean BMI 21.0+/-1.5 kg/m(2)) female adolescents (age 12-19 years) during an eyes-closed resting-state condition. From these recordings, the synchronization likelihood (SL), a common method that estimates both linear and non-linear interdependencies between MEG signals, was calculated within and between brain regions, and within standard frequency bands (delta, theta, alpha1, alpha2, beta and gamma). The obese adolescents had increased synchronization in delta (0.5-4 Hz) and beta (13-30 Hz) frequency bands compared to lean controls (P(delta total) = 0.001; P(beta total) = 0.002). CONCLUSIONS/SIGNIFICANCE This study identified increased resting-state functional connectivity in severe obese adolescents. Considering the importance of functional coupling between brain areas for cognitive functioning, the present findings strengthen the hypothesis that obesity may have a major impact on human brain function. The cause of the observed excessive synchronization is unknown, but might be related to disturbed motivational pathways, the recently demonstrated increase in white matter volume in obese subjects or altered metabolic processes like hyperinsulinemia. The question arises whether the changes in brain structure and communication are a dynamic process due to weight gain and whether these effects are reversible or not.
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Affiliation(s)
- Kim T. E. Olde Dubbelink
- Department of Paediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Clinical Neurophysiology, Institute for Clinical and Experimental Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Abraham Felius
- Department of Paediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jeroen P. A. Verbunt
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - Bob W. van Dijk
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - Henk W. Berendse
- Department of Clinical Neurophysiology, Institute for Clinical and Experimental Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis J. Stam
- Department of Clinical Neurophysiology, Institute for Clinical and Experimental Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
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Sokhadze TM, Cannon RL, Trudeau DL. EEG biofeedback as a treatment for substance use disorders: review, rating of efficacy, and recommendations for further research. Appl Psychophysiol Biofeedback 2008; 33:1-28. [PMID: 18214670 PMCID: PMC2259255 DOI: 10.1007/s10484-007-9047-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Accepted: 12/19/2007] [Indexed: 12/01/2022]
Abstract
Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training-either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given.
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Affiliation(s)
- Tato M Sokhadze
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA.
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35
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Chen ACH, Porjesz B, Rangaswamy M, Kamarajan C, Tang Y, Jones KA, Chorlian DB, Stimus AT, Begleiter H. Reduced Frontal Lobe Activity in Subjects With High Impulsivity and Alcoholism. Alcohol Clin Exp Res 2007; 31:156-65. [PMID: 17207114 DOI: 10.1111/j.1530-0277.2006.00277.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Impulsivity is an important characteristic of many psychiatric disorders, including substance-related disorders. These disinhibitory disorders have a similar underlying genetic diathesis, with each disorder representing a different expression of the same underlying genetic liability. This study assessed whether there is a relationship between impulsivity and alcohol dependence, and their correlations with P3 (P300) amplitude, a proposed endophenotype of alcoholism. METHODS Healthy control subjects (n=58) and subjects with DSM-IV diagnosis of alcohol dependence (n=57) were assessed with a visual oddball task. Event-Related Potentials (ERPs) were recorded from 61 scalp electrodes and P3 amplitudes measured. Barratt Impulsiveness Scale (BIS), version 11, was used to evaluate impulsivity. Source localization of P3 was computed using low-resolution brain electromagnetic tomography (LORETA). RESULTS Alcoholic subjects manifested reductions in target P3 amplitudes (p<0.0001). Using LORETA, significantly reduced activation was mapped in the cingulate, medial, and superior frontal regions in alcoholic subjects and highly impulsive subjects. Alcoholic subjects had significantly higher scores on the BIS (p<0.0001) than nonalcoholic individuals. There were significant negative correlations between total scores on BIS and P3 amplitude (r=-0.274, p=0.003, on Pz; r=-0.250, p=0.007, on Cz). CONCLUSIONS Our results demonstrate a strong frontal focus of reduced activation during processing of visual targets in alcoholic subjects and individuals with higher impulsivity. The findings suggest that impulsivity may be an important factor that underlies the pathogenesis of alcohol dependence. Studies are underway to examine the relationship between impulsivity and ERPs in offspring of alcoholic subjects, and to identify genes associated with the underlying predisposition involved in disinhibitory disorders.
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Affiliation(s)
- Andrew C H Chen
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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de Bruin EA, Stam CJ, Bijl S, Verbaten MN, Kenemans JL. Moderate-to-heavy alcohol intake is associated with differences in synchronization of brain activity during rest and mental rehearsal. Int J Psychophysiol 2006; 60:304-14. [PMID: 16150505 DOI: 10.1016/j.ijpsycho.2005.07.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Revised: 02/17/2005] [Accepted: 07/11/2005] [Indexed: 11/30/2022]
Abstract
In alcohol-dependent individuals, synchronization of brain activity is different from that in non-alcohol-dependent individuals as reflected by EEG differences at alpha and beta frequencies (8-30 Hz). These EEG differences may not only be related to long-term alcohol intake but also to genetic factors that are associated with alcohol dependence. Thus, it is not known what the pure effect of long-term alcohol intake on synchronization of brain activity is. Therefore, we investigated whether EEG synchronization differs between light (0.5-6 drinks per week), moderate (7-20 drinks per week), and heavy (21-53 drinks per week) drinkers. All participants (49 males and 47 females) were free of a personal and family history of alcohol dependence. Eyes-closed EEG was recorded at rest and during mental rehearsal of pictures. EEG synchronization was determined by computing Synchronization Likelihood for six frequency bands (0.5-4 Hz, 4-8 Hz, 8-12 Hz, 12-20 Hz, 20-30 Hz, 30-45 Hz). Both male and female heavy drinkers displayed a loss of lateralization in alpha (8-12 Hz) and slow-beta (12-20 Hz) synchronization. In addition, moderately and heavily drinking males had lower fast-beta (20-30 Hz) synchronization than lightly drinking males. It is concluded that both male and female drinkers who drink 21 alcoholic drinks per week or more have impaired synchronization of brain activity during rest and mental rehearsal at alpha and beta frequencies as compared to individuals who drink less. As individuals with a personal or family history of alcohol dependence were excluded, the confounding effects of genetic factors related to alcohol dependence on synchronization of brain activity were minimized.
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Affiliation(s)
- Eveline A de Bruin
- Utrecht Institute of Pharmaceutical Sciences, Department of Psychopharmacology, Utrecht University, The Netherlands.
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Padmanabhapillai A, Porjesz B, Ranganathan M, Jones KA, Chorlian DB, Tang Y, Kamarajan C, Rangaswamy M, Stimus A, Begleiter H. Suppression of early evoked gamma band response in male alcoholics during a visual oddball task. Int J Psychophysiol 2006; 60:15-26. [PMID: 16019097 DOI: 10.1016/j.ijpsycho.2005.03.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Revised: 02/15/2005] [Accepted: 03/03/2005] [Indexed: 11/15/2022]
Abstract
We investigated the early evoked gamma frequency band activity in alcoholics (n=122) and normal controls (n=72) during a visual oddball task. A time-frequency representation method was applied to EEG data in order to obtain phase-locked gamma band activity (29-45 Hz) and was analyzed within a 0-150 ms time window range. Significant reduction of the gamma band response in the frontal region during target stimulus processing was observed in alcoholic compared to control subjects. In contrast, significantly higher gamma band response for the non-target stimulus was observed in alcoholics compared to controls. It is suggested that the reduction in early evoked frontal gamma band response to targets may be associated with frontal lobe dysfunction commonly observed in alcoholics. This perhaps can be characterized by a deficient top-down processing mechanism.
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Affiliation(s)
- Ajayan Padmanabhapillai
- Department of Psychiatry, Neurodynamics Laboratory, SUNY Health Science Center, Brooklyn, NY, USA
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Kamarajan C, Porjesz B, Jones K, Chorlian D, Padmanabhapillai A, Rangaswamy M, Stimus A, Begleiter H. Event-related oscillations in offspring of alcoholics: neurocognitive disinhibition as a risk for alcoholism. Biol Psychiatry 2006; 59:625-34. [PMID: 16213472 PMCID: PMC3766847 DOI: 10.1016/j.biopsych.2005.08.017] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 07/28/2005] [Accepted: 08/10/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Event-related oscillations (EROs) are increasingly being used to assess neurocognitive functioning in normal and clinical populations. The current study compares different frequency activities in offspring of alcoholics (OA) and in normal control subjects (NC) to examine whether the OA group exhibits any abnormality in oscillatory activity while performing a Go/NoGo task. METHODS The S-transform algorithm was employed to decompose the electroencephalographic (EEG) signals into different time-frequency bands, and the oscillatory responses in the P300 time window (300-700 milliseconds) were statistically analyzed in both groups. RESULTS The OA group manifested significantly decreased activity in delta (1-3 Hz), theta (4-7 Hz), and alpha1 (8-9 Hz) bands during the NoGo condition, as well as reduced delta and theta activity during the Go condition. This reduction was more prominent in the NoGo than in the Go condition. CONCLUSIONS The decreased response in delta, theta, and alpha1 oscillations, especially during the NoGo condition in high-risk individuals, is perhaps suggestive of cognitive and neural disinhibition and may serve as an endophenotypic marker in the development of alcoholism and/or other disinhibitory disorders.
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Affiliation(s)
- Chella Kamarajan
- Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Bernice Porjesz
- Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Kevin Jones
- Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - David Chorlian
- Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Ajayan Padmanabhapillai
- Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Madhavi Rangaswamy
- Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Arthur Stimus
- Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Henri Begleiter
- Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
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Posthuma D, de Geus EJC, Mulder EJCM, Smit DJA, Boomsma DI, Stam CJ. Genetic components of functional connectivity in the brain: the heritability of synchronization likelihood. Hum Brain Mapp 2006; 26:191-8. [PMID: 15929086 PMCID: PMC6871713 DOI: 10.1002/hbm.20156] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cognitive functions require the integrated activity of multiple specialized, distributed brain areas. Such functional coupling depends on the existence of anatomical connections between the various brain areas as well as physiological processes whereby the activity in one area influences the activity in another area. Recently, the Synchronization Likelihood (SL) method was developed as a general method to study both linear and nonlinear aspects of coupling. In the present study the genetic architecture of the SL in different frequency bands was investigated. Using a large genetically informative sample of 569 subjects from 282 extended twin families we found that the SL is moderately to highly heritable (41-67%) especially in the alpha frequency (8-13 Hz) range. This index of functional connectivity of the brain has been associated with a number of pathological states of the brain. The significant heritability found here suggests that SL can be used to examine the genetic susceptibility to these conditions.
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Affiliation(s)
- Danielle Posthuma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Stam CJ. Nonlinear dynamical analysis of EEG and MEG: review of an emerging field. Clin Neurophysiol 2005; 116:2266-301. [PMID: 16115797 DOI: 10.1016/j.clinph.2005.06.011] [Citation(s) in RCA: 745] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2005] [Revised: 06/03/2005] [Accepted: 06/11/2005] [Indexed: 02/07/2023]
Abstract
Many complex and interesting phenomena in nature are due to nonlinear phenomena. The theory of nonlinear dynamical systems, also called 'chaos theory', has now progressed to a stage, where it becomes possible to study self-organization and pattern formation in the complex neuronal networks of the brain. One approach to nonlinear time series analysis consists of reconstructing, from time series of EEG or MEG, an attractor of the underlying dynamical system, and characterizing it in terms of its dimension (an estimate of the degrees of freedom of the system), or its Lyapunov exponents and entropy (reflecting unpredictability of the dynamics due to the sensitive dependence on initial conditions). More recently developed nonlinear measures characterize other features of local brain dynamics (forecasting, time asymmetry, determinism) or the nonlinear synchronization between recordings from different brain regions. Nonlinear time series has been applied to EEG and MEG of healthy subjects during no-task resting states, perceptual processing, performance of cognitive tasks and different sleep stages. Many pathologic states have been examined as well, ranging from toxic states, seizures, and psychiatric disorders to Alzheimer's, Parkinson's and Cre1utzfeldt-Jakob's disease. Interpretation of these results in terms of 'functional sources' and 'functional networks' allows the identification of three basic patterns of brain dynamics: (i) normal, ongoing dynamics during a no-task, resting state in healthy subjects; this state is characterized by a high dimensional complexity and a relatively low and fluctuating level of synchronization of the neuronal networks; (ii) hypersynchronous, highly nonlinear dynamics of epileptic seizures; (iii) dynamics of degenerative encephalopathies with an abnormally low level of between area synchronization. Only intermediate levels of rapidly fluctuating synchronization, possibly due to critical dynamics near a phase transition, are associated with normal information processing, whereas both hyper-as well as hyposynchronous states result in impaired information processing and disturbed consciousness.
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Affiliation(s)
- C J Stam
- Department of Clinical Neurophysiology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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Porjesz B, Rangaswamy M, Kamarajan C, Jones KA, Padmanabhapillai A, Begleiter H. The utility of neurophysiological markers in the study of alcoholism. Clin Neurophysiol 2005; 116:993-1018. [PMID: 15826840 DOI: 10.1016/j.clinph.2004.12.016] [Citation(s) in RCA: 236] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Revised: 12/09/2004] [Accepted: 12/17/2004] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This review attempts to differentiate neuroelectric measures (electroencephalogram (EEG), event-related potentials (ERPs) and event-related oscillations (EROs)) related to acute and chronic effects of alcohol on the brain from those that reflect underlying deficits related to the predisposition to develop alcoholism and related disorders. The utility of these neuroelectric measures as endophenotypes for psychiatric genetics is evaluated. METHODS This article reviews the main findings of EEG and ERP abnormalities in alcoholics, offspring of alcoholics at high risk to develop alcoholism and the electrophysiological effects of alcohol on high risk compared to low-risk offspring. It highlights findings using EROs, a fast developing tool in examining brain function and cognition. It also reviews evidence of genetic findings related to these electrophysiological measures and their relationship to clinical diagnosis. RESULTS Many of these abnormal neuroelectric measures are under genetic control, may precede the development of alcoholism, and may be markers of a predisposition toward the development of a spectrum of disinhibitory conditions including alcoholism. Genetic loci underlying some neuroelectic measures that involve neurotransmitter systems of the brain have been identified. CONCLUSIONS Quantitative neuroelectric measures (EEG, ERPs, EROs) provide valuable endophenotypes in the study of genetic risk to develop alcoholism and related disorders. SIGNIFICANCE Genetic studies of neuroelectric endophenotypes offer a powerful strategy for identifying susceptibility genes for developing psychiatric disorders, and provide novel insights into etiological factors.
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Affiliation(s)
- Bernice Porjesz
- Neurodynamics Laboratory, Department of Psychiatry, SUNY, Downstate Medical Center, Brooklyn, NY 11203, USA.
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