Cocaine use and the mid-latency auditory evoked responses

Relationships of behavioral measures of frontal lobe dysfunction with underlying electrophysiology in cocaine-dependent patients

BACKGROUND AND OBJECTIVES

Despite evidence that frontal lobe functioning is impaired in cocaine-dependent individuals, relationships between behavioral measures of frontal dysfunction and electrophysiological measures of inhibition in cocaine use have not been explored.

METHODS

Using the Frontal Systems Behavior Scale (FrSBe), frontal dysfunction was assessed in a group of abstinent cocaine-dependent subjects (N = 49) and healthy controls (N = 32). Using transcranial magnetic stimulation (TMS) and evoked potential (EP)-based electrophysiological measures of inhibition, we assessed associations between these measures and FrSBe estimates of frontal dysfunction.

RESULTS

Patients had significantly higher FrSBe scores for executive dysfunction, disinhibition, and apathy than controls. Lower TMS-based resting motor thresholds (ie, hyperexcitability) were significantly associated with higher executive dysfunction scores in the patients.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Relationships between FrSBe scores and TMS-based measures highlight neurophysiological aberrations underlying frontal lobe dysfunction in cocaine abusers. TMS and EP measures may be useful probes of the intermediary steps between frontal lobe dysfunction and addictive behavior.

Event-related potentials in substance use disorders: a narrative review based on articles from 1984 to 2012

Mechanisms that mediate the transition from occasional, controlled, drug use to the impaired control that characterizes severe dependence are still a matter of investigation. The etiology of substance use disorders (SUDs) is complex, and in this context of complexity, the concept of "endophenotype," has gained extensive popularity in recent years. The main aim of endophenotypes is to provide a simpler, more proximal target to discover the biological underpinnings of a psychiatric syndrome. In this view, neurocognitive and neurophysiological impairments that suggest functional impairments associated with SUDs have been proposed as possible endophenotypes. Because of its large amplitude and relatively easy elicitation, the most studied of the cognitive brain event-related potentials (ERPs), the P300 component, has been proposed as one possible candidate. However, if a P300 amplitude alteration is a common finding in SUDs, it is also observable in other psychiatric afflictions, suggesting that the associations found may just reflect a common measure of brain dysfunction. On this basis, it has been proposed that a multivariate endophenotype, based on a weighted combination of electrophysiological features, may provide greater diagnostic classification power than any single endophenotype. The rationale for investigating multiple features is to show that combining them provides extra useful information that is not available in the individual features, leading ultimately to a multivariate phenotype.The aim of the present article is to outline the potential usefulness of this kind of "combined electrophysiological procedure" applied to SUDs. We present a review of ERP studies, combining data from people with SUD, family members, and normal control subjects, to verify whether the combination of 4ERPs (P50, MMN, P300, and N400) may produce profiles of cortical anomalies induced by different types of SUD (alcohol vs cocaine vs cannabis vs heroin).

Differential relationships of impulsivity or antisocial symptoms on P50, N100, or P200 auditory sensory gating in controls and antisocial personality disorder

Limited information is available on the relationship between antisocial personality disorder (ASPD) and early filtering, or gating, of information, even though this could contribute to the repeatedly reported impairment in ASPD of higher-order information processing. In order to investigate early filtering in ASPD, we compared electrophysiological measures of auditory sensory gating assessed by the paired-click paradigm in males with ASPD (n = 37) to healthy controls (n = 28). Stimulus encoding was measured by P50, N100, and P200 auditory evoked potentials; auditory sensory gating (ASG) was measured by a reduction in amplitude of evoked potentials following click repetition. Effects were studied of co-existing past alcohol or drug use disorders, ASPD symptom counts, and trait impulsivity. Controls and ASPD did not differ in P50, N100, or P200 amplitude or ASG. Past alcohol or drug use disorders had no effect. In controls, impulsivity related to improved P50 and P200 gating. In ASPD, P50 or N100 gating was impaired with more symptoms or increased impulsivity, respectively, suggesting impaired early filtering of irrelevant information. In controls the relationship between P50 and P200 gating and impulsivity was reversed, suggesting better gating with higher impulsivity scores. This could reflect different roles of ASG in behavioral regulation in controls versus ASPD.

The level of arousal modulates P50 peak amplitude

We aimed to evaluate the effect of arousal level in healthy subjects on P50 potential, as the variation in the level of arousal may be a source of variance in the recordings as well as it may provide additional information about the pathology under study. Eleven healthy volunteers participated in the study. A standard auditory P50 potential paradigm was applied. Two stimulation conditions were selected: eyes-open, i.e., high arousal level condition and eyes-closed, i.e., low arousal level condition. P50 component amplitudes in response to both the first (S1) and second stimulus (S2) of the pair, their ratio and difference were evaluated. P50 amplitude in response to S1 was significantly higher during the low arousal closed eyes condition as compared to high arousal open eyes condition. There was no P50 amplitude difference in response to S2 and no arousal effect on gating measures. This prompts for more careful evaluation of patients' arousal level when performing P50 studies and interpreting the results.

Diminished P50, N100 and P200 auditory sensory gating in bipolar I disorder

Bipolar I disorder is associated with diminished gating of the auditory evoked P50 component. P50 gating may relate to early filtering of sensory information, protecting higher-order cognitive functions. Gating of the auditory evoked N100 and P200 components has not been investigated in bipolar I disorder, although N100 and P200 gating could reflect different mechanisms and functions in the process of filtering sensory information in addition to those reflected by P50 gating. We investigated P50, N100, and P200 gating assessed with the paired-click paradigm in 22 subjects with bipolar I disorder and 54 healthy controls. Peak amplitudes and latencies were assessed at Cz for the P50, N100, and P200 components. Gating was defined as the reduction in peak amplitude from the first (S1) to the second stimulus (S2) of a stimulus pair, and expressed as gating ratio ([S2(amplitude)/S1(amplitude)]()100) and difference score (S1(amplitude)-S2(amplitude)). Group differences were detected with multivariate analyses and controlled for differences in age and ethnicity. Subjects with bipolar I disorder had higher P50, N100 and P200 ratios and lower difference scores compared with findings for controls. These findings extend the existing evidence on impaired sensory gating in bipolar I disorder beyond the P50, suggesting impaired filtering at both pre-attentive and early attentive levels in bipolar I disorder.

P50 sensory gating ratios in schizophrenics and controls: a review and data analysis

Many studies have found that the P50 sensory gating ratio in a paired click task is smaller in normal control subjects than in patients with schizophrenia, indicating more effective sensory gating. However, a wide range of gating ratios has been reported in the literature for both groups. The purpose of this study was to compile these findings and to compare reported P50 gating ratios in controls and patients with schizophrenia. Current data collected from individual controls in eight studies from the University of California, Irvine (UCI), Indiana University (IU), and Yale University also are reported. The IU, UCI, and Yale data showed that approximately 40% of controls had P50 ratios within 1 S.D. below the mean of means for patients with schizophrenia. The meta-analysis rejected the null hypothesis that all studies showed no effect. The meta-analysis also showed that the differences were not the same across all studies. The mean ratios in 45 of the 46 group comparisons were smaller for controls than for patients, and the observed difference in means was significant for 35 of those studies. Reported gating ratios for controls from two laboratories whose findings were reported in the literature differed from all the other control groups. Variables affecting the gating ratio included band pass filter setting, rules regarding the inclusion of P30, sex, and age. Standards of P50 collection and measurement would help determine whether the gating ratio can be sufficiently reliable to be labeled an endophenotype, and suggestions are made toward this goal.

Neurophysiological biomarkers for drug development in schizophrenia

Schizophrenia represents a pervasive deficit in brain function, leading to hallucinations and delusions, social withdrawal and a decline in cognitive performance. As the underlying genetic and neuronal abnormalities in schizophrenia are largely unknown, it is challenging to measure the severity of its symptoms objectively, or to design and evaluate psychotherapeutic interventions. Recent advances in neurophysiological techniques provide new opportunities to measure abnormal brain functions in patients with schizophrenia and to compare these with drug-induced alterations. Moreover, many of these neurophysiological processes are phylogenetically conserved and can be modelled in preclinical studies, offering unique opportunities for use as translational biomarkers in schizophrenia drug discovery.

Ototoxicity and noise trauma: electron transfer, reactive oxygen species, cell signaling, electrical effects, and protection by antioxidants: practical medical aspects

Ototoxins are substances of various structures and classes. This review provides extensive evidence for involvement of electron transfer (ET), reactive oxygen species (ROS) and oxidative stress (OS) as a unifying theme. Successful application is made to the large majority of ototoxins, as well as noise trauma. We believe it is not coincidental that these toxins generally incorporate ET functionalities (quinone, metal complex, ArNO(2), or conjugated iminium) either per se or in metabolites, potentially giving rise to ROS by redox cycling. Some categories, e.g., peroxides and noise, appear to operate via non-ET routes in generating OS. These highly reactive entities can then inflict injury via OS upon various constituents of the ear apparatus. The theoretical framework is supported by the extensive literature on beneficial effects of antioxidants, both for toxins and noise. Involvement of cell signaling and electrical effects are discussed. This review is the first comprehensive one based on a unified mechanistic approach. Various practical medical aspects are also addressed. There is extensive documentation for beneficial effects of antioxidants whose use might be recommended clinically for prevention of ototoxicity and noise trauma. Recent research indicates that catalytic antioxidants may be more effective. In addition to ototoxicity, a widespread problem consists of ear infections by bacteria which are demonstrating increasing resistance to conventional therapies. A recent, novel approach to improved drugs involves use of agents which inhibit quorum sensors that play important roles in bacterial functioning. Prevention of ear injury by noise trauma is also discussed, along with ear therapeutics.

Objective response detection technique in frequency-domain for reflecting changes in MLAEP

The mid-latency auditory evoked potential (MLAEP) occurs within the interval 10-100ms post-stimulus and exhibits morphological changes due to coma, general anaesthesia and neurological and psychiatric diseases. This work evaluates an objective response detection technique in the frequency domain, the magnitude squared coherence (kappa(2)(f)), in reflecting MLAEPs changes in amplitude and latencies. Both simulation and EEG data were used in this investigation. The EEG during auditory stimulation in 10 volunteers under propofol-induced anaesthesia was acquired. Based on the null hypothesis of non-existing response, critical values have been derived in order to detect the auditory response. The alternative hypothesis was used to infer about maximal-response frequencies as well as to derive confidence intervals for the estimated values of kappa(2)(f) during anaesthesia. Changes in both simulated and real MLAEPs could be tracked by kappa(2)(f), even for low SNR. High degree of cortical activation occurred predominantly between 30 and 90Hz. This finding could be related to the sensory-originated phase-locked oscillation in the gamma band (30-70Hz). Hence, for applications where changes on MLAEPs should be assessed, the use of kappa(2)(f) as an objective statistical response detection technique is worth to be applied.

P50 auditory evoked potential suppression in bipolar disorder patients with psychotic features and their unaffected relatives

BACKGROUND

Diminished suppression of the P50 response, a consistent finding in schizophrenia, has also been reported in patients with psychotic bipolar disorder. It is a promising endophenotype for schizophrenia, but its relationship to genetic liability in bipolar disorder is unknown. We therefore assessed whether diminished P50 suppression is associated with familial risk for psychotic bipolar disorder.

METHODS

The P50 response was collected in a conditioning (C)--testing (T) paradigm from 42 outpatients with bipolar 1 disorder who had experienced psychotic symptoms and 44 of their unaffected first-degree relatives, all from families multiply affected with bipolar disorder or another non-organic psychotic disorder; 48 healthy control subjects were also studied. The T/C ratio was compared between the groups, with linear regression analyses and robust variance estimators for clustered data.

RESULTS

Both patients (estimated mean difference in T/C ratio to control subjects, 32, 95% confidence interval [CI] 15-48, p=.001) and unaffected relatives (20, 95% CI 7-32, p=.002) demonstrated higher T/C ratio, thus indicating diminished P50 suppression compared with control subjects.

CONCLUSIONS

To our knowledge, this is the first report of diminished P50 gating in unaffected relatives of psychotic bipolar disorder patients from multiply affected families. Our results suggest that impaired P50 gating is a putative endophenotype for psychotic bipolar disorder and thus might reflect the impact of susceptibility genes across psychosis.

The effects of interstimulus interval on sensory gating and on preattentive auditory memory in the oddball paradigm. Can magnitude of the sensory gating affect preattentive auditory comparison process?

P50, and mismatch negativity (MMN) are components of event-related potentials (ERP) reflecting sensory gating and preattentive auditory memory, respectively. Interstimulus interval (ISI) is an important determinant of the amplitudes of these components and N1. In the present study the interrelation between stimulus gating and preattentive auditory sensory memory were investigated as a function of ISI in 1.5, 2.5 and 3.5s in 15 healthy volunteered participants. ISI factor affected the N1 peak amplitude significantly. MMN amplitude in 2.5s ISI was significantly smaller compared to 1.5 and 3.5s ISI. ISI X stimuli interaction on P50 amplitude was statistically significant. P50 amplitudes to deviant stimuli in 2.5s ISI were larger than the P50 amplitudes in other ISIs. P50 difference (P50d) waveform amplitude correlated significantly with MMN amplitude. The results suggest that: (i) auditory sensory gating could affect preattentive auditory sensory memory by supplying input to the comparator mechanism; (ii) 2.5s ISI is important in displaying the sensory gating and preattentive auditory sensory memory relation.

Cocaine-dependence and cocaine-induced paranoia and mid-latency auditory evoked responses and sensory gating

Cocaine-dependence has been shown to affect the amplitudes of the P50 mid-latency auditory evoked response (MLAER) as well as P50 sensory gating. The effects on subsequent MLAERs (N100 and P200) have not been examined. The objective of the current study was to further assess the effects of chronic cocaine use on the P50, N100, and P200 components. Thirty-four, at least three weeks abstinent, cocaine-dependent individuals and 34 age and gender matched healthy controls were examined. The amplitudes, latencies and gating measures were calculated and compared between the groups. The N100 and P200 were significantly smaller in patients as compared to control subjects. Sensory gating of the P50, the N100, and the P200 were deficient in cocaine-dependent subjects. Latencies of all measured components were prolonged in subjects who reported developing paranoia while intoxicated. Finally, a positive correlation was found between length of abstinence and evoked response amplitudes. We conclude that the effects of cocaine on sensory gating extend beyond the P50 to the N100 and the P200 components. The data also suggest that prolonged latency of the evoked potentials may be a correlate of cocaine-induced psychosis. Finally, the data suggest that some recovery of amplitude and gating occurs with abstinence.

P50 sensory gating deficit in children with centrotemporal spikes and sharp waves in the EEG

Sensory gating refers to the ability of the brain to inhibit irrelevant sensory input. In several studies, a pathogenic role of the CHRNA7 gene and the CHRNA7-like gene, respectively, is suggested. In linkage analysis concerning familial centrotemporal spikes and sharp waves (CTS) and benign rolandic epilepsy, evidence for linkage was found to a region on chromosome 15q14, close to the alpha-7 subunit gene of the neuronal nicotinic acetylcholine receptor (CHRNA7). According to these findings, P50 evoked potentials to paired click stimuli were studied in 13 children with CTS in the EEG to determine whether they had normal sensory gating. The control group consisted of 13 healthy probands matched for gender and age. Children with CTS showed a significant sensory gating deficit (p=0.001). These results (1) suggest an inhibitory deficit in early pre-attentive auditory sensory processing in children with CTS and (2) confirm the assumption of a cholinergic pathology in CTS.

Auditory sensory gating deficit in abstinent chronic alcoholics

P50 event-related potential was studied in abstinent chronic alcoholics to determine whether they had normal sensory gating. Repeated tones were presented to 17 recently detoxified chronic alcoholic patients and 17 healthy subjects while EEG was recorded. Low-resolution tomography (LORETA) was performed to obtain cerebral sources of P50. Abstinent chronic alcoholics showed reduced P50 sensory gating. Present results suggest an inhibitory deficit in early pre-attentive auditory sensory processing in chronic alcoholism.

Comparison of sensory gating to mismatch negativity and self-reported perceptual phenomena in healthy adults

To better understand the possible functional significance of electrophysiological sensory gating measures, response suppression of midlatency auditory event related potential (ERP) components was compared to the mismatch negativity (MMN) and to self-rated indices of stimulus filtering and passive attention-switching phenomena in an age-restricted sample of healthy adults. P1 sensory gating, measured during a paired-click paradigm, was correlated with MMN amplitude, measured during an acoustic oddball paradigm (intensity deviation). Also, individuals that exhibited less robust P1 suppression endorsed higher rates of "perceptual modulation" difficulties, whereas component N1 suppression was more closely related to "over-inclusion" of irrelevant sounds into the focus of attention. These findings suggest that the ERP components investigated are not redundant, but correspond to distinct-possibly related-pre-attentive processing systems.

Neuronal substrates of sensory gating within the human brain

BACKGROUND

For the human brain, habituation to irrelevant sensory input is an important function whose failure is associated with behavioral disturbances. Sensory gating can be studied by recording the brain's electrical responses to repeated clicks: the P50 potential is normally reduced to the second of two paired clicks but not in schizophrenia patients. To identify its neural correlates, we recorded electrical traces of sensory gating directly from the human hippocampus and neocortex.

METHODS

Intracranial evoked potentials were recorded using hippocampal depth electrodes and subdural strip and grid electrodes in 32 epilepsy patients undergoing invasive presurgical evaluation.

RESULTS

We found evidence of sensory gating only in the hippocampus, the temporo-parietal region (Brodmann's areas 22 and 2), and the prefrontal cortex (Brodmann's areas 6 and 24); however, whereas neocortical habituating responses to paired clicks were peaking around 50 msec, responses within the hippocampus proper had a latency of about 250 msec.

CONCLUSIONS

Consistent with data from animal studies, our findings show that the hippocampus proper contributes to sensory gating, albeit during a time window following neocortical habituation processes. Thus, sensory gating may be a multistep process, with an early phase subserved by the temporo-parietal and prefrontal cortex and a later phase mediated by the hippocampus.

Sensory gating impairment associated with schizophrenia persists into REM sleep

Physiological measures of sensory gating are increasingly used to study biological factors associated with attentional dysfunction in psychiatric and neurologic patient populations. The present study was designed to assess sensory gating during rapid eye movement (REM) sleep in patients with schizophrenia, a population bearing a genetic load for gating impairment. Auditory event-related potentials (ERPs) were recorded in response to paired clicks during separate waking and overnight sleep recording sessions in controls and schizophrenia patients. Suppression of ERP component P50 was significantly impaired in the patient group during both waking and REM sleep, whereas the difference between groups for N100 gating was dependent on state. These results suggest that REM sleep is an appropriate state during which to assess P50 gating in order to disentangle the effects of state and trait on sensory gating impairment in other clinical populations.

The effect of state on sensory gating: comparison of waking, REM and non-REM sleep

OBJECTIVES

Auditory sensory gating is an electrophysiological assay that has been employed in clinical and basic research to clarify the neurobiological basis of perceptual and attentional impairments associated with schizophrenia and other diseases. In addition to genetically-linked characteristics, this measure also exhibits potentially confounding sensitivity to behavioral state, most notably acute stress. The goal of the present study is to determine if auditory sensory gating of evoked potential component P50 ('P1') could be measured during rapid eye movement (REM) sleep, as an alternative to the waking state.

METHODS

The suppression of vertex-recorded auditory evoked potential components, P30, P50 and N100, was measured as a function of stimulus redundancy using the paired-click paradigm during all-night sleep in 10 control subjects. Average evoked responses were computed separately for 30 min periods of waking, REM sleep, and non-REM (stage 2) sleep.

RESULTS

Evoked response component P50 exhibited suppression to the paired-click stimulus during REM sleep, not significantly different than waking. Suppression of wave N100 was significantly poorer during both sleep stages than waking. Component P30 was not suppressed in response to repetitive stimuli under any state of vigilance.

CONCLUSIONS

In addition to waking, response suppression of evoked potential component P50 can be measured during REM sleep, thus allowing the separation of trait- and state-dependent effects in future investigations of auditory sensory gating.