Mismatch negativity and N100 in comatose patients

Twenty-four-hour rhythmicities in disorders of consciousness are associated with a favourable outcome

Fluctuations of consciousness and their rhythmicities have been rarely studied in patients with a disorder of consciousness after acute brain injuries. 24-h assessment of brain (EEG), behaviour (eye-opening), and circadian (clock-controlled hormones secretion from urine) functions was performed in acute brain-injured patients. The distribution, long-term predictability, and rhythmicity (circadian/ultradian) of various EEG features were compared with the initial clinical status, the functional outcome, and the circadian rhythmicities of behaviour and clock-controlled hormones. Here we show that more physiological and favourable patterns of fluctuations are associated with a higher 24 h predictability and sharp up-and-down shape of EEG switches, reminiscent of the Flip-Flop model of sleep. Multimodal rhythmic analysis shows that patients with simultaneous circadian rhythmicity for brain, behaviour, and hormones had a favourable outcome. Finally, both re-emerging EEG fluctuations and homogeneous 24-h cycles for EEG, eye-opening, and hormones appeared as surrogates for preserved functionality in brainstem and basal forebrain, which are key prognostic factors for later improvement. While the recovery of consciousness has previously been related to a high short-term complexity, we suggest in this exploratory study the importance of the high predictability of the 24 h long-term generation of brain rhythms and highlight the importance of circadian body-brain rhythms in awakening.

Phase Property of Envelope-Tracking EEG Response Is Preserved in Patients with Disorders of Consciousness

When listening to speech, the low-frequency cortical response below 10 Hz can track the speech envelope. Previous studies have demonstrated that the phase lag between speech envelope and cortical response can reflect the mechanism by which the envelope-tracking response is generated. Here, we analyze whether the mechanism to generate the envelope-tracking response is modulated by the level of consciousness, by studying how the stimulus-response phase lag is modulated by the disorder of consciousness (DoC). It is observed that DoC patients in general show less reliable neural tracking of speech. Nevertheless, the stimulus-response phase lag changes linearly with frequency between 3.5 and 8 Hz, for DoC patients who show reliable cortical tracking to speech, regardless of the consciousness state. The mean phase lag is also consistent across these DoC patients. These results suggest that the envelope-tracking response to speech can be generated by an automatic process that is barely modulated by the consciousness state.

Assessment of electroencephalography and event-related potentials in unresponsive patients with brain injury

OBJECTIVE

To investigate the predictors of clinical outcomes in unresponsive patients with acquired brain injuries.

METHODS

Patients with coma or disorders of consciousness were enrolled from August 2019 to March 2021. A retrospective analysis of demographics, etiology, clinical score, diagnosis, electroencephalography (EEG), and event-related potential (ERP) data from 1 week to 2 months after coma onset was conducted. Findings were assessed for predicting favorable outcomes at 6 months post-coma, and functional outcomes were determined using the Glasgow Outcome Scale-Extended (GOS-E).

RESULTS

Of 68 patients, 22 patients had a good neurological outcome at 6 months, while 11 died. Univariate analysis showed that motor response (Motor-R; p < 0.001), EEG pattern (p = 0.015), sleep spindles (p = 0.018), EEG reactivity (EEG-R; p < 0.001), mismatch negativity (MMN) amplitude at electrode Fz (FzMMNA; p = 0.001), P3a latency (p = 0.044), and P3a amplitude at electrode Cz (CzP3aA; p < 0.001) were significantly correlated with patient prognosis. Multivariable logistic regression analysis showed that FzMMNA, CzP3aA, EEG-R, and Motor-R were significant independent predictors of a favorable outcome. The sensitivity and specificity of FzMMNA (dichotomized at 1.16 μV) were 86.4% and 58.5%, and of CzP3aA (cut-off value 2.76 μV) were 90.9% and 70.7%, respectively. ERP amplitude (ERP-A), a combination of FzMMNA and CzP3aA, improved prediction accuracy, with an area under the receiver operating characteristic curve (AUC) of 0.884. A model incorporating Motor-R, EEG-R, and ERP-A yielded an outstanding predictive performance (AUC=0.921) for a favorable outcome.

CONCLUSION

ERP-A and the prognostic model resulted in the efficient prediction of a favorable outcome in unresponsive patients.

Shorter Contextual Timescale Rather Than Memory Deficit in Aging

Many aspects of cognitive ability and brain function that change as we age look like deficits on account of measurable differences in comparison to younger adult groups. One such difference occurs in auditory sensory responses that index perceptual learning. Meta-analytic findings show reliable age-related differences in auditory responses to repetitive patterns of sound and to rare violations of those patterns, variously attributed to deficits in auditory sensory memory and inhibition. Here, we determine whether proposed deficits would render older adults less prone to primacy effects, robustly observed in young adults, which present as a tendency for first learning to have a disproportionate influence over later perceptual inference. The results confirm this reduced sensitivity to primacy effects but do not support impairment in auditory sensory memory as the origin of this difference. Instead, the aging brain produces data consistent with shorter timescales of contextual reference. In conclusion, age-related differences observed previously for perceptual inference appear highly context-specific necessitating reconsideration of whether and to what function the notion of deficit should be attributed, and even whether the notion of deficit is appropriate at all.

Clinical significance of mismatch negativity in predicting the awakening of comatose patients after severe brain injury

We assessed the clinical significance of mismatch negativity (MMN) in predicting the awakening of comatose patients with severe brain injury. The clinical data of patients with severe brain injury, admitted to the neurosurgical intensive care unit of Xiangya Hospital of Central South University from July 2018 to March 2020, who underwent auditory MMN examinations within 28 days after coma onset, were reviewed. Correlations between clinical factors and prognosis [Glasgow Outcome Scale (GCS) for 3 mo] were analyzed. Fifty-three patients were included; 37 (69.8%) had favorable outcomes. A univariate analysis revealed the Glasgow Coma Scale (GCS) and absolute MMN amplitudes at electrodes Fz and Cz were significantly correlated with prognosis. Only GCS scores and MMN amplitude at Fz were independent predictors in multivariate logistic regression analysis (area under the curve 0.744 vs. 0.753, respectively); both combined, improved accuracy to 84.6%. MMN amplitudes at Fz were dichotomized at a value of 1.08 μV with a sensitivity and specificity of 81.1% and 68.7%, respectively, for predicting comatose patients' awakening. In conclusion, MMN amplitude at Fz is a reliable prognostic indicator for comatose patients with severe brain injury; the prediction value improved when combined with GCS. Thus, an event-related potential component with a clear site and cutoff value may support prognostication in severe brain injury.NEW & NOTEWORTHY Mismatch negativity (MMN) can assess the prognosis of comatose patients after severe brain injury, especially for MMN amplitude. In addition, MMN analysis at electrode Fz best predicts recovery of consciousness in patients with severe brain injury. Importantly, a quantitative approach (cutoff value of 1.08 μV) may improve the use of MMN for prognostication.

A Critical Review of the Deviance Detection Theory of Mismatch Negativity

Mismatch negativity (MMN) is a component of the difference waveform derived from passive auditory oddball stimulation. Since its inception in 1978, this has become one of the most popular event-related potential techniques, with over two-thousand published studies using this method. This is a testament to the ingenuity and commitment of generations of researchers engaging in basic, clinical and animal research. Despite this intensive effort, high-level descriptions of the mechanisms theorized to underpin mismatch negativity have scarcely changed over the past four decades. The prevailing deviance detection theory posits that MMN reflects inattentive detection of difference between repetitive standard and infrequent deviant stimuli due to a mismatch between the unexpected deviant and a memory representation of the standard. Evidence for these mechanisms is inconclusive, and a plausible alternative sensory processing theory considers fundamental principles of sensory neurophysiology to be the primary source of differences between standard and deviant responses evoked during passive oddball stimulation. By frequently being restated without appropriate methods to exclude alternatives, the potentially flawed deviance detection theory has remained largely dominant, which could lead some researchers and clinicians to assume its veracity implicitly. It is important to have a more comprehensive understanding of the source(s) of MMN generation before its widespread application as a clinical biomarker. This review evaluates issues of validity concerning the prevailing theoretical account of mismatch negativity and the passive auditory oddball paradigm, highlighting several limitations regarding its interpretation and clinical application.

Cortical Microcircuit Mechanisms of Mismatch Negativity and Its Underlying Subcomponents

In the neocortex, neuronal processing of sensory events is significantly influenced by context. For instance, responses in sensory cortices are suppressed to repetitive or redundant stimuli, a phenomenon termed “stimulus-specific adaptation” (SSA). However, in a context in which that same stimulus is novel, or deviates from expectations, neuronal responses are augmented. This augmentation is termed “deviance detection” (DD). This contextual modulation of neural responses is fundamental for how the brain efficiently processes the sensory world to guide immediate and future behaviors. Notably, context modulation is deficient in some neuropsychiatric disorders such as schizophrenia (SZ), as quantified by reduced “mismatch negativity” (MMN), an electroencephalography waveform reflecting a combination of SSA and DD in sensory cortex. Although the role of NMDA-receptor function and other neuromodulatory systems on MMN is established, the precise microcircuit mechanisms of MMN and its underlying components, SSA and DD, remain unknown. When coupled with animal models, the development of powerful precision neurotechnologies over the past decade carries significant promise for making new progress into understanding the neurobiology of MMN with previously unreachable spatial resolution. Currently, rodent models represent the best tool for mechanistic study due to the vast genetic tools available. While quantifying human-like MMN waveforms in rodents is not straightforward, the “oddball” paradigms used to study it in humans and its underlying subcomponents (SSA/DD) are highly translatable across species. Here we summarize efforts published so far, with a focus on cortically measured SSA and DD in animals to maintain relevance to the classically measured MMN, which has cortical origins. While mechanistic studies that measure and contrast both components are sparse, we synthesize a potential set of microcircuit mechanisms from the existing rodent, primate, and human literature. While MMN and its subcomponents likely reflect several mechanisms across multiple brain regions, understanding fundamental microcircuit mechanisms is an important step to understand MMN as a whole. We hypothesize that SSA reflects adaptations occurring at synapses along the sensory-thalamocortical pathways, while DD depends on both SSA inherited from afferent inputs and resulting disinhibition of non-adapted neurons arising from the distinct physiology and wiring properties of local interneuronal subpopulations and NMDA-receptor function.

Mismatch-negativity (MMN) in animal models: Homology of human MMN?

Mismatch negativity (MMN) has long been considered to be one of the deviance-detecting neural characteristics. Animal models exhibit similar neural activities, called MMN-like responses; however, there has been considerable debate on whether MMN-like responses are homologous to MMN in humans. Herein, we reviewed several studies that compared the electrophysiological, pharmacological, and functional properties of MMN-like responses and adaptation-exhibiting middle-latency responses (MLRs) in animals with those in humans. Accumulating evidence suggests that there are clear differences between MMN-like responses and MLRs, in particular that MMN-like responses can be distinguished from mere effects of adaptation, i.e., stimulus-specific adaptation. Finally, we discuss a new direction for research on MMN-like responses by introducing our recent work, which demonstrated that MMN-like responses represent empirical salience of deviant stimuli, suggesting a new functional role of MMN beyond simple deviance detection.

Task-free auditory EEG paradigm for probing multiple levels of speech processing in the brain

While previous studies on language processing highlighted several ERP components in relation to specific stages of sound and speech processing, no study has yet combined them to obtain a comprehensive picture of language abilities in a single session. Here, we propose a novel task-free paradigm aimed at assessing multiple levels of speech processing by combining various speech and nonspeech sounds in an adaptation of a multifeature passive oddball design. We recorded EEG in healthy adult participants, who were presented with these sounds in the absence of sound-directed attention while being engaged in a primary visual task. This produced a range of responses indexing various levels of sound processing and language comprehension: (a) P1-N1 complex, indexing obligatory auditory processing; (b) P3-like dynamics associated with involuntary attention allocation for unusual sounds; (c) enhanced responses for native speech (as opposed to nonnative phonemes) from ∼50 ms from phoneme onset, indicating phonological processing; (d) amplitude advantage for familiar real words as opposed to meaningless pseudowords, indexing automatic lexical access; (e) topographic distribution differences in the cortical activation of action verbs versus concrete nouns, likely linked with the processing of lexical semantics. These multiple indices of speech-sound processing were acquired in a single attention-free setup that does not require any task or subject cooperation; subject to future research, the present protocol may potentially be developed into a useful tool for assessing the status of auditory and linguistic functions in uncooperative or unresponsive participants, including a range of clinical or developmental populations.

Deep temporal models and active inference

How do we navigate a deeply structured world? Why are you reading this sentence first - and did you actually look at the fifth word? This review offers some answers by appealing to active inference based on deep temporal models. It builds on previous formulations of active inference to simulate behavioural and electrophysiological responses under hierarchical generative models of state transitions. Inverting these models corresponds to sequential inference, such that the state at any hierarchical level entails a sequence of transitions in the level below. The deep temporal aspect of these models means that evidence is accumulated over nested time scales, enabling inferences about narratives (i.e., temporal scenes). We illustrate this behaviour with Bayesian belief updating - and neuronal process theories - to simulate the epistemic foraging seen in reading. These simulations reproduce perisaccadic delay period activity and local field potentials seen empirically. Finally, we exploit the deep structure of these models to simulate responses to local (e.g., font type) and global (e.g., semantic) violations; reproducing mismatch negativity and P300 responses respectively.

Great Expectations: Is there Evidence for Predictive Coding in Auditory Cortex?

Predictive coding is possibly one of the most influential, comprehensive, and controversial theories of neural function. While proponents praise its explanatory potential, critics object that key tenets of the theory are untested or even untestable. The present article critically examines existing evidence for predictive coding in the auditory modality. Specifically, we identify five key assumptions of the theory and evaluate each in the light of animal, human and modeling studies of auditory pattern processing. For the first two assumptions - that neural responses are shaped by expectations and that these expectations are hierarchically organized - animal and human studies provide compelling evidence. The anticipatory, predictive nature of these expectations also enjoys empirical support, especially from studies on unexpected stimulus omission. However, for the existence of separate error and prediction neurons, a key assumption of the theory, evidence is lacking. More work exists on the proposed oscillatory signatures of predictive coding, and on the relation between attention and precision. However, results on these latter two assumptions are mixed or contradictory. Looking to the future, more collaboration between human and animal studies, aided by model-based analyses will be needed to test specific assumptions and implementations of predictive coding - and, as such, help determine whether this popular grand theory can fulfill its expectations.

Deep temporal models and active inference

How do we navigate a deeply structured world? Why are you reading this sentence first - and did you actually look at the fifth word? This review offers some answers by appealing to active inference based on deep temporal models. It builds on previous formulations of active inference to simulate behavioural and electrophysiological responses under hierarchical generative models of state transitions. Inverting these models corresponds to sequential inference, such that the state at any hierarchical level entails a sequence of transitions in the level below. The deep temporal aspect of these models means that evidence is accumulated over nested time scales, enabling inferences about narratives (i.e., temporal scenes). We illustrate this behaviour with Bayesian belief updating - and neuronal process theories - to simulate the epistemic foraging seen in reading. These simulations reproduce perisaccadic delay period activity and local field potentials seen empirically. Finally, we exploit the deep structure of these models to simulate responses to local (e.g., font type) and global (e.g., semantic) violations; reproducing mismatch negativity and P300 responses respectively.

Coherence in resting-state EEG as a predictor for the recovery from unresponsive wakefulness syndrome

We investigated differences of EEG coherence within (short-range), and between (long-range) specified brain areas as diagnostic markers for different states in disorders of consciousness (DOC), and their predictive value for recovery from unresponsive wakefulness syndrome (UWS). EEGs of 73 patients and 24 controls were recorded and coma recovery scale- revised (CRS-R) scores were assessed. CRS-R of UWS patients was collected after 12 months and divided into two groups (improved/unimproved). Frontal, parietal, fronto-parietal, fronto-temporal, and fronto-occipital coherence was computed, as well as EEG power over frontal, parietal, occipital, and temporal areas. Minimally conscious patients (MCS) and UWS patients could not be differentiated based on their coherence patterns or on EEG power. Fronto-parietal and parietal coherence could positively predict improvement of UWS patients, i.e. recovery from UWS to MCS. Parietal coherence was significantly higher in delta and theta frequencies in the improved group, as well as the coherence between frontal and parietal regions in delta, theta, alpha, and beta frequencies. High parietal delta and theta, and high fronto-parietal theta and alpha coherence appear to provide strong early evidence for recovery from UWS with high predictive sensitivity and specificity. Short and long-range coherence can have a diagnostic value in the prognosis of recovery from UWS.

Is it time to move mismatch negativity into the clinic?

Since its inception in the 1970s, the mismatch negativity (MMN) event-related potential has improved our understanding of pre-attentive detection of rule violations, which is a fundamental cognitive process considered by some a form of "primitive intelligence". The body of research to date ranges from animal studies (i.e. when investigating the neural mechanisms and pharmacological properties of MMN generation) to researching the psychophysiological nature of human consciousness. MMN therefore offers the possibility to detect abnormal functioning in the neural system involved in MMN generation, such as it occurs in some neurodevelopmental disorders or patients in vegetative state. While the clinical research data holds considerable promise for translation into clinical practice, standardization and normative data of an optimized (i.e. disorder-specific) MMN recording algorithm is needed in order for MMN to become a valuable clinical investigation tool.

Detection of event-related potentials in individual subjects using support vector machines

Event-related potentials (ERPs) are tiny electrical brain responses in the human electroencephalogram that are typically not detectable until they are isolated by a process of signal averaging. Owing to the extremely smallsize of ERP components (ranging from less than 1 μV to tens of μV), compared to background brain rhythms, statistical analyses of ERPs are predominantly carried out in groups of subjects. This limitation is a barrier to the translation of ERP-based neuroscience to applications such as medical diagnostics. We show here that support vector machines (SVMs) are a useful method to detect ERP components in individual subjects with a small set of electrodes and a small number of trials for a mismatch negativity (MMN) ERP component. Such a reduced experiment setup is important for clinical applications. One hundred healthy individuals were presented with an auditory pattern containing pattern-violating deviants to evoke the MMN. Two-class SVMs were then trained to classify averaged ERP waveforms in response to the standard tone (tones that match the pattern) and deviant tone stimuli (tones that violate the pattern). The influence of kernel type, number of epochs, electrode selection, and temporal window size in the averaged waveform were explored. When using all electrodes, averages of all available epochs, and a temporal window from 0 to 900-ms post-stimulus, a linear SVM achieved 94.5 % accuracy. Further analyses using SVMs trained with narrower, sliding temporal windows confirmed the sensitivity of the SVM to data in the latency range associated with the MMN.

A rapid event-related potential (ERP) method for point-of-care evaluation of brain function: development of the Halifax Consciousness Scanner

BACKGROUND

Event-related potentials (ERPs) may provide a non-invasive index of brain function for a range of clinical applications. However, as a lab-based technique, ERPs are limited by technical challenges that prevent full integration into clinical settings.

NEW METHOD

To translate ERP capabilities from the lab to clinical applications, we have developed methods like the Halifax Consciousness Scanner (HCS). HCS is essentially a rapid, automated ERP evaluation of brain functional status. The present study describes the ERP components evoked from auditory tones and speech stimuli. ERP results were obtained using a 5-min test in 100 healthy individuals. The HCS sequence was designed to evoke the N100, the mismatch negativity (MMN), P300, the early negative enhancement (ENE), and the N400. These components reflected sensation, perception, attention, memory, and language perception, respectively. Component detection was examined at group and individual levels, and evaluated across both statistical and classification approaches.

RESULTS

All ERP components were robustly detected at the group level. At the individual level, nonparametric statistical analyses showed reduced accuracy relative to support vector (SVM) machine classification, particularly for speech-based ERPs. Optimized SVM results were MMN: 95.6%; P300: 99.0%; ENE: 91.8%; and N400: 92.3%.

CONCLUSIONS

A spectrum of individual-level ERPs can be obtained in a very short time. Machine learning classification improved detection accuracy across a large healthy control sample. Translating ERPs into clinical applications is increasingly possible at the individual level.

Prognostic Value of Evoked Responses and Event-Related Brain Potentials in

The behaviourally unresponsive patient, unable to exhibit the presence of cognition, constitutes a conundrum for health care specialists. Prognostic uncertainty impedes accurate management decisions and the application of ethical principles. An early, reliable prognosis is highly desirable. In this review investigations studying comatose patients with coma of different etiologies were selected. It is concluded that objective prognostication is enhanced by the use of electrophysiological tests. Persistent abnormalities of brainstem auditory evoked potentials and short-latency somatosensory evoked potentials reliably indicate the likelihood of irreversible neurological deficit or death. Meanwhile, the presence of “cognitive” event-related brain potentials (e.g., P300 and mismatch negativity) reflects the functional integrity of higher level information processing and, therefore, the likelihood of capacity for cognition. An approach that combines clinical and electrophysiological values provides optimal prediction of outcome and level of disability.

Animal models and measures of perceptual processing in schizophrenia

This paper summarizes the discussions regarding animal paradigms for assessing perception at the seventh meeting of the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS). A breakout group at the meeting addressed candidate tests in animals that might best parallel the human paradigms selected previously in the CNTRICS program to assess two constructs in the domain of perception: gain control and visual integration. The perception breakout group evaluated the degree to which each of the nominated tasks met pre-specified criteria: comparability of tasks across multiple species; construct validity; neuroanatomical homology between species; and dynamic range across parametric variation.

Attention to language: novel MEG paradigm for registering involuntary language processing in the brain

Previous research indicates that, under explicit instructions to listen to spoken stimuli or in speech-oriented behavioural tasks, the brain's responses to senseless pseudowords are larger than those to meaningful words; the reverse is true in non-attended conditions. These differential responses could be used as a tool to trace linguistic processes in the brain and their interaction with attention. However, as previous studies relied on explicit instructions to attend or ignore the stimuli, a technique for automatic attention modulation (i.e., not dependent on explicit instruction) would be more advantageous, especially when cooperation with instructions may not be guaranteed (e.g., neurological patients, children etc). Here we present a novel paradigm in which the stimulus context automatically draws attention to speech. In a non-attend passive auditory oddball sequence, rare words and pseudowords were presented among frequent non-speech tones of variable frequency and length. The low percentage of spoken stimuli guarantees an involuntary attention switch to them. The speech stimuli, in turn, could be disambiguated as words or pseudowords only in their end, at the last phoneme, after the attention switch would have already occurred. Our results confirmed that this paradigm can indeed be used to induce automatic shifts of attention to spoken input. At ~250ms after the stimulus onset, a P3a-like neuromagnetic deflection was registered to spoken (but not tone) stimuli indicating an involuntary attention shift. Later, after the word-pseudoword divergence point, we found a larger oddball response to pseudowords than words, best explained by neural processes of lexical search facilitated through increased attention. Furthermore, we demonstrate a breakdown of this orderly pattern of neurocognitive processes as a result of sleep deprivation. The new paradigm may thus be an efficient way to assess language comprehension processes and their dynamic interaction with those of attention allocation. It does it in an automatic and task-free fashion, indicating its potential benefit for assessing uncooperative clinical populations.

Cross-diagnostic comparison of duration mismatch negativity and P3a in bipolar disorder and schizophrenia

OBJECTIVES

Bipolar disorder and schizophrenia share common pathophysiological processes and may have similar perceptual abnormalities. Mismatch negativity (MMN) and P3a - event-related potentials associated with auditory preattentional processing - have been extensively studied in schizophrenia, but rarely in bipolar disorder. Furthermore, MMN and P3a have not been examined between diagnostic subgroups of patients with bipolar disorder. We evaluated MMN and P3a in patients with bipolar disorder compared to patients with schizophrenia and healthy controls.

METHODS

MMN and P3a were assessed in 52 bipolar disorder patients, 30 schizophrenia patients, and 27 healthy control subjects during a duration-deviant auditory oddball paradigm.

RESULTS

Significant MMN and P3a amplitude reductions were present in patients with bipolar disorder and schizophrenia relative to controls. The MMN reduction was more prominent in patients with schizophrenia than bipolar disorder, at a trend level. P3a did not differ significantly between patient groups. There were no MMN or P3a differences between patients with bipolar I (n = 34) and bipolar II (n = 18) disorder. Patients with bipolar I disorder failed to show lateralized MMN, in contrast to the other groups. No MMN or P3a differences were found between patients with bipolar disorder taking (n = 12) and not taking (n = 40) lithium, as well as between those taking (n = 30) and not taking (n = 22) antipsychotic medications.

CONCLUSIONS

Patients with bipolar disorder showed deficits in preattentive auditory processing, including MMN deficits that are less severe and P3a deficits that are slightly more pronounced, than those seen in schizophrenia.

The mismatch negativity (MMN)--a unique window to disturbed central auditory processing in ageing and different clinical conditions

In this article, we review clinical research using the mismatch negativity (MMN), a change-detection response of the brain elicited even in the absence of attention or behavioural task. In these studies, the MMN was usually elicited by employing occasional frequency, duration or speech-sound changes in repetitive background stimulation while the patient was reading or watching videos. It was found that in a large number of different neuropsychiatric, neurological and neurodevelopmental disorders, as well as in normal ageing, the MMN amplitude was attenuated and peak latency prolonged. Besides indexing decreased discrimination accuracy, these effects may also reflect, depending on the specific stimulus paradigm used, decreased sensory-memory duration, abnormal perception or attention control or, most importantly, cognitive decline. In fact, MMN deficiency appears to index cognitive decline irrespective of the specific symptomatologies and aetiologies of the different disorders involved.

"What" and "where" in auditory sensory processing: a high-density electrical mapping study of distinct neural processes underlying sound object recognition and sound localization

Functionally distinct dorsal and ventral auditory pathways for sound localization (WHERE) and sound object recognition (WHAT) have been described in non-human primates. A handful of studies have explored differential processing within these streams in humans, with highly inconsistent findings. Stimuli employed have included simple tones, noise bursts, and speech sounds, with simulated left–right spatial manipulations, and in some cases participants were not required to actively discriminate the stimuli. Our contention is that these paradigms were not well suited to dissociating processing within the two streams. Our aim here was to determine how early in processing we could find evidence for dissociable pathways using better titrated WHAT and WHERE task conditions. The use of more compelling tasks should allow us to amplify differential processing within the dorsal and ventral pathways. We employed high-density electrical mapping using a relatively large and environmentally realistic stimulus set (seven animal calls) delivered from seven free-field spatial locations; with stimulus configuration identical across the “WHERE” and “WHAT” tasks. Topographic analysis revealed distinct dorsal and ventral auditory processing networks during the WHERE and WHAT tasks with the earliest point of divergence seen during the N1 component of the auditory evoked response, beginning at approximately 100 ms. While this difference occurred during the N1 timeframe, it was not a simple modulation of N1 amplitude as it displayed a wholly different topographic distribution to that of the N1. Global dissimilarity measures using topographic modulation analysis confirmed that this difference between tasks was driven by a shift in the underlying generator configuration. Minimum-norm source reconstruction revealed distinct activations that corresponded well with activity within putative dorsal and ventral auditory structures.

Momentary Fluctuations in Allocation of Attention: Cross-modal Effects of Visual Task Load on Auditory Discrimination

Even when our attention is dedicated to an important task, background processes monitor the environment for significant events. The mismatch negativity (MMN) event-related potential is thought to reflect such a monitoring process. Nevertheless, there is continuing debate concerning the susceptibility of the MMN to attentional manipulation. We investigated the trial-by-trial relationship between brain activity related to change detection, reflected in the MMN, and visual psychophysical performance—while varying task difficulty. We find that auditory change detection is indeed “automatic” in that MMN remains robust despite increasing (visual) task load. However, the MMN amplitude and latency are susceptible to both visual load and to momentary attentional fluctuations as reflected in success or failure to identify a following visual target. We conclude that background central auditory processing is sensitive to the demands of a visual task, and fluctuates based on moment-to-moment allocation of attentional resources to the visual task.

Semantic processing in comatose patients with intact temporal lobes as reflected by the N400 event-related potential

The present study aimed at determining whether the N400 effect (an ERP index of semantic processing) for spoken words occurs in comatose patients. The patients, treated in an intensive care unit, scored less than 8 points in the glasgow coma score at the time of the recording. Semantically related and unrelated spoken word pairs were delivered to patients through headphones at a rate of 1/3s. Patients with an intact temporal lobe exhibited differential N400-like responses for semantically related and unrelated word pairs, which suggests that word semantics can be processed even in the comatose state. In contrast, patients with an injured temporal lobe showed no such effect.

Improving the clinical assessment of consciousness with advances in electrophysiological and neuroimaging techniques

In clinical neurology, a comprehensive understanding of consciousness has been regarded as an abstract concept - best left to philosophers. However, times are changing and the need to clinically assess consciousness is increasingly becoming a real-world, practical challenge. Current methods for evaluating altered levels of consciousness are highly reliant on either behavioural measures or anatomical imaging. While these methods have some utility, estimates of misdiagnosis are worrisome (as high as 43%) - clearly this is a major clinical problem. The solution must involve objective, physiologically based measures that do not rely on behaviour. This paper reviews recent advances in physiologically based measures that enable better evaluation of consciousness states (coma, vegetative state, minimally conscious state, and locked in syndrome). Based on the evidence to-date, electroencephalographic and neuroimaging based assessments of consciousness provide valuable information for evaluation of residual function, formation of differential diagnoses, and estimation of prognosis.

Neurophysiological measures of sensory registration, stimulus discrimination, and selection in schizophrenia patients

Cortical Neurophysiological event related potentials (ERPs) are multidimensional measures of information processing that are well suited to efficiently parse automatic and controlled components of cognition that span the range of deficits exhibited in schizophrenia patients. Components following a stimulus reflect the sequence of neural processes triggered by the stimulus, beginning with early automatic sensory processes and proceeding through controlled decision and response related processes. Previous studies employing ERP paradigms have reported deficits of information processing in schizophrenia across automatic through attention dependent processes including sensory registration (N1), automatic change detection (MMN), the orienting or covert shift of attention towards novel or infrequent stimuli (P3a), and attentional allocation following successful target detection processes (P3b). These automatic and attention dependent information components are beginning to be recognized as valid targets for intervention in the context of novel treatment development for schizophrenia and related neuropsychiatric disorders. In this review, we describe three extensively studied ERP components (N1, mismatch negativity, P300) that are consistently deficient in schizophrenia patients and may serve as genetic endophenotypes and as quantitative biological markers of response outcome.

Event-related potentials in clinical research: guidelines for eliciting, recording, and quantifying mismatch negativity, P300, and N400

This paper describes recommended methods for the use of event-related brain potentials (ERPs) in clinical research and reviews applications to a variety of psychiatric and neurological disorders. Techniques are presented for eliciting, recording, and quantifying three major cognitive components with confirmed clinical utility: mismatch negativity (MMN), P300, and N400. Also highlighted are applications of each of the components as methods of investigating central nervous system pathology. The guidelines are intended to assist investigators who use ERPs in clinical research, in an effort to provide clear and concise recommendations and thereby to standardize methodology and facilitate comparability of data across laboratories.

A mismatch negativity study of local-global auditory processing

We used mismatch negativity (MMN) to examine structural encoding of local and global auditory patterns in perceptual memory. Unlike previous MMN studies of local-global auditory perceptual organization that used interval-contour stimuli, here we presented hierarchical stimuli in which local pattern organization formed global patterns. Importantly, our stimuli allowed independent manipulation of the two structural levels. In separate blocks, participants were exposed to frequent local standard patterns and rare local deviant patterns, or to frequent global standard patterns and rare global deviant patterns. Within each deviant pattern, the variation from the standard pattern could occur at onset (early), towards the end of the pattern (late) or over both time windows (both). To isolate pattern indexing at one level, the other level continuously changed (e.g., in a global standard block, local elements varied trial-by-trial). MMN was found only for global deviant patterns, and only when deviation occurred late in the pattern. In a separate behavioral experiment, global deviants were detected more often than local ones, although initial similarity followed by a late deviation from the standard pattern was not required for explicit deviant detection (as with the MMN). This report demonstrates neural structural encoding for global information, when independently manipulated from local information. Furthermore, it extends previous MMN findings that have revealed indexing of complex abstract auditory information to the realm of hierarchical perceptual organization.

The mismatch negativity in cognitive and clinical neuroscience: Theoretical and methodological considerations

Mismatch negativity (MMN) component of the event-related brain potentials has become popular in cognitive and clinical brain research during the recent years. It is an early response to a violation of an auditory rule such as an infrequent change in the physical feature of a repetitive sound. There is a lot of evidence on the association of the MMN parameters and behavioral discrimination ability, although this relationship is not always straight-forward. Since the MMN reflects sound discrimination accuracy, it can be used for probing how well different groups of individuals perceive sound differences, and how training or remediation affects this ability. In the present review, we first introduce some of the essential MMN findings in probing sound discrimination, memory, and their deficits. Thereafter, issues which need to be taken into account in MMN investigations as well as new improved recording paradigms are discussed.

The Mismatch Negativity

In the present article, I will selectively review some of the recent research on the brain substrates of central-auditory processing using the mismatch negativity (MMN) and its magnetoencephalographic equivalent MMNm, trying to identify some of the most promising trends in this research work. Although the early MMN research dealt almost exclusively with basic cognitive-neuroscience issues, more recently, the usefulness of the MMN phenomenon with regard to a large number of clinical and other applied issues has also been realized. Nine research lines or issues with particular promise will be identified, many of which are of a clinical/applied nature. Cognitive brain research using the MMN, an automatic electric response to any discriminable change in auditory stimulation, has continued for three decades and seems continuously to gain in number, inspired by novel findings, there now being approximately 1,000 articles in English-language international journals using, or referring to, the MMN. There are several highly promising research lines or issues: (1) the MMN as an index of early cognitive development, (2) the MMN as an index of the functional condition of the NMDA-receptor system, (3) the MMN as an index of the different brain pathologies underlying schizophrenia, (4) the role of the MMN in genetic research of psychopathology, (5) the extremely wide range of MMN deficiency across different clinical conditions and diseases, (6) the MMN in prediction of coma outcome, (7) the MMN as an index of primitive sensory intelligence in audition, and (8) the MMN as an index of brain mechanisms of speech perception and understanding. These findings, in particular (8), extend the interpretation of the MMN, currently mainly confined to sensory representations, to involve auditory memory in general.

Graded visual attention modulates brain responses evoked by task-irrelevant auditory pitch changes

Previous studies suggested that auditory change-specific neural responses are attention-independent and reflect central auditory processing. The automaticity of the brain's response to infrequent changes in pitch within a series of auditory tone pips was examined in parallel functional magnetic resonance imaging (fMRI) and event-related potential (ERP) studies. Subjects performed a continuous perceptual-motor visual tracking task at two levels of difficulty while simultaneously hearing a series of task-irrelevant standard tone pips and infrequent pitch-deviant tones. fMRI results revealed that the unattended pitch-deviant tones strongly activated superior temporal and frontal cortical regions. These activations were significantly modulated by the tracking difficulty of the primary task. ERP results revealed that the amplitude of the scalp-negative component evoked by deviant tones (MMN) was attenuated during the more difficult tracking task. Our results demonstrate that the brain's response to task-irrelevant sensory changes is strongly influenced by intermodal attentional demands.

Deviance-related electrophysiological activity in mice: is there mismatch negativity in mice?

OBJECTIVE

Mismatch negativity (MMN) is an auditory event-related potential (ERP) that provides an index of auditory sensory memory and has become an important tool to investigate auditory sensory memory in cognitive neuroscience and disorders such as schizophrenia and dyslexia. The development of a mouse model of human MMN would permit to investigate the molecular biology of normal and dysfunctional MMN generation. However, the presence of MMN-like electrophysiological activity in mice has not been demonstrated.

METHODS

Deviance-related ERPs were recorded in awake mice using 3 frequency deviance paradigms and one duration deviance paradigm. These paradigms were modelled after paradigms used in human studies to characterize MMN.

RESULTS

Significant deviance-related activity was observed in all paradigms. However, in all frequency deviance paradigms this activity manifested as an enhancement of similar activity to the standard due to differences in stimulation rate between deviant and standard stimuli rather than qualitatively different MMN-like activity. In the duration deviance paradigm negative deflections were observed that showed characteristics typical of human MMN.

CONCLUSIONS

MMN-like activity can be observed in mice in duration deviance paradigms. In frequency deviance paradigms effects of different stimulation rates of deviant and standard stimuli seem to be the main determinants of deviance-related activity.

SIGNIFICANCE

Investigations of MMN-like ERPs in mice may permit to investigate the molecular basis for normal and abnormal MMN generation in neuropsychiatric disorders and dyslexia.

Event-related potentials in an auditory oddball situation in the rat

Evoked potentials were recorded from the auditory cortex of both freely moving and anesthetized rats when deviant sounds were presented in a homogenous series of standard sounds (oddball condition). A component of the evoked response to deviant sounds, the mismatch negativity (MMN), may underlie the ability to discriminate acoustic differences, a fundamental aspect of auditory perception. Whereas most MMN studies in animals have been done using simple sounds, this study involved a more complex set of sounds (synthesized vowels). The freely moving rats had previously undergone behavioral training in which they learned to respond differentially to these sounds. Although we found little evidence in this preparation for the typical, epidurally recorded, MMN response, a significant difference between deviant and standard evoked potentials was noted for the freely moving animals in the 100-200 ms range following stimulus onset. No such difference was found in the anesthetized animals.

Event-related potential measures of consciousness: two equations with three unknowns

This is a brief review of event-related brain potentials (ERPs) as indices of cortical information processing in conditions in which conscious perception of stimuli is supposed to be absent: sleep, coma, vegetative state, general anesthesia, neglect as well as presentation of subliminal or masked stimuli. Exogenous ERP components such as N1 and P2 are much more likely to remain in all these conditions than endogenous components. Further, all varieties of the late posterior positive ERP waves (e.g., P3b, P600, late positive complex) are most difficult to be elicited in such conditions, indicating that the cortical activity underlying the late posterior positivity may have a particularly close relationship to brain mechanisms of conscious perception. Contrary to what might be expected, reliable ERP effects indicating complex analysis of semantic stimulus features (i.e., meaning) can be recorded without conscious awareness, generally, as easy as (in some conditions, even easier than) ERP components related to rather simple physical stimulus features. It should be emphasized, however, that we never should overestimate our confidence about the degree of subjects' unawareness. Particularly in the conditions in which no behavioral response can be obtained (e.g., sleep, coma, anesthesia), residual conscious processing, at least in some subjects and on some trials, cannot be ruled out.

Preattentional and attentional cognitive deficits as targets for treating schizophrenia

BACKGROUND AND RATIONALE

Pharmacotherapy of schizophrenia has traditionally targeted positive psychotic symptoms. An emerging view is that developing medications that improve cognition in schizophrenia patients is a major step forward in achieving better functional outcome. The cognitive deficits that are often observed in schizophrenia can be assessed using (1) neuropsychological tests; and (2) neurophysiological tests, the topic of this article. These neurophysiological measures cover a spectrum from automatic preattentional to attention-dependent processes.

OBJECTIVES

This article focuses on cognitive deficits that appear to be promising targets for a new "third generation" of medications that may be used to treat schizophrenia and other patients with specific deficits in cognition and functioning. We discuss the possible use of the following six measures of preattentional and attention-dependent cognitive deficits: mismatch negativity, P50 event-related potential suppression, prepulse inhibition of the startle response, P300 event-related potential, continuous performance task performance, and oculomotor antisaccade performance.

CONCLUSIONS

The use of preattentional and attention-dependent measures offer unique opportunities to improve our armamentarium of pharmacologic strategies for the treatment of cognitive deficits in schizophrenia patients. This review illustrates the usefulness of these measures as targets for existing and new antipsychotic medications that will potentially (1) characterize the cognitive deficits that occur in schizophrenia patients and (2) assess medication-related improvement on these measures and the potential associated improvement in functional outcome.

Les potentiels évoqués cognitifs, auditifs et somesthésiques dans les comas : valeur pronostique pour l’éveil et la réintégration socioprofessionnelle

OBJECTIVE

To appreciate prognostical value of event-related potentials in comatose states and the influence of the stimulation's modality.

PATIENTS AND METHODS

Thirty-five patients were recorded with the auditory modality whose thirteen were also recorded with the somesthetic modality. They were free of sedation except for five. For 21 patients out of coma, it was possible to get information about their social readaptation 14 months later.

RESULTS

When present, cognitive components predict awakening in 100 % of the cases, but only 50 % of the patients who awake had these components. The somesthetic modality seemed to enlarge their detection, but did not improve short-term forecasts. We could not confirm their absence could hamper social reinstatement.

CONCLUSION

Event-related potentials are strengthened as having excellent positive prognostic value. Further studies should clarify the interest of the somesthetic modality, and the possibility to get remote prognostic.

Event-Related Potentials as Indices of Time Processing: A Review

Abstract This review examines ERP data that document the mechanisms and neural bases of time processing in the millisecond-to-minute range. Several types of ERP attest to the existence of timing capacities. Among them, one component of the Contingent Negative Variation (CNV) provides an on-line index of timing. CNV data strengthen the temporal accumulator concept, designed to subtend duration encoding. This conclusion is based on four main results: The positive relationship between temporal estimates and CNV amplitude is an index of the accumulation mechanism; the CNV peak is an index of time-based decision making; the CNV relates to temporal encoding, whereas temporal long-term memory may be linked to shifts of positive polarity; learning effects on CNV amplitude depend on topographic features, thus revealing functional differences among brain regions with respect to timing.

Effects of sleep onset on the mismatch negativity (MMN) to frequency deviants using a rapid rate of presentation

This study examined the effects of sleep onset-the transition from a waking, conscious state to one of sleep and unconsciousness-on the mismatch negativity (MMN) following frequency deviants when a rapid rate of stimulus presentation is employed. The MMN is thought to reflect a brief-lasting sensory memory. Rapid rates of stimulus presentation should guard the sensory memory from fading. A 1,000 Hz standard stimulus was presented every 150 ms. At random, on 6.6% of the trials, the standard was changed to either a large 2,000 or a small 1,100 Hz deviant. During alert wakefulness (when subject ignored the stimuli and read a book), the large deviant elicited a larger deviant related negativity (DRN) than did the small deviant. This negativity may be a composite of both N1 and MMN activity while that following the small deviant is probably a 'true' MMN. The large deviant continued to elicit a DRN in relaxed wakefulness (eyes closed) and Stages 1 and 2 of sleep, although it was much reduced in amplitude. A significant MMN was recorded for the small deviant only in alert wakefulness. The failure to observe an MMN to small deviance and the attenuation of the DRN to large deviance at sleep onset therefore is probably not due to a decay of sensory memory. It is more likely that cortical encoding of both the standard and deviant is weakened during sleep onset because of prior thalamic inhibition of sensory input.

Processing of low-probability sounds by cortical neurons

The ability to detect rare auditory events can be critical for survival. We report here that neurons in cat primary auditory cortex (A1) responded more strongly to a rarely presented sound than to the same sound when it was common. For the rare stimuli, we used both frequency and amplitude deviants. Moreover, some A1 neurons showed hyperacuity for frequency deviants--a frequency resolution one order of magnitude better than receptive field widths in A1. In contrast, auditory thalamic neurons were insensitive to the probability of frequency deviants. These phenomena resulted from stimulus-specific adaptation in A1, which may be a single-neuron correlate of an extensively studied cortical potential--mismatch negativity--that is evoked by rare sounds. Our results thus indicate that A1 neurons, in addition to processing the acoustic features of sounds, may also be involved in sensory memory and novelty detection.