Computer analysis of cortical evoked potentials following severe head injury

It is time to combine the two main traditions in the research on the neural correlates of consciousness: C = L × D

Research on neural correlates of consciousness has been conducted and carried out mostly from within two relatively autonomous paradigmatic traditions – studying the specific contents of conscious experience and their brain-process correlates and studying the level of consciousness. In the present paper we offer a theoretical integration suggesting that an emphasis has to be put on understanding the mechanisms of consciousness (and not a mere correlates) and in doing this, the two paradigmatic traditions must be combined. We argue that consciousness emerges as a result of interaction of brain mechanisms specialized for representing the specific contents of perception/cognition – the data – and mechanisms specialized for regulating the level of activity of whatever data the content-carrying specific mechanisms happen to represent. Each of these mechanisms are necessary because without the contents there is no conscious experience and without the required level of activity the processed contents remain unconscious. Together the two mechanisms, when activated up to a necessary degree each, provide conditions sufficient for conscious experience to emerge. This proposal is related to pertinent experimental evidence.

The relevance of QEEG to the evaluation of behavioral disorders and pharmacological interventions

It has become apparent that the electrical signals recorded from the scalp of healthy individuals under standardized conditions are predictable, and that patients with a wide variety of brain disorders display activity with unusual features. It also early became apparent that centrally active medications produced striking changes in this activity. The application of computerized signal analysis to EEG recordings collected using standardized procedures has made it possible to obtain quantitative descriptions of brain electrical activity (QEEG) in normal individuals and patients with disorders of brain function or structure, as well as quantitative description of the ways in which centrally active medications alter this activity (Pharmaco-EEG or "PEEG"). With the emergence of three-dimensional EEG source localization techniques, it has recently become possible to visualize the mathematically most probable generators of QEEG abnormalities within the brain as well as the neuroanatomical regions where abnormal activity is most altered by efficacious medication. As QEEG and PEEG have evolved, a vast body of facts has been accumulated, describing changes in the EEG or event-related potentials (ERPs). observed in a variety of brain disorders or after administration of a variety of medications. With some notable exceptions, these studies have tended to be phenomenological rather than analytic. There has not been a systematic attempt to integrate these phenomena in order to build better understanding of how the abnormal behaviors of a particular psychiatric patient might be related to the specific pattern of the deviant electrical activity, nor just how pharmacological reduction of that deviant activity may have resulted in more normal behavior. This article is an endeavor to provide a more specific theoretical framework for understanding the relationships between the neuroanatomy and neurochemistry of the homeostatic system underlying the regulation of the QEEG, and the mechanisms revealed by Pharmaco-EEG that aid in correcting these illnesses.

From synchronous neuronal discharges to subjective awareness?

For practical clinical purposes, as well as because of their deep philosophical implications, it becomes increasingly important to be aware of contemporary studies of the brain mechanisms that generate subjective experiences. Current research has progressed to the point where plausible theoretical proposals can be made about the neurophysiological and neurochemical processes which mediate perception and sustain subjective awareness. An adequate theory of consciousness must describe how information about the environment is encoded by the exogenous system, how memories are stored in the endogenous system and released appropriately for the present circumstances, how the exogenous and endogenous systems interact to produce perception, and explain how consciousness arises from that interaction. Evidence assembled from a variety of neuroscience areas, together with the invariant reversible electrophysiological changes observed with loss and return of consciousness in anesthesia as well as distinctive quantitative electroencephalographic profiles of various psychiatric disorders, provides an empirical foundation for this theory of consciousness. This evidence suggests the need for a paradigm shift to explain how the brain accomplishes the transformation from synchronous and distributed neuronal discharges to seamless global subjective awareness. This chapter undertakes to provide a detailed description and explanation of these complex processes by experimental evidence marshaled from a wide variety of sources.

The neurophysics of consciousness

Consciousness combines information about attributes of the present multimodal sensory environment with relevant elements of the past. Information from each modality is continuously fractionated into distinct features, processed locally by different brain regions relatively specialized for extracting these disparate components and globally by interactions among these regions. Information is represented by levels of synchronization within neuronal populations and of coherence among multiple brain regions that deviate from random fluctuations. Significant deviations constitute local and global negative entropy, or information. Local field potentials reflect the degree of synchronization among the neurons of the local ensembles. Large-scale integration, or 'binding', is proposed to involve oscillations of local field potentials that play an important role in facilitating synchronization and coherence, assessed by neuronal coincidence detectors, and parsed into perceptual frames by cortico-thalamo-cortical loops. The most probable baseline levels of local synchrony, coherent interactions among brain regions, and frame durations have been quantitatively described in large studies of their age-appropriate normative distributions and are considered as an approximation to a conscious 'ground state'. The level of consciousness during anesthesia can be accurately predicted by the magnitude and direction of reversible multivariate deviations from this ground state. An invariant set of changes takes place during anesthesia, independent of the particular anesthetic agent. Evidence from a variety of neuroscience areas supporting these propositions, together with the invariant reversible electrophysiological changes observed with loss and return of consciousness, are used to provide a foundation for this theory of consciousness. This paper illustrates the increasingly recognized need to consider global as well as local processes in the search for better explanations of how the brain accomplishes the transformation from synchronous and distributed neuronal discharges to seamless global subjective awareness.

A field theory of consciousness

This article summarizes a variety of current as well as previous research in support of a new theory of consciousness. Evidence has been steadily accumulating that information about a stimulus complex is distributed to many neuronal populations dispersed throughout the brain and is represented by the departure from randomness of the temporal pattern of neural discharges within these large ensembles. Zero phase lag synchronization occurs between discharges of neurons in different brain regions and is enhanced by presentation of stimuli. This evidence further suggests that spatiotemporal patterns of coherence, which have been identified by spatial principal component analysis, may encode a multidimensional representation of a present or past event. How such distributed information is integrated into a holistic precept constitutes the binding problem. How a precept defined by a spatial distribution of nonrandomness can be subjectively experienced constitutes the problem of consciousness. Explanations based on a discrete connectionistic network cannot be reconciled with the relevant facts. Evidence is presented herein of invariant features of brain electrical activity found to change reversibly with loss and return of consciousness in a study of 176 patients anesthetized during surgical procedures. A review of relevant research areas, as well as the anesthesia data, leads to a postulation that consciousness is a property of quantum-like processes, within a brain field resonating within a core of structures, which may be the neural substrate of consciousness. This core includes regions of the prefrontal cortex, the frontal cortex, the pre- and paracentral cortex, thalamus, limbic system, and basal ganglia.

Electrophysiological correlates of visual impairments after traumatic brain injury

Our aims were to investigate: (i) the VEP correlates of functional visual impairments following traumatic brain injury (TBI), in particular of the reduced spatial form perception; and (ii) the VEP correlates of visual sustained arousal in TBI patients. We used two approaches: (i) the analysis of latency and amplitude of the peaks; and (ii) the study of the correlations among the latencies of the peaks as a label of temporal synchronization. Thirty-five severe TBI outcome inpatients and 35 matching controls were studied. Pattern-reversal VEPs were recorded at Oz-Fz and Cz-A1, first without counting, then with counting of the reversals. Seven peaks of the waveform at Oz and eight peaks at Cz were measured. We found several differences in amplitude and latency between patients and controls, and between nocount/count. The temporal binding of the peaks within each channel and between the two channels was calculated by correlation matrices, and tested by factor analysis. Results indicated that the synchronization of the peaks within each channel did not differ between patients and controls. The temporal covariation between peaks occurring at Oz and Cz, however, was highly significantly altered in patients. This suggests that visual impairments in TBI patients may be due to a deranged synchronization of the activity of different brain regions.

Status of quantitative EEG (QEEG) in clinical practice, 1994

Clinical quantitative EEG (qEEG) is a complex specialty that may include not only standard EEG but also digital ("paperless") EEG, topographic mapping, spectral analysis, spectral coherence, long latency and event related potentials (EP), significance probability mapping (SPM), dipole source localization methodology (DLM), and discriminant function analysis. There are three basic clinical uses: non-specific detection of organicity/encephalopathy, specific categorization of disease or clinical condition, and epileptic source localization. Extreme variations exist in the competency of laboratories practicing clinical qEEG; universally agreed upon standards of practice have not been established but there are a number of efforts to do so. As expected, the clinical value of qEEG to patients varies similarly. Criticisms of qEEG have now been answered: Color displays need not be deceptive. Statistical "capitalization upon chance" can be easily avoided. By training and with newer analytic procedures, artifacts can be recognized and often removed. Data based upon spectral analysis and EP can reliably classify clinical conditions thereby demonstrating a greater sensitivity to EEG/EP data than possible by conventional visual inspection. QEEG is clearly of clinical value when performed in concert with standard EEG and analyzed by clinicians with demonstrated competency in standard EEG followed by specialized training and demonstrated competency in qEEG. QEEG is not a simple substitute for conventional EEG and cannot be seen as a substitute for clinical competence. Although continuing to develop, qEEG technology has matured sufficiently and is now well established. Concerns regarding its clinical use have primarily resulted from its misapplication and misinterpretation stemming, largely, from inadequate personnel training and expertise.

Quantified EEG and cortical evoked responses in patients with chronic traumatic frontal lesions

Eighteen frontal trauma patients and 17 age-matched control subjects had quantified EEGs and measurements of sensory (SEP) and auditory evoked potentials (P300) using a Biologic Brain Atlas III system. The findings were compared to the conventional paper EEG, and to the frontal lesion volumes, severity of head injury, and outcome variables. The quantified EEG confirmed the pathological findings detected by visual inspection, but some regional abnormalities were more easily detected by topographic mapping. The regional distribution of pathological slowing corresponded well with the morphological lesions in most patients. The modal frequency of EEG correlated both with lesion volume and injury severity and with the outcome variables. There were no pathological findings in the SEPs, and all but one patient had clearly distinguishable P300 responses. There was a significant reduction in P300 amplitude in the frontal patients at the anterior, but not at the posterior electrodes. The topographical distribution of the P300 changes corresponded well with the morphological lesions. Our findings indicate that the P300 potential is, in part, dependent upon the prefrontal cortical areas. The present study thus supports P300 investigations which have shown amplitude reduction in other disorders (e.g., schizophrenia) with a presumed prefrontal dysfunction.

Effects of anesthesia and stimulus intensity on posterior tibial nerve somatosensory evoked potentials

Under anesthesia peak latencies occurring up to 75 milliseconds after stimulus onset upon somatosensory evoked potential testing of the somatosensory evoked potential testing of the posterior tibial nerve were not affected by stimulus intensity (between 5 and 19 ma) or by length of time under isoflurane and nitrous oxide up to over 2 hours. When pre- and postoperative tests on patients who were not under anesthesia were compared with results under anesthesia, no significant latency differences were found in relation to stimulus intensity for peaks N30, P40 and N50. For peaks P60 and N75, however, significantly increased latencies were seen during anesthesia, more pronounced and consistent for N75. Amplitudes, however, were affected by both stimulus intensity and anesthesia duration. A curvilinear relationship was found during early anesthesia. Maximum amplitudes were found at 7 or 11 ma stimulus intensity levels, depending upon which peak was analyzed, with lesser amplitudes occurring at both lower and higher stimulus intensity levels. Stimulus intensity and anesthesia interacted such that maximum amplitude occurred, in general, at 11 ma after short duration anesthesia (6') and at 7 ma after long duration anesthesia (125'). Under long duration anesthesia amplitudes were significantly diminished, mostly at the 11 ma intensity level. At 15 and 19 ma intensity levels peak amplitudes remained relatively constant regardless of anesthesia duration and therefore are the intensities to use to monitor changes during prolonged surgeries. When preoperative during prolonged surgeries. When preoperative and postoperative tests were compared to tests under anesthesia, there was a decrease in amplitude under anesthesia, greater for long than short duration anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)