Nonlinear analysis of electroencephalogram in schizophrenia patients with persistent auditory hallucination

Resting-State Electroencephalographic Signatures Predict Treatment Efficacy of tACS for Refractory Auditory Hallucinations in Schizophrenic Patients

Transcranial alternating current stimulation (tACS) has been reported to treat refractory auditory hallucinations in schizophrenia. Despite diligent efforts, it is imperative to underscore that tACS does not uniformly demonstrate efficacy across all patients as with all treatments currently employed in clinical practice. The study aims to find biomarkers predicting individual responses to tACS, guiding treatment decisions, and preventing healthcare resource wastage. We divided 17 schizophrenic patients with refractory auditory hallucinations into responsive(RE) and non-responsive(NR) groups based on their auditory hallucination symptom reduction rates after one month of tACS treatment. The pre-treatment resting-state electroencephalogram(rsEEG) was recorded and then computed absolute power spectral density (PSD), Hjorth parameters (HPs, Hjorth activity (HA), Hjorth mobility (HM), and Hjorth complexity (HC) included) from different frequency bands to portray the brain oscillations. The results demonstrated that statistically significant differences localized within the high gamma frequency bands of the right brain hemisphere. Immediately, we input the significant dissociable features into popular machine learning algorithms, the Cascade Forward Neural Network achieved the best recognition accuracy of 93.87%. These findings preliminarily imply that high gamma oscillations in the right brain hemisphere may be the main influencing factor leading to different responses to tACS treatment, and incorporating rsEEG signatures could improve personalized decisions for integrating tACS in clinical treatment.

Brain entropy, fractal dimensions and predictability: A review of complexity measures for EEG in healthy and neuropsychiatric populations

There has been an increasing trend towards the use of complexity analysis in quantifying neural activity measured by electroencephalography (EEG) signals. On top of revealing complex neuronal processes of the brain that may not be possible with linear approaches, EEG complexity measures have also demonstrated their potential as biomarkers of psychopathology such as depression and schizophrenia. Unfortunately, the opacity of algorithms and descriptions originating from mathematical concepts have made it difficult to understand what complexity is and how to draw consistent conclusions when applied within psychology and neuropsychiatry research. In this review, we provide an overview and entry-level explanation of existing EEG complexity measures, which can be broadly categorized as measures of predictability and regularity. We then synthesize complexity findings across different areas of psychological science, namely, in consciousness research, mood and anxiety disorders, schizophrenia, neurodevelopmental and neurodegenerative disorders, as well as changes across the lifespan, while addressing some theoretical and methodological issues underlying the discrepancies in the data. Finally, we present important considerations when choosing and interpreting these metrics.

Multiscale Weighted Permutation Entropy Analysis of Schizophrenia Magnetoencephalograms

Schizophrenia is a neuropsychiatric disease that affects the nonlinear dynamics of brain activity. The primary objective of this study was to explore the complexity of magnetoencephalograms (MEG) in patients with schizophrenia. We combined a multiscale method and weighted permutation entropy to characterize MEG signals from 19 schizophrenia patients and 16 healthy controls. When the scale was larger than 42, the MEG signals of schizophrenia patients were significantly more complex than those of healthy controls (p<0.004). The difference in complexity between patients with schizophrenia and the controls was strongest in the frontal and occipital areas (p<0.001), and there was almost no difference in the central area. In addition, the results showed that the dynamic range of MEG complexity is wider in healthy individuals than in people with schizophrenia. Overall, the multiscale weighted permutation entropy method reliably quantified the complexity of MEG from schizophrenia patients, contributing to the development of potential magnetoencephalographic biomarkers for schizophrenia.

Altered Brain Criticality in Schizophrenia: New Insights From Magnetoencephalography

Schizophrenia has a complex etiology and symptomatology that is difficult to untangle. After decades of research, important advancements toward a central biomarker are still lacking. One of the missing pieces is a better understanding of how non-linear neural dynamics are altered in this patient population. In this study, the resting-state neuromagnetic signals of schizophrenia patients and healthy controls were analyzed in the framework of criticality. When biological systems like the brain are in a state of criticality, they are thought to be functioning at maximum efficiency (e.g., optimal communication and storage of information) and with maximum adaptability to incoming information. Here, we assessed the self-similarity and multifractality of resting-state brain signals recorded with magnetoencephalography in patients with schizophrenia patients and in matched controls. Schizophrenia patients had similar, although attenuated, patterns of self-similarity and multifractality values. Statistical tests showed that patients had higher values of self-similarity than controls in fronto-temporal regions, indicative of more regularity and memory in the signal. In contrast, patients had less multifractality than controls in the parietal and occipital regions, indicative of less diverse singularities and reduced variability in the signal. In addition, supervised machine-learning, based on logistic regression, successfully discriminated the two groups using measures of self-similarity and multifractality as features. Our results provide new insights into the baseline cognitive functioning of schizophrenia patients by identifying key alterations of criticality properties in their resting-state brain data.

The Etiology of Auditory Hallucinations in Schizophrenia: From Multidimensional Levels

Enormous efforts have been made to unveil the etiology of auditory hallucinations (AHs), and multiple genetic and neural factors have already been shown to have their own roles. Previous studies have shown that AHs in schizophrenia vary from those in other disorders, suggesting that they have unique features and possibly distinguishable mechanisms worthy of further investigation. In this review, we intend to offer a comprehensive summary of current findings related to AHs in schizophrenia from aspects of genetics and transcriptome, neurophysiology (neurometabolic and electroencephalogram studies), and neuroimaging (structural and functional magnetic resonance imaging studies and transcriptome–neuroimaging association study). Main findings include gene polymorphisms, glutamate level change, electroencephalographic alterations, and abnormalities of white matter fasciculi, cortical structure, and cerebral activities, especially in multiple regions, including auditory and language networks. More solid and comparable research is needed to replicate and integrate ongoing findings from multidimensional levels.

Alteration of power law scaling of spontaneous brain activity in schizophrenia

Nonlinear dynamical analysis has been used to quantify the complexity of brain signal at temporal scales. Power law scaling is a well-validated method in physics that has been used to describe the dynamics of a system in the frequency domain, ranging from noisy oscillation to complex fluctuations. In this research, we investigated the power-law characteristics in a large-scale resting-state fMRI data of schizophrenia and healthy participants derived from Taiwan Aging and Mental Illness cohort. We extracted the power spectral density (PSD) of resting signal by Fourier transform. Power law scaling of PSD was estimated by determining the slope of the regression line fitting to the logarithm of PSD. t-Test was used to assess the statistical difference in power law scaling between schizophrenia and healthy participants. The significant differences in power law scaling were found in six brain regions. Schizophrenia patients have significantly more positive power law scaling (i.e., more homogenous frequency components) at four brain regions: left precuneus, left medial dorsal nucleus, right inferior frontal gyrus, and right middle temporal gyrus and less positive power law scaling (i.e., more dominant at lower frequency range) in bilateral putamen compared with healthy participants. Moreover, significant correlations of power law scaling with the severity of psychosis were found. These findings suggest that schizophrenia has abnormal brain signal complexity linked to psychotic symptoms. The power law scaling represents the dynamical properties of resting-state fMRI signal may serve as a novel functional brain imaging marker for evaluating patients with mental illness.

Schizophrenia EEG Signal Classification Based on Swarm Intelligence Computing

One of the serious mental disorders where people interpret reality in an abnormal state is schizophrenia. A combination of extremely disordered thinking, delusion, and hallucination is caused due to schizophrenia, and the daily functions of a person are severely disturbed because of this disorder. A wide range of problems are caused due to schizophrenia such as disturbed thinking and behaviour. In the field of human neuroscience, the analysis of brain activity is quite an important research area. For general cognitive activity analysis, electroencephalography (EEG) signals are widely used as a low-resolution diagnosis tool. The EEG signals are a great boon to understand the abnormality of the brain disorders, especially schizophrenia. In this work, schizophrenia EEG signal classification is performed wherein, initially, features such as Detrend Fluctuation Analysis (DFA), Hurst Exponent, Recurrence Quantification Analysis (RQA), Sample Entropy, Fractal Dimension (FD), Kolmogorov Complexity, Hjorth exponent, Lempel Ziv Complexity (LZC), and Largest Lyapunov Exponent (LLE) are extracted initially. The extracted features are, then, optimized for selecting the best features through four types of optimization algorithms here such as Artificial Flora (AF) optimization, Glowworm Search (GS) optimization, Black Hole (BH) optimization, and Monkey Search (MS) optimization, and finally, it is classified through certain classifiers. The best results show that, for normal cases, a classification accuracy of 87.54% is obtained when BH optimization is utilized with Support Vector Machine-Radial Basis Function (SVM-RBF) kernel, and for schizophrenia cases, a classification accuracy of 92.17% is obtained when BH optimization is utilized with SVM-RBF kernel.

Complexity analysis of spontaneous brain activity in mood disorders: A magnetoencephalography study of bipolar disorder and major depression

BACKGROUND AND PURPOSE

The lack of a biomarker for Bipolar Disorder (BD) causes problems in the differential diagnosis with other mood disorders such as major depression (MD), and misdiagnosis frequently occurs. Bearing this in mind, we investigated non-linear magnetoencephalography (MEG) patterns in BD and MD.

METHODS

Lempel-Ziv Complexity (LZC) was used to evaluate the resting-state MEG activity in a cross-sectional sample of 60 subjects, including 20 patients with MD, 16 patients with BD type-I, and 24 control (CON) subjects. Particular attention was paid to the role of age. The results were aggregated by scalp region.

RESULTS

Overall, MD patients showed significantly higher LZC scores than BD patients and CONs. Linear regression analyses demonstrated distinct tendencies of complexity progression as a function of age, with BD patients showing a divergent tendency as compared with MD and CON groups. Logistic regressions confirmed such distinct relationship with age, which allowed the classification of diagnostic groups.

CONCLUSIONS

The patterns of neural complexity in BD and MD showed not only quantitative differences in their non-linear MEG characteristics but also divergent trajectories of progression as a function of age. Moreover, neural complexity patterns in BD patients resembled those previously observed in schizophrenia, thus supporting preceding evidence of common neuropathological processes.

Brain-imaging studies of treatment-resistant schizophrenia: a systematic review

Around 30% of patients with schizophrenia show an inadequate response to antipsychotics-ie, treatment resistance. Neuroimaging studies can help to uncover the underlying neurobiological reasons for such resistance and identify these patients earlier. Additionally, studies examining the effect of clozapine on the brain can help to identify aspects of clozapine that make it uniquely effective in patients with treatment resistance. We did a systematic search of PubMed between Jan 1, 1980, and April 13, 2015, to identify all neuroimaging studies that examined treatment-resistant patients or longitudinally assessed the effects of clozapine treatment. We identified 330 articles, of which 61 met the inclusion criteria. Replicated differences between treatment-resistant and treatment-responsive patients include reductions in grey matter and perfusion of frontotemporal regions, and increases in white matter and basal ganglia perfusion, with effect sizes ranging from 0·4 to greater than 1. Clozapine treatment led to reductions in caudate nucleus volume in three separate studies. The available evidence supports the hypothesis that some of the neurobiological changes seen in treatment-resistant schizophrenia lie along a continuum with treatment-responsive schizophrenia, whereas other differences are categorical in nature and have potential to be used as biomarkers. However, further replication is needed, and for neuroimaging findings to be clinically translatable, future studies need to focus on a-priori hypotheses and be adequately powered.

Analysis of the Complexity Measures in the EEG of Schizophrenia Patients

Complexity measures have been enormously used in schizophrenia patients to estimate brain dynamics. However, the conflicting results in terms of both increased and reduced complexity values have been reported in these studies depending on the patients' clinical status or symptom severity or medication and age status. The objective of this study is to investigate the nonlinear brain dynamics of chronic and medicated schizophrenia patients using distinct complexity estimators. EEG data were collected from 22 relaxed eyes-closed patients and age-matched healthy controls. A single-trial EEG series of 2 min was partitioned into identical epochs of 20 s intervals. The EEG complexity of participants were investigated and compared using approximate entropy (ApEn), Shannon entropy (ShEn), Kolmogorov complexity (KC) and Lempel-Ziv complexity (LZC). Lower complexity values were obtained in schizophrenia patients. The most significant complexity differences between patients and controls were obtained in especially left frontal (F3) and parietal (P3) regions of the brain when all complexity measures were applied individually. Significantly, we found that KC was more sensitive for detecting EEG complexity of patients than other estimators in all investigated brain regions. Moreover, significant inter-hemispheric complexity differences were found in the frontal and parietal areas of schizophrenics' brain. Our findings demonstrate that the utilizing of sensitive complexity estimators to analyze brain dynamics of patients might be a useful discriminative tool for diagnostic purposes. Therefore, we expect that nonlinear analysis will give us deeper understanding of schizophrenics' brain.

Brown Norway rats, a putative schizophrenia model, show increased electroencephalographic activity at rest and decreased event-related potential amplitude, power, and coherence in the auditory sensory gating paradigm

In recent schizophrenia clinical research, electroencephalographic (EEG) oscillatory activities induced by a sensory stimulus or behavioral tasks have gained considerable interest as functional and pathophysiological biomarkers. The Brown Norway (BN) rat is a putative schizophrenia model that shows naturally low sensorimotor gating and deficits in cognitive performance, although other phenotypes have not been studied. The present study aimed to investigate the neurophysiological features of BN rats, particularly EEG/event-related potential (ERP). EEG activity was recorded at rest and during the auditory sensory gating paradigm under an awake, freely moving condition. Frequency and ERP analysis were performed along with time-frequency analysis of evoked power and intertrial coherence. Compared with Wistar-Kyoto rats, a well-documented control line, BN rats showed increased EEG power at rest, particularly in the theta and gamma ranges. In ERP analysis, BN rats showed reduced N40-P20 amplitude but normal sensory gating. The rats also showed reduced evoked power and intertrial coherence against auditory stimuli. These results suggest that BN rats show features of EEG/ERP measures clinically relevant to schizophrenia and may provide additional opportunities for translational research.

Physiological correlates of positive symptoms in schizophrenia

Patients with schizophrenia have been hypothesized to have a functional impairment in filtering irrelevant sensory information, which may result in positive symptoms such as hallucinations or delusions. Many evidences suggest that abnormalities in the event-related brain potentials (ERPs), resting state electroencephalography (EEG) and synchronized oscillatory activity of neurons may reflect core pathophysiological mechanisms of schizophrenia. Abnormalities in amplitude and latency of the ERPs reflecting aberrations in gating and difficulties in the detection of changes in auditory stimuli, as well as defects in stimuli evaluation and integration of information are common in patients with schizophrenia. This chapter highlights the findings of electrophysiological studies in schizophrenia dealing with early sensory perception and attention, automatic sensory detection of stimuli changes and cognitive evaluation and integration of information, relevant to the pathophysiological mechanisms underpinning hallucinations and delusions. Results of electrophysiological studies investigating the neural correlates of positive symptoms suggest aberrant intrinsic organization of functional brain networks.

Complexity and schizophrenia

Complexity estimators have been broadly utilized in schizophrenia investigation. Early studies reported increased complexity in schizophrenia patients, associated with a higher variability or "irregularity" of their brain signals. However, further investigations showed reduced complexities, thus introducing a clear divergence. Nowadays, both increased and reduced complexity values are reported. The explanation of such divergence is a critical issue to understand the role of complexity measures in schizophrenia research. Considering previous arguments a complementary hypothesis is advanced: if the increased irregularity of schizophrenia patients' neurophysiological activity is assumed, a "natural" tendency to increased complexity in EEG and MEG scans should be expected, probably reflecting an abnormal neuronal firing pattern in some critical regions such as the frontal lobes. This "natural" tendency to increased complexity might be modulated by the interaction of three main factors: medication effects, symptomatology, and age effects. Therefore, young, medication-naïve, and highly symptomatic (positive symptoms) patients are expected to exhibit increased complexities. More importantly, the investigation of these interacting factors by means of complexity estimators might help to elucidate some of the neuropathological processes involved in schizophrenia.

Complexity of spontaneous brain activity in mental disorders

Recent reports of functional and anatomical studies have provided evidence that aberrant neural connectivity lies at the heart of many mental disorders. Information related to neural networks has elucidated the nonlinear dynamical complexity in brain signals over a range of temporal scales. The recent advent of nonlinear analytic methods, which have served for the quantitative description of the brain signal complexity, has provided new insights into aberrant neural connectivity in many mental disorders. Although many studies have underpinned aberrant neural connectivity, findings related to complexity behavior are still inconsistent. This inconsistency might result from (i) heterogeneity in mental disorders, (ii) analytical issues, (iii) interference of typical development and aging. First, most mental disorders are heterogeneous in their clinical feature or intrinsic pathological mechanisms. Second, neurophysiologic output signals from complex brain connectivity might be characterized with multiple time scales or frequencies. Finally, age-related brain complexity changes must be considered when investigating pathological brain because typical brain complexity is not constant across generations. Future systematic studies addressing these issues will greatly expand our knowledge of neural connections and dynamics related to mental disorders.

Nonlinear analysis of electroencephalogram at rest and during cognitive tasks in patients with schizophrenia

BACKGROUND

In spite of the large number of studies on schizophrenia, a full understanding of its core pathology still eludes us. The application of the nonlinear theory of electroencephalography (EEG) analysis provides an interesting tool to differentiate between physiologic conditions (e.g., resting state and mathematical task) and normal and pathologic brain activities. The aim of the present study was to investigate nonlinear EEG activity in patients with schizophrenia.

METHODS

We recorded 19-lead EEGs in patients with stable schizophrenia and healthy controls under 4 different conditions: eyes closed, eyes open, forward counting and backward counting. A nonlinear measure of complexity was calculated by means of correlation dimension (D2).

RESULTS

We included 17 patients and 17 controls in our analysis. Comparing the 2 populations, we observed greater D2 values in the patient group. In controls, increased D2 values were observed during active states (eyes open and the 2 cognitive tasks) compared with baseline conditions. This increase of brain complexity, which can be interpreted as an increase of information processing and integration, was not preserved in the patient population.

LIMITATIONS

Patients with schizophrenia were taking antipsychotic medications, so the presence of medication effects cannot be excluded.

CONCLUSION

Our results suggest that patients with schizophrenia present changes in brain activity compared with healthy controls, and this pathologic alteration can be successfully studied with nonlinear EEG analysis.