Brain networks affected by synchronized sleep visualized by positron emission tomography

Higher order diffusion imaging as a putative index of human sleep-related microstructural changes and glymphatic clearance

The brain has a unique macroscopic waste clearance system, termed the glymphatic system which utilises perivascular tunnels surrounded by astroglia to promote cerebrospinal-interstitial fluid exchange. Rodent studies have demonstrated a marked increase in glymphatic clearance during sleep which has been linked to a sleep-induced expansion of the extracellular space and concomitant reduction in intracellular volume. However, despite being implicated in the pathophysiology of multiple human neurodegenerative disorders, non-invasive techniques for imaging glymphatic clearance in humans are currently limited. Here we acquired multi-shell diffusion weighted MRI (dwMRI) in twenty-one healthy young participants (6 female, 22.3 ± 3.2 years) each scanned twice, once during wakefulness and once during sleep induced by a combination of one night of sleep deprivation and 10 mg of the hypnotic zolpidem 30 min before scanning. To capture hypothesised sleep-associated changes in intra/extracellular space, dwMRI were analysed using higher order diffusion modelling with the prediction that sleep-associated increases in interstitial (extracellular) fluid volume would result in a decrease in diffusion kurtosis, particularly in areas associated with slow wave generation at the onset of sleep. In line with our hypothesis, we observed a global reduction in diffusion kurtosis (t15=2.82, p = 0.006) during sleep as well as regional reductions in brain areas associated with slow wave generation during early sleep and default mode network areas that are highly metabolically active during wakefulness. Analysis with a higher-order representation of diffusion (MAP-MRI) further indicated that changes within the intra/extracellular domain rather than membrane permeability likely underpin the observed sleep-associated decrease in kurtosis. These findings identify higher-order modelling of dwMRI as a potential new non-invasive method for imaging glymphatic clearance and extend rodent findings to suggest that sleep is also associated with an increase in interstitial fluid volume in humans.

The Kappa Opioid Receptor and the Sleep of Reason: Cortico-Subcortical Imbalance Following Salvinorin-A

BACKGROUND

The mechanisms through which kappa opioid receptor (KOR) agonists induce psychotomimetic effects are largely unknown, although the modulation of this receptor has attracted attention for its clinical use. In this work, we characterize the neuropharmacological effects of salvinorin-A, a highly selective KOR agonist.

METHODS

Changes in multimodal electroencephalography, single-photon emission computed tomography, and subjective effects following the acute administration of salvinorin-A are reported. The study included 2 sub-studies that employed a double-blind, crossover, randomized, placebo-controlled design.

RESULTS

The electroencephalography measures showed a marked increase in delta and gamma waves and a decrease in alpha waves while subjects were under the effect of salvinorin-A. Regarding single-photon emission computed tomography measures, significant decreases in regional cerebral blood flow were detected in multiple regions of the frontal, temporal, parietal, and occipital cortices. Significant regional cerebral blood flow increases were observed in some regions of the medial temporal lobe, including the amygdala, the hippocampal gyrus, and the cerebellum. The pattern of subjective effects induced by salvinorin-A was similar to those observed in relation to other psychotomimetic drugs but with an evidently dissociative nature. No dysphoric effects were reported.

CONCLUSION

The salvinorin-A-mediated KOR agonism induced dramatic psychotomimetic effects along with a generalized decrease in cerebral blood flow and electric activity within the cerebral cortex.

The subcortical belly of sleep: New possibilities in neuromodulation of basal ganglia?

Early studies posited a relationship between sleep and the basal ganglia, but this relationship has received little attention recently. It is timely to revisit this relationship, given new insights into the functional anatomy of the basal ganglia and the physiology of sleep, which has been made possible by modern techniques such as chemogenetic and optogenetic mapping of neural circuits in rodents and intracranial recording, functional imaging, and a better understanding of human sleep disorders. We discuss the functional anatomy of the basal ganglia, and review evidence implicating their role in sleep. Whilst these studies are in their infancy, we suggest that the basal ganglia may play an integral role in the sleep-wake cycle, specifically by contributing to a thalamo-cortical-basal ganglia oscillatory network in slow-wave sleep which facilitates neural plasticity, and an active state during REM sleep which enables the enactment of cognitive and emotional networks. A better understanding of sleep mechanisms may pave the way for more effective neuromodulation strategies for sleep and basal ganglia disorders.

Sleep and Neuroimaging

We spend about one-third of our lives either sleeping or attempting to sleep. Therefore, the socioeconomic implications of sleep disorders may be higher than expected. However, the fundamental mechanisms and functions of sleep are not yet fully understood. Neuroimaging has been utilized to reveal the connectivity between sleep and the brain, which is associated with the physiology of sleep. Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) imaging studies have become increasingly common in sleep research. Recently, significant progress has been made in understanding the physiology of sleep through neuroimaging and the use of various radiopharmaceuticals, as the sleep-wake cycle is regulated by multiple neurotransmitters, including dopamine, adenosine, glutamate, and others. In addition, the characteristics of rapid eye and non-rapid eye movement sleep have been investigated by measuring cerebral glucose metabolism. The physiology of sleep has been investigated using PET to study glymphatic function as a means to clear the amyloid burden. However, the basic mechanisms and functions of sleep are not yet fully understood. Further studies are needed to investigate the effects and consequences of chronic sleep deprivation, and the relevance of sleep to other diseases.

Neural correlates of rumination in major depressive disorder: A brain network analysis

Patients with major depressive disorder (MDD) exhibit higher levels of rumination, i.e., repetitive thinking patterns and exaggerated focus on negative states. Rumination is known to be associated with the cortical midline structures / default mode network (DMN) region activity, although the brain network topological organization underlying rumination remains unclear. Implementing a graph theoretical analysis based on ultra-high field 7-Tesla functional MRI data, we tested whether whole brain network connectivity hierarchies during resting state are associated with rumination in a dimensional manner across 20 patients with MDD and 20 healthy controls. Applying this data-driven approach we found a significant correlation between rumination tendency and connectivity strength degree of the right precuneus, a key node of the DMN. In order to interrogate this region further, we then applied the Dependency Network Analysis (D_EPNA), a recently developed method used to quantify the connectivity influence of network nodes. This revealed that rumination was associated with lower connectivity influence of the left medial orbito-frontal cortex (MOFC) cortex on the right precuneus. Lastly, we used an information theory entropy measure that quantifies the cohesion of a network's correlation matrix. We show that subjects with higher rumination scores exhibit higher entropy levels within the DMN i.e. decreased overall connectivity within the DMN. These results emphasize the general DMN involvement during self-reflective processing related to maladaptive rumination in MDD. This work specifically highlights the impact of the MOFC on the precuneus, which might serve as a target for clinical neuromodulation treatment.

Pleasure: The missing link in the regulation of sleep

Although largely unrecognized by sleep scholars, sleeping is a pleasure. This report aims first, to fill the gap: sleep, like food, water and sex, is a primary reinforcer. The levels of extracellular mesolimbic dopamine show circadian oscillations and mark the "wanting" for pro-homeostatic stimuli. Further, the dopamine levels decrease during waking and are replenished during sleep, in opposition to sleep propensity. The wanting of sleep, therefore, may explain the homeostatic and circadian regulation of sleep. Accordingly, sleep onset occurs when the displeasure of excessive waking is maximal, coinciding with the minimal levels of mesolimbic dopamine. Reciprocally, sleep ends after having replenished the limbic dopamine levels. Given the direct relation between waking and mesolimbic dopamine, sleep must serve primarily to gain an efficient waking. Pleasant sleep (i.e. emotional sleep), can only exist in animals capable of feeling emotions. Therefore, although sleep-like states have been described in invertebrates and primitive vertebrates, the association sleep-pleasure clearly marks a difference between the sleep of homeothermic vertebrates and cool blooded animals.

Hyperarousal and Beyond: New Insights to the Pathophysiology of Insomnia Disorder through Functional Neuroimaging Studies

Neuroimaging studies have produced seemingly contradictory findings in regards to the pathophysiology of insomnia. Although most study results are interpreted from the perspective of a "hyperarousal" model, the aggregate findings from neuroimaging studies suggest a more complex model is needed. We provide a review of the major findings from neuroimaging studies, then discuss them in relation to a heuristic model of sleep-wake states that involves three major factors: wake drive, sleep drive, and level of conscious awareness. We propose that insomnia involves dysregulation in these factors, resulting in subtle dysregulation of sleep-wake states throughout the 24 h light/dark cycle.

Sleep-Wake Differences in Relative Regional Cerebral Metabolic Rate for Glucose among Patients with Insomnia Compared with Good Sleepers

STUDY OBJECTIVES

The neurobiological mechanisms of insomnia may involve altered patterns of activation across sleep-wake states in brain regions associated with cognition, self-referential processes, affect, and sleep-wake promotion. The objective of this study was to compare relative regional cerebral metabolic rate for glucose (rCMRglc) in these brain regions across wake and nonrapid eye movement (NREM) sleep states in patients with primary insomnia (PI) and good sleeper controls (GS).

METHODS

Participants included 44 PI and 40 GS matched for age (mean = 37 y old, range 21-60), sex, and race. We conducted [18F]fluoro-2-deoxy-D-glucose positron emission tomography scans in PI and GS during both morning wakefulness and NREM sleep at night. Repeated measures analysis of variance was used to test for group (PI vs. GS) by state (wake vs. NREM sleep) interactions in relative rCMRglc.

RESULTS

Significant group-by-state interactions in relative rCMRglc were found in the precuneus/posterior cingulate cortex, left middle frontal gyrus, left inferior/superior parietal lobules, left lingual/fusiform/occipital gyri, and right lingual gyrus. All clusters were significant at Pcorrected < 0.05.

CONCLUSIONS

Insomnia was characterized by regional alterations in relative glucose metabolism across NREM sleep and wakefulness. Significant group-by-state interactions in relative rCMRglc suggest that insomnia is associated with impaired disengagement of brain regions involved in cognition (left frontoparietal), self-referential processes (precuneus/posterior cingulate), and affect (left middle frontal, fusiform/lingual gyri) during NREM sleep, or alternatively, to impaired engagement of these regions during wakefulness.

Spatial patterns of neuronal activity in rat cerebral cortex during non-rapid eye movement sleep

It is commonly assumed that cortical activity in non-rapid eye movement sleep (NREMS) is spatially homogeneous on the mesoscopic scale. This is partly due to the limited observational scope of common metabolic or imaging methods in sleep. We used the recently developed technique of thallium-autometallography (TlAMG) to visualize mesoscopic patterns of activity in the sleeping cortex with single-cell resolution. We intravenously injected rats with the lipophilic chelate complex thallium diethyldithiocarbamate (TlDDC) during spontaneously occurring periods of NREMS and mapped the patterns of neuronal uptake of the potassium (K+) probe thallium (Tl+). Using this method, we show that cortical activity patterns are not spatially homogeneous during discrete 5-min episodes of NREMS in unrestrained rats-rather, they are complex and spatially diverse. Along with a relative predominance of infragranular layer activation, we find pronounced differences in metabolic activity of neighboring neuronal assemblies, an observation which lends support to the emerging paradigm that sleep is a distributed process with regulation on the local scale.

The pathophysiology of insomnia

Insomnia disorder is characterized by chronic dissatisfaction with sleep quantity or quality that is associated with difficulty falling asleep, frequent nighttime awakenings with difficulty returning to sleep, and/or awakening earlier in the morning than desired. Although progress has been made in our understanding of the nature, etiology, and pathophysiology of insomnia, there is still no universally accepted model. Greater understanding of the pathophysiology of insomnia may provide important information regarding how, and under what conditions, the disorder develops and is maintained as well as potential targets for prevention and treatment. The aims of this report are (1) to summarize current knowledge on the pathophysiology of insomnia and (2) to present a model of the pathophysiology of insomnia that considers evidence from various domains of research. Working within several models of insomnia, evidence for the pathophysiology of the disorder is presented across levels of analysis, from genetic to molecular and cellular mechanisms, neural circuitry, physiologic mechanisms, sleep behavior, and self-report. We discuss the role of hyperarousal as an overarching theme that guides our conceptualization of insomnia. Finally, we propose a model of the pathophysiology of insomnia that integrates the various types of evidence presented.

Neuroimaging studies of sleep and memory in humans

Human brain dynamics are nowadays routinely explored at the macroscopic level using a wide variety of non-invasive neuroimaging techniques, including single photon emission computed tomography (SPECT) and positron emission tomography (PET), near infrared spectroscopy (NIRS) and functional magnetic resonance imaging (fMRI). In the past decades, the application of brain imaging methods to the study of sleep raised a renewed interest for the field, especially in the domain of neuroscience. Indeed, these studies enabled researchers to characterize the functional neuroanatomy of sleep stages and identify the neural correlates of phasic and tonic sleep mechanisms. Furthermore, they provided the scientific community with tools to address the crucial question of brain plasticity processes during human sleep, the role of sleep-related plasticity for memory consolidation, and how sleep and the lack of post-training sleep impacts brain functioning in the neural networks underlying memory-related cognitive processes. This chapter reviews the contributions of neuroimaging to our understanding of the functional neuroanatomy of sleep and sleep stages, and discusses how sleep contributes to the long-term consolidation of recently acquired memories in light of contemporary neural models for memory consolidation during sleep.

Morning-evening variation in human brain metabolism and memory circuits

It has been posited that a critical function of sleep is synaptic renormalization following a net increase in synaptic strength during wake. We hypothesized that wake would alter the resting-state functional organization of the brain and increase its metabolic cost. To test these hypotheses, two experiments were performed. In one, we obtained morning and evening resting-state functional MRI scans to assess changes in functional brain organization. In the second experiment, we obtained quantitative positron emission tomography measures of glucose and oxygen consumption to assess the cost of wake. We found selective changes in brain organization. Most prominently, bilateral medial temporal regions were locally connected in the morning but in the evening exhibited strong correlations with frontal and parietal brain regions involved in memory retrieval. We speculate that these changes may reflect aspects of memory consolidation recurring on a daily basis. Surprisingly, these changes in brain organization occurred without increases in brain metabolism.

EEG alpha phase shifts during transition from wakefulness to drowsiness

Phases of alpha oscillations recorded by EEG were typically studied in the context of event or task related experiments, rarely during spontaneous alpha activity and in different brain states. During wake-to-drowsy transition they change unevenly, depending on the brain region. To explore their dynamics, we recorded ten adult healthy individuals in these two states. Alpha waves were treated as stable frequency and variable amplitude signals with one carrier frequency (CF). A method for calculating their CF phase shifts (CFPS) and CF phase potentials (CFPP) was developed and verified on surrogate signals as more accurate than phase shifts of Fourier components. Probability density estimate (PDE) of CFPS, CFPP and CF phase locking showed that frontal and fronto-temporal areas of the cortex underwent more extensive changes than posterior regions. The greatest differences were found between pairs of channels involving F7, F8, F3 and F4 (PDE of CFPS); F7, F8, T3 and T4 (CFPP); F7, F8, F3, F4, C3, C4 and T3 (decrease in CF phase locking). A topographic distribution of channels with above the average phase locking in the wake state revealed two separate regions occupying anterior and posterior brain areas (with intra regional and inter hemispheric connections). These regions merged and became mutually phase locked longitudinally in the drowsy state. Changes occurring primarily in the frontal and fronto-temporal regions correlated with an early decrease of alertness. Areas of increased phase locking might be correlated with topography of synchronous neuronal assemblies conceptualized within neural correlates of consciousness.

Sleep Disturbances in Pediatric Depression

Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, understanding its etiology and pathophysiology during this developmental stage is critical for developing effective prevention and intervention strategies. There is considerable evidence of sleep alterations in adult major depressive disorder. However, studies in children and adolescents have not found consistent changes in sleep architecture paralleling adult depression. This review article summarizes sleep polysomnography research in early-onset depression, highlighting the factors associated with variable findings across studies. In addition, potential avenues for future research will be suggested in order to develop more comprehensive theoretical models and interventions for pediatric depression.

Functional neuroimaging insights into the physiology of human sleep

Functional brain imaging has been used in humans to noninvasively investigate the neural mechanisms underlying the generation of sleep stages. On the one hand, REM sleep has been associated with the activation of the pons, thalamus, limbic areas, and temporo-occipital cortices, and the deactivation of prefrontal areas, in line with theories of REM sleep generation and dreaming properties. On the other hand, during non-REM (NREM) sleep, decreases in brain activity have been consistently found in the brainstem, thalamus, and in several cortical areas including the medial prefrontal cortex (MPFC), in agreement with a homeostatic need for brain energy recovery. Benefiting from a better temporal resolution, more recent studies have characterized the brain activations related to phasic events within specific sleep stages. In particular, they have demonstrated that NREM sleep oscillations (spindles and slow waves) are indeed associated with increases in brain activity in specific subcortical and cortical areas involved in the generation or modulation of these waves. These data highlight that, even during NREM sleep, brain activity is increased, yet regionally specific and transient. Besides refining the understanding of sleep mechanisms, functional brain imaging has also advanced the description of the functional properties of sleep. For instance, it has been shown that the sleeping brain is still able to process external information and even detect the pertinence of its content. The relationship between sleep and memory has also been refined using neuroimaging, demonstrating post-learning reactivation during sleep, as well as the reorganization of memory representation on the systems level, sometimes with long-lasting effects on subsequent memory performance. Further imaging studies should focus on clarifying the role of specific sleep patterns for the processing of external stimuli, as well as the consolidation of freshly encoded information during sleep.

Brief hourly exercise during night work can help maintain workers' performance

Increased night work is an important issue because of its implications on workers' health, safety and performance. This study examined the effects of brief hourly exercise as a countermeasure against the adverse effects of night work, especially for workers requiring sustained attention while working in a prolonged sitting posture. During simulated night work (22:00-08:00), participants were required to follow an hourly schedule comprising a 30-min task, 15-min test and 15-min break. The study included 2 experimental conditions: (1) hourly exercise (HE; hourly exercise for 3 min during breaks) and (2) control (without exercise during breaks). Throughout the test period, work performance in the last 10 min of each 30-min task was better under the HE condition than under the control condition (p<0.01). During the second half of the test period, exercise showed an effect on sustained attention (p=0.02). Parasympathetic nerve activity under the HE condition was less than that under the control condition (p<0.01). However, exercise was not effective in reducing subjective fatigue and sleepiness. These results suggest that brief hourly exercise acts as a restraint on parasympathetic nerve activity and is capable of sustaining attention levels during the circadian rhythm nadir that occurs during early morning.

Is sleep essential?

No current hypothesis can explain why animals need to sleep. Yet, sleep is universal, tightly regulated, and cannot be deprived without deleterious consequences. This suggests that searching for a core function of sleep, particularly at the cellular level, is still a worthwhile exercise.

Low frequency BOLD fluctuations during resting wakefulness and light sleep: a simultaneous EEG-fMRI study

Recent blood oxygenation level dependent functional MRI (BOLD fMRI) studies of the human brain have shown that in the absence of external stimuli, activity persists in the form of distinct patterns of temporally correlated signal fluctuations. In this work, we investigated the spontaneous BOLD signal fluctuations during states of reduced consciousness such as drowsiness and sleep. For this purpose, we performed BOLD fMRI on normal subjects during varying levels of consciousness, from resting wakefulness to light (non-slow wave) sleep. Depth of sleep was determined based on concurrently acquired EEG data. During light sleep, significant increases in the fluctuation level of the BOLD signal were observed in several cortical areas, among which visual cortex was the most significant. Correlations among brain regions involved with the default-mode network persisted during light sleep. These results suggest that activity in areas such as the default-mode network and primary sensory cortex, as measured from BOLD fMRI fluctuations, does not require a level of consciousness typical of wakefulness.

Neuroimaging in sleep medicine

The development of neuroimaging techniques has made possible the characterization of cerebral function throughout the sleep-wake cycle in normal human subjects. Indeed, human brain activity during sleep is segregated within specific cortical and subcortical areas in relation to the sleep stage, sleep physiological events and previous waking activity. This approach has allowed sleep physiological theories developed from animal data to be confirmed, but has also introduced original concepts about the neurobiological mechanisms of sleep, dreams and memory in humans. In contrast, at present, few neuroimaging studies have been dedicated to human sleep disorders. The available work has brought interesting data that describe some aspects of the pathophysiology and neural consequences of disorders such as insomnia, sleep apnea and narcolepsy. However, the interpretation of many of these results is restricted by limited sample size and spatial/temporal resolution of the employed technique. The use of neuroimaging in sleep medicine is actually restrained by concerns resulting from the technical experimental settings and the characteristics of the diseases. Nevertheless, we predict that future studies, conducted with state of the art techniques on larger numbers of patients, will be able to address these issues and contribute significantly to the understanding of the neural basis of sleep pathologies. This may finally offer the opportunity to use neuroimaging, in addition to the clinical and electrophysiological assessments, as a helpful tool in the diagnosis, classification, treatment and monitoring of sleep disorders in humans.

Low-resolution brain electromagnetic tomography (LORETA) identifies brain regions linked to psychometric performance under modafinil in narcolepsy

Low-resolution brain electromagnetic tomography (LORETA) showed a functional deterioration of the fronto-temporo-parietal network of the right hemispheric vigilance system in narcolepsy and a therapeutic effect of modafinil. The aim of this study was to determine the effects of modafinil on cognitive and thymopsychic variables in patients with narcolepsy and investigate whether neurophysiological vigilance changes correlate with cognitive and subjective vigilance alterations at the behavioral level. In a double-blind, placebo-controlled crossover design, EEG-LORETA and psychometric data were obtained during midmorning hours in 15 narcoleptics before and after 3 weeks of placebo or 400 mg modafinil. Cognitive investigations included the Pauli Test and complex reaction time. Thymopsychic/psychophysiological evaluation comprised drive, mood, affectivity, wakefulness, depression, anxiety, the Symptom Checklist 90 and critical flicker frequency. The Multiple Sleep Latency Test (MSLT) and the Epworth Sleepiness Scale (ESS) were performed too. Cognitive performance (Pauli Test) was significantly better after modafinil than after placebo. Concerning reaction time and thymopsychic variables, no significant differences were observed. Correlation analyses revealed that a decrease in prefrontal delta, theta and alpha-1 power correlated with an improvement in cognitive performance. Moreover, drowsiness was positively correlated with theta power in parietal and medial prefrontal regions and beta-1 and beta-2 power in occipital regions. A less significant correlation was observed between midmorning EEG LORETA and the MSLT; between EEG LORETA and the ESS, the correlation was even weaker. In conclusion, modafinil did not influence thymopsychic variables in narcolepsy, but it significantly improved cognitive performance, which may be related to medial prefrontal activity processes identified by LORETA.

Functional EEG topography in sleep and waking: State-dependent and state-independent features

Power spectra in the non-rapid eye movement sleep (NREMS) electroencephalogram (EEG) have been shown to exhibit frequency-specific topographic features that may point to functional differences in brain regions. Here, we extend the analysis to rapid eye movement sleep (REMS) and waking (W) to determine the extent to which EEG topography is determined by state under two different levels of sleep pressure. Multichannel EEG recordings were obtained from young men during a baseline night, a 40-h waking period, and a recovery night. Sleep deprivation enhanced EEG power in the low-frequency range (1-8 Hz) in all three vigilance states. In NREMS, the effect was largest in the delta band, in W, in the theta band, while in REMS, there was a peak in both the delta and the theta band. The response of REMS to prolonged waking and its pattern of EEG topography was intermediate between NREMS and W. Cluster analysis revealed a major topographic segregation into three frequency bands (1-8 Hz, 9-15 Hz, 16-24 Hz), which was largely independent of state and sleep pressure. To assess individual topographic traits within each state, the differences between pairs of power maps were compared within (i.e., for baseline and recovery) and between individuals (i.e., separately for baseline and recovery). A high degree of intraindividual correspondence of the power maps was observed. The frequency-specific clustering of power maps suggests that distinct generators underlie EEG frequency bands. Although EEG power is modulated by state and sleep pressure, basic topographic features appear to be state-independent.

Brain areas involved in medial temporal lobe seizures: a principal component analysis of ictal SPECT data

The study describes brain areas involved in medial temporal lobe (mTL) seizures of 12 patients. All patients showed so-called oro-alimentary behavior within the first 20 s of clinical seizure manifestation characteristic of mTL seizures. Single photon emission computed tomography (SPECT) images of regional cerebral blood flow (rCBF) were acquired from the patients in ictal and interictal phases and from normal volunteers. Image analysis employed categorical comparisons with statistical parametric mapping and principal component analysis (PCA) to assess functional connectivity. PCA supplemented the findings of the categorical analysis by decomposing the covariance matrix containing images of patients and healthy subjects into distinct component images of independent variance, including areas not identified by the categorical analysis. Two principal components (PCs) discriminated the subject groups: patients with right or left mTL seizures and normal volunteers, indicating distinct neuronal networks implicated by the seizure. Both PCs were correlated with seizure duration, one positively and the other negatively, confirming their physiological significance. The independence of the two PCs yielded a clear clustering of subject groups. The local pattern within the temporal lobe describes critical relay nodes which are the counterpart of oro-alimentary behavior: (1) right mesial temporal zone and ipsilateral anterior insula in right mTL seizures, and (2) temporal poles on both sides that are densely interconnected by the anterior commissure. Regions remote from the temporal lobe may be related to seizure propagation and include positively and negatively loaded areas. These patterns, the covarying areas of the temporal pole and occipito-basal visual association cortices, for example, are related to known anatomic paths.

Fatal familial insomnia: a model disease in sleep physiopathology

Fatal Familial Insomnia (FFI) is characterized by loss of sleep, oneiric stupor with autonomic/motor hyperactivity and somato-motor abnormalities (pyramidal signs, myoclonus, dysarthria/dysphagia, ataxia). Positon emission tomography (PET) disclosed thalamic hypometabolism and milder involvement of the cortex; neuropathology severe neuronal loss in the thalamic nuclei variably affecting the caudate, gyrus cinguli and fronto-temporal cortices. Genetic analysis disclosed a mutation in the PRNP gene and FFI was transmitted to experimental animals, thus classifying FFI within the prion diseases. Rare Sporadic Fatal Insomnia (SFI) cases occur without PRNP mutation but with features similar to FFI. FFI represents a model disease for the study of sleep-wake regulation: (I) the profound thalamic hypometabolism/atrophy associated with lack of sleep spindles and delta sleep implicate the thalamus in the origin of slow wave sleep (SWS); (II) loss of SWS is associated with marked autonomic and motor hyperactivity; termed 'agrypnia excitata', this association has been proposed as a useful clinical concept representative of thalamo-limbic dysfunction; (III) lack of SWS occurs with substantial preservation of stage 1 NREM sleep, implying that the latter has mechanisms different from SWS and unaffected by thalamic atrophy; accordingly, conflating stage 1 NREM with SWS into NREM sleep is inappropriate.

The precuneus: a review of its functional anatomy and behavioural correlates

Functional neuroimaging studies have started unravelling unexpected functional attributes for the posteromedial portion of the parietal lobe, the precuneus. This cortical area has traditionally received little attention, mainly because of its hidden location and the virtual absence of focal lesion studies. However, recent functional imaging findings in healthy subjects suggest a central role for the precuneus in a wide spectrum of highly integrated tasks, including visuo-spatial imagery, episodic memory retrieval and self-processing operations, namely first-person perspective taking and an experience of agency. Furthermore, precuneus and surrounding posteromedial areas are amongst the brain structures displaying the highest resting metabolic rates (hot spots) and are characterized by transient decreases in the tonic activity during engagement in non-self-referential goal-directed actions (default mode of brain function). Therefore, it has recently been proposed that precuneus is involved in the interwoven network of the neural correlates of self-consciousness, engaged in self-related mental representations during rest. This hypothesis is consistent with the selective hypometabolism in the posteromedial cortex reported in a wide range of altered conscious states, such as sleep, drug-induced anaesthesia and vegetative states. This review summarizes the current knowledge about the macroscopic and microscopic anatomy of precuneus, together with its wide-spread connectivity with both cortical and subcortical structures, as shown by connectional and neurophysiological findings in non-human primates, and links these notions with the multifaceted spectrum of its behavioural correlates. By means of a critical analysis of precuneus activation patterns in response to different mental tasks, this paper provides a useful conceptual framework for matching the functional imaging findings with the specific role(s) played by this structure in the higher-order cognitive functions in which it has been implicated. Specifically, activation patterns appear to converge with anatomical and connectivity data in providing preliminary evidence for a functional subdivision within the precuneus into an anterior region, involved in self-centred mental imagery strategies, and a posterior region, subserving successful episodic memory retrieval.

Brain activation and hypothalamic functional connectivity during human non-rapid eye movement sleep: an EEG/fMRI study

Regional differences in sleep EEG dynamics indicate that sleep-related brain activity involves local brain processes with sleep stage specific activity patterns of neuronal populations. Macroscopically, it is not fully understood which cerebral brain regions are involved in the successive discontinuation of wakefulness. We simultaneously used EEG and functional MRI on 9 subjects (6 female: mean = 24.1 years, 3 male: mean = 26.0 years) and analyzed local blood oxygenation level dependent signal changes linked to the transition from wakefulness to different non-rapid eye movement (NREM) sleep stages (according to Rechtschaffen and Kales) of the first sleep cycles after 36 h of total sleep deprivation. Several brain regions throughout the cortex, the limbic lobe, the thalamus, the caudate nucleus, as well as midbrain structures, such as the mammillary body/hypothalamus, showed reduced activity during NREM sleep across all sleep stages. Additionally, we found deactivation patterns specific to NREM sleep stages compared with wakefulness suggesting that a synchronized sleeping state can be established only if these regions interact in a well-balanced way. Sleep stage 2, which is usually linked to the loss of self-conscious awareness, is associated with signal decreases comprising thalamic and hypothalamic regions, the cingulate cortex, the right insula and adjacent regions of the temporal lobe, the inferior parietal lobule and the inferior/middle frontal gyri. The hypothalamic region known to be of particular importance in the regulation of the sleep-wake cycle shows specific temporally correlated network activity with the cortex while the system is in the sleeping state, but not during wakefulness. We describe a specific pattern of decreased brain activity during sleep and suggest that this pattern must be synchronized for establishing and maintaining sleep.

Cerebral correlates of delta waves during non-REM sleep revisited

We aimed at characterizing the neural correlates of delta activity during Non Rapid Eye Movement (NREM) sleep in non-sleep-deprived normal young adults, based on the statistical analysis of a positron emission tomography (PET) sleep data set. One hundred fifteen PET scans were obtained using H(2)(15)O under continuous polygraphic monitoring during stages 2-4 of NREM sleep. Correlations between regional cerebral blood flow (rCBF) and delta power (1.5-4 Hz) spectral density were analyzed using statistical parametric mapping (SPM2). Delta power values obtained at central scalp locations negatively correlated during NREM sleep with rCBF in the ventromedial prefrontal cortex, the basal forebrain, the striatum, the anterior insula, and the precuneus. These regions embrace the set of brain areas in which rCBF decreases during slow wave sleep (SWS) as compared to Rapid Eye Movement (REM) sleep and wakefulness (Maquet, P., Degueldre, C., Delfiore, G., Aerts, J., Peters, J.M., Luxen, A., Franck, G., 1997. Functional neuroanatomy of human slow wave sleep. J. Neurosci. 17, 2807-S2812), supporting the notion that delta activity is a valuable prominent feature of NREM sleep. A strong association was observed between rCBF in the ventromedial prefrontal regions and delta power, in agreement with electrophysiological studies. In contrast to the results of a previous PET study investigating the brain correlates of delta activity (Hofle, N., Paus, T., Reutens, D., Fiset, P., Gotman, J., Evans, A.C., Jones, B.E., 1997. Regional cerebral blood flow changes as a function of delta and spindle activity during slow wave sleep in humans. J. Neurosci. 17, 4800-4808), in which waking scans were mixed with NREM sleep scans, no correlation was found with thalamus activity. This latter result stresses the importance of an extra-thalamic delta rhythm among the synchronous NREM sleep oscillations. Consequently, this rCBF distribution might preferentially reflect a particular modulation of the cellular processes involved in the generation of cortical delta waves during NREM sleep.

Antero-posterior functional coupling at sleep onset: changes as a function of increased sleep pressure

The use of the directed transfer function (DTF), an advanced computational analysis of electroencephalogaphic (EEG) data, which provides an estimation of the direction of the information flow underlying cortico-cortical functional coupling, has shown that the presleep period is characterized by posterior-to-anterior functional cortical coupling, while at sleep onset there is an inversion of that direction. This finding supported the idea that anterior cortical areas first synchronize sleep EEG activity. The aim of the present study was to assess the changes of functional coupling between anterior and posterior midline cortical areas during the sleep onset process when sleep pressure is heightened by a selective slow-wave sleep (SWS) deprivation. The hypothesis was that the anterior-to-posterior direction of the cortical functional coupling at sleep onset is enhanced by SWS deprivation. Ten normal right-handed male students slept for six consecutive nights in the laboratory (1: adaptation, 2: baseline, 3: baseline with awakenings, 4 and 5: SWS deprivations, 6: recovery), with standard polysomnographic recordings. The DTF was computed on data recorded during nights two and six from anterior (Fz(A1)) and posterior (Pz(A1), Oz(A1)) derivations. Results showed that, during the recovery night, the anterior-to-posterior direction of functional cortical coupling is already present in the presleep period, indicating that SWS deprivation advances the shift to an anterior-to-posterior directionality of functional cortical coupling, possibly as a consequence of heightened sleep pressure. These findings support the notion that a spread of synchronizing signals from associative prefrontal to posterior areas play a role in the wake-sleep transition.

Functional imaging of the sleeping brain: review of findings and implications for the study of insomnia

Despite the growing literature indicating that insomnia is prevalent and a substantial risk factor for medical and psychiatric morbidity, the pathophysiology of both Primary and Secondary Insomnia is poorly understood. Multiple trait and state factors are thought to give rise to and/or moderate illness severity in insomnia, but 'hyperarousal' is widely believed to be the final common pathway of the disorder. To date, very little work has been undertaken using functional imaging to explore the CNS correlates, underpinnings, or consequences of hyperarousal as it occurs in Primary Insomnia. In fact, all but one of the extant studies have been of healthy good sleepers or subjects with Secondary Insomnia. In the present article, we: (1) review the studies that have been undertaken in good sleepers and in patients using functional neuroimaging methodologies, and (2) discuss how these data can inform a research agenda aimed at describing the neuropathophysiology of insomnia.

Functional MRI during sleep: BOLD signal decreases and their electrophysiological correlates

Prominent local decreases in blood oxygenation level (BOLD) can be observed by functional magnetic resonance imaging (fMRI) upon acoustic stimulation during sleep. The goal of this study was to further characterize this BOLD signal decrease with respect to corresponding neurophysiological phenomena using a simultaneous electroencephalography (EEG)/fMRI approach in sleeping human subjects. Healthy volunteers were subjected to acoustic stimulation during non-rapid eye movement (NREM) sleep. On the basis of statistical parametric maps, the correlations between the fMRI response (both amplitude and extent of the BOLD response) and the concomittant changes in the EEG (delta power and K-complexes) were calculated. Amplitude and extent of the stimulus-induced negative BOLD effect correlated positively with measures of EEG synchronization, namely an increase in the number of K-complexes and EEG delta power. Stimulus-induced BOLD decreases were most prominent during light (stage 2) NREM sleep and disappeared during slow wave sleep, indicating an influence of the baseline degree of hyperpolarization. Our observations provide first evidence that 'negative' BOLD signal changes during human sleep are associated with electrophysiological indicators of altered neuronal activity. Increased number of K-complexes and delta power reflecting hyperpolarization suggests true cortical deactivation upon stimulus presentation. This sleep stage-dependent deactivation might serve to protect the brain from arousing stimuli, particularly during the light phases of sleep shortly after sleep onset.

Microwave effects on the nervous system

Studies have evaluated the electroencephalography (EEG) of humans and laboratory animals during and after Radiofrequency (RF) exposures. Effects of RF exposure on the blood-brain barrier (BBB) have been generally accepted for exposures that are thermalizing. Low level exposures that report alterations of the BBB remain controversial. Exposure to high levels of RF energy can damage the structure and function of the nervous system. Much research has focused on the neurochemistry of the brain and the reported effects of RF exposure. Research with isolated brain tissue has provided new results that do not seem to rely on thermal mechanisms. Studies of individuals who are reported to be sensitive to electric and magnetic fields are discussed. In this review of the literature, it is difficult to draw conclusions concerning hazards to human health. The many exposure parameters such as frequency, orientation, modulation, power density, and duration of exposure make direct comparison of many experiments difficult. At high exposure power densities, thermal effects are prevalent and can lead to adverse consequences. At lower levels of exposure biological effects may still occur but thermal mechanisms are not ruled out. It is concluded that the diverse methods and experimental designs as well as lack of replication of many seemingly important studies prevents formation of definite conclusions concerning hazardous nervous system health effects from RF exposure. The only firm conclusion that may be drawn is the potential for hazardous thermal consequences of high power RF exposure.

Sleep, consciousness and the spontaneous and evoked electrical activity of the brain. Is there a cortical integrating mechanism?

The physiological mechanisms that underlie consciousness and unconsciousness are the sleep/wake mechanisms. Deep sleep is a state of physiological reversible unconsciousness. The change from that state to wakefulness is mediated by the reticular activating mechanism. The reverse change from wakefulness to sleep is also an active process effected by an arousal inhibitory mechanism based on a partial blockade of the thalamus and upper brain stem, associated with thalamic sleep spindles and also with cortical sub-delta activity (<1 Hz). The deactivation of the thalamus has been demonstrated both electrically and by positron emission tomography during deep sleep. Normally, wakefulness is associated with instant awareness (defined as the ability to integrate all sensory information from the external environment and the internal environment of the body). Awareness may be a function of the thalamo-cortical network in the cerebral hemispheres, which forms the final path of the sleep/wake mechanism. Anatomical and physiological studies suggest that there may be a double thalamo-cortical network; one relating to cortical and thalamic areas with specific functions and the other global, involving all cortical areas and so-called 'non-specific' thalamic nuclei. The global system might function as a cortical integrating mechanism permitting the spread of information between the specific cortical areas and thus underlying awareness. The global system may also be responsible for much of the spontaneous and evoked electrical activity of the brain. The cognitive change between sleep and wakefulness is accompanied by changes in the autonomic system, the cerebral blood flow and cerebral metabolism. Awareness is an essential component of total consciousness (defined as continuous awareness of the external and internal environment, both past and present, together with the emotions arising from it). In addition to awareness, full consciousness requires short-term and explicit memory and intact emotional responses.

Effects of sleep loss in men and women with insufficient sleep suffering from chronic disease: a model for supportive nursing care

This study evaluated self-reported subjective health and effects of sleep loss according to perceived interfering cognitive anxiety related to falling asleep in patients with and without insufficient sleep and gender differences in these aspects 5 years after coronary artery bypass graft and transluminal coronary angioplasty. A total of 145 patients, five years after intervention, responded to a mailed questionnaire. Nearly 60% had severe combined sleep disturbances; 35.9% of these had complained of insufficient sleep and 15% also perceived difficulty falling asleep related to cognitive anxiety. Measurable gender differences were small. A theoretical framework is presented which can increase understanding among nurses, patients and their relatives concerning the quality and quantity of sleep and sleep loss related to quality of life. These results suggest that there are significant relationships between sleep quality, resilience to stress and coping strategy in patients with a chronic disease, indicating the need for more individualised supportive nursing care.

The cerebral circulation during sleep: regulation mechanisms and functional implications

Cerebral blood flow measurements during sleep are reviewed and discussed in relation to the different techniques utilized (Positron Emission Tomography, functional Magnetic Resonance Imaging, Flowmeters, Radioactive MicroIspheres, Brain Temperature Recordings, Spectrophotometry) since these methodological approaches aim at diverse features of circulation changes in the spatial or temporal domain. The regulation of cerebral circulation during sleep reveals no specific state-dependent features, flow-activity coupling being the prevailing mechanism, with O(2) as the primary candidate for the metabolic side of the link. On a general level, the latest data on brain circulation are compatible with the classical hypothesis of a "restorative" function of sleep processes.

Brain regions involved in fatigue sensation: reduced acetylcarnitine uptake into the brain

Fatigue is an indispensable sense for ordering rest. However, the neuronal and molecular mechanisms of fatigue remain unclear. Chronic fatigue syndrome (CFS) with long-lasting fatigue sensation seems to be a good model for studying these mechanisms underlying fatigue sensation. Recently, we found that most patients with CFS showed a low level of serum acetylcarnitine, which well correlated with the rating score of fatigue, and that a considerable amount of acetyl moiety of serum acetylcarnitine is taken up into the brain. Here we show by metabolite analysis of the mouse brain that an acetyl moiety taken up into the brain through acetylcarnitine is mainly utilized for the biosynthesis of glutamate. When we studied the cerebral uptake of acetylcarnitine by using [2-(11)C]acetyl-L-carnitine in 8 patients with CFS and in 8 normal age- and sex-matched controls, a significant decrease was found in several regions of the brains of the patient group, namely, in the prefrontal (Brodmann's area 9/46d) and temporal (BA21 and 41) cortices, anterior cingulate (BA24 and 33), and cerebellum. These findings suggest that the levels of biosynthesis of neurotransmitters through acetylcarnitine might be reduced in some brain regions of chronic fatigue patients and that this abnormality might be one of the keys to unveiling the mechanisms of the chronic fatigue sensation.