Advances in Clinical Neurophysiology

Including some of the newest advances in the field of neurophysiology, this book can be considered as one of the treasures that interested scientists would like to collect. It discusses many disciplines of clinical neurophysiology that are, currently, crucial in the practice as they explain methods and findings of techniques that help to improve diagnosis and to ensure better treatment. While trying to rely on evidence-based facts, this book presents some new ideas to be applied and tested in the clinical practice. Advances in Clinical Neurophysiology is important not only for the neurophysiologists but also for clinicians interested or working in wide range of specialties such as neurology, neurosurgery, intensive care units, pediatrics and so on. Generally, this book is written and designed to all those involved in, interpreting or requesting neurophysiologic tests

Predictive modelling of Loss Of Consciousness under general anaesthesia

Treballs Finals de Grau d'Enginyeria Biomèdica. Facultat de Medicina i Ciències de la Salut. Universitat de Barcelona. Curs: 2021-2022. Director: Pedro L. Gambú

Tracking brain dynamics across transitions of consciousness

How do we lose and regain consciousness? The space between healthy wakefulness and unconsciousness encompasses a series of gradual and rapid changes in brain activity. In this thesis, I investigate computational measures applicable to the electroencephalogram to quantify the loss and recovery of consciousness from the perspective of modern theoretical frameworks. I examine three different transitions of consciousness caused by natural, pharmacological and pathological factors: sleep, sedation and coma. First, I investigate the neural dynamics of falling asleep. By combining the established methods of phase-lag brain connectivity and EEG microstates in a group of healthy subjects, a unique microstate is identified, whose increased duration predicts behavioural unresponsiveness to auditory stimuli during drowsiness. This microstate also uniquely captures an increase in frontoparietal theta connectivity, a putative marker of the loss of consciousness prior to sleep onset. I next examine the loss of behavioural responsiveness in healthy subjects undergoing mild and moderate sedation. The Lempel-Ziv compression algorithm is employed to compute signal complexity and symbolic mutual information to assess information integration. An intriguing dissociation between responsiveness and drug level in blood during sedation is revealed: responsiveness is best predicted by the temporal complexity of the signal at single- channel and low-frequency integration, whereas drug level is best predicted by the complexity of spatial patterns and high-frequency integration. Finally, I investigate brain connectivity in the overnight EEG recordings of a group of patients in acute coma. Graph theory is applied on alpha, theta and delta networks to find that increased variability in delta network integration early after injury predicts the eventual coma recovery score. A case study is also described where the re-emergence of frontoparietal connectivity predicted a full recovery long before behavioural improvement. The findings of this thesis inform prospective clinical applications for tracking states of consciousness and advance our understanding of the slow and fast brain dynamics underlying its transitions. Collating these findings under a common theoretical framework, I argue that the diversity of dynamical states, in particular in temporal domain, and information integration across brain networks are fundamental in sustaining consciousness.My PhD was funded by the Cambridge Trust and a MariaMarina award from Lucy Cavendish College

C-Trend parameters and possibilities of federated learning

Abstract. In this observational study, federated learning, a cutting-edge approach to machine learning, was applied to one of the parameters provided by C-Trend Technology developed by Cerenion Oy. The aim was to compare the performance of federated learning to that of conventional machine learning. Additionally, the potential of federated learning for resolving the privacy concerns that prevent machine learning from realizing its full potential in the medical field was explored. Federated learning was applied to burst-suppression ratio’s machine learning and it was compared to the conventional machine learning of burst-suppression ratio calculated on the same dataset. A suitable aggregation method was developed and used in the updating of the global model. The performance metrics were compared and a descriptive analysis including box plots and histograms was conducted. As anticipated, towards the end of the training, federated learning’s performance was able to approach that of conventional machine learning. The strategy can be regarded to be valid because the performance metric values remained below the set test criterion levels. With this strategy, we will potentially be able to make use of data that would normally be kept confidential and, as we gain access to more data, eventually develop machine learning models that perform better. Federated learning has some great advantages and utilizing it in the context of qEEGs’ machine learning could potentially lead to models, which reach better performance by receiving data from multiple institutions without the difficulties of privacy restrictions. Some possible future directions include an implementation on heterogeneous data and on larger data volume.C-Trend-teknologian parametrit ja federoidun oppimisen mahdollisuudet. Tiivistelmä. Tässä havainnointitutkimuksessa federoitua oppimista, koneoppimisen huippuluokan lähestymistapaa, sovellettiin yhteen Cerenion Oy:n kehittämään C-Trend-teknologian tarjoamaan parametriin. Tavoitteena oli verrata federoidun oppimisen suorituskykyä perinteisen koneoppimisen suorituskykyyn. Lisäksi tutkittiin federoidun oppimisen mahdollisuuksia ratkaista yksityisyyden suojaan liittyviä rajoitteita, jotka estävät koneoppimista hyödyntämästä täyttä potentiaaliaan lääketieteen alalla. Federoitua oppimista sovellettiin purskevaimentumasuhteen koneoppimiseen ja sitä verrattiin purskevaimentumasuhteen laskemiseen, johon käytettiin perinteistä koneoppimista. Kummankin laskentaan käytettiin samaa dataa. Sopiva aggregointimenetelmä kehitettiin, jota käytettiin globaalin mallin päivittämisessä. Suorituskykymittareiden tuloksia verrattiin keskenään ja tehtiin kuvaileva analyysi, johon sisältyi laatikkokuvioita ja histogrammeja. Odotetusti opetuksen loppupuolella federoidun oppimisen suorituskyky pystyi lähestymään perinteisen koneoppimisen suorituskykyä. Menetelmää voidaan pitää pätevänä, koska suorituskykymittarin arvot pysyivät alle asetettujen testikriteerien tasojen. Tämän menetelmän avulla voimme ehkä hyödyntää dataa, joka normaalisti pidettäisiin salassa, ja kun saamme lisää dataa käyttöömme, voimme lopulta kehittää koneoppimismalleja, jotka saavuttavat paremman suorituskyvyn. Federoidulla oppimisella on joitakin suuria etuja, ja sen hyödyntäminen qEEG:n koneoppimisen yhteydessä voisi mahdollisesti johtaa malleihin, jotka saavuttavat paremman suorituskyvyn saamalla tietoja useista eri lähteistä ilman yksityisyyden suojaan liittyviä rajoituksia. Joitakin mahdollisia tulevia suuntauksia ovat muun muassa heterogeenisen datan ja suurempien tietomäärien käyttö

Anesthetic-induced unresponsiveness: Electroencephalographic correlates and subjective experiences

Anesthetic drugs can induce reversible alterations in responsiveness, connectedness and consciousness. The measures based on electroencephalogram (EEG) have marked potential for monitoring the anesthetized state because of their relatively easy use in the operating room. In this study, 79 healthy young men participated in an awake experiment, and 47 participants continued to an anesthesia experiment where they received either dexmedetomidine or propofol as target-controlled infusion with stepwise increments until the loss of responsiveness. The participants were roused during the constant drug infusion and interviewed. The drug dose was increased to 1.5-fold to achieve a deeper unresponsive state. After regaining responsiveness, the participants were interviewed. EEG was measured throughout the experiment and the N400 event-related potential component and functional and directed connectivity were studied. Prefrontal-frontal connectivity in the alpha frequency band discriminated the states that differed with respect to responsiveness or drug concentration. The net direction of connectivity was frontal-to-prefrontal during unresponsiveness and reversed back to prefrontal-to-frontal upon return of responsiveness. The understanding of the meaning of spoken language, as measured with the N400 effect, was lost along with responsiveness but, in the dexmedetomidine group, the N400 component was preserved suggesting partial preservation of the processing of words during anesthetic-induced unresponsiveness. However, the N400 effect could not be detected in all the awake participants and the choice of analysis method had marked impact on its detection rate at the individual-level. Subjective experiences were common during unresponsiveness induced by dexmedetomidine and propofol but the experiences most often suggested disconnectedness from the environment. In conclusion, the doses of dexmedetomidine or propofol minimally sufficient to induce unresponsiveness do not render the participants unconscious and dexmedetomidine does not completely abolish the processing of semantic stimuli. The local anterior EEG connectivity in the alpha frequency band may have potential in monitoring the depth of dexmedetomidine- and propofol-induced anesthesia.Anesteettien aiheuttama vastauskyvyttömyys: aivosähkökäyräpohjaiset korrelaatit ja subjektiiviset kokemukset Anestesialääkkeillä voidaan saada aikaan palautuvia muutoksia vastauskykyisyydessä, kytkeytyneisyydessä ja tajunnassa. Aivosähkökäyrään (EEG) pohjautuvat menetelmät tarjoavat lupaavia mahdollisuuksia mitata anestesian vaikutusta aivoissa, sillä niitä on suhteellisen helppo käyttää leikkaussalissa. Tässä tutkimuksessa 79 tervettä nuorta miestä osallistui valvekokeeseen ja 47 heistä jatkoi anestesiakokeeseen. Anestesiakokeessa koehenkilöille annettiin joko deksmedetomidiinia tai propofolia tavoiteohjattuna infuusiona nousevia annosportaita käyttäen, kunnes he menettivät vastauskykynsä. Koehenkilöt herätettiin tasaisen lääkeinfuusion aikana ja haastateltiin. Koko kokeen ajan mitattiin EEG:tä, josta tutkittiin N400-herätevastetta sekä toiminnallista ja suunnattua konnektiivisuutta. Prefrontaali-frontaalivälillä mitattu konnektiivisuus alfa-taajuuskaistassa erotteli toisistaan tilat, jotka erosivat vastauskykyisyyden tai lääkepitoisuuden suhteen. Konnektiivisuuden vallitseva suunta oli frontaalialueilta prefrontaalialueille vastauskyvyttömyyden aikana, mutta se kääntyi takaisin prefrontaalisesta frontaaliseen kulkevaksi koehenkilöiden vastauskyvyn palatessa. N400-efektillä mitattu puhutun kielen ymmärtäminen katosi vastauskyvyn menettämisen myötä. Deksmedetomidiiniryhmässä N400-komponentti säilyi, mikä viittaa siihen, että anesteettien aiheuttaman vastauskyvyttömyyden aikana sanojen prosessointi voi säilyä osittain. Yksilötasolla N400-efektiä ei kuitenkaan havaittu edes kaikilla hereillä olevilla henkilöillä, ja analyysimenetelmän valinnalla oli suuri vaikutus herätevasteen havaitsemiseen. Subjektiiviset kokemukset olivat yleisiä deksmedetomidiinin ja propofolin aiheuttaman vastauskyvyttömyyden aikana, mutta kokemukset olivat usein ympäristöstä irtikytkeytyneitä. Yhteenvetona voidaan todeta, että deksmedetomidiini- ja propofoliannokset, jotka juuri ja juuri riittävät aikaansaamaan vastauskyvyttömyyden, eivät aiheuta tajuttomuutta. Deksmedetomidiini ei myöskään täysin estä merkityssisällöllisten ärsykkeiden käsittelyä. Frontaalialueen sisällä EEG:llä mitattu konnektiivisuus alfataajuuskaistassa saattaa olla tulevaisuudessa hyödyllinen menetelmä deksmedetomidiini- ja propofolianestesian syvyyden mittaamiseksi

What Happened Last Night? Sleep, Sex, and Recollection

Previous research has repeatedly illustrated the beneficial influence of sleep on memory processes. Further, evidence has demonstrated the power of sexual valance to enhance memory for certain types of stimuli. The present study investigated the possible interaction effect between sleep and sexual valance on recollection memory in 44 undergraduate and graduate student participants at Eastern Kentucky University, based upon a method by Alger, Lau, & Fishbein (2012); however, in the current study, recollection memory items were words received audibly rather than visually. Behavioral data, electroencephalography (EEG), and skin conductance data was collected to assess memory performance, sleep progress, autonomic nervous system activity, and sleep-related behavior. Results indicated a significant interaction effect between condition (sleep/awake) and image type (sexual/nonsexual): words paired with sexual images were best recalled by sleep participants, while awake participants recalled nonsexual images better than sexual images

Night sleep in patients with vegetative state

Polysomnographic recording of night sleep was carried out in 15 patients with the diagnosis vegetative state (syn. unresponsive wakefulness syndrome). Sleep scoring was performed by three raters, and confirmed by means of a spectral power analysis of the electroencephalogram, electrooculogram and electromyogram. All patients but one exhibited at least some signs of sleep. In particular, sleep stage N1 was found in 13 patients, N2 in 14 patients, N3 in nine patients, and rapid eye movement sleep in 10 patients. Three patients exhibited all phenomena characteristic for normal sleep, including spindles and rapid eye movements. However, in all but one patient, sleep patterns were severely disturbed as compared with normative data. All patients had frequent and long periods of wakefulness during the night. In some apparent rapid eye movement sleep episodes, no eye movements were recorded. Sleep spindles were detected in five patients only, and their density was very low. We conclude that the majority of vegetative state patients retain some important circadian changes. Further studies are necessary to disentangle multiple factors potentially affecting sleep pattern of vegetative state patients. © 2017 European Sleep Research SocietyThis study was supported by the Deutsche Forschungsgemeinschaft