Development of nonlinear techniques based on time-frequency representation and information theory for the analysis of EEG signals to assess different states of consciousness

Electroencephalogram (EEG) recordings provide insight into the changes in brain activity associated with various states of anesthesia, epilepsy, brain attentiveness, sleep disorders, brain disorders, etc. EEG's are complex signals whose statistical properties depend on both space and time. Their randomness and non-stationary characteristics make them impossible to be described in an accurate way with a simple technique, requiring analysis and characterization involves techniques that take into account their non-stationarity. For that, new advanced techniques in order to improve the efficiency of the EEG based methods used in the clinical practice have to be developed. The main objective of this thesis was to investigate and implement different methods based on nonlinear techniques in order to develop indexes able to characterize the frequency spectrum, the nonlinear dynamics and the complexity of the EEG signals recorded in different state of consciousness. Firstly, a new method for removing peak and spike in biological signal based on the signal envelope was successfully designed and applied to simulated and real EEG signals, obtaining performances significantly better than the traditional adaptive filters. Then, several studies were carried out in order to extract and evaluate EEG measures based on nonlinear techniques in different contexts such as the automatic detection of sleepiness and the characterization and prediction of the nociceptive stimuli and the assessment of the sedation level. Four novel indexes were defined by calculating entropy of the Choi-Williams distribution (CWD) with respect to time or frequency, by using the probability mass function at each time instant taken independently or by using the probability mass function of the entire CWD. The values of these indexes tend to decrease, with different proportion, when the behavior of the signals evolved from chaos or randomness to periodicity and present differences when comparing EEG recorded in eyes-open and eyes-closed states and in ictal and non-ictal states. Measures obtained with time-frequency representation, mutual information function and correntropy, were applied to EEG signals for the automatic sleepiness detection in patients suffering sleep disorders. The group of patients with excessive daytime sleepiness presented more power in ¿ band than the group without sleepiness, which presented higher spectral and cross-spectral entropy in the frontal zone in d band. More complexity in the occipital zone was found in the group of patients without sleepiness in ß band, while a stronger nonlinear coupling between the occipital and frontal regions was detected in patients with excessive daytime sleepiness, in ß band. Time-frequency representation and non-linear measures were also used in order to study how adaptation and fatigue affect the event-related brain potentials to stimuli of different modalities. Differences between the responses to infrequent and frequent stimulation in different recording periods were found in series of averaged EEG epochs recorded after thermal, electrical and auditory stimulation. Nonlinear measures calculated on EEG filtered in the traditional frequency bands and in higher frequency bands improved the assessment of the sedation level. These measures were obtained by applying all the developed techniques on signals recorded from patients sedated, in order to predict the responses to pain stimulation such as nail bad compression and endoscopy tube insertion. The proposed measures exhibit better performances than the bispectral index (BIS), a traditional indexes used for hypnosis assessment. In conclusion, nonlinear measures based on time-frequency representation, mutual information functions and correntropy provided additional information that helped to improve the automatic sleepiness detection, the characterization and prediction of the nociceptive responses and thus the assessment of the sedation level.El registro de la señal Electroencefalografíca (EEG) proporciona información sobre los cambios en la actividad cerebral asociados con varios estados de la anestesia, la epilepsia, la atención cerebral, los trastornos del sueño, los trastornos cerebrales, etc. Los EEG son señales complejas cuyas propiedades estadísticas dependen del espacio y del tiempo. Sus características aleatorias y no estacionarias hacen imposible que el EEG se describa de forma precisa con una técnica sencilla requiriendo un análisis y una caracterización que implica técnicas que tengan en cuenta su no estacionariedad. Todo esto aumenta la necesidad de desarrollar nuevas técnicas avanzadas con el fin de mejorar la eficiencia de los métodos utilizados en la práctica clínica que son basados en el análisis de EEG. En esta tesis se han investigado y aplicado diferentes métodos utilizando técnicas no lineales con el fin de desarrollar índices capaces de caracterizar el espectro de frecuencias, la dinámica no lineal y la complejidad de las señales EEG registradas en diferentes estados de conciencia. En primer lugar, se ha desarrollado un nuevo algoritmo basado en la envolvente de la señal para la eliminación de ruido de picos en las señales biológicas. Este algoritmo ha sido aplicado a señales simuladas y reales obteniendo resultados significativamente mejores comparados con los filtros adaptativos tradicionales. Seguidamente, se han llevado a cabo varios estudios con el fin de extraer y evaluar las medidas de EEG basadas en técnicas no lineales en diferentes contextos. Se han definido nuevos índices mediante el cálculo de la entropía de la distribución de Choi-Williams (DCW) con respecto al tiempo o la frecuencia. Se ha observado que los valores de estos índices tienden a disminuir, en diferentes proporciones, cuando el comportamiento de las señales evoluciona de caótico o aleatorio a periódico. Además, se han encontrado valores diferentes de estos índices aplicados a la señal EEG registrada en diferentes estados. Diferentes medidas basadas en la representación tiempo-frecuencia, la función de información mutua y la correntropia se han aplicado al EEG para la detección automática de la somnolencia en pacientes que sufren trastornos del sueño. Se ha observado en la zona frontal que la potencia en la banda θ es mayor en los pacientes con somnolencia diurna excesiva, mientras que la entropía espectral y la entropía espectral cruzada en la banda δ es mayor en los pacientes sin somnolencia. En el grupo sin somnolencia se ha encontrado más complejidad en la zona occipital, mientras que el acoplamiento no lineal entre las regiones occipital y frontal ha resultado más fuerte en pacientes con somnolencia diurna excesiva, en la banda β. La representación tiempo-frecuencia y las medidas no lineales se han utilizado para estudiar cómo la adaptación y la fatiga afectan a los potenciales cerebrales relacionados con estímulos térmicos, eléctricos y auditivos. Analizando el promedio de varias épocas de EEG grabadas después de la estimulación, se han encontrado diferencias entre las respuestas a la estimulación frecuente e infrecuente en diferentes períodos de registro. Todas las técnicas que se han desarrollado, se han aplicado a señales EEG registradas en pacientes sedados, con el fin de predecir las respuestas a la estimulación del dolor. Un conjunto de medidas calculadas en señales EEG filtradas en diferentes bandas de frecuencia ha permitido mejorar la evaluación del nivel de sedación. Las medidas propuestas han presentado un mejor rendimiento comparado con el índice bispectral, un indicador de hipnosis tradicional. En conclusión, las medidas no lineales basadas en la representación tiempofrecuencia, funciones de información mutua y correntropia han proporcionado informaciones adicionales que contribuyeron a mejorar la detección automática de la somnolencia, la caracterización y predicción de las respuestas nociceptivas y por lo tanto la evaluación del nivel de sedación

Attentional modulations of pain perception: evidence from laser evoked potentials

This thesis aims to provide a contribution to the current neurophysiological and psychophysiological understanding of nociception and pain processing in humans. The introduction of high-power, radiant heat stimulators (lasers) in sensory physiology has revolutionised the study of the nociceptive system. Laser pulses activate Aδ and/or C skin nociceptors selectively, i.e. without coactivating deeper, tactile mechanoreceptors, and elicit brain responses that can be detected using electroencephalography, and are called laser-evoked potentials (LEP). This was the technique applied in the two experimental studies reported in the present thesis work. The doctoral dissertation is organized in five chapters. Chapter 1 – Introduction - defines the concepts of nociception and pain. It also provides an introduction to the event related potential technique (ERP), a description of basic biophysics and neurophysiology related to LEP recording, followed by a literature review of its related cortical generators. In addition, the Chapter attempts to draw an elementary parallel between LEPs and other EPs elicited by stimuli belonging to other sensory modalities. Chapter 2 – Determinants of vertex potentials – describes the determinants of neural processes of pain perception and support their interpretation through a neurocognitive model of attention. The mechanism of attention allows allocating resources for selection and integration of this process with working memory requirements. More in detail, cognitive science suggested that the attention mechanism can be divided into two categories: stimulus-driven (or ‘bottom-up’) and goal-directed (or ‘top-down’). ‘Top-down’ and ‘bottom-up’ are treated as key interpretative categories to explain the findings reported in this thesis. Infact, they are metaphors which are used to represent information processing in a hierarchical fashion, where lower levels of processing would rely on the physical features of the stimulus while higher levels would involve comparisons with information stored in memory, selection of relevant information in competition and response to the stimulus. A review of selected literature in the field or ERP studies of sensory processing is provided and interpreted within this framework. The thesis aims to contribute to the understanding of both ‘bottom-up’ and ‘top-down’ mechanisms of attention during nociceptive processing, with two distinct experiments. Chapter 3 – Contribution to the analysis of ‘bottom-up features: “Dishabituation of laser-evoked EEG responses: dissecting the effect of certain and uncertain changes in stimulus modality” - presents a study where the hypothesis that a change of modality (from auditory to nociceptive and vicerversa, rather than no change at all) can significantly modulate brain responses (no matter the subjects expectation of this change) has been tested. The results of this study bring support for a determinant role of saliency (here modulated by the novelty introduced by a change in the stimulus modality) in affecting brain responses to the sensory input. Chapter 4 - Hypnotic modulation of sensory and affective dimensions of pain: a top-down signature on pain experience - introduces a study where hypnotic suggestions were used to draw subject’s attention either on intensity or on unpleasantness of pain perception. Thus, the study aimed to investigate whether this manipulation could induce a dissociation between this two measure of subjective experience and whether LEP could reflect the role of focused attention and expectation in indexing changes of subjective feeling. The results are discussed according to previous literature and to a neurocognitive model of pain processing as observed during an altered state of consciousness known to heighten the fronto-parietal network of sustained attention. In Chapter 5 - General discussion - the findings related to these two different research lines are integrated and discussed considering the existing theoretical accounts. The critical assumption is that the understanding of pain processing would largely benefit from the application of an attention-driven interpretative framework within which can be included different theoretical-epistemological views concerning (II) the Bayesian inference in perception, (III) the motivational account of pain monitoring and control, (IV) the neuroanatomy of homeostatic feeling of body integrity and self-regulation. As conclusive remark, the work presented in this thesis wish to highlight the importance of a renewed concept of ‘pain matrix’, based on its function of potential threat detector and action planner, in order to preserve the integrity of the body. In addition, the interpretation of pain as homeostatic-motivational force naturally carries us to consider the ‘pain matrix’ not as a sensory-specific cortical network but rather as an action-specific network, representing the activity by which the individual identifies and responds purposefully to a sudden, potential threat inside or outside of the body

Neurocognitive and Neuroplastic Mechanisms of Novel Clinical Signs in CRPS.

Complex regional pain syndrome (CRPS) is a chronic, debilitating pain condition that usually arises after trauma to a limb, but its precise etiology remains elusive. Novel clinical signs based on body perceptual disturbances have been reported, but their pathophysiological mechanisms remain poorly understood. Investigators have used functional neuroimaging techniques (including MEG, EEG, fMRI, and PET) to study changes mainly within the somatosensory and motor cortices. Here, we provide a focused review of the neuroimaging research findings that have generated insights into the potential neurocognitive and neuroplastic mechanisms underlying perceptual disturbances in CRPS. Neuroimaging findings, particularly with regard to somatosensory processing, have been promising but limited by a number of technique-specific factors (such as the complexity of neuroimaging investigations, poor spatial resolution of EEG/MEG, and use of modeling procedures that do not draw causal inferences) and more general factors including small samples sizes and poorly characterized patients. These factors have led to an underappreciation of the potential heterogeneity of pathophysiology that may underlie variable clinical presentation in CRPS. Also, until now, neurological deficits have been predominantly investigated separately from perceptual and cognitive disturbances. Here, we highlight the need to identify neurocognitive phenotypes of patients with CRPS that are underpinned by causal explanations for perceptual disturbances. We suggest that a combination of larger cohorts, patient phenotyping, the use of both high temporal, and spatial resolution neuroimaging methods, and the identification of simplified biomarkers is likely to be the most fruitful approach to identifying neurocognitive phenotypes in CRPS. Based on our review, we explain how such phenotypes could be characterized in terms of hierarchical models of perception and corresponding disturbances in recurrent processing involving the somatosensory, salience and executive brain networks. We also draw attention to complementary neurological factors that may explain some CRPS symptoms, including the possibility of central neuroinflammation and neuronal atrophy, and how these phenomena may overlap but be partially separable from neurocognitive deficits.This is the final version of the article. It first appeared from Frontiers via http://dx.doi.org/10.3389/fnhum.2016.0001

Altered perception of appetitive and aversive somatosensory stimuli in borderline personality disorder

Borderline personality disorder (BPD) is characterized by altered perception of affective stimuli, including pain. Little is known about positive somatosensation and the mechanisms behind altered pain perception. This thesis aimed to investigate altered affective somatosensation and the underlying mechanisms in BPD. Two studies each on participants with BPD and healthy controls (HC) were conducted. In study 1, standardized pleasant touch was applied to the hands of 25 participants with BPD and 25 HC. Perception of touch was assessed via self-report and the affect-modulated startle response served as physiological correlate of the valence of touch perception. Body-related dissociative state, in terms of body ownership, was assessed before and after touch stimulation. We observed a significantly reduced perceived pleasantness of touch in BPD compared to HC. In BPD, a more negative touch perception was associated with a decrease in body ownership from pre to post stimulation. The results suggest that altered somatosensation in BPD is not limited to pain perception and a perception-specific effect of pleasant touch stimulation on dissociative state. In study 2, temporal summation of pain was assessed in 24 BPD and 24 HC. Pain perception was assessed via self-report and the RIII-reflex served as measure of nociceptive processing on the spinal level. Dissociative state was assessed before and after pain stimulation. Heightened pain thresholds in BPD compared to HC were replicated. Unexpectedly temporal summation of pain unpleasantness was higher in BPD compared to HC, whereas temporal summation of pain intensity and the RIII reflex was not significantly different. Pain threshold and temporal summation of pain were not interrelated. There was a trend towards significance for a perception-specific effect of pain stimulation on dissociative state with higher temporal summation of pain being associated with decreased dissociative state. Different neural mechanisms might underlie reduced pain sensitivity in terms of heightened pain threshold and enhanced temporal summation of pain unpleasantness. Temporal summation of pain might be related to reduction in dissociation in response to painful stimulation. Three different mechanisms are discussed to underlie altered affective somatosensation in BPD: (1) threat hypersensitivity (2) altered cognitive evaluation (3) negative self-image. It is suggested that altered affective somatosensory perception in BPD is related to self-functioning, and specifically altered pleasant touch perception might play an important role in disturbed interpersonal-functioning

The Opposing Roles of GluN2C and GluN2D NMDA Receptor Subunits in Modulating Neuronal Oscillations

N-methyl-D-aspartate receptors (NMDARs) are ligand-gated ion channels consisting of two GluN1 subunits and two other subunits from among GluN2A-2D and GluN3A-3B subunits. NMDARs play critical roles in synaptic plasticity, learning and memory, and higher brain function such as cognition and perception. Dysfunction of NMDARs (hyper-function and hypo-function of NMDARs) are related to various diseases, including stroke, schizophrenia, Alzheimer’s disease, and others. However, to date, NMDARs antagonists have mostly failed in clinical trials due to adverse effects. NMDARs antagonists replicate the core symptoms of schizophrenia which may underlie its ability to alter neuronal oscillations in the neural circuitry of different brain regions. Recent evidence has shown that GluN2C subunits of NMDAR are expressed in astrocytes in the cortex, and that GluN2D NMDAR subunits are enriched in the parvalbumin-containing GABAergic inhibitory interneurons in the cortex and midbrain structures. Other studies have shown that both astrocytes and parvalbumin-containing interneurons play an essential role in generating and maintaining neuronal oscillations. These findings imply that GluN2C and GluN2D subunits may be involved in the distinct neural circuitry which regulates neuronal oscillations and thus influence the brain function and contribute to various diseases states. The initial aims of this dissertation are to determine if GluN2C and GluN2D subunits have a role in regulating neuronal oscillations. We also measured the auditory evoked responses in wildtype and GluN2C- and GluN2D-KO mice. Lastly, we use ketamine as the tool drug to determine the role of NMDARs in neuronal oscillations in a CDKL5-KO mouse model. We found that spontaneous basal neuronal oscillations were elevated in GluN2C- and GluN2D-KO mice compared to WT mice. NMDARs antagonists increased the power of neuronal oscillations in WT mice; we found drug-induced power increase is abolished in GluN2D-KO mice and is augmented in GluN2C-KO mice. Furthermore, we also found GluN2D-KO mice displayed abnormal auditory evoked responses. Lastly, we test subunit-selective NMDARs drug and NMDARs allosteric modulators with distinct subunits selectivity developed by our lab, including PAMs and NAMs on these KO models

Does any aspect of mind survive brain damage that typically leads to a persistent vegetative state? Ethical considerations

Recent neuroscientific evidence brings into question the conclusion that all aspects of consciousness are gone in patients who have descended into a persistent vegetative state (PVS). Here we summarize the evidence from human brain imaging as well as neurological damage in animals and humans suggesting that some form of consciousness can survive brain damage that commonly causes PVS. We also raise the issue that neuroscientific evidence indicates that raw emotional feelings (primary-process affects) can exist without any cognitive awareness of those feelings. Likewise, the basic brain mechanisms for thirst and hunger exist in brain regions typically not damaged by PVS. If affective feelings can exist without cognitive awareness of those feelings, then it is possible that the instinctual emotional actions and pain "reflexes" often exhibited by PVS patients may indicate some level of mentality remaining in PVS patients. Indeed, it is possible such raw affective feelings are intensified when PVS patients are removed from life-supports. They may still experience a variety of primary-process affective states that could constitute forms of suffering. If so, withdrawal of life-support may violate the principle of nonmaleficence and be tantamount to inflicting inadvertent "cruel and unusual punishment" on patients whose potential distress, during the process of dying, needs to be considered in ethical decision-making about how such individuals should be treated, especially when their lives are ended by termination of life-supports. Medical wisdom may dictate the use of more rapid pharmacological forms of euthanasia that minimize distress than the de facto euthanasia of life-support termination that may lead to excruciating feelings of pure thirst and other negative affective feelings in the absence of any reflective awareness

A P300 Based Cognitive Assessment Battery for Severely Motor-impaired and Overtly Non-responsive Patients

Diagnosing disorders of consciousness (DOC) is notoriously difficult, with estimates of misdiagnosis rates as high as 40%. Moreover, recent studies have demonstrated that patients who do not show signs of volitional motor responses can exhibit preserved command following detected by functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). Although these patients clearly retain some cognitive abilities, lack of consistent motor responses makes administration of standard neuropsychological tests impossible. Consequently, the extent of their cognitive function is unknown. In the current study, we developed and validated a P300b event related potential (ERP) neuropsychological battery in healthy participants to assess components of executive function without requiring motor output. First, participants were instructed to attend to a target auditory stimulus. P300b responses to attended relative to unattended stimuli were used as a neural proxy for detecting command following. To assess working memory capacity we adapted a digit span test to use a similar P300b response mechanism. Finally, reasoning was assessed by adapting a verbal reasoning task in the same manner. At the group level, and in a large majority of participants at the single-participant level, accurate performance could be detected using the P300b ERP, validating the potential utility of the battery. Additionally, the normalized magnitude of the P300b predicted individual differences in performance, but only when a suitable level of variability between participants was present. A post hoc Monte Carlo analysis was conducted to examine the necessary time required to conduct the battery as well as the interaction between time and performance in determining statistically significant performance. At 100% accuracy, a mean time of five minutes was required to achieve a significant result, with time increasing as a function of decreasing performance. These results demonstrate that covert control of attention, as measured by the P300b ERP, can be used to assess command following, working memory and reasoning abilities with a high degree of reliabilit

The reverse translation of a quantitative neuropsychiatric framework into preclinical studies:Focus on social interaction and behavior

Following the Research Domain Criteria (RDoC) concept, major brain circuits are conserved in evolution and malfunctioning of a brain circuit will lead to specific behavioral symptoms. Reverse translation of patient-based findings from Alzheimer’s disease (AD), schizophrenia (SZ) and major depression (MD) patients to preclinical models accordingly can be a starting point for developing a deeper understanding of the functional circuit biology and contribute to the validation of new hypotheses for therapeutic intervention in patients. In the context of the EU funded PRISM project, a preclinical test battery of tasks has been selected and aligned with the clinical test battery. It allows for assessment of social functioning, sensory processing, attention and working memory and is designed for validation of biological substrates from human molecular landscaping of social withdrawal. This review will broadly summarize the available literature on tasks for studying social behavior in rodents and outline the development of a preclinical test battery for the PRISM project by reverse translation

Neurophysiologie de l’hypnose

We here review behavioral, neuroimaging and electrophysiological studies of hypnosis as a state, as well as hypnosis as a tool to modulate brain responses to painful stimulations. Studies have shown that hypnotic processes modify internal (self awareness) as well as external (environmental awareness) brain networks. Brain mechanisms underlying the modulation of pain perception under hypnotic conditions involve cortical as well as subcortical areas including anterior cingulate and prefrontal cortices, basal ganglia and thalami. Combined with local anesthesia and conscious sedation in patients undergoing surgery, hypnosis is associated with improved peri- and postoperative comfort of patients and surgeons. Finally, hypnosis can be considered as a useful analogue for simulating conversion and dissociation symptoms in healthy subjects, permitting better characterization of these challenging disorders by producing clinically similar experiences

Exploring the electrophysiological responses to sudden sensory events

Living in rapidly changing and potentially dangerous environments has shaped animal nervous systems toward high sensitivity to sudden and intense sensory events - often signalling threats or affordances requiring swift motor reactions. Unsurprisingly, such events can elicit both rapid behavioural responses (e.g. the defensive eye-blink) and one of the largest electrocortical responses recordable from the scalp of several animals: the widespread Vertex Potential (VP). While generally assumed to reflect sensory-specific processing, growing evidence suggests that the VP instead largely reflects supramodal neural activity, sensitive to the behavioural-relevance of the eliciting stimulus. In this thesis, I investigate the relationship between sudden events and the brain responses and behaviours they elicit. In Chapters 1-3, I give a general introduction to the topic. In Chapter 4, I dissect the sensitivity of the VP to stimulus intensity - showing that its amplitude is sensitive only to the relative increase of intensity, and not the absolute intensity. In Chapter 5, I show that both increases and decreases of auditory and somatosensory stimulus intensity elicit the same supramodal VP, demonstrating that the VP is sensitive to any sufficiently abrupt sensory change, regardless of its direction or sensory modality. In Chapter 6, I observe strong correlations between the magnitudes of the VP and the eye-blink elicited by somatosensory stimuli (hand-blink reflex; HBR), demonstrating a tight relationship between cortical activity and behaviour elicited by sudden stimuli. In Chapter 7, I explore this relationship further, showing that the HBR is sensitive to high-level environmental dynamics. In Chapter 8, I propose an account of the underlying neural substrate of the VP, consistent with my results and the literature, which elucidates the relationship between the VP and behaviour. I also detail future experiments using fMRI and intracranial recordings to test this hypothesis, using the knowledge gained from this thesis