RECENT STUDIES OF COMPARATIVE PHILOSOPHY IN THE BALKANS: INTERVIEW WITH JANA S. ROŠKER

ADAS&M

Localization of brain networks engaged by the sustained attention to response task provides quantitative markers of executive impairment in amyotrophic lateral sclerosis

Objective: To identify cortical regions engaged during the sustained attention to response task (SART) and characterize changes in their activity associated with the neurodegenerative condition amyotrophic lateral sclerosis (ALS). Methods: High-density electroencephalography (EEG) was recorded from 33 controls and 23 ALS patients during a SART paradigm. Differences in associated event-related potential peaks were measured for Go and NoGo trials. Sources active during these peaks were localized, and ALS-associated differences were quantified. Results: Go and NoGo N2 and P3 peak sources were localized to the left primary motor cortex, bilateral dorsolateral prefrontal cortex (DLPFC), and lateral posterior parietal cortex (PPC). NoGo trials evoked greater bilateral medial PPC activity during N2 and lesser left insular, PPC and DLPFC activity during P3. Widespread cortical hyperactivity was identified in ALS during P3. Changes in the inferior parietal lobule and insular activity provided very good discrimination (AUROC > 0.75) between patients and controls. Activation of the right precuneus during P3 related to greater executive function in ALS, indicative of a compensatory role. Interpretation: The SART engages numerous frontal and parietal cortical structures. SART–EEG measures correlate with specific cognitive impairments that can be localized to specific structures, aiding in differential diagnosis

Cognitive network hyperactivation and motor cortex decline correlate with ALS prognosis

We aimed to quantitatively characterize progressive brain network disruption in Amyotrophic Lateral Sclerosis (ALS) during cognition using the mismatch negativity (MMN), an electrophysiological index of attention switching. We measured the MMN using 128-channel EEG longitudinally (2–5 timepoints) in 60 ALS patients and cross-sectionally in 62 healthy controls. Using dipole fitting and linearly constrained minimum variance beamforming we investigated cortical source activity changes over time. In ALS, the inferior frontal gyri (IFG) show significantly lower baseline activity compared to controls. The right IFG and both superior temporal gyri (STG) become progressively hyperactive longitudinally. By contrast, the left motor and dorsolateral prefrontal cortices are initially hyperactive, declining progressively. Baseline motor hyperactivity correlates with cognitive disinhibition, and lower baseline IFG activities correlate with motor decline rate, while left dorsolateral prefrontal activity predicted cognitive and behavioural impairment. Shorter survival correlates with reduced baseline IFG and STG activity and later STG hyperactivation. Source-resolved EEG facilitates quantitative characterization of symptom-associated and symptom-preceding motor and cognitive-behavioral cortical network decline in ALS

Altered supraspinal motor networks in survivors of poliomyelitis: a cortico-muscular coherence study

Objective Poliomyelitis results in changes to the anterior horn cell. The full extent of cortical network changes in the motor physiology of polio survivors has not been established. Our aim was to investigate how focal degeneration of the lower motor neurons (LMN) in infancy/childhood affects motor network connectivity in adult survivors of polio. Methods Surface electroencephalography (EEG) and electromyography (EMG) were recorded during an isometric pincer grip task in 25 patients and 11 healthy controls. Spectral signal analysis of cortico-muscular (EEG-EMG) coherence (CMC) was used to identify the cortical regions that are functionally synchronous and connected to the periphery during the pincer grip task. Results A pattern of CMC was noted in polio survivors that was not present in healthy individuals. Significant CMC in low gamma frequency bands (30–47 Hz) was observed in frontal and parietal regions. Conclusion These findings imply a differential engagement of cortical networks in polio survivors that extends beyond the motor cortex and suggest a disease-related functional reorganisation of the cortical motor network. Significance This research has implications for other similar LMN conditions, including spinal muscular atrophy (SMA). CMC has potential in future clinical trials as a biomarker of altered function in motor networks in post-polio syndrome, SMA, and other related conditions

Resting-state EEG reveals four subphenotypes of amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis is a devastating disease characterized primarily by motor system degeneration, with clinical evidence of cognitive and behavioural change in up to 50% of cases. Amyotrophic lateral sclerosis is both clinically and biologically heterogeneous. Subgrouping is currently undertaken using clinical parameters, such as site of symptom onset (bulbar or spinal), burden of disease (based on the modified El Escorial Research Criteria) and genomics in those with familial disease. However, with the exception of genomics, these subcategories do not take into account underlying disease pathobiology, and are not fully predictive of disease course or prognosis. Recently, we have shown that resting-state EEG can reliably and quantitatively capture abnormal patterns of motor and cognitive network disruption in amyotrophic lateral sclerosis. These network disruptions have been identified across multiple frequency bands, and using measures of neural activity (spectral power) and connectivity (comodulation of activity by amplitude envelope correlation and synchrony by imaginary coherence) on source-localized brain oscillations from high-density EEG. Using data-driven methods (similarity network fusion and spectral clustering), we have now undertaken a clustering analysis to identify disease subphenotypes and to determine whether different patterns of disruption are predictive of disease outcome. We show that amyotrophic lateral sclerosis patients (n = 95) can be subgrouped into four phenotypes with distinct neurophysiological profiles. These clusters are characterized by varying degrees of disruption in the somatomotor (α-band synchrony), frontotemporal (β-band neural activity and γl-band synchrony) and frontoparietal (γl-band comodulation) networks, which reliably correlate with distinct clinical profiles and different disease trajectories. Using an in-depth stability analysis, we show that these clusters are statistically reproducible and robust, remain stable after reassessment using a follow-up EEG session, and continue to predict the clinical trajectory and disease outcome. Our data demonstrate that novel phenotyping using neuroelectric signal analysis can distinguish disease subtypes based exclusively on different patterns of network disturbances. These patterns may reflect underlying disease neurobiology. The identification of amyotrophic lateral sclerosis subtypes based on profiles of differential impairment in neuronal networks has clear potential in future stratification for clinical trials. Advanced network profiling in amyotrophic lateral sclerosis can also underpin new therapeutic strategies that are based on principles of neurobiology and designed to modulate network disruption

Mapping electroencephalographic changes in amyotrophic lateral sclerosis

Background: Amyotrophic lateral sclerosis (ALS) is a rapidly progressing neurodegenerative disorder that predominantly affects the motor neurons, leading to muscle weakness and impairments in motor functions. Additionally, a significant proportion of patients exhibit cognitive and behavioural changes. To date, ALS remains an incurable disease, and the prediction of its onset and progression remains elusive. Hence, an unmet need exists for objective biomarkers that can facilitate early diagnosis, assess disease progression, and provide novel insights contributing to targeted treatment strategies. Objective: This thesis seeks to explore the utility of electroencephalography (EEG) as a tool for unravelling the intricacies of network disruption in ALS. Methods: Chapters 2, 3, and 4 employ resting-state EEG analysis of spectral power and connectivity to investigate ALS patients for potential biomarkers relevant to disease diagnosis and progression. Chapter 5 employs clustering analysis on EEG-derived measures from previous chapters to categorise ALS patients into subgroups with similar network impairments. Chapter 6 focuses on the sustained attention to response task (SART) and event-related analysis to study ALS patients, while Chapter 7 employs the same approach to study asymptomatic family members of individuals with familial C9orf72-associated ALS. Results: The thesis reveals changes in power and connectivity in ALS across multiple brain networks, not confined solely to motor functions. Some of these alterations correspond with disease severity and progression, suggesting potential objective biomarkers. Additionally, the thesis demonstrates the ability to categorise ALS patients into stable groups with distinct brain network alterations. Finally, the thesis identifies impaired SART networks in ALS patients and their asymptomatic family members, the latter potentially indicating early pathological changes in the course of ALS. Conclusions: The thesis maps uncharted territories of EEG changes in ALS. It underscores the value of EEG in advancing our understanding of ALS and it unveils promising avenues for the enhancement of diagnostic tools, innovative patient subgrouping strategies, and the early identification of prodromal signs of the disease

Non-parametric rank statistics for spectral power and coherence

Despite advances in multivariate spectral analysis of neural signals, the statistical inference of measures such as spectral power and coherence in practical and real-life scenarios remains a challenge. The non-normal distribution of the neural signals and presence of artefactual components make it difficult to use the parametric methods for robust estimation of measures or to infer the presence of specific spectral components above the chance level. Furthermore, the bias of the coherence measures and their complex statistical distributions are impediments in robust statistical comparisons between 2 different levels of coherence. Non-parametric methods based on the median of auto-/cross-spectra have shown promise for robust estimation of spectral power and coherence estimates. However, the statistical inference based on these non-parametric estimates remain to be formulated and tested. In this report a set of methods based on non-parametric rank statistics for 1-sample and 2-sample testing of spectral power and coherence is provided. The proposed methods were demonstrated and tested using simulated neural signals in different conditions. The results show that non-parametric methods provide robustness against artefactual components. Moreover, they provide new possibilities for robust 1-sample and 2-sample testing of the complex coherency function, including both the magnitude and phase, where existing methods fall short of functionality. The utility of the methods were further demonstrated by examples on experimental neural data. The proposed approach provides a new framework for non-parametric spectral analysis of digital signals. These methods are especially suited to neuroscience and neural engineering applications, given the attractive properties such as minimal assumption on distributions, statistical robustness, and the diverse testing scenarios afforded

Electroencephalographic β-band oscillations in the sensorimotor network reflect motor symptom severity in amyotrophic lateral sclerosis

Background and purposeResting-state electroencephalography (EEG) holds promise for assessing brain networks in amyotrophic lateral sclerosis (ALS). We investigated whether neural β-band oscillations in the sensorimotor network could serve as an objective quantitative measure of progressive motor impairment and functional disability in ALS patients.MethodsResting-state EEG was recorded in 18 people with ALS and 38 age- and gender-matched healthy controls. We estimated source-localized β-band spectral power in the sensorimotor cortex. Clinical evaluation included lower (LMN) and upper motor neuron scores, Amyotrophic Lateral Sclerosis Functional Rating Scale–Revised score, fine motor function (FMF) subscore, and progression rate. Correlations between clinical scores and β-band power were analysed and corrected using a false discovery rate of q = 0.05.Resultsβ-Band power was significantly lower in people with ALS than controls (p = 0.004), and correlated with LMN score (R = −0.65, p = 0.013), FMF subscore (R = −0.53, p = 0.036), and FMF progression rate (R = 0.52, p = 0.036).Conclusionsβ-Band spectral power in the sensorimotor cortex reflects clinically evaluated motor impairment in ALS. This technology merits further investigation as a biomarker of progressive functional disability

Cortico-muscular coherence in primary lateral sclerosis reveals abnormal cortical engagement during motor function beyond primary motor areas

Primary lateral sclerosis (PLS) is a slowly progressing disorder, which is characterized primarily by the degeneration of upper motor neurons (UMNs) in the primary motor area (M1). It is not yet clear how the function of sensorimotor networks beyond M1 are affected by PLS. The aim of this study was to use cortico-muscular coherence (CMC) to characterize the oscillatory drives between cortical regions and muscles during a motor task in PLS and to examine the relationship between CMC and the level of clinical impairment. We recorded EEG and EMG from hand muscles in 16 participants with PLS and 18 controls during a pincer-grip task. In PLS, higher CMC was observed over contralateral-M1 (α- and γ-band) and ipsilateral-M1 (β-band) compared with controls. Significant correlations between clinically assessed UMN scores and CMC measures showed that higher clinical impairment was associated with lower CMC over contralateral-M1/frontal areas, higher CMC over parietal area, and both higher and lower CMC (in different bands) over ipsilateral-M1. The results suggest an atypical engagement of both contralateral and ipsilateral M1 during motor activity in PLS, indicating the presence of pathogenic and/or adaptive/compensatory alterations in neural activity. The findings demonstrate the potential of CMC for identifying dysfunction within the sensorimotor networks in PLS