Optic nerve topography in multiple sclerosis diagnostic criteria: Existing knowledge and future directions

Current diagnostic criteria for multiple sclerosis (MS) do not consider the optic nerve as a typical topography for establishing the diagnosis. Recent studies have proved the utility of optic nerve magnetic resonance imaging, optical coherence tomography and visual evoked potentials in detecting optic nerve lesions during the early stages of MS. In addition, emerging evidence supports the inclusion of optic nerve topography as a fifth region to fulfil the dissemination in space criteria. Anticipating a modification in the McDonald criteria, it is crucial for neurologists to familiarize with the diagnostic properties of each test in detecting optic nerve lesions and understand how to incorporate them into the MS diagnostic process. Therefore, the objective of this article is to review the existing evidence supporting the use of these tests in the diagnostic process of MS and provide a practical algorithm that can serve as a valuable guide for clinical practice.

Optic nerve compression: a rare ocular manifestation of Proteus syndrome

Proteus syndrome is characterized by progressive, asymmetric, and distorting overgrowth that involves the skeletal, cutaneous, subcutaneous, and nervous systems. We report the case of a 10-year-old girl with Proteus syndrome and a constellation of ocular signs, including congenital glaucoma, myopia, amblyopia, strabismus, megaloglobus, epibulbar tumors, and right retinal detachment. A decrease in left eye visual acuity coupled with significant deterioration in visual evoked potential response over time prompted urgent neuroimaging, which revealed massive overgrowth of the sphenoid bone, with bilateral optic nerve compression due to optic canal stenosis. Successful removal of the roof of the optic canal along its entire course resulted in optic nerve decompression.

Neurodegeneration with Brain Iron Accumulation Disorders and Retinal Neurovascular Structure

BACKGROUND

The unique neurovascular structure of the retina has provided an opportunity to observe brain pathology in many neurological disorders. However, such studies on neurodegeneration with brain iron accumulation (NBIA) disorders are lacking.

OBJECTIVES

To investigate NBIA's neurological and ophthalmological manifestations.

METHODS

This cross-sectional study was conducted on genetically confirmed NBIA patients and an age-gender-matched control group. The thickness of retinal layers, central choroidal thickness (CCT), and capillary plexus densities were measured by spectral domain-optical coherence tomography (SD-OCT) and OCT angiography, respectively. The patients also underwent funduscopy, electroretinography (ERG), visual evoked potential (VEP), and neurological examination (Pantothenate-Kinase Associated Neurodegeneration-Disease Rating Scale [PKAN-DRS]). The generalized estimating equation model was used to consider inter-eye correlations.

RESULTS

Seventy-four patients' and 80 controls' eyes were analyzed. Patients had significantly decreased visual acuity, reduced inner or outer sectors of almost all evaluated layers, increased CCT, and decreased vessel densities, with abnormal VEP and ERG in 32.4% and 45.9%, respectively. There were correlations between visual acuity and temporal peripapillary nerve fiber layer (positive) and between PKAN-DRS score and disease duration (negative), and scotopic b-wave amplitudes (positive). When considering only the PKAN eyes, ONL was among the significantly decreased retinal layers, with no differences in retinal vessel densities. Evidence of pachychoroid was only seen in patients with Kufor Rakeb syndrome.

CONCLUSION

Observing pathologic structural and functional neurovascular changes in NBIA patients may provide an opportunity to elucidate the underlying mechanisms and differential retinal biomarkers in NBIA subtypes in further investigations. © 2023 International Parkinson and Movement Disorder Society.

Open-source versatile 3D-print animal conditioning platform design for in vivo preclinical brain imaging in awake mice and anesthetized mice and rats

Proper animal conditioning is a key factor in the quality and success of preclinical neuroimaging applications. Here, we introduce an open-source easy-to-modify multimodal 3D printable design for rodent conditioning for magnetic resonance imaging (MRI) or other imaging modalities. Our design can be used for brain imaging in anesthetized or awake mice, and in anesthetized rats. We show ease of use and reproducibility of subject conditioning with anatomical T2-weighted imaging for both mice and rats. We also demonstrate the application of our design for awake functional MRI in mice using both visual evoked potential and olfactory stimulation paradigms. In addition, using a combined MRI, positron emission tomography and X-ray computed tomography experiment, we demonstrate that our proposed cradle design can be utilized for multiple imaging modalities.

Distinct patterns of spatial attentional modulation of steady-state visual evoked magnetic fields (SSVEFs) in subdivisions of the human early visual cortex

In recent years, steady-state visual evoked potentials (SSVEPs) became an increasingly valuable tool to investigate neural dynamics of competitive attentional interactions and brain-computer interfaces. This is due to their good signal-to-noise ratio, allowing for single-trial analysis, and their ongoing oscillating nature that enables to analyze temporal dynamics of facilitation and suppression. Given the popularity of SSVEPs, it is surprising that only a few studies looked at the cortical sources of these responses. This is in particular the case when searching for studies that assessed the cortical sources of attentional SSVEP amplitude modulations. To address this issue, we used a typical spatial attention task and recorded neuromagnetic fields (MEG) while presenting frequency-tagged stimuli in the left and right visual fields, respectively. Importantly, we controlled for attentional deployment in a baseline period before the shifting cue. Subjects either attended to a central fixation cross or to two peripheral stimuli simultaneously. Results clearly showed that signal sources and attention effects were restricted to the early visual cortex: V1, V2, hMT+, precuneus, occipital-parietal, and inferior-temporal cortex. When subjects attended to central fixation first, shifting attention to one of the peripheral stimuli resulted in a significant activation increase for the to-be-attended stimulus with no activation decrease for the to-be-ignored stimulus in hMT+ and inferio-temporal cortex, but significant SSVEF decreases from V1 to occipito-parietal cortex. When attention was first deployed to both rings, shifting attention away from one ring basically resulted in a significant activation decrease in all areas for the then-to-be-ignored stimulus.

Characteristics of Visual Function in Children With Cerebral Palsy and Intellectual Disabilities in Urban Beijing

Objective

To investigate ocular development and the characteristics of visual function among children with cerebral palsy (CP) and intellectual disabilities in Beijing's Chaoyang District schools.

Methods

A total of 160 children (320 eyes) with CP and intellectual disabilities, including 86 males and 74 females aged between 6 and 18 years old (median, 13.5 years), were included in this study. A total of 214 healthy children aged 6 to 18 years (median, 10 years) were recruited as a control group for visual function, including 116 males and 98 females. Subjective far vision, objective vision (electrophysiological sweep visual evoked potential), corrected vision, near stereopsis, ametropia, the anterior segment, and the fundus were examined.

Results

A total of 232 eyes (76.32%) were ametropic among 304 eyes that could cooperate; 200 eyes (65.79%) were astigmatic, 16 eyes (5.26%) were hyperopic, and 120 eyes (39.47%) were myopic. A total of 64 children had strabismus (40%), and 24 had nystagmus (15%). The near stereopsis test showed that 72 children (64.29%) demonstrated 100″ and less. A total of 214 healthy children aged 6 to 18 years were recruited as a control group for visual function. There was a significant difference in visual functions between children with intellectual disabilities and those without (Z = -10.370; P < 0.001).

Conclusions

The prevalence of abnormal visual function in children with CP and intellectual disability was significantly higher than that in healthy children. Among them, myopia is the main refractive error, and the correction rate was low.

Translational Relevance

The electrical signals generated by stimulating the retina with black and white stripes are transmitted to the brain. Scanning electrophysiological devices can capture the activity of the cerebral cortex and convert it into an electroencephalogram. Scanning electrophysiological electrooculography is used to examine the objective vision of children with cerebral palsy.

Infantile epileptic spasm syndrome as a new NR2F1 gene phenotype

INTRODUCTION

NR2F1 pathogenetic variants are associated with the Bosch-Boonstra-Schaaf optic atrophy syndrome (BBSOAS). Recent studies indicate that BBSOAS patients not only have visual impairments but may also have developmental delays, hypotonia, thin corpus callosum and epileptic seizures. However, reports of BBSOAS occurrence along with infantile epileptic spasm syndrome (IESS) are rare.

METHODS

Here, we report three cases involving children with IESS and BBSOAS caused by de novo NR2F1 pathogenetic variants and summarize the genotype, clinical characteristics, diagnosis and treatment of them.

RESULTS

All three children experienced epileptic spasms and global developmental delays, with brain Magnetic Resonance Imaging (MRI) suggesting abnormalities (thinning of the corpus callosum or widened extracerebral spaces) and two of the children exhibiting abnormal visual evoked potentials.

CONCLUSIONS

Our findings indicate that new missense NR2F1 pathogenetic variants may lead to IESS with abnormal visual evoked potentials. Thus, clinicians should be aware of the Bosch-Boonstra-Schaaf optic atrophy syndrome and regular monitoring of the fundus, and the optic nerve is necessary during follow-up.

The sphingosine-1-phosphate receptor 1 modulator ponesimod repairs cuprizone-induced demyelination and induces oligodendrocyte differentiation

Sphingosine-1-phosphate receptor (S1PR) modulators are clinically used to treat relapse-remitting multiple sclerosis (MS) and the early phase of progressive MS when inflammation still prevails. In the periphery, S1PR modulators prevent lymphocyte egress from lymph nodes, hence hampering neuroinflammation. Recent findings suggest a role for S1PR modulation in remyelination. As the Giα-coupled S1P1 subtype is the most prominently expressed S1PR in oligodendrocyte precursor cells (OPCs), selective modulation (functional antagonism) of S1P1 may have direct effects on OPC functionality. We hypothesized that functional antagonism of S1P1 by ponesimod induces remyelination by boosting OPC differentiation. In the cuprizone mouse model of demyelination, we found ponesimod to decrease the latency time of visual evoked potentials compared to vehicle conditions, which is indicative of functional remyelination. In addition, the Y maze spontaneous alternations test revealed that ponesimod reversed cuprizone-induced working memory deficits. Myelin basic protein (MBP) immunohistochemistry and transmission electron microscopy of the corpus callosum revealed an increase in myelination upon ponesimod treatment. Moreover, treatment with ponesimod alone or in combination with A971432, an S1P5 monoselective modulator, significantly increased primary mouse OPC differentiation based on O4 immunocytochemistry. In conclusion, S1P1 functional antagonism by ponesimod increases remyelination in the cuprizone model of demyelination and significantly increases OPC differentiation in vitro.

SSFVEP as a potential electrophysiological examination for evaluating visual function of fundus diseases with vitreous hemorrhages: a clinical study

To investigate the sensitivity and potential application of steady-state flash visual evoked potentials (SSFVEP) in assessing the visual function of fundus diseases with vitreous hemorrhage. 18 patients diagnosed with monocular vitreous hemorrhages in the fundus were examined the flash visual evoked potentials (FVEP) and SSFVEP in both eyes. The difference in the P2-wave amplitude of FVEP and the average amplitude of SSFVEP waveform between the diseased eyes and those without vitreous hemorrhage were statistically compared. There was no significant difference in the waveform of FVEP between both eyes. The amplitude of P2-wave from FVEP of the diseased eye was slightly lower than that without vitreous hemorrhage. However, the difference was not statistically significant (P = 0.111). The waveform of SSFVEP in the eye without vitreous hemorrhage showed a towering shape, while that of the diseased eye was flat. The average amplitude of SSFVEP in the diseased eye was statistically lower than that without vitreous hemorrhage (P = 0.036). The difference ratio of SSFVEP amplitude between both eyes was significantly greater than that of FVEP amplitude (P = 0.028). In some fundus diseases with vitreous hemorrhage, SSFVEP had a higher sensitivity than FVEP, providing a novel potential application for visual function assessment.

From Perugino to Picasso revisited: Electrophysiological responses to faces in paintings from different art styles

Behavioral research (Ventura, et al., 2023) suggested that pictorial representations of faces varying along a realism-distortion spectrum elicit holistic processing as natural faces. Whether holistic face neural responses are engaged similarly remains, however, underexplored. In the present study, we evaluated the neural correlates of naturalist and artistic face processing, by exploring electrophysiological responses to faces in photographs versus in four major painting styles. The N170 response to faces in photographs was indistinguishable from that elicited by faces in the renaissance art style (depicting the most realistic faces), whilst both categories elicited larger N170 than faces in other art styles (post-impressionism, expressionism, and cubism), with a gradation in brain activity. The present evidence suggest that visual processing may become finer grained the more the realistic nature of the face. Despite behavioral equivalence, the neural mechanisms for holistic processing of natural faces and faces in diverse art styles are not equivalent.

Brain stimulation with 40 Hz heterochromatic flicker extended beyond red, green, and blue

Alzheimer's disease (AD) is associated with electrophysiological changes in the brain. Pre-clinical and early clinical trials have shown promising results for the possible therapy of AD with 40 Hz neurostimulation. The most notable findings used stroboscopic flicker, but this technique poses an inherent barrier for human applications due to its visible flickering and resulting high level of perceived discomfort. Therefore, alternative options should be investigated for entraining 40 Hz brain activity with light sources that appear less flickering. Previously, chromatic flicker based on red, green, and blue (RGB) have been studied in the context of brain-computer interfaces, but this is an incomplete representation of the colours in the visual spectrum. This study introduces a new kind of heterochromatic flicker based on spectral combinations of blue, cyan, green, lime, amber, and red (BCGLAR). These combinations are investigated by the steady-state visually evoked potential (SSVEP) response from the flicker with an aim of optimising the choice of 40 Hz light stimulation with spectrally similar colour combinations in BCGLAR space. Thirty healthy young volunteers were stimulated with heterochromatic flicker in an electroencephalography experiment with randomised complete block design. Responses were quantified as the 40 Hz signal-to-noise ratio and analysed using mixed linear models. The size of the SSVEP response to heterochromatic flicker is dependent on colour combinations and influenced by both visual and non-visual effects. The amber-red flicker combination evoked the highest SSVEP, and combinations that included blue and/or red consistently evoked higher SSVEP than combinations only with mid-spectrum colours. Including a colour from either extreme of the visual spectrum (blue and/or red) in at least one of the dyadic phases appears to be more important than choosing pairs of colours that are far from each other on the visual spectrum. Spectrally adjacent colour pairs appear less flickering to the perceiver, and thus the results motivate investigations into the limits for how alike the two phases can be and still evoke a 40 Hz response. Specifically, combining a colour on either extreme of the visual spectrum with another proximal colour might provide the best trade-off between flickering sensation and SSVEP magnitude.

A High-Resolution LED Stimulator for Steady-State Visual Stimulation: Customizable, Affordable, and Open Source

Visually evoked steady-state potentials (SSVEPs) are neural responses elicited by visual stimuli oscillating at specific frequencies. In this study, we introduce a novel LED stimulator system explicitly designed for steady-state visual stimulation, offering precise control over visual stimulus parameters, including frequency resolution, luminance, and the ability to control the phase at the end of the stimulation. The LED stimulator provides a personalized, modular, and affordable option for experimental setups. Based on the Teensy 3.2 board, the stimulator utilizes direct digital synthesis and pulse width modulation techniques to control the LEDs. We validated its performance through four experiments: the first two measured LED light intensities directly, while the last two assessed the stimulator's impact on EEG recordings. The results demonstrate that the stimulator can deliver a stimulus suitable for generating SSVEPs with the desired frequency and phase resolution. As an open source resource, we provide comprehensive documentation, including all necessary codes and electrical diagrams, which facilitates the system's replication and adaptation for specific experimental requirements, enhancing its potential for widespread use in the field of neuroscience setups.

Early impairment of magnocellular visual pathways mediated by isolated-check visual evoked potentials in primary open-angle glaucoma: a cross-sectional study

OBJECTIVE

To explore different performances in the magnocellular (MC) and parvocellular (PC) visual pathways in patients with primary open-angle glaucoma (POAG) and to objectively assess impairment in early stage of POAG.

METHODS AND ANALYSIS

This is a cross-sectional study. MC and PC visual pathways were assessed using isolated-check visual evoked potential (ic-VEP). Visual acuity, intraocular pressure, fundus examination, optical coherence tomography and visual field were measured. Signal-to-noise ratios (SNRs), mediated by ic-VEP were recorded. The Spearman's correlation analysis was used to estimate the relationships between visual functions and structures. Receiver-operating-characteristic (ROC) curves were used to estimate the accuracy in detection of early POAG.

RESULTS

60 participants (30 early POAG eyes and 30 age-matched control subjects) were recruited. MC visual pathway showed a non-linear response function, while PC visual pathway was a linear response function as contrast increased. Early POAG eyes exhibited significantly weaker initial contrast gains and lower maximum responses in the MC visual pathway (p=0.001, p=0.004, respectively). The SNRs at 8% and 32% depths of modulation (DOM) were significantly correlated with temporal-side retinal nerve fibre layer (RNFL) thickness in early POAG in MC-biased stimulation (p=0.017, p=0.020, respectively). The areas under ROC of 16% DOM were 0.780 (sensitivity 80.0%, specificity 63.3%) with the cut-off SNR of 2.07.

CONCLUSIONS

The MC visual pathway was damaged in the early stage of POAG. The SNRs at 8% and 32% DOM of MC-biased stimulation were significantly correlated with temporal-side RNFL thickness in early POAG, which helped in understanding the mechanisms of visual impairment in the early stage of POAG.

In-Car Environment Control Using an SSVEP-Based Brain-Computer Interface with Visual Stimuli Presented on Head-Up Display: Performance Comparison with a Button-Press Interface

Controlling the in-car environment, including temperature and ventilation, is necessary for a comfortable driving experience. However, it often distracts the driver's attention, potentially causing critical car accidents. In the present study, we implemented an in-car environment control system utilizing a brain-computer interface (BCI) based on steady-state visual evoked potential (SSVEP). In the experiment, four visual stimuli were displayed on a laboratory-made head-up display (HUD). This allowed the participants to control the in-car environment by simply staring at a target visual stimulus, i.e., without pressing a button or averting their eyes from the front. The driving performances in two realistic driving tests-obstacle avoidance and car-following tests-were then compared between the manual control condition and SSVEP-BCI control condition using a driving simulator. In the obstacle avoidance driving test, where participants needed to stop the car when obstacles suddenly appeared, the participants showed significantly shorter response time (1.42 ± 0.26 s) in the SSVEP-BCI control condition than in the manual control condition (1.79 ± 0.27 s). No-response rate, defined as the ratio of obstacles that the participants did not react to, was also significantly lower in the SSVEP-BCI control condition (4.6 ± 14.7%) than in the manual control condition (20.5 ± 25.2%). In the car-following driving test, where the participants were instructed to follow a preceding car that runs at a sinusoidally changing speed, the participants showed significantly lower speed difference with the preceding car in the SSVEP-BCI control condition (15.65 ± 7.04 km/h) than in the manual control condition (19.54 ± 11.51 km/h). The in-car environment control system using SSVEP-based BCI showed a possibility that might contribute to safer driving by keeping the driver's focus on the front and thereby enhancing the overall driving performance.

Alpha and SSVEP power outperform gamma power in capturing attentional modulation in human EEG

Attention typically reduces power in the alpha (8-12 Hz) band and increases power in gamma (>30 Hz) band in brain signals, as reported in macaque local field potential (LFP) and human electro/magneto-encephalogram (EEG/MEG) studies. In addition, EEG studies often use flickering stimuli that produce a specific measure called steady-state-visually-evoked-potential (SSVEP), whose power also increases with attention. However, effectiveness of these neural measures in capturing attentional modulation is unknown since stimuli and task paradigms vary widely across studies. In a recent macaque study, attentional modulation was more salient in the gamma band of the LFP, compared to alpha or SSVEP. To compare this with human EEG, we designed an orientation change detection task where we presented both static and counterphasing stimuli of matched difficulty levels to 26 subjects and compared attentional modulation of various measures under similar conditions. We report two main results. First, attentional modulation was comparable for SSVEP and alpha. Second, non-foveal stimuli produced weak gamma despite various stimulus optimizations and showed negligible attentional modulation although full-screen gratings showed robust gamma activity. Our results are useful for brain-machine-interfacing studies where suitable features are used for decoding attention, and also provide clues about spatial scales of neural mechanisms underlying attention.

Adding the Optic Nerve in Multiple Sclerosis Diagnostic Criteria: A Longitudinal, Prospective, Multicenter Study

BACKGROUND AND OBJECTIVES

The optic nerve is not one of the areas of the CNS that can be used to demonstrate dissemination in space (DIS) within the 2017 McDonald criteria for the diagnosis of multiple sclerosis (MS). Objectives were (1) to assess whether optic nerve-MRI (ON-MRI), optical coherence tomography (OCT), and visual evoked potentials (VEP) detect optic nerve involvement in clinically isolated syndrome (CIS) and (2) to evaluate the contribution of the optic nerve topography to the current diagnostic criteria in a prospective, multicenter cohort.

METHODS

MAGNIMS centers were invited to provide prospective data on patients with CIS who underwent a visual assessment with at least 2 of 3 investigations (ON-MRI, OCT, or VEP) within 6 months of onset. Modified DIS criteria were constructed by adding the optic nerve topography, defined by each investigation separately and any combination of them, as the fifth area of the CNS. A risk assessment analysis and the performance of the different DIS criteria were analyzed using the diagnosis of MS according to the 2017 McDonald criteria as the primary outcome and new T2 lesions and/or a second relapse as the secondary outcome.

RESULTS

We included 157 patients with CIS from 5 MAGNIMS centers; 60/157 (38.2%) patients presented with optic neuritis. Optic nerve involvement on ON-MRI was found in 40.2% patients at study entry and in 72.5% of those with optic neuritis.At follow-up (mean 27.9 months, SD 14.5), 111/157 patients (70.7%) were diagnosed with MS according to the 2017 McDonald criteria. Fulfilling either 2017 DIS or any modified DIS criteria conferred a similar high risk for reaching primary and secondary outcomes. The modified DIS criteria had higher sensitivity (92.5% [with ON-MRI] vs 88.2%), but slightly lower specificity (80.0% [with GCIPL IEA ≥4 μm] vs 82.2%), with overall similar accuracy (86.6% [with ON-MRI] vs 86.5%) than 2017 DIS criteria. Consistent results were found for secondary outcomes.

DISCUSSION

In patients with CIS, the presence of an optic nerve lesion defined by MRI, OCT, or VEP is frequently detected, especially when presenting with optic neuritis. Our study supports the addition of the optic nerve as a fifth topography to fulfill DIS criteria.

Multi-frequency steady-state visual evoked potential dataset

The Steady-State Visual Evoked Potential (SSVEP) is a widely used modality in Brain-Computer Interfaces (BCIs). Existing research has demonstrated the capabilities of SSVEP that use single frequencies for each target in various applications with relatively small numbers of commands required in the BCI. Multi-frequency SSVEP has been developed to extend the capability of single-frequency SSVEP to tasks that involve large numbers of commands. However, the development on multi-frequency SSVEP methodologies is falling behind compared to the number of studies with single-frequency SSVEP. This dataset was constructed to promote research in multi-frequency SSVEP by making SSVEP signals collected with different frequency stimulation settings publicly available. In this dataset, SSVEPs were collected from 35 participants using single-, dual-, and tri-frequency stimulation and with three different multi-frequency stimulation variants.

Assessment of amblyopic children undergoing occlusion therapy by pattern visual evoked potentials and contrast sensitivity tests

Background: Amblyopia is a case where one or less commonly, both eyes have impaired visual performance, even with the best optical correction and no visible disease of the visual system. Objectives: To assess contrast sensitivity tests (CST) and pattern visual evoked potentials (PVEP) results in amblyopic children who have already started occlusion therapy for durations ranging from 6 to 12 months. Methods: This cross-sectional study was conducted on 200 eyes of 50 patients with monocular amblyopia and 50 age and sex matched controls. Both patients and controls underwent ophthalmological assessment, PVEP, and CST. Results: There was no statistically significant difference in the results of P100 latencies of qualitative PVEP in amblyopic eyes compared to non-amblyopic eyes and control eyes, while the qualitative CST showed a highly statistically significant difference, being affected in 98% of amblyopic eyes compared to unaffected eyes (4%) and control eyes (4%). The maximum contrast level and minimal contrast level of quantitative CST were significantly lower in amblyopic eyes compared to non-amblyopic and control eyes. The cutoff value of maximal contrast level at mean frequencies of 2.5 ± 0.9 Hz, and a range of (1.1-4.1) for amblyopic eyes is ≤21 dB, while the cutoff value of minimal contrast level at mean frequencies of 13.4 ± 2.6 Hz, and a range of (6.7-18) for amblyopic eyes is ≤12 dB. Conclusion: Detection of amblyopia by CST is a noninvasive and easy procedure, which represents a promising tool to support the diagnosis of amblyopia.

A new model of axon degeneration in the mouse optic nerve using repeat intraocular pressure challenge

We characterize a new experimental model for inducing retinal ganglion cell (RGC) dysfunction and degeneration in mice. C57BL/6J mice were subjected to two acute periods of intraocular pressure (IOP) elevation (50 mmHg for 30 min) by cannulation of the anterior chamber. We used full-field electroretinography and visual evoked potentials (VEPs) to measure subsequent changes in retina and optic nerve function, and histochemical techniques to assess RGC survival and optic nerve structure. In 12 month old mice, a single IOP challenge caused loss and subsequent recovery of RGC function over the following 28 days with minimal cell death and no observed axonal damage. A second identical IOP challenge resulted in persistent RGC dysfunction and significant (36%) loss of RGC somas. This was accompanied by a 16.7% delay in the latency and a 27.6% decrease in the amplitude of the VEP. Severe axonal damage was seen histologically with enlargement of axons, myelin disruption, reduced axon density, and the presence of glial scarring. In contrast, younger 3 month old mice when exposed to a single or repeat IOP challenge showed quicker RGC functional recovery after a single challenge and full functional recovery after a repeat challenge with no detectable optic nerve dysfunction. These data demonstrate a highly reproducible and minimally invasive method for inducing RGC degeneration and axonal damage in mice. Resilience of the optic nerve to damage is highly dependent on animal age. The time-defined nature of functional versus structural loss seen in this model stands to facilitate investigation of neuroglial responses in the retina after IOP injury and the associated evaluation of neuroprotective treatment strategies. Further, the model may be used to investigate the impact of aging and the cellular switch between neurorecovery and neurodegeneration.

Comparison of surgical effect in active and inactive Dysthyroid Optic Neuropathy after Endoscopic Transnasal Medial Orbital Decompression

PURPOSE

To evaluate and compare the changes in orbital soft tissue volume and visual function after endoscopic transnasal medial orbital decompression in patients with active and inactive dysthyroid optic neuropathy (DON).

METHODS

This prospective, cohort study recruited 112 patients (112 eyes) with DON who were divided into an active and inactive DON group (56 eyes each) by clinical activity scores. All patients underwent endoscopic transnasal medial orbital decompression. The pre- and post-operative orbital soft tissue volumes were measured with high-resolution computed tomography (CT) using Mimics software. Visual function, including best-corrected visual acuity (BCVA), visual field (VF), and visual evoked potential (VEP), was recorded before and after surgery.

RESULTS

Preoperatively, compared with the inactive DON group, the active DON group had greater extraocular muscle volume (EMV) and EMV/orbital volume (OV) ratio, but worse BCVA, VF, and exophthalmos. Postoperatively, although the EMV slightly increased, with the enlarged medial rectus muscle contributing dramatically, the EMV/OV ratio decreased in patients with DON. Besides, visual function including BCVA, VF, VEP and exophthalmos was also improved in both groups after surgery. There were no significant differences in postoperative OV; EMV; EMV/OV ratio; and the BCVA, VF, and VEP parameters between both groups (all P > 0.05).

CONCLUSION

Patients with DON who did not respond well to steroids, regardless of disease activity, may benefit from orbital decompression via the decrease in the proportion of EMV in OV, especially patients with active DON, who showed more improved visual function than patients with inactive DON.

One-year follow up of a tobacco alcohol optic neuropathy case with atypical course: Conventional assessment and Laser speckle flowgraphy

PURPOSE

To describe the unexpected one-year course of a probable Tobacco Alcohol Optic Neuropathy (TAON) and the unprecedented Laser Speckle Flowgraphy (LSFG) assessment.

CASE REPORT

A 49-year-old Caucasian man with no family history of visual impairment referred because of unilateral and painless visual acuity (VA) decrease in the right eye (RE). Also, color vision and visual evoked potentials were unilaterally altered. Optical coherence tomography (OCT), instead, revealed bilateral thinning of the macular ganglion cell inner plexiform layer. Funduscopy, intraocular pressure, pupillary shape/reactivity and ocular motility were normal. Blood testing revealed macrocytic/normochromic anemia and low levels of vitamin B2 and folic acid. The patient admitted heavy tobacco and alcohol intake for many years. After an initial compliance to the prescribed regimen, the patient quitted the vitamin intake and resumed his smoking and drinking habits. After a 13-month follow up the VA further reduced in the RE; the fellow eye preserved normal visual function despite the bilateral and progressive alterations of the OCT assessment. Both eyes underwent LSFG examination. All the conventional nets evaluated by the instrument (i.e., Mean Tissue, Mean All and Mean Vascular perfusion) were lower in the RE.

CONCLUSIONS

Based on patient's behavior, visual deficiencies and laboratory findings, we assumed that the patient suffered from TAON. Also after one year, however, a deep discrepancy between the strictly unilateral, progressive VA impairment and the bilateral, symmetrical OCT alterations persisted. The LSFG data clearly indicate that the perfusion of the two eyes differed, especially referring to tissular vascularization in the optic nerve head area of the RE.

Stability of steady-state visual evoked potential contrast response functions

Repetitive sensory stimulation has been shown to induce neuroplasticity in sensory cortical circuits, at least under certain conditions. We measured the plasticity-inducing effect of repetitive contrast-reversal-sweep steady-state visual-evoked potential (ssVEP) stimuli, hoping to employ the ssVEP's high signal-to-noise electrophysiological readout in the study of human visual cortical neuroplasticity. Steady-state VEP contrast-sweep responses were measured daily for 4 days (four 20-trial blocks per day, 20 participants). No significant neuroplastic changes in response amplitude were observed either across blocks or across days. Furthermore, response amplitudes were stable within-participant, with measured across-block and across-day coefficients of variation (CV = SD/mean) of 15-20 ± 2% and 22-25 ± 2%, respectively. Steady-state VEP response phase was also highly stable, suggesting that temporal processing delays in the visual system vary by at most 2-3 ms across blocks and days. While we fail to replicate visual stimulation-dependent cortical plasticity, we show that contrast-sweep steady-state VEPs provide a stable human neurophysiological measure well suited for repeated-measures longitudinal studies.

[Anatomo-functional state of the central retina in premature infants with intraventricular hemorrhage and retinopathy of prematurity]

OBJECTIVE

Assessment of the anatomo-functional state of the central retina in children with intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) in the long-term period.

MATERIAL AND METHODS

We examined 51 patients (102 eyes) born 25-34 weeks' of gestation (birth weight 700-2290 g), aged 8.83±3.5 years, and 18 children (36 eyes) born prematurely aged 10.8±3.2 years. The children underwent standard ophthalmologic examination, optical coherence tomography (OCT) and visual evoked potentials (VEP).

RESULTS

Retinal thickness (RT) and retinal volume (RV) in the fovea of premature infants with PH and/or IVH are significantly higher than in healthy full-term infants, which correlates with lower visual acuity (p<0.05). RT and RV in the fovea has an inverse proportional relationship with gestational age (GA), (p<0.05). According to the results of VEP, moderate organic changes in the conduction tract of the visual analyzer are noted in 45% of premature infants (p<0.05).

CONCLUSION

The process of macula formation is affected by many perinatal and postnatal factors, namely: GA, birth weight, ROP, hypoxic-ischemic CNS diseases, and refractive disorders.

A challenging differential diagnosis - Leber's Hereditary Optic Neuropathy

Leber's hereditary optic neuropathy (LHON) is the most common maternally inherited disease linked to mitochondrial DNA (mtDNA). The patients present with subacute asymmetric bilateral vision loss. Approximately 95% of the LHON cases are caused by m.3460G>A (MTND1), m.11778G>A (MTND4), and m.14484T>C (MTND6) mutations. The hallmark of hereditary optic neuropathies determined by mitochondrial dysfunction is the vulnerability and degeneration of retinal ganglion cells (RGC). We present the case of a 28-year-old man who came to our clinic complaining of a subacute decrease in visual acuity of his left eye. From his medical history, we found out that one month before he had the same symptoms in the right eye. From the family history, we noted that an uncle has had vision problems since childhood. We carried out complete blood tests, including specific antibodies for autoimmune and infectious diseases. Laboratory tests and MRI were within normal limits. A blood test of the mtDNA showed the presence of 11778 G>A mutation on the mtND6 gene. The medical history, the fundus appearance, the OCT, and the paraclinical investigations, made us diagnose our patient with Leber's hereditary optic neuropathy. As soon as possible, we began the treatment with systemic idebenone, 900 mg/day. We examined the patient 2, 6, and 10 weeks after initiating the treatment. Abbreviations: LHON = Leber's Hereditary Optic Neuropathy, mtDNA = mitochondrial DNA, VA = visual acuity, RE = right eye, LE = left eye, OCT = Optical coherence tomography, pRNFL = peripapillary retinal nerve fiber layer, GCL = retinal ganglion cells layer, MRI = magnetic resonance imaging, VEP = visual evoked potentials, VEP IT = VEP implicit time, VEP A = VEP amplitude.

Filter bank second-order underdamped stochastic resonance analysis for implementing a short-term high-speed SSVEP detection

OBJECTIVE

The progression of brain-computer interfaces (BCIs) has been propelled by breakthroughs in neuroscience, signal processing, and machine learning, marking it as a dynamic field of study over the past few decades. Nevertheless, the nonlinear and non-stationary characteristics of steady-state visual evoked potentials (SSVEPs), coupled with the incongruity between frequently employed linear techniques and nonlinear signal attributes, resulted in the subpar performance of mainstream non-training algorithms like canonical correlation analysis (CCA), multivariate synchronization index (MSI), and filter bank CCA (FBCCA) in short-term SSVEP detection.

METHODS

To tackle this problem, the novel fusions of common filter bank analysis, CCA dimensionality reduction methods, USSR models, and MSI recognition models are used in SSVEP signal recognition.

RESULTS

Unlike conventional linear techniques such as CCA, MSI, and FBCCA, the filter bank second-order underdamped stochastic resonance (FBUSSR) analysis demonstrates superior efficacy in the detection of short-term high-speed SSVEPs.

CONCLUSION

This research enlists 32 subjects and uses a public dataset to assess the proposed approach, and the experimental outcomes indicate that the non-training method can attain greater recognition precision and stability. Furthermore, under the conditions of the newly proposed fusion method and light stimulation, the USSR model exhibits the most optimal enhancement effect.

SIGNIFICANCE

The findings of this study underscore the expansive potential for the application of BCI systems in the realm of neuroscience and signal processing.

No influence of threat uncertainty on fear generalization

Fear overgeneralization and perceived uncertainty about future outcomes have been suggested as risk factors for clinical anxiety. However, little is known regarding how they influence each other. In this study, we investigated whether different levels of threat uncertainty influence fear generalization. Three groups of healthy participants underwent a differential fear conditioning protocol followed by a generalization test. All groups learned to associate one female face (conditioned stimulus, CS+) with a female scream (unconditioned stimulus, US), whereas the other face (CS-) was not associated with the scream. In order to manipulate threat uncertainty, one group (low uncertainty, n = 26) received 80%, the second group (moderate uncertainty, n = 32) received 60%, and the third group (high uncertainty, n = 30) 40% CS-US contingency. In the generalization test, all groups saw CS+ and CS- again along with four morphs resembling the CSs in steps of 20%. Subjective (expectancy, valence, and arousal ratings), psychophysiological (skin conductance response, SCR), and visuocortical (steady-state visual evoked potentials, ssVEPs) indices of fear were registered. Participants expected the US according to their reinforcement schedules and the discriminative responses to CS+/CS- increased with more uncertainty in skin conductance. However, acquisition of conditioned fear was not evident in ssVEPs. During the generalization test, we found no effect of threat uncertainty in any of the measured variables, but the strength of generalization for threat expectancy ratings was positively correlated with dispositional intolerance of uncertainty. This study suggests that mere threat uncertainty does not modulate fear generalization.

Neurophysiological Alterations of the Visual Pathway in Posterior Cortical Atrophy: Systematic Review and a Case Series

Background

The clinical features of posterior cortical atrophy (PCA), a rare condition often caused by Alzheimer's disease, have been recently defined, while little is known about its neurophysiological correlates.

Objective

To describe neurophysiological alterations of the visual pathway as assessed using visual field test (VF), visual evoked potentials (VEP), and electroretinogram (ERG) in PCA patients.

Methods

Studies reporting VF, VEPs, and ERG in PCA patients were selected according PRISMA method. Of the 323 articles that emerged from the literature, 17 included the outcomes of interest. To these data, we added those derived from a patient cohort enrolled at our clinic.

Results

The literature review included 140 patients, half of them (50%) presented with homonymous hemianopia or quadrantanopia. VEPs were available in 4 patients (2 normal findings, 1 decreased amplitude, and 1 increased latency) and ERG in 3 patients (substantially normal findings). Our case series included 6 patients, presenting with homonymous lateral hemianopia in 50% and contralateral cortical atrophy. VEPs showed normal amplitude in 66-83% according to the stimulation check, and increased latency in 67% in absence of myelin damage on MRI. Latency was increased in both eyes in 50% and only on one side in the other 50%. Such alterations were observed in patients with more severe and symmetric atrophy. ERG showed normal findings.

Conclusions

Neurophysiological investigations of the visual pathway in PCA are almost absent in literature. Alterations involve both amplitude and latency and can be also monocular. A multiple-point involvement of the optical pathway can be hypothesized.

Visual evoked potential evaluation following brain injury in school-aged children

Aim: The research aimed to establish reference values of visual evoked potentials among school-aged children after brain injury. Methods: Eighteen patients with persisting visual symptoms after brain injury have been examined. A pattern-VEP test has been used during the examination. Results: The prolongation of the N2 wave in 55,6%-66,6%, P wave in 55,7%-66,7%, and N3 wave in 16,7%-22,2% was determined in the research group. Likewise, the decrease in the amplitude of the P wave was determined in the case of 16,7%-33,3%. According to the topography, we concluded that the prechiasmatic alteration was predominantly determined as bilateral in the optic pathways, with emphasis equally on the right and left. Conclusions: VEP evaluation remains one of the most credible methods of examination. In the case of moderate or severe traumatic optic neuropathy, it allows the detection of damage to the optic pathways before the appearance of organic changes that are often irreversible. The possibility of early detection of such modifications could justify the initiation of a dosed stimulatory treatment, to avoid damage to the optic pathways that would induce secondary optic atrophy. Abbreviations: VEP = visual evoked potentials, MRI = magnetic resonance imaging.

Ethambutol and its ophthalmic effects; is screening and collaboration the new way forward?

AIM

To screen patients on ethambutol and evaluate its role on visual functions and toxic optic neuropathy.

SETTING AND DESIGN

Retrospective, observational single tertiary centre cohort of 80 patients.

METHODS AND MATERIAL

A total of 69 from the initial 80 patients with visual complaints were categorised into two groups A and B; ongoing anti-tubercular therapy with ethambutol and having stopped ethambutol for greater than six months respectively. All patients underwent vision (V) testing on ETDRS chart and anterior and posterior segment evaluation. Additionally, patients in group A recorded color vision (CV) on Ishihara chart and visual evoked potential (VEP).

STATISTICAL ANALYSIS USED

P value was calculated using Chi square test (SPSS ver. 20).

RESULTS

Out of 69 patients in our study, 58 (84.05%) patients recorded reduced visual acuity. The mean visual acuity was 0.58 logMAR units. 33 out of our 58 (57%) patients with reduced visual acuity showed normal optic discs while 25 out of 58 (43%) showed altered optic discs. In group B, 14 out of 32 patients with vision of less than 20/20 also had optic disc pallor (p = 0.02). 12 out of 15 patients in group A recorded an altered color vision and also had a vision of less than 20/20 (p = 0.023). 15 patients who recorded altered VEP also had vision of less than 20/20 (p = 0.037).

CONCLUSION

Visual acuity, color vision and vep are sensitive and sustainable tools which can be implemented in regular screening. Ethambutol toxicity is a real problem and a collaborative approach is necessary to establish screening protocols and prevent ethambutol induced toxic optic neuropathy.

The impact of COVID-19 on a Southern Chinese cohort with neuromyelitis optica spectrum disorders

BACKGROUND

There are few studies on risk factors for coronavirus disease 2019 (COVID-19) infection in patients with Neuromyelitis Optica Spectrum Disorders (NMOSD). The relationship between NMOSD relapse and COVID-19 needs to be evaluated. The objective of our study is to identify the risk factors of COVID-19 infection and NMOSD relapse among NMOSD patients with COVID-19.

METHOD

A total of 379 NMOSD patients registered in a NMOSD database were included in this case-control study after the end of the COVID-19 quarantine and restriction policies on December 6, 2022 in China. Data were obtained from the database. Additional information was obtained by questionnaires and the Neurology out-patient clinic. The clinical characteristics of NMOSD patients with COVID-19 were described. Risk factors associated with COVID-19 infection and outcome among patients with NMOSD were analyzed. Risk factors associated with relapse in NMOSD patients with COVID-19 were also identified.

RESULTS

239 (63.1%) NMOSD patients were infected with COVID-19. Patients with NMOSD who were infected with COVID-19, in comparison to those without COVID-19, were younger at the time of interview (median [IQR] age: 43.00 [32.00-55.00] vs 49.50 [35.25-56.00] years, P = 0.029), younger at NMOSD onset (median [IQR] age: 38.00 [27.00-51.00] vs 45.00 [32.00-52.75] years, P = 0.013), had abnormal visual evoked potentials before infection (73.4% vs 54.3% P = 0.029), had lower baseline Activities of Daily Living Scale (ADL) scores (median [IQR] ADL: 14.00 [14.00-16.00] vs 14.00 [14.00-19.00], P = 0.014) or lower baseline modified Rankin Scale (mRS) scores (1.12±0.749 vs 1.33±0.991, P = 0.037), and were less frequently treated with more than 10 mg prednisone or 8 mg methylprednisolone (25.0% vs 36.0%,p = 0.026). All 9 NMOSD patients who had symptomatic cerebral syndrome developed moderate/severe COVID-19. A higher percentage of patients with moderate/severe COVID-19 experienced more than one core clinical NMOSD symptoms (61.5% vs 55.1%, p = 0.044), compared to patients with mild COVID-19. Higher risk of NMOSD relapse among NMOSD patients with COVID-19 was associated with higher Expanded Disability Status Scale (EDSS) scores (median[IQR] EDSS: 2.00 [1.00-3.00] vs 1.50 [1.00-2.25], P = 0.037) and drug treatments disruption (21.6% vs 5.0% P<0.001).

CONCLUSIONS

NMOSD patients with younger age, lower baseline ADL or mRS had higher incidence of being diagnosed with COVID-19 during pandemic. Glucocorticoid use may decrease the risk of COVID-19. NMOSD patients with symptomatic cerebral syndrome before the COVID-19 pandemic are associated with worse COVID-19 outcomes. Drug treatment disruption may result in relapse among NMOSD patients with COVID-19.

Eyetracking-enhanced VEP for nystagmus

Visual evoked potentials (VEPs) are an important prognostic indicator of visual ability in patients with nystagmus. However, VEP testing requires stable fixation, which is impossible with nystagmus. Fixation instability reduces VEP amplitude, and VEP reliability is therefore low in this important patient group. We investigated whether VEP amplitude can be increased using an eye tracker by triggering acquisition only during slow periods of the waveform. Data were collected from 10 individuals with early-onset nystagmus. VEP was obtained under continuous (standard) acquisition, or triggered during periods of low eye velocity, as detected by an eye tracker. VEP amplitude was compared using Bonferroni corrected paired samples t-tests. VEP amplitude is significantly increased when triggered during low eye velocity (95% CI 1.42-6.83 µV, t(15) = 3.25, p = 0.0053). This study provides proof-of-concept that VEP amplitude (and therefore prognostic reliability) can be increased in patients with early onset nystagmus by connecting an eye tracker and triggering acquisition during periods of lower eye velocity.

Surgical Outcomes of Standardized Endoscopical Deep Medial Orbital Decompression in Dysthyroid Optic Neuropathy

INTRODUCTION

The aim of the study was to standardize the endoscopic deep medial orbital decompression surgery for better relief of optic nerve compression in dysthyroid optic neuropathy (DON).

METHODS

A total of 128 eyes from patients received the standardized endoscopic deep medial orbital decompression surgery were recruited in this study. The efficacy of the procedure was assessed at a 1-month follow-up by the best-corrected visual acuity (VA), visual field (VF), and visual evoked potential (VEP). Clinical data were collected to explore the factors that affected visual recovery. Oxygen saturation of retinal blood vessels, retinal thickness, and vessel density were measured to demonstrate the potential recovery mechanisms.

RESULTS

After surgery, the ratio of extraocular muscle volume in the orbital apex to orbital apex volume significantly decreased from 44.32 ± 22.31% to 36.82 ± 12.02% (p < 0.001). 96.87% of eyes' final VA improved; average VA improved from 0.93 ± 0.73 to 0.50 ± 0.60 at 1 week (p < 0.001) and 0.40 ± 0.53 at 1 month (p < 0.001). Postoperatively, VF and VEP also improved, the oxygen saturation of retinal arteries increased, and the retinal thickness was reduced. Preoperative VA, visual impairment duration, and clinical activity score evaluation were associated with visual recovery.

CONCLUSION

In this study, we standardized the endoscopic deep medial orbital decompression, of which key point was to relieve pressure in the orbital apex and achieved satisfactory visual recovery in DON patients.

Burst c-VEP Based BCI: Optimizing stimulus design for enhanced classification with minimal calibration data and improved user experience

The utilization of aperiodic flickering visual stimuli under the form of code-modulated Visual Evoked Potentials (c-VEP) represents a pivotal advancement in the field of reactive Brain-Computer Interface (rBCI). A major advantage of the c-VEP approach is that the training of the model is independent of the number and complexity of targets, which helps reduce calibration time. Nevertheless, the existing designs of c-VEP stimuli can be further improved in terms of visual user experience but also to achieve a higher signal-to-noise ratio, while shortening the selection time and calibration process. In this study, we introduce an innovative variant of code-VEP, referred to as "Burst c-VEP". This original approach involves the presentation of short bursts of aperiodic visual flashes at a deliberately slow rate, typically ranging from two to four flashes per second. The rationale behind this design is to leverage the sensitivity of the primary visual cortex to transient changes in low-level stimuli features to reliably elicit distinctive series of visual evoked potentials. In comparison to other types of faster-paced code sequences, burst c-VEP exhibit favorable properties to achieve high bitwise decoding performance using convolutional neural networks (CNN), which yields potential to attain faster selection time with the need for less calibration data. Furthermore, our investigation focuses on reducing the perceptual saliency of c-VEP through the attenuation of visual stimuli contrast and intensity to significantly improve users' visual comfort. The proposed solutions were tested through an offline 4-classes c-VEP protocol involving 12 participants. Following a factorial design, participants were instructed to focus on c-VEP targets whose pattern (burst and maximum-length sequences) and amplitude (100% or 40% amplitude depth modulations) were manipulated across experimental conditions. Firstly, the full amplitude burst c-VEP sequences exhibited higher accuracy, ranging from 90.5% (with 17.6s of calibration data) to 95.6% (with 52.8s of calibration data), compared to its m-sequence counterpart (71.4% to 85.0%). The mean selection time for both types of codes (1.5 s) compared favorably to reports from previous studies. Secondly, our findings revealed that lowering the intensity of the stimuli only slightly decreased the accuracy of the burst code sequences to 94.2% while leading to substantial improvements in terms of user experience. Taken together, these results demonstrate the high potential of the proposed burst codes to advance reactive BCI both in terms of performance and usability. The collected dataset, along with the proposed CNN architecture implementation, are shared through open-access repositories.

Using oscillatory and aperiodic neural activity features for identifying idle state in SSVEP-based BCIs reduces false triggers

Objective.In existing studies, rhythmic (oscillatory) components were used as main features to identify brain states, such as control and idle states, while non-rhythmic (aperiodic) components were ignored. Recent studies have shown that aperiodic (1/f) activity is functionally related to cognitive processes. It is not clear if aperiodic activity can distinguish brain states in asynchronous brain-computer interfaces (BCIs) to reduce false triggers. In this paper, we propose an asynchronous method based on the fusion of oscillatory and aperiodic features for steady-state visual evoked potential-based BCIs.Approach.The proposed method first evaluates the oscillatory and aperiodic components of control and idle states using irregular-resampling auto-spectral analysis. Oscillatory features are then extracted using the spectral power of fundamental, second-harmonic, and third-harmonic frequencies of the oscillatory component, and aperiodic features are extracted using the slope and intercept of the first-order polynomial of the spectral fit of the aperiodic component under a log-logarithmic axis. The process produces two types of feature pools (oscillatory, aperiodic features). Next, feature selection (dimensionality reduction) is applied to the feature pools by Bonferroni correctedp-values from two-way analysis of variance. Last, these spatial-specific statistically significant features are used as input for classification to identify the idle state.Mainresults.On a 7-target dataset from 15 subjects, the mix of oscillatory and aperiodic features achieved an average accuracy of 88.39% compared to 83.53% when using oscillatory features alone (4.86% improvement). The results demonstrated that the proposed idle state recognition method achieved enhanced performance by incorporating aperiodic features.Significance.Our results demonstrated that (1) aperiodic features were effective in recognizing idle states and (2) fusing features of oscillatory and aperiodic components enhanced classification performance by 4.86% compared to oscillatory features alone.

Late Presentation of Hypoxic Injury of Brain in an Infant

Perinatal asphyxia is one of the leading causes of hypoxic-ischemic encephalopathy. In a developing country like Nepal, home delivery is the leading cause of perinatal asphyxia. Neuroimaging remains the diagnostic modality of choice. We present a case report of a 10-month-old infant who presented to the pediatric Out-patient-department with complaints of being unable to hold his head and unable to sit without support. Detailed history, physical examination, and developmental assessment along with lab investigation flash visual evoked potentials and Magnetic Resonance Imaging of the brain was performed. Hypoxic ischemic injury has common five types of imaging patterns in neonates. There are a few imaging differentials to be considered while evaluating the case for hypoxic injury. Clinicians and radiologists must go hand in hand to narrow down the possibilities which can fasten the treatment thereby decreasing morbidity and mortality. Keywords: Hypoxic ischemic encephalopathy, Infant, Magnetic Resonance Imaging.

An Accumulating Neural Signal Underlying Binocular Rivalry Dynamics

During binocular rivalry, conflicting images are presented one to each eye and perception alternates stochastically between them. Despite stable percepts between alternations, modeling suggests that neural signals representing the two images change gradually, and that the duration of stable percepts are determined by the time required for these signals to reach a threshold that triggers an alternation. However, direct physiological evidence for such signals has been lacking. Here, we identify a neural signal in the human visual cortex that shows these predicted properties. We measured steady-state visual evoked potentials (SSVEPs) in 84 human participants (62 females, 22 males) who were presented with orthogonal gratings, one to each eye, flickering at different frequencies. Participants indicated their percept while EEG data were collected. The time courses of the SSVEP amplitudes at the two frequencies were then compared across different percept durations, within participants. For all durations, the amplitude of signals corresponding to the suppressed stimulus increased and the amplitude corresponding to the dominant stimulus decreased throughout the percept. Critically, longer percepts were characterized by more gradual increases in the suppressed signal and more gradual decreases of the dominant signal. Changes in signals were similar and rapid at the end of all percepts, presumably reflecting perceptual transitions. These features of the SSVEP time courses are well predicted by a model in which perceptual transitions are produced by the accumulation of noisy signals. Identification of this signal underlying binocular rivalry should allow strong tests of neural models of rivalry, bistable perception, and neural suppression.SIGNIFICANCE STATEMENT During binocular rivalry, two conflicting images are presented to the two eyes and perception alternates between them, with switches occurring at seemingly random times. Rivalry is an important and longstanding model system in neuroscience, used for understanding neural suppression, intrinsic neural dynamics, and even the neural correlates of consciousness. All models of rivalry propose that it depends on gradually changing neural activity that on reaching some threshold triggers the perceptual switches. This manuscript reports the first physiological measurement of neural signals with that set of properties in human participants. The signals, measured with EEG in human observers, closely match the predictions of recent models of rivalry, and should pave the way for much future work.

Chronic Inflammatory Demyelinating Polyneuropathy and Evaluation of the Visual Evoked Potentials: A Review of the Literature

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune disorder characterised by the progressive demyelination of peripheral nerves, resulting in motor and sensory deficits. While much research has focused on clinical and electrophysiological aspects of CIDP, there is an emerging interest in exploring its impact on the visual system through visual evoked potentials (VEPs). This comprehensive review synthesises existing literature on VEP findings in CIDP patients, shedding light on their potential diagnostic and prognostic value. The review thoroughly examines studies spanning the last two decades, exploring VEP abnormalities in CIDP patients. Notably, VEP studies have consistently revealed prolonged latencies and reduced amplitudes in CIDP patients compared to healthy controls. These alterations in VEP parameters suggest that the demyelinating process extends beyond the peripheral nervous system to affect the central nervous system, particularly the optic nerve and its connections. The correlation between VEP abnormalities and clinical manifestations of CIDP, such as visual impairment and sensory deficits, underscores the clinical relevance of VEP assessment in CIDP management. Furthermore, this review addresses the potential utility of VEPs in aiding CIDP diagnosis and monitoring disease progression. VEP abnormalities may serve as valuable biomarkers for disease activity, helping clinicians make timely therapeutic decisions. Moreover, this review discusses the limitations and challenges associated with VEP assessment in CIDP, including variability in recording techniques and the need for standardised protocols. In conclusion, this review highlights the evolving role of VEPs as a non-invasive tool in CIDP evaluation. The consistent VEP abnormalities observed in CIDP patients suggest the involvement of the central nervous system in this demyelinating disorder. As our understanding of CIDP and its pathophysiology continues to evolve, further research in this area may lead to improved diagnostic accuracy and monitoring strategies, ultimately enhancing the clinical management of CIDP patients.

Event-related potential (ERP) evidence for visual processing differences in children and adults with cystinosis (CTNS gene mutations)

BACKGROUND

Cystinosis, a rare lysosomal storage disease caused by mutations in the CTNS gene, is characterized by cystine crystallization and accumulation within multiple tissues, including kidney and brain. Its impact on neural function appears mild relative to its effects on other organs during early disease, but since therapeutic advances have led to substantially increased life expectancy, neurological implications are of increasing interest, necessitating deeper understanding of the impact of cystinosis on neurocognitive function. Behavioral difficulties have been reported in cystinosis in the visual domain. Very little is known, however, about how the brains of people living with cystinosis process visual information. This is especially interesting given that cystine accumulation in the cornea and posterior ocular structures is a hallmark of cystinosis.

METHODS

Here, high-density scalp electrophysiology was recorded to visual stimuli (during a Go/No-Go task) to investigate visual processing in individuals with cystinosis, compared to age-matched controls. Analyses focused on early stages of cortical visual processing.

RESULTS

The groups differed in their initial cortical response, with individuals with cystinosis exhibiting a significantly larger visual evoked potential (VEP) in the 130-150 ms time window. The groups also differed in the associations between neural responses and verbal abilities: While controls with higher IQ scores presented larger neural responses, that relationship was not observed in cystinosis.

CONCLUSIONS

The enlarged VEP in cystinosis could be the result of cortical hyperexcitability and/or differences in attentional engagement and explain, at least partially, the visual and visual-spatial difficulties described in this population.

Simultaneous Dry and Gel-Based High-Density Electroencephalography Recordings

Evaluations of new dry, high-density EEG caps have only been performed so far with serial measurements and not with simultaneous (parallel) measurements. For a first comparison of gel-based and dry electrode performance in simultaneous high-density EEG measurements, we developed a new EEG cap comprising 64 gel-based and 64 dry electrodes and performed simultaneous measurements on ten volunteers. We analyzed electrode-skin impedances, resting state EEG, triggered eye blinks, and visual evoked potentials (VEPs). To overcome the issue of different electrode positions in the comparison of simultaneous measurements, we performed spatial frequency analysis of the simultaneously measured EEGs using spatial harmonic analysis (SPHARA). The impedances were 516 ± 429 kOhm (mean ± std) for the dry electrodes and 14 ± 8 kOhm for the gel-based electrodes. For the dry EEG electrodes, we obtained a channel reliability of 77%. We observed no differences between dry and gel-based recordings for the alpha peak frequency and the alpha power amplitude, as well as for the VEP peak amplitudes and latencies. For the VEP, the RMSD and the correlation coefficient between the gel-based and dry recordings were 1.7 ± 0.7 μV and 0.97 ± 0.03, respectively. We observed no differences in the cumulative power distributions of the spatial frequency components for the N75 and P100 VEP peaks. The differences for the N145 VEP peak were attributed to the different noise characteristics of gel-based and dry recordings. In conclusion, we provide evidence for the equivalence of simultaneous dry and gel-based high-density EEG measurements.

Rhythmic visual stimulation as a window into early brain development: A systematic review

Rhythmic visual stimulation (RVS), the periodic presentation of visual stimuli to elicit a rhythmic brain response, is increasingly applied to reveal insights into early neurocognitive development. Our systematic review identified 69 studies applying RVS in 0- to 6-year-olds. RVS has long been used to study the development of the visual system and applications have more recently been expanded to uncover higher cognitive functions in the developing brain, including overt and covert attention, face and object perception, numeral cognition, and predictive processing. These insights are owed to the unique benefits of RVS, such as the targeted frequency and stimulus-specific neural responses, as well as a remarkable signal-to-noise ratio. Yet, neural mechanisms underlying the RVS response are still poorly understood. We discuss critical challenges and avenues for future research, and the unique potentials the method holds. With this review, we provide a resource for researchers interested in the breadth of developmental RVS research and hope to inspire the future use of this cutting-edge method in developmental cognitive neuroscience.

Effects of pupil size as manipulated through ipRGC activation on visual processing

The size of the eyes' pupils determines how much light enters the eye and also how well this light is focused. Through this route, pupil size shapes the earliest stages of visual processing. Yet causal effects of pupil size on vision are poorly understood and rarely studied. Here we introduce a new way to manipulate pupil size, which relies on activation of intrinsically photosensitive retinal ganglion cells (ipRGCs) to induce sustained pupil constriction. We report the effects of both experimentally induced and spontaneous changes in pupil size on visual processing as measured through EEG. We compare these to the effects of stimulus intensity and covert visual attention, because previous studies have shown that these factors all have comparable effects on some common measures of early visual processing, such as detection performance and steady-state visual evoked potentials; yet it is still unclear whether these are superficial similarities, or rather whether they reflect similar underlying processes. Using a mix of neural-network decoding, ERP analyses, and time-frequency analyses, we find that induced pupil size, spontaneous pupil size, stimulus intensity, and covert visual attention all affect EEG responses, mainly over occipital and parietal electrodes, but-crucially-that they do so in qualitatively different ways. Induced and spontaneous pupil-size changes mainly modulate activity patterns (but not overall power or intertrial coherence) in the high-frequency beta range; this may reflect an effect of pupil size on oculomotor activity and/ or visual processing. In addition, spontaneous (but not induced) pupil size tends to correlate positively with intertrial coherence in the alpha band; this may reflect a non-causal relationship, mediated by arousal. Taken together, our findings suggest that pupil size has qualitatively different effects on visual processing from stimulus intensity and covert visual attention. This shows that pupil size as manipulated through ipRGC activation strongly affects visual processing, and provides concrete starting points for further study of this important yet understudied earliest stage of visual processing.

Poster Session I: Binocular contrast integration: Cortical and behavioral signals reflect different computations

PURPOSE

Although binocular contrast perception under dichoptic viewing conditions has been extensively characterized behaviorally, little is known about how the signals from each eye are combined in cortex. Here we compared simultaneously-collected behavioral and EEG measures of dichoptic contrast perception.

METHODS

Observers (n=16) dichoptically viewed a 2-cpd grating flickering at 7.5 Hz and rotating slowly (1º/s). The contrast of the grating shown to each eye modulated sinusoidally over time at independent rates (1/6 and 1/8 Hz). We recorded EEG activity while observers positioned a joystick lever to report perceived contrast as it changed over time.

ANALYSIS

A multiband filter was used to isolate the SSVEP responses to 7.5 Hz signals from electrode Oz (occipital pole), and the standard deviation of this signal provided a measure of neural response amplitude as a function of contrast.

RESULTS

A simple model was fit to VEP and behavioral responses, [(L^m+R^m)/2]^(1/m)], which essentially characterized whether responses were better fit by a mean (m≈1) or a max (m>1) model. VEP responses (m = 1.0; MSE = 0.013) were well fit by a mean model, suggesting the EEG signal may have been driven by the input layers of V1. In contrast, behavioral responses (m = 8.8; MSE = 0.011) were well fit by a model that was heavily shifted towards a max model, suggesting a significant non-linear transformation of the contrast signal between the input layers of V1 and conscious perception.

Invited Session I: 30 years of normalization in the visual system: Contrast normalization accounts for binocular interactions in healthy vision and amblyopia

We investigated the interaction between dichoptic stimuli using steady-state visual evoked potentials and frequency-domain analysis. The stimulus in each eye flickered with a unique temporal frequency, which allowed us to "frequency-tag" the responses to each eye's input (self terms) as well as the responses to the combination of inputs from the two eyes (intermodulation terms). We measured two forms of binocular interaction: one associated with the suppressive effect of one eye's stimulus on the other, and the other associated with a direct measure of interocular interaction between the two eyes' inputs. Fits of a contrast gain control model to the data demonstrated that a common gain control mechanism is consistent with both forms of binocular interaction. We then used the contrast normalization framework to investigate the disruptions to binocular interaction in amblyopia. Although anisometropic amblyopes showed a similar pattern of responses to normal-vision observers, strabismic amblyopes exhibited both reduced responses to the amblyopic eye stimulus in the presence of a mask in the other eye, as well as substantially reduced intermodulation responses indicating reduced interocular interactions in visual cortex. A contrast normalization model that simultaneously fit self- and IM-term responses showed that the excitatory contribution to binocular interaction is significantly reduced in strabismic amblyopia.

Inclusion of optic neuritis in dissemination in space improves the performance of McDonald 2017 criteria in Hispanic people with suspected multiple sclerosis

BACKGROUND

Hispanic people compared to White people with multiple sclerosis (MS) are two times more likely to present with optic neuritis (ON). ON in dissemination in space (DIS) after a single attack is not part of the current McDonald 2017 criteria.

OBJECTIVE

To evaluate if adding ON in DIS (ON-modified criteria) improves the performance of the McDonald 2017 criteria in the diagnosis of MS after a single attack of ON.

METHODS

Retrospective study of 102 patients of Hispanic background. Cases were reviewed between 2017 and 2021. Clinical ON was reported for 35 cases. ON in DIS was verified for 28 patients via MRI, optical coherence tomography, and/or visual evoked potential. We investigated the performance of the McDonald 2017 criteria and ON-modified criteria and calculated sensitivity, specificity, positive and negative predictive values, and accuracy.

RESULTS

The ON-modified criteria significantly improved the performance of the McDonald 2017 criteria (p = 0.003) and identified an additional nine patients. Both sensitivity and accuracy increased from 64% to 74% and 62% to 71%, respectively, while specificity remained unchanged (40% (95% confidence interval (CI): 0.10, 0.70)).

CONCLUSION

This study provides evidence that the inclusion of ON in DIS improved the overall performance of the McDonald 2017 criteria among Hispanic people.

Visual Processing During the Interictal Period Between Migraines: A Meta-Analysis

Migraine is a poorly understood neurological disorder and a leading cause of disability in young adults, particularly women. Migraines are characterized by recurring episodes of severe pulsating unilateral headache and usually visual symptoms. Currently there is some disagreement in the electrophysiological literature regarding the universality of all migraineurs exhibiting physiological visual impairments also during interictal periods (i.e., the symptom free period between migraines). Thus, this meta-analysis investigated the evidence for altered visual function as measured electrophysiologically via pattern-reversal visual evoked potential (VEP) amplitudes and habituation in adult migraineurs with or without visual aura and controls in the interictal period. Twenty-three studies were selected for random effects meta-analysis which demonstrated slightly diminished VEP amplitudes in the early fast conducting P100 component but not in N135, and substantially reduced habituation in the P100 and the N135 in migraineurs with and without visual aura symptoms compared to controls. No statistical differences were found between migraineurs with and without aura, possibly due to inadequate studies. Overall, insufficient published data and substantial heterogeneity between studies was observed for all latency components of pattern-reversal VEP, highlighting the need for further electrophysiological experimentation and more targeted temporal analysis of visual function, in episodic migraineurs.

Poster Session II: Attentional modulation of the achromatic and chromatic reversal VEP

Previous literature has consistently revealed attentional modulation of the Visual Evoked Potential (VEP) response to achromatic pattern reversal stimuli but little to no attentional modulation of the VEP response to chromatic pattern onsets. Magnetic Resonance Imaging (MRI) research, however, has reported modulation of the responses to both achromatic and chromatic pattern reversal stimuli. Numerous methodological differences including mode of presentation, stimulus contrast, and attentional demand, make comparison of these results difficult. In this study, we report the results of experiments using comparable perceptual contrasts, pattern reversals, and a coextensive and highly-demanding, multiple object tracking (MOT) task. Our findings support prior VEP results indicating that although achromatic VEPs are modulated by attention, chromatic VEPs are more robust to attentional modulation, even for highly demanding distractor tasks. We also found that when compared to a non-attentional condition, the attenuation of the VEP when attending to the MOT task was greater in magnitude than the enhancement of the VEP when attending to the VEP stimulus. This supports prior conclusions, that while avoiding active distraction is likely important, insuring an "attentive state" is not always necessary when recording VEPs. Further experiments are underway to investigate why attentional modulation of chromatic signals in early visual cortex are observed in MRI but not VEP recordings.

Poster Session I: Comparison of tripolar and traditional electrodes: Waveform morphology

The waveforms of visual evoked potentials (VEPs) recorded by tripolar electrodes are different from those recorded by traditional electrode arrays. Traditional arrays record potentials using both an active and a reference electrode. The location of this reference will affect the waveform amplitude and shape. Conversely, tripolar electrodes measure the surface Laplacian across three concentric rings housed within a single electrode surface. These differences may influence the morphology of evoked responses. We compared these two modalities by recording pattern-reversal VEPs to two sizes of checkerboard. Visual inspection of the VEPs suggest that the signals recorded by the tripolar system have attenuated higher frequencies and increased latency of the major waveform components. Root-mean-square comparison of the two signal types confirm attenuation at the higher frequencies in the tripolar recording. Additionally, there is a cumulative delay present within both the large and small check conditions, such that each subsequent component recorded by the tripolar electrodes is shifted increasingly later in time compared to the same components recoded by the traditional electrodes. Such latency shifts may be indicative of a difference in the physiological sources that are measured by the two EEG systems.

The diagnostic accuracy of photopic negative responses evoked by broadband and chromatic stimuli in a clinically heterogeneous population

PURPOSE

To compare the diagnostic accuracy of the photopic negative response (PhNR) elicited by red-blue (RB) and white-white (WW) stimuli, for detection of retinal ganglion cell (RGC) dysfunction in a heterogeneous clinical cohort.

METHODS

Adults referred for electrophysiological investigations were recruited consecutively for this single-centre, prospective, paired diagnostic accuracy study. PhNRs were recorded to red flashes (1.5 cd·s·m-2) on a blue background (10 cd·m-2) and to white flashes on a white background (the latter being the ISCEV standard LA 3 stimulus). PhNR results were compared with a reference test battery assessing RGC/optic nerve structure and function including optical coherence tomography (OCT) retinal nerve fibre layer thickness and mean RGC volume measurements, fundus photography, pattern electroretinography and visual evoked potentials. Primary outcome measures were differences in sensitivity and specificity of the two PhNR methods.

RESULTS

Two hundred and forty-three participants were initially enrolled, with 200 (median age 54; range 18-95; female 65%) meeting inclusion criteria. Sensitivity was 53% (95% confidence intervals [CI] 39% to 68%) and 62% (95% CI 48% to 76%), for WW and RB PhNRs, respectively. Specificity was 80% (95% CI 74% to 86%) and 78% (95% CI 72% to 85%), respectively. There was a statistically significant difference between sensitivities (p = 0.046) but not specificities (p = 0.08) of the two methods. Receiver operator characteristic (ROC) area under the curve (AUC) values were 0.73 for WW and 0.74 for RB PhNRs.

CONCLUSION

PhNRs to red flashes on a blue background may be more sensitive than white-on-white stimuli, but there is no significant difference between specificities. This study highlights the value and potential convenience of using white-on-white stimuli, already used widely for routine ERG assessment.

Poster Session II: Alternating orientation of the chromatic pattern VEP improves signal even in the absence of contrast adaptation

The visual evoked potential (VEP) to chromatic pattern reversal is greatly reduced compared to VEPs to pattern onsets. Chromatic pattern onsets produce large and stereotypical waveforms that reliably differ from standard achromatic pattern reversal VEP waveforms used in clinical applications. Rapid contrast adaptation for sustained chromatic but not transient achromatic mechanisms has been suggested as one explanation for these observations. Here we first examined changes in the magnitude of response during recordings to reversing and onset grating patterns that preferentially modulate the L-M, S, and achromatic pathways. Given the evidence for both chromatic and achromatic orientation-selective mechanisms, we then hypothesized that contrast adaptation may be reduced by changing the orientation of the pattern for each reversal or onset. VEPs were recorded for 60 s with 2 onsets/reversals per second using both fixed and alternating (horizontal/vertical) orientations. FFT amplitudes for 6-second windows did not reveal evidence of adaptation for chromatic or achromatic onsets or reversal patterns over the 60-second recording period. Despite this, alternating pattern orientation increased the signal for all chromatic but not achromatic conditions. Although alternating the orientation for reversals increased the signal, the onset responses were still larger, even for non-alternating orientations. Mechanisms other than contrast adaptation must be invoked to explain the results.

Rapid withdrawal from a threatening animal is movement-specific and mediated by reflex-like neural processing

Responses to potentially dangerous stimuli are among the most basic animal behaviors. While research has shown that threats automatically capture the attention of human participants, research has failed to demonstrate automatic behavioral responses to threats in humans. Using a novel naturalistic paradigm, we show that two species of animals humans often report fearing trigger rapid withdrawal responses: participants withdrew their arm from photos of snakes and spiders faster, and with higher acceleration when compared to bird and butterfly stimuli. The behavior was specific to withdrawal as approach movements or button-press/release tasks failed to detect a similar difference. Moreover, between-participant differences in how aversive they found the stimuli predicted the participant's withdrawal speed, indicating that the paradigm was also sensitive to trait-level differences between individuals. Using electroencephalography (EEG), we show that the fast withdrawal was mediated by two attentional processes. First, fast withdrawal responses were associated with early amplification of sensory signals (40-110 ms after stimulus). Second, a later correlate of feature-based attention (early posterior negativity, EPN, 200-240 ms after stimulus) revealed the opposite pattern: Stronger EPN was associated with slower behavioral responses, suggesting that the deployment of attention towards the threatening stimulus features, or failure to "disengage" attention from the stimulus, was detrimental for withdrawal speed. Altogether, the results suggest that rapid behavioral withdrawal from a threatening animal is mediated by reflex-like attentional processing, and later, conscious attention to stimulus features may hinder escaping the treat.