Intensity dependence of auditory evoked potentials as an indicator of central serotonergic neurotransmission: a new hypothesis

Role of the serotonin system in ADHD: treatment implications

A limited number of studies have considered whether the activity of serotonin (5-hydroxytryptamine [5-HT]) contributes to the problems experienced by youngsters with attention-deficit/hyperactivity disorder (ADHD). The aim of this article is to review this work and propose interpretations. Peripheral measures of 5-HT and its metabolite do not point to a widespread association with the diagnosis. However, separate consideration of the major domains of dysfunction (motor activity, inattention and impulsivity) support a more differentiated assessment. The marked innervation of motor regions of the brain by 5-HT projections and the clear involvement of 5-HT systems in the control of locomotion in animals suggests a likely node for dysfunction in ADHD. The few relevant studies do not show evidence of this, but more attention should be accorded to the issue. The situation is different for attention-related processes; here, there are deficiencies in perceptual sensitivity and the appropriate designation of saliency to stimulation. These are attributable, in part, to altered 5-HT activity. Marked and opposite changes of 5-HT responsivity are associated with behavioral and cognitive impulsivity. There is also a growing series of studies demonstrating preferential transmission of various genetic markers for 5-HT receptors that are expressed in ADHD. Currently, the heterogeneity of methods in this young discipline restricts the possibilities of definition of these markers and the types of ADHD in which they are expressed.

Reliability of intensity dependence of auditory-evoked potentials

OBJECTIVE

Intensity dependence of auditory-evoked potentials (IAEP) is a suggested indicator of serotonergic neurotransmission. In contrast to its clinical renaissance, the reliability of IAEP has only been examined in a few studies, most of which are limited due to the possibly confounding effects of age and gender. Therefore, the present study examines different reliabilities of various IAEP parameterizations while controlling for age and gender.

METHODS

Auditory-evoked potentials were recorded from 166 students. Of these 37 women and 25 men were retested after three weeks.

RESULTS

Test-retest and odd-even reliabilities were remarkable at Cz in both females (r=.88/.86) and males (r=.82/.79). Reliabilities were higher in women, higher with linear than median slopes and best at Cz. Bisection of sweep number, split-half reliability, the second run, and lower intensities revealed lower reliabilities.

CONCLUSIONS

Reliabilities at Cz can reach the same level as previously reported by dipole-source-localization methods, if sufficient sweep number and linear slopes are applied.

SIGNIFICANCE

Based on theoretical arguments and current data, the continued use of the easy and rapidly done single-channel IAEP is suggested, although ideally in combination with multi-channel source-localization methods. This would be seminal for a drafted program standardizing IAEP to further improve its clinical utility.

High-dose glycine inhibits the loudness dependence of the auditory evoked potential (LDAEP) in healthy humans

RATIONALE

The loudness dependence of the auditory evoked Potential (LDAEP) has been suggested to be a putative marker of central serotonin function, with reported abnormalities in clinical disorders presumed to reflect serotonin dysfunction. Despite considerable research, very little is known about the LDAEP's sensitivity to other neurotransmitter systems.

OBJECTIVES

Given the role of N-methyl-D-aspartate (NMDA) receptors in modulating pyramidal cell activity in cortico-cortico and thalamo-cortical loops, we examined the effect of targeting the glycine modulatory site of the NMDA receptor with high-dose glycine on the LDAEP in healthy subjects.

MATERIALS AND METHODS

The study was a double-blind, placebo-controlled repeated-measures design in which 14 healthy participants were tested under two acute treatment conditions, placebo and oral glycine (0.8 g/kg). Changes in the amplitude of the N1/P2 at varying intensities (60, 70, 80, 90, 100 dB) were examined at C(Z).

RESULTS

Compared to placebo, high-dose glycine induced a weaker LDAEP (a pronounced decrease in the slope of the N1/P2 with increasing tone loudness; p < 0.02).

CONCLUSION

While the exact mechanism responsible for the effects of glycine on the LDAEP are not known, the findings suggest an inhibitory effect in the cortex, possibly via activation of NMDA receptors on GABA interneurons or inhibitory glycine receptors. The findings add to the growing literature exhibiting modulation of the LDAEP by multiple neurochemical systems in addition to the serotonergic system.

Shortened cortical silent period in facial muscles of patients with migraine

Despite intensive neurophysiological research, evidence is lacking to show whether abnormal cortical excitability in migraine reflects a primary cortical disturbance or reduced control by thalamo-cortical loops. One way to contribute to the scientific discussion on this topic is to deliver transcranial magnetic stimulation (TMS) and test the cortical silent period (SP) recorded in facial muscles. The facial-muscle SP is a purely cortical phenomenon that reflects the excitability of inhibitory interneurons, and can disclose changes in cortical inhibition even in patients without documented primary lesions of the motor cortices. To test the interictal excitability of cortical motor inhibitory interneurons in migraine, we investigated the facial-SP in patients with migraine with and without aura between attacks. In 26 patients and 15 age-matched controls, high-intensity magnetic stimuli were delivered with a round coil centered at the vertex during a maximal muscle contraction. Electromyographic responses were recorded from surface electrodes placed over the subjects' perioral muscles. Facial SPs were significantly shorter in patients than in controls. The SP shortening provides neurophysiological evidence showing hypoexcitability of cortical inhibitory neurons in patients with migraine between attacks. Despite a possible primary deficit of cortical inhibitory interneurons in migraine, we favor the interpretation of a secondary disfacilitation by hypoactive thalamo-cortical loops. Based on this interpretation, the interictal reduced cortical inhibition documented by the shortened SP could be considered the motor counterpart of the reduced preactivation excitability level in the sensory cortices purported to explain why cortical evoked responses habituate poorly in patients with migraine.

Loudness dependence of auditory evoked potentials is not associated with polymorphisms or haplotypes in the serotonin transporter gene in a community-based sample of German healthy volunteers

Three previous studies found an association between the loudness dependence (LD) of the auditory evoked potential N1/P2 component, an indicator of central serotonergic neurotransmission, and a functional variation in the promoter region of the 5-hydroxytryptamine transporter (5-HTT) gene (rs4795541 Ins/Del). The results of these three studies were contradictory and possibly biased by the recruitment methods used. We therefore aimed to re-investigate this association (rs4795541) using a community-based sample randomly selected from the general population and to extend the analysis to four further putative variations in this gene (rs3783594, rs3794808, rs140701, rs6354). In this carefully recruited sample, genotypes or haplotypes under investigation were not associated with LD. We speculate that the LD endophenotype depends more on genetic variations in components of the serotonergic system controlling release than on those controlling the uptake mechanism.

Brain dynamics in the active vs. passive auditory oddball task: Exploration of narrow-band EEG phase effects

OBJECTIVE

We aimed to examine relationships between the phase of narrow-band electroencephalographic (EEG) activity at stimulus onset and the resultant event-related potentials (ERPs) in active vs. passive auditory oddball tasks, using a novel conceptualisation of orthogonal phase effects.

METHODS

This study focused on the operation of three recently-reported phase-influenced mechanisms, and ERP responses to the standard stimuli were analysed. Prestimulus narrow-band EEG activity (in 1 Hz bands from 1 to 13 Hz) at Cz was assessed for each trial using digital filtering. For each frequency, the cycle at stimulus onset was used to sort trials into four phases, for which ERPs were derived from both the filtered and unfiltered EEG activity at Fz, Cz and Pz.

RESULTS

Preferred brain states at various frequencies were indicated by approximately 20% differential occurrence within the orthogonal phase dimensions explored.

CONCLUSIONS

The preferred states were associated with more efficient processing of the stimulus, as reflected in differences in latency and/or amplitude of various ERP components, and provided evidence for the operation of the three separate phase-influenced mechanisms.

SIGNIFICANCE

Both the occurrence of preferred brain states, and the mechanisms linking them to ERP outcomes focused on here, appeared relatively invariant across tasks, suggesting that they largely reflect reflexive brain processes.

An electrophysiological endophenotype of hypomanic and hyperthymic personality

BACKGROUND

Hyperthymic Temperament (HYT) and a closely related trait, Hypomanic Personality (HYP), have both been related to bipolar affective disorder (BAD). Intensity dependence of auditory evoked potentials (IAEP) is a suggested inverse indicator of serotonergic neurotransmission and has been found to be elevated in BAD. Therefore the present study explored for the first time whether subclinical variance of HYT/HYP is also associated with IAEP in a healthy sample. As several traits from biological personality research are correlated with HYT/HYP and also with BAD, the specificity of results against these traits was further analyzed by calculating multiple regression analyses.

METHODS

Evoked potentials were recorded from a sample (N=87) homogenous for confounding variables influencing IAEP. For this reason, only 19 to 27-year-old non-smoker psychiatrically healthy male students were included.

RESULTS

Significant correlations were found between IAEP and both HYP and HYT. Including Sensation or Novelty Seeking and Extraversion in Regression Analyses did not weaken the associations of HYP with IAEP much, but did affect those of HYT. However, these competing biological personality traits were hardly able to predict IAEP themselves. Impulsivity, though, was able to reduce the predictive power of HYP and HYT and to explain unique IAEP-variance. This was even more the case for Behavioral-Activation-System-Sensitivity (BAS) subscale Fun Seeking clearly dominating all regression analyses.

LIMITATIONS

Homogeneity of sample.

CONCLUSIONS

The impact of BAS is in agreement with the assumption that heightened BAS-sensitivity is an underlying biological cause for HYP/HYT and for BAD. Future studies on BAD should include BAS and Impulsivity besides HYP/HYT to further explore uniqueness of the latter and to develop questionnaires based on those items of a hyperthymic-hypomanic-impulsive-funseeking item pool, which possess the most external validity.

Individual Differences in Auditory, Pain, and Motor Stimulation

Abstract. Augmenting/reducing is a personality dimension related to the processing of sensory stimuli. Augmenters are assumed to augment the impact of stimuli leading to stimulation-avoidant behavior and lower pain tolerance. Reducers are assumed to attenuate sensory stimuli leading to stimulation-seeking behavior and higher pain tolerance. Augmenting/reducing can be assessed by the method of evoked potentials or - as in this study - by questionnaire. Two studies were conducted to examine associations between augmenting/reducing as assessed by questionnaire and stimulus intensity modulation. Study 1 found reducers (n = 24, 12 females) to more frequently consume psychoactive substances and to turn music on louder than augmenters (n = 25, 12 females) even after controlling for individual hearing ability. In Study 2, reducers (n = 19, 10 females) were more pain tolerant than augmenters (n = 18, 9 females) and this difference increased with increasing stimulation time. Moreover, reducers were faster than augmenters in a rapid tapping task but there was no difference in a lower-stimulation tracking task. The results suggest that differences between augmenters and reducers are most reliable when the stimulation potential is high. The clinical relevance of this construct is discussed.

Visual emotional context modulates brain potentials elicited by unattended tones

To examine whether brain electrical responses to environmental stimuli were influenced by emotional contexts, event-related potentials (ERPs) elicited by nonstartle probe tones were recorded from 13 student volunteers while they were viewing emotionally positive, neutral, and negative slides of the International Affective Picture System. The auditory stimuli consisted of high-deviant (2000 Hz, p=.08), low-deviant (1050 Hz, p=.08), and standard (1000 Hz, p=.84) tones with a mean onset-to-onset interval of 600 ms. Participants were told to ignore the tones. High-deviant tones elicited a larger N1 (peaking around 100 ms) when participants were viewing negative slides than when viewing positive slides. The amplitude of the P2 elicited by standard tones (peaking around 170 ms) was smaller when participants were viewing positive slides than when viewing negative and neutral slides. The amplitude of the mismatch negativity (150-200 ms) tended to reduce during positive slide presentation, but this difference appeared to be due to reduction of the P2 elicited by standard tones. These findings suggest that visually induced emotional states have a sequential effect on auditory information processing, in that the influence of negative emotion appears at an earlier stage than that of positive emotion.

Prediction of clinical response to antidepressants in patients with depression: neurophysiology in clinical practice

Brain monoaminergic neurotransmission is involved in the pathophysiology of various psychiatric disorders including depression. Reliable indicators of central monoaminergic activity might be helpful to specifically identify and differentiate dysfunctions in individual patients in order to selectively adjust medication and predict clinical response. In patients with depression, predictors of treatment response to serotonergic versus non-serotonergic (e.g., noradrenergic) antidepressants could be of considerable clinical relevance by avoiding unfavorable factors such as a prolonged duration of the disorder, risk of suicidality and therapy-resistance. Consequently, these tools might help to decrease direct and indirect costs of treatment. The loudness dependence of the N1/P2 component of auditory evoked potentials (LD) has been proposed as a noninvasive neurophysiological indicator of central serotonergic function. This review focuses on recent studies providing evidence for the validity of LD as an indirect serotonergic marker and highlights data on the clinical application in terms of prediction of treatment response in patients with depression.

Challenge tests of monoaminergic systems: neurophysiological aspects

Monoaminergic challenge tests allow investigating central nervous changes in humans under acute depletion of specific neurotransmitters (5-HT, DA, NE). Along with studies using alpha-methyl-para-tyrosine test (AMPT) and phenylalanine/tyrosine depletion test (APTD), the tryptophan depletion test (ATDT) represents the currently most established human challenge tool for the assessment of brain serotonin functioning. Neurophysiological studies in healthy and clinical samples may contribute to the search for a non-invasive and reliable biological marker of monoaminergic vulnerability or dysfunction. In the design of these studies, various biochemical and methodological aspects have to be taken into account. This article focuses on electrophysiological methodology and results of monoamine depletion studies (i.e., electroencephalography, magnetoencephalography, polysomnography, auditory evoked potentials and startle response).

Rostral anterior cingulate cortex activity in the theta band predicts response to antidepressive medication

During the last 10 years the knowledge about rostral anterior cingulate cortex (ACC) activity in major depression has substantially increased. Several groups have independently described a relationship between resting activity in this area and response to antidepressant treatment. We have recently confirmed a relationship between resting activity of rostral ACC activity and response in a group of 20 patients with major depression using resting theta activity. In this earlier study regions of interest (ROI) were defined in order to establish regional specificity. Differences between responders and nonresponders were only found in the ACC-ROI, but not in the posterior cingulate region. We have now reanalyzed our data using a whole brain voxelwise approach, in order not to miss any other relevant functional differences. In addition to major differences between responders and nonresponders in the rostral ACC, we have identified a nearby region in the midline orbito-frontal region.

Habituation of sympathetic skin response in migraine and tension type headache

This study aimed to investigate the changes of habituations in the autonomic function of patients suffering from migraine or tension type headache through sympathetic skin responses. Patients with migraine without aura (n=26), with episodic tension type headache without migraine (n=28) and 30 healthy controls were studied. During continuous stimulation, four blocks of 20 responses were sequentially recorded. Mean amplitude changes in the second, third and fourth blocks are expressed as the percentages of the first block. In both headache groups, there was a lack of habituation compared to the control group.

Facial expressions and personality: a kinematical investigation during an emotion induction experiment

BACKGROUND/AIMS

In order to elucidate the relationship between personality traits and expression of positive emotions in healthy volunteers, standardized personality inventories and kinematical analysis of facial expressions can be helpful and were applied in the present study.

METHODS

Markers fixed at distinct points of the face emitting ultrasonic signals at high frequency gave a direct measure of facial movements with high spatial-temporal resolution. Forty-six healthy participants (mean age: 40.7 years; 20 males, 26 females) watching a witty movie ("Mr. Bean") were investigated.

RESULTS

Speed of "laughing" was associated with higher scores on Zuckerman's Sensation Seeking Scale and NEO-FFI (Openness to Experience).

CONCLUSION

Kinematical analysis of facial expressions seems to reflect sensation seeking and related personality styles. Higher speed of facial movements in sensation seekers suggests lowered serotonergic function.

The promise of the quantitative electroencephalogram as a predictor of antidepressant treatment outcomes in major depressive disorder

Recent studies have shown overall accuracy rates of 72% and 88% using baseline and/or 1-week change in QEEG biomarkers to predict clinical outcome to treatment with various antidepressant medications. In some cases, findings have been replicated across academic institutions and have been studied in the context of randomized, placebo-controlled trials. Recent EEG findings are corroborated by studies that use techniques with greater spatial resolution (eg, PET, MEG) in localizing brain regions pertinent to clinical response. As such, EEG measurements increasingly are validated by other physiologic measurements that have the ability to assess deeper brain structures. Continued progress along these lines may lead to the realized promise of QEEG biomarkers as predictors of antidepressant treatment outcome in routine clinical practice. In the larger context, use of QEEG technology to predict antidepressant response in major depression may mean that more patients will achieve response and remission with less of the trial-and-error approach that currently accompanies antidepressant treatment.

Prediction of treatment response in major depression: integration of concepts

BACKGROUND

Two promising approaches have been introduced for the prediction of treatment response in major depression: one concept is based on the activity in the rostral anterior cingulate cortex (rACC). Subjects with higher metabolic rates respond better to sleep deprivation or antidepressive medication. Another approach is the investigation of the loudness dependence of the auditory evoked potential (LDAEP). Here, a high LDAEP is supposed to reflect low central serotonergic activity. We present the first study comparing both approaches in the same group of patients.

METHODS

Patients with major depression (n=20) were investigated using both resting EEG and LDAEP before treatment with either citalopram or reboxetine.

RESULTS

We found significant differences between responders and non-responders in the rACC in the theta-frequency range (6.5-8 Hz, p<0.05). In the subgroup of patients, treated with citalopram we found higher LDAEP-values in responders versus non-responders (p<0.05) and a significant correlation between pre-treatment-LDAEP and improvement in the Hamilton score after treatment (r=0.71, p<0.05).

CONCLUSIONS

In combining both methods a prediction whether a patient with major depression might be at risk for non-response to a standard therapy as well as a suggestion for a pharmacological approach of choice seems to be possible.

A functional disturbance in the auditory cortex related to a low serotonergic neurotransmission in women with type 2 diabetes

BACKGROUND/AIMS

To determine if the slope of the amplitude/stimulus intensity function (ASF) of the N1/P2 component of the auditory evoked potential was increased in women with type 2 diabetes reflecting a low brain serotonergic activity in the auditory cortex.

METHODS

In a comparative study in women with type 2 diabetes and controls, we measured free, bound and total plasma L-tryptophan (L-Trp), neutral amino acids (NAA) and free fatty acids (FFA) and recorded the N1/P2 component of the auditory evoked potential.

RESULTS

The diabetic patients were overweight and FFA and NAA in plasma were significantly elevated. The free, bound to albumin and total L-Trp were decreased. The values of free/total L-Trp and free/NAA ratios were significantly lower. The latencies of N1 and P2 at all intensities and the slope ASF of the N1/P2 component significantly increased.

CONCLUSION

The decrease of the free fraction of L-Trp in plasma and the increase of the ASF slope of the N1/P2 component reflect a functional relationship between the brain serotonergic activity and the N1/P2 changes in the auditory cortex, suggesting a cortical impaired activity associated with anomalies of brain serotonergic neurotransmission in women with type 2 diabetes. We proposed the ASF slope together with measurement of the plasma FFT as noninvasive clinical indicators of serotonergic neurotransmission in the brain in these as well as in other types of patients.

Event-related potentials in psychiatry

Electrophysiological assessments of psychiatric disorders have produced a number of promising, highly replicable findings and thus carry the potential of becoming clinically utilizable in the diagnostic or prognostic evaluation of psychopathological conditions. The procedures involved are rather complex technically and the interpretation of the findings require a combined neurophysiological and clinical expertise. On the other hand, electrophysiological techniques are in general non-invasive and relatively inexpensive, and neurophysiology laboratories are widely available in the clinical setting. Among these techniques, event-related potentials (ERPs) are of major interest in psychiatry, particularly since these tools can indicate cortical neuronal dysfunctions, which play a major role in various neuropsychiatric disorders.

Inter-modal attention: ERPs to auditory targets in an inter-modal oddball task

This study investigated ERPs to auditory targets amidst visual standard stimuli in an inter-modal oddball task. Twenty subjects completed three tasks in random order: 1) an inter-modal oddball, 2) an auditory oddball, 3) and a single tone task. Target stimuli were identical in each task. In the inter-modal condition the auditory N100, N130 and P200 components were not substantially affected by the presence of the visual standard stimulus. In contrast, the later components P250, P300 and P350 differed between conditions. It is suggested that the processing of auditory targets in the inter-modal oddball occurs in two-stages--with initial auditory processing occurring independently of the visual standards, followed by activity indicative of an integration of stimulus characteristics. Furthermore, these data indicate that the context in which stimuli are presented affects the ERP. These results are discussed in light of previous findings in inter-modal research.

Is the loudness dependence of auditory evoked potentials modulated by the selective serotonin reuptake inhibitor citalopram in healthy subjects?

The loudness dependence of auditory evoked potentials (LDAEP) has been discussed as a non-invasive in vivo marker of central serotonergic function. Evidence for this has been found in animal studies, but studies in humans provide less consistent results. In this study, the relationship between LDAEP and directly modulated central serotonergic activity in healthy subjects was investigated. In a single-blind cross-over design, the LDAEP of female participants (age: 24.0 +/- 2.3 years) was measured under two conditions: (1) infusion of 20 mg citalopram diluted in 250 ml 0.9% saline and (2) infusion of 250 ml 0.9% saline as placebo. LDAEP was measured at five different time points before, during and up to 60 min after drug/placebo administration and dipole source analysis was performed. The increase of the central serotonin activity in response to citalopram was not accompanied by a significant change of the LDAEP compared to the placebo condition. The result underlines that the acceptance of LDAEP as a marker of central serotonergic function still needs further discussion.

Intensity dependence of auditory-evoked cortical potentials in fibromyalgia patients: a test of the generalized hypervigilance hypothesis

On the basis of recent evidence concerning the amplification of incoming stimulation in fibromyalgia (FM) patients, it has been proposed that a generalized hypervigilance of painful and nonpainful sensations may be at the root of this disorder. So far, research into this issue has been inconclusive, possibly owing to the lack of agreement as to the operational definition of "generalized hypervigilance" and to the lack of robust objective measures characterizing the sensory style of FM patients. In this study, we recorded auditory-evoked potentials (AEPs) elicited by tones of increasing intensity (60, 70, 80, 90, and 105 dB) in 27 female FM patients and 25 healthy controls. Fibromyalgia patients presented shorter N1 and P2 latencies and a stronger intensity dependence of their AEPs. Both results suggest that FM patients may be hypervigilant to sensory stimuli, especially when very loud tones are used. The most noteworthy difference between patients and control subjects is at the highest stimulus intensity, for which far more patients maintained increased N1-P2 amplitudes in relation to the 90-dB tones. The larger AEP amplitudes to the 105-dB tones suggest that defects in an inhibitory system protecting against overstimulation may be a crucial factor in the pathophysiology of FM. Because a stronger loudness dependence of AEPs has been related to weak serotonergic transmission, it is hypothesized that for many FM patients deficient inhibition of the response to noxious and intense auditory stimuli may be due to a serotonergic deficit.

PERSPECTIVE

The study of auditory-evoked potentials in response to tones of increasing intensity in FM patients may help to clarify the pathophysiology of this disorder, especially regarding the role of inhibition deficits involving serotonergic dysfunction, and may be a useful tool to guide the pharmacologic treatment of FM patients.

Further evidence for an association of 5-HTTLPR with intensity dependence of auditory-evoked potentials

Intensity dependence of auditory-evoked potentials (IAEP) has been suggested as an indicator of central serotonergic neurotransmission. Two recent studies investigated a possible association of IAEP with a functional polymorphism in the transcriptional control region of the serotonin transporter gene (5-HTTLPR) that has a short (s) and a long (l) variant. Although both studies found an association between 5-HTTLPR and IAEP, Gallinat et al found l/l individuals to exhibit lower IAEP, whereas Strobel et al observed stronger IAEP in l/l individuals. These conflicting results require further evaluation and more attention needs to be paid to variables that are known to be confounded with the effects of IAEP and 5-HTTLPR. Using a paradigm comparable to Strobel et al, the present study analyzes the effect of 5-HTTLPR on IAEP in a healthy male student sample (N=91; age=23 years, SD=1.9) that was homogenous for most significant confounding variables. A stronger IAEP was shown in l/l individuals, irrespective of the method of IAEP parametrization. This also held at retest after 3 weeks in a subsample (N=18). Given the successful replication of Strobel et al, several possible reasons for conflicting results with regard to Gallinat et al are discussed. It is argued that the most significant difference between Gallinat et al on the one hand, and Strobel et al and this study on the other, is that different intensity ranges are used which impact IAEP. Therefore, this study encourages further analysis of dose dependence of results.

Dopamine receptor stimulation does not modulate the loudness dependence of the auditory evoked potential in humans

RATIONALE

The Loudness Dependence of the Auditory Evoked Potential (LDAEP) has been suggested as a reliable measure of central serotonin function in humans; however, its specificity for the serotonin system remains a topic of debate, with possible modulation of this purported serotonin marker by other neurotransmitters, including dopamine.

OBJECTIVES

We examined the effect of dopaminergic modulation on the LDAEP using the D1/D2/D3 dopamine receptor agonist pergolide and the D2/D3 agonist bromocriptine.

METHODS

The study was a double-blind, placebo-controlled repeated-measures design in which healthy participants were tested under three acute treatment conditions: placebo, bromocriptine (2.5 mg), and pergolide (0.1 mg). Changes in the amplitude of the N1/P2 at intensities (60, 70, 80, 90, and 100 dB) were examined at C Z.

RESULTS

Acute stimulation of D1/D2/D3 receptors with pergolide and D2/D3 receptors with bromocriptine in comparison with placebo had no effect on the LDAEP.

CONCLUSION

These findings indicate that acute stimulation of dopamine D1, D2, and D3 receptors does not modulate the LDAEP in humans. Although the findings suggest that the LDAEP may not be modulated by acute changes in dopamine neurotransmission, further studies are needed to fully characterize its dopaminergic sensitivity.

Not tonight, I have a headache?

OBJECTIVE

The present study examined the relationship between the diagnosis of migraine and self-reported sexual desire.

BACKGROUND

There is evidence for a complex relationship between sexual activity and headache, particularly migraine. The current headache diagnostic criteria even distinguish between several types of primary headaches associated with sexual activity.

METHODS

Members of the community or students at the Illinois Institute of Technology (N = 68) were administered the Brief Headache Diagnostic Interview and the Sexual Desire Inventory (SDI). Based on the revised diagnostic criteria established by the International Headache Society (ICHD-II), participants were placed in 1 of the 2 headache diagnostic groups: migraine (n = 23) or tension-type (n = 36).

RESULTS

Migraine subjects reported higher SDI scores, and rated their own perceived level of desire higher than those suffering from tension-type headache. The presence of the symptom "headache aggravated by routine physical activity" significantly predicted an elevated SDI score.

CONCLUSIONS

Migraine headaches and sexual desire both appear to be at least partially modulated by serotonin (5-HT). The metabolism of 5-HT has been shown to covary with the onset of a migraine attack, and migraineurs appear to have chronically low systemic 5-HT. As sexual desire also has been linked to serotonin levels, the results are consistent with the hypothesis that migraine and sexual desire both may be modulated by similar serotonergic phenomena.

Serotonin receptors modulate trigeminovascular responses in ventroposteromedial nucleus of thalamus: a migraine target?

Triptans, serotonin 5-HT(1B/1D), receptor agonists, which are so effective in acute migraine, are considered to act directly on the trigeminovascular system. Using an in vivo model of trigeminovascular nociception, we report a potentially novel action for the triptans within the somatosensory thalamus. Both microiontophoretically applied and intravenous naratriptans potently and reversibly modulate nociceptive neurotransmission by trigeminovascular thalamic neurons in the ventroposteromedial nucleus (VPM) driven by stimulation of the superior sagittal sinus. Naratriptan also suppresses l-glutamate activated trigeminovascular VPM neurons. Co-ejection of naratriptan with the 5-HT(1B/1D) receptor antagonist GR127935 antagonized this effect. (S)-WAY 100135 the 5-HT(1A) receptor antagonist also partially inhibited the effect of naratriptan in the VPM when co-ejected with it. Taken together, the new data suggest a potential effect of triptans in the VPM nucleus of the thalamus acting through 5-HT(1A/1B/1D) mechanisms, and offer an entirely new direction for the development of and understanding of the effects of anti-migraine medicines.

Dynamics of narrow-band EEG phase effects in the passive auditory oddball task

Evidence suggests that the component frequencies of the electroencephalogram (EEG) are dynamically adjusted to provide particular brain states at stimulus occurrence, and that these facilitate cortical processing of the stimulus. We examined relationships between stimulus intensity, the phase of narrow-band EEG activity at stimulus onset, and the resultant event-related potentials (ERPs) in a passive auditory oddball task, using a novel conceptualization of orthogonal phase effects (cortical negativity vs. positivity, negative driving vs. positive driving, waxing vs. waning). EEG responses to the standard stimuli (50 vs. 80 dB, varied between subjects) were analysed. Prestimulus narrow-band EEG activity (in 1-Hz bands from 1 to 13 Hz) at Cz was assessed for each trial by digital filtering. For each frequency, the cycle at stimulus onset was used to sort trials into four phases, for which ERPs were derived from both the filtered and unfiltered EEG activity at Fz, Cz and Pz. Preferred brain states at various frequencies were indicated by 16-34% differential occurrence within the orthogonal phase dimensions explored. The preferred states were associated with smaller N1, N2 and N3, larger P2 and P3, shorter N1, P2, N2 and P3 latencies, and some intensity effects. These effects reflected the operation of three separate phase-influenced mechanisms, involving anticipatory potentials and prestimulus/poststimulus amplitudes in various EEG frequencies. Results indicate that, even in paradigms with a slightly varying interstimulus interval, brain dynamics provide preferred brain states at the moment of stimulus presentation, which differentially affect the EEG correlates of stimulus processing.

Event rate and event-related potentials in ADHD

BACKGROUND

It has been repeatedly found that performance of children with attention deficit hyperactivity disorder (ADHD) is more impaired when a long inter-stimulus interval (ISI) is used than when a short ISI is used. According to the cognitive-energetic model, this may reflect difficulty in remaining in an optimal motor activation state because of insufficient effort allocation.

METHOD

Event-related potentials (ERPs) were evaluated during a Go/No-Go task that incorporates a condition with a fast and a slow presentation rate.

RESULTS

ADHD, whether or not comorbid with oppositional defiant/conduct disorder (ODD/CD), was associated with a steeper increase in reaction time (RT) from the fast to the slow condition accompanied by a missing increment of the parietal P3. Speed of responding was found to be correlated with P3 amplitude. In the fast condition, children with ADHD made more errors of commission, accompanied by a smaller No-Go N2, a component thought to be related to inhibition; however, after controlling for ODD/CD these differences disappeared.

CONCLUSIONS

The association between the steeper increase in RT and reduced parietal P3s may indicate that the children with ADHD did not allocate enough extra effort to adjust to a potentially under-activated state. However, the event rate effects could not account for all of the differences between groups and also early automatic information processing stages seem disturbed in this disorder as indexed by larger P2 amplitudes. Alternative explanations are discussed.

Event related potentials and fMRI in neuropsychopharmacology

Event related potentials (ERP) are important clinical and research instruments in neuropsychiatry, particularly due to their strategic role for the investigation of brain function. These techniques are often underutilized in the evaluation of neurological and psychiatric disorders, but nevertheless they can be most useful and highly effective in the diagnostic workup of a wide range of neuropsychiatric disorders as well as in monitoring the course of the disorders and the prediction of treatment responses. ERP are noninvasive instruments that directly reflect cortical neuronal activity. Cortical neuronal dysfunction plays a major role in variable neuropsychiatric disorders, and a change in cortical activity under medication might reflect treatment response and could be useful for monitoring drug effects. ERP are the only methods with a sufficiently high time resolution for the analysis of the dynamic patterns of neuronal brain activity, e.g., synchronization and desynchronization, oscillations, coherence, gamma band activity, latency of event related activity, etc., which are crucial for a deeper understanding of functional (neurophysiological) correlates of cognitive, emotional and behavioral disturbances in neuropsychiatric patients. Methodological advances have further improved and strengthened the position of ERP concerning research and clinical application. The usefulness and applicability of ERP in determining and monitoring clinico-pharmacological effects will be summarized mainly by focussing on the auditory evoked P300 and the N1/P2 component of auditory evoked potentials. Owing to important recent developments in the field of brain functional diagnostics the combination of neurophysiological techniques and functional magnetic resonance imaging (fMRI) will be included.

Intensity dependence of auditory evoked dipole source activity in polydrug ecstasy users: evidence from an 18 months longitudinal study

Numerous animal studies have been able to demonstrate neurotoxic damage to central serotonergic systems after exposure to 3,4-methylenedioxymethamphetamine (MDMA, ecstasy). It has been suggested that a high loudness dependence of auditory evoked potentials (LDAEP) and, particularly, of the tangential N1/P2 source activity is associated with a low functioning of serotonergic activity. Therefore, the LDAEP may be used as a non-invasive indicator for a possible neurotoxic damage caused by the long-term use of ecstasy in recreational users. We recorded auditory evoked potentials (AEP) with a passive listening paradigm in 18 polydrug ecstasy users at baseline (t1) and after 18 months (t2). Several aspects of ecstasy use, such as frequency of use, cumulative lifetime dose or period of abstinence were associated with the LDAEP for several tangential dipoles at both measuring times. However, we failed to demonstrate any significant relationship between drug use reported at follow-up and AEP changes from baseline to follow-up. Despite some incertitude these data suggest, yet do not unambiguously con.rm, the hypothesis that abstinent ecstasy users present with diminished central serotonergic activity. This feature of information processing is potentially related to the neurotoxic potential of ecstasy. However, alternative interpretations of these data refer to possible preexisting traits and the potential impact of other illicit drugs, particularly amphetamine, since ecstasy users typically exhibit polydrug use patterns. Thus, further research with larger sample sizes and prospective study designs are needed to definitively establish a causative link between ecstasy use and neurotoxicity-related dysfunctions in sensory processing.

Neurotoxicity of methylenedioxyamphetamines (MDMA; ecstasy) in humans: how strong is the evidence for persistent brain damage?

BACKGROUND

The popular dance drug ecstasy (3,4-methylenedioxymethamphetamine: MDMA and some analogues) causes selective and persistent neurotoxic damage of central serotonergic neurones in laboratory animals. Serotonin plays a role in numerous functional systems in the central nervous system (CNS). Consequently, various abnormalities including psychiatric, vegetative, neuroendocrine and cognitive disorders could be expected in humans following MDMA-induced neurotoxic brain damage.

AIMS

In recent years, the question of ecstasy-induced neurotoxicity and possible functional sequelae has been addressed in several studies with drug users. The aim of this paper was to review this literature and weigh the strength of the evidence for persistent brain damage in ecstasy users.

METHODS

We used Medline to view all available publications on 'ecstasy' or 'MDMA'. All available studies dealing with ecstasy users entered this analysis.

FINDINGS AND CONCLUSIONS

Despite large methodological problems the bulk of evidence suggests residual alterations of serotonergic transmission in MDMA users, although at least partial restitution may occur after long-term abstinence. However, functional sequelae may persist even after longer periods of abstinence. To date, the most consistent findings associate subtle cognitive, particularly memory, impairments with heavy ecstasy use. However, the evidence cannot be considered definite and the issues of possible pre-existing traits or the effects of polydrug use are not resolved.

RECOMMENDATIONS

Questions about the neurotoxic effects of ecstasy on the brain remain highly topical in light of its popularity among young people. More longitudinal and prospective studies are clearly needed in order to obtain a better understanding of the possible long-term sequelae of ecstasy use in humans.

Cerebral information processing in personality disorders: I. Intensity dependence of auditory evoked potentials

Patients with personality disorders such as the histrionic type exaggerate their responses when receiving external social or environmental stimuli. We speculated that they might also show an augmenting pattern of the auditory evoked potential N1-P2 component in response to stimuli with increasing levels of intensity, a response pattern that is thought to be inversely correlated with cerebral serotonin (5-HT) activity. To test this hypothesis, we collected auditory evoked potentials in 191 patients with personality disorders (19 patients with the paranoid type, 12 schizoid, 14 schizotypal, 18 antisocial, 15 borderline, 13 histrionic, 17 narcissistic, 25 avoidant, 30 dependent and 28 obsessive-compulsive) and 26 healthy volunteers. Their personality traits were measured using the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). Compared with healthy subjects and other patient groups, the histrionic group scored higher on the basic traits Affective Instability, Stimulus Seeking, Rejection and Narcissism, and on the higher traits Emotional Dysregulation and Dissocial, than the other groups, and the schizoid group scored lower on most of the DAPP-BQ basic and higher traits. In addition, the histrionic group showed steeper amplitude/stimulus intensity function (ASF) slopes at three midline scalp electrodes than the healthy controls or the other patient groups. The ASF slopes were not correlated with any DAPP-BQ traits in the total sample of 217 subjects. However, the DAPP-BQ basic trait Rejection was positively correlated with the ASF slopes at all three electrode sites in the histrionic group. The increased intensity dependence of the auditory N1-P2 component might indicate that cerebral 5-HT neuronal activity is, on average, weak in the histrionic patients.

Meta-analytic review of event-related potential studies in post-traumatic stress disorder

In recent years there has been an accumulation of studies that have utilized the measurement of event-related potentials (ERP) to examine the neuroelectric correlates of hypothesized alterations in information processing in persons with post-traumatic stress disorder (PTSD). The objective of this meta-analysis was to summarize the findings of ERP PTSD research, including studies that have examined P50 auditory sensory gating, augmenting-reducing P200, and P300 in target detection oddball tasks. The results suggest that persons with PTSD exhibit alterations in the amplitude and latency of ERP within these paradigms that support the hypothesis that changes in information processing can accompany PTSD. The results were also consistent with recent cognitive neuropsychological findings in PTSD research.

Direct evidence that acutely enhancing serotonin with the selective serotonin reuptake inhibitor citalopram modulates the loudness dependence of the auditory evoked potential (LDAEP) marker of central serotonin function

The loudness dependence of the auditory evoked potential (LDAEP) has been suggested as a reliable measure of central serotonin function in humans. The most convincing evidence for a direct relationship between serotonergic function and LDAEP to date has come from animal studies, while evidence in humans has been circumstantial and inconsistent. In the current study, we examine the direct effect of serotonergic modulation with the selective serotonin reuptake inhibitor (SSRI) citalopram on the LDAEP. The study was a double-blind placebo controlled design in which healthy participants were tested under two acute treatment conditions: placebo and citalopram (20 mg). Enhancement of serotonin function with citalopram in comparison to placebo decreased the slope of the LDAEP (i.e. weaker LDAEP). The findings provide direct evidence in humans, of a relationship between central serotonin function and the LDAEP, supporting findings previously observed in animals and clinical populations. Together the results provide further support for the validity of the LDAEP as a non-invasive in vivo measure of central serotonin function in humans.

Prenatal impairment of brain serotonergic transmission in infants

OBJECTIVE

To evaluate whether the free fraction of L-tryptophan (L-Trp) and the N1/P2 component of the auditory evoked potentials (AEPs) are associated with impaired brain serotonin neurotransmission in infants with intrauterine growth restriction (IUGR).

STUDY DESIGN

We measured free, bound, and total plasma L-Trp and recorded the N1/P2 component of AEP in a prospective, longitudinal, and comparative study comparing IUGR and control infants.

RESULTS

Plasma free L-Trp was increased and the amplitude of N1/P2 component was significantly decreased in IUGR relative to control infants. The free fraction of L-Trp and N1/P2 component had a negative association.

CONCLUSIONS

In newborns with IUGR, the changes in measured plasma free fraction of L-Trp and in the amplitude the N1/P2 component of the AEP suggest an inverse association between free L-Trp and components of the AEP. The changes observed in the free fraction of L-Trp and AEP may be causally associated with brain serotonergic activity in utero. In IUGR, epigenetic factors such as stress-induced disturbances in brain serotonin metabolism or serotonergic activity, identifiable by alterations in AEP, influence cerebral sensory cortex development and may be causally associated with serotonin-related disorders in adulthood.

Effects of pre-stimulus processing on subsequent events in a warned Go/NoGo paradigm: response preparation, execution and inhibition

The cued Go/NoGo task elicits response preparation during the foreperiod, and, depending on the S2 signal, either response execution or inhibition. This study aimed to determine how processes in the foreperiod might affect or predict post-S2 processing. Thirty-two adults participated in a cued Go/NoGo task (50% Go), with a median split of mean RT producing "Fast" and "Slow" groups. ERP measures were subjected to both ANOVA and regression techniques. There were no differences in the NoGo N2 effect related to response speed, nor was the effect related to pre-S2 processes. The anterior shift of the NoGo P3 was larger in the Fast group, and while the late CNV was associated with the absolute amplitude of both Go and NoGo P3, it was not related to the anterior-posterior Go/NoGo differences. Together, these data suggest that the inhibitory process may be reflected in the NoGo P3 effect, rather than the NoGo N2 effect.

Selective serotonin reuptake inhibitors treatment effects on auditory measures in depressed female subjects

The purpose of this study was to evaluate the auditory effects of selective serotonin reuptake inhibitors (SSRI), known to enhance serotonin (5-HT) transmission in the brain. The experimental group consisted of 14 clinically depressed female subjects, and the control group consisted of 11 non-depressed females. A battery of tests was administered to the experimental group while on and off of SSRI medication. The control group was also administered the test battery twice. Results indicated no significant differences in the control group between sessions. The experimental group showed significantly smaller transient evoked emissions, higher SCAN-A (auditory processing test) composite scores, and smaller amplitude growth functions for Auditory brainstem response peak V and Auditory late response peak N(1)P(2) while on SSRI medication. The increased 5-HT levels in the presence of SSRI (due to reduced reuptake of 5-HT) may be contributing to the significant changes seen in auditory measures with the experimental group.

Serotonin transporter gene polymorphism and personality traits in a Korean population

Recently, there has been growing enthusiasm for exploring biological approaches to personality, especially in the area of genetic research into the identification of those genes responsible for particular personality traits. The aim of this study was to investigate the association between the serotonin transporter-linked promoter region (5-HTTLPR) polymorphism and personality traits. We recruited 211 unrelated, normal subjects. The Korean version of the Temperament and Character Inventory (TCI) was used to assess certain personality traits. From blood samples taken from the subjects, DNA was isolated using standard techniques and the 5-HTTLPR polymorphism was genotyped by means of polymerase chain reaction and electrophoresis. We classified the subject into the s/s, s/l, and l/l groups according to their genotype. The differences in the temperament factors of the TCI between group S (s/s genotype) and group L (s/l + l/l genotype) were assessed, after the inclusion of gender and age as covariates in the analysis of variance. After controlling for gender and age, there were no associations between the harm avoidance, novelty seeking, and reward dependence scores and the genotypes. However, the persistence score of group S was significantly higher than that of group L. Our results suggest that the 5-HTTLPR polymorphism may be associated with the persistence score of the TCI in a normal Korean population.

Sound level dependence of the primary auditory cortex: Simultaneous measurement with 61-channel EEG and fMRI

Sound level dependence has been investigated for years with event-related potentials (ERP). A serotonergic modulation of the sound level dependence only of the primary auditory cortex but not of the auditory association cortex has been suggested by a number of clinical and preclinical studies. Therefore, a precise covering of the activity of the primary auditory cortex seems necessary if sound level dependence is used as an indicator of the central serotonergic system. Recent fMRI studies described a pronounced sound level dependence only in the Heschl gyrus/primary auditory cortex but not in auditory association areas. In the present simultaneous 61-channel EEG and fMRI study investigating fourteen healthy subjects, we found a high correlation between the loudness-dependent change of the extent of fMRI activation (number of activated voxels) and the corresponding changes of the mean current source density within the same region of interest covering the primary auditory cortex (r = 0.84, P < 0.001). Our findings suggest a close relationship between the fMRI signal and event-related potential activity. In addition, the correspondence of the ERP-based data and the fMRI results further supports the validity of the ERP localization approach.

Association of BDNF serum concentrations with central serotonergic activity: evidence from auditory signal processing

Disturbances of serotonergic neurotransmission in the brain have been implicated in the pathogenesis and maintenance of several psychiatric disorders. According to recent preclinical and clinical studies, the loudness dependence of auditory evoked potentials (LD) is related to the central serotonergic neurotransmission in humans. As the serotonergic phenotype has been reported to be associated with brain-derived neurotrophic factor (BDNF), we studied whether BDNF serum concentrations are related to LD in 109 healthy human volunteers (62 male, 47 female, age: 42.5+/-13.1 years). Pearson correlation showed a significant negative correlation between the BDNF serum concentrations and the LD measured at Fz (r=-0.259, p=0.007) and a trend for the Cz electrode (r=-0.185, p=0.055). Although this association needs to be replicated, the results are in line with the assumption that low serum BDNF levels reflect low central serotonergic neurotransmission as indicated by a strong LD.

Linking Brainwaves to the Brain: An ERP Primer

This article reviews literature on the characteristics and possible interpretations of the event-related potential (ERP) peaks commonly identified in research. The description of each peak includes typical latencies, cortical distributions, and possible brain sources of observed activity as well as the evoking paradigms and underlying psychological processes. The review is intended to serve as a tutorial for general readers interested in neuropsychological research and as a reference source for researchers using ERP techniques.

Association analysis for the C-1019G promoter variant of the 5-HT1A receptor gene with auditory evoked potentials in major depression

Involvement of the serotonergic system in N1 and P2 components of auditory evoked potentials (AEPs) has been implicated. Moreover, studies have indicated the presence of heritability in the genesis of AEP components. The serotonin 1A (5-HT1A) receptor gene is a strong candidate for N1 and P2 components of the AEPs because 5-HT1A receptor regulates the firing of serotonergic neurons. The present study tested the hypothesis that the 5-HT1A promoter genetic polymorphism (C-1019G) is associated with N1 and P2 components of AEPs in unmedicated major depression patients. The sample consisted of 221 Chinese patients (mean age: 44.3 years; male/female: 93/128) diagnosed with major depression. AEPs and 5-HT1A genotyping were done for each patient. Patients with the C/C genotype had a significantly shorter P2 latency when compared with C/G or G/G genotype patients (p = 0.049), and the difference in P2 latency was significant among the 5-HT1A genotype groups in male patients (p = 0.031) but not in female patients (p = 0.398). These findings suggest that this 5-HT1A polymorphism may affect AEP P2 latency in a gender-dependent manner. Further studies with other genetic polymorphisms in the serotonergic system may help to clarify the relation between serotonergic function and AEP components.

Serotonergic modulation of mismatch negativity

Neurochemical mechanisms mediating the interaction between emotional and cognitive processing are not yet fully understood. Here, we utilized acute tryptophan depletion (ATD) to reduce the brain synthesis of serotonin (5-HT), which is thought to have a central role in regulation of emotions and mood in humans. ATD effects on event-related potentials and magnetic fields were studied using a passive odd-ball paradigm in a randomized, double-blinded, controlled, cross-over design. Auditory responses were recorded simultaneously with high-resolution magnetoencephalography (MEG) and electroencephalography (EEG) in 14 healthy subjects, 5 h after ATD or a control condition. ATD significantly increased depressed mood and lowered plasma tryptophan concentration (total tryptophan decreased by 75%, free tryptophan decreased by 39%). As compared with the control condition, ATD increased the amplitudes of mismatch negativity (MMN) to duration and frequency changes and decreased the latencies of magnetic MMN to frequency changes in the hemisphere ipsilateral to the ear stimulated. Further, ATD modulated N1m latencies and decreased P2m source activity. ATD increased the interhemispheric latency difference of MMNm to frequency changes. No effects on P50 were observed. The present results suggest serotonergic modulation of preattentive auditory change detection, suggested to initiate involuntary attention shifting in the human brain.

Preclinical neuropharmacology of naratriptan

The basic CNS neuropharmacology of naratriptan is reviewed here. Naratriptan is a second-generation triptan antimigraine drug, developed at a time when CNS activity was thought not to be relevant to its therapeutic effect in migraine. It was, however, developed to be a more lipid-soluble, more readily absorbed and less readily metabolized variant on preexisting triptans and these variations conferred on it a higher CNS profile. Naratriptan is a 5-HT(1B/1D) receptor agonist with a highly selective action on migraine pain and nausea, without significant effect on other pain or even other trigeminal pain. Probable sites of therapeutic action of naratriptan include any or all of: the cranial vasculature; the peripheral terminations of trigeminovascular sensory nerves; the first-order synapses of the trigeminovascular sensory system; the descending pain control system; and the nuclei of the thalamus. Naratriptan may prevent painful dilatation of intracranial vessels or reverse such painful dilatation. Naratriptan can prevent the release of sensory peptides and inhibit painful neurogenic vasodilatation of intracranial blood vessels. At the first order synapse of the trigeminal sensory system, naratriptan can selectively suppress neurotransmission from sensory fibers from dural and vascular tissue, while sparing transmission from other trigeminal fibers, probably through inhibition of neuropeptide transmitter release. In the periaqueductal gray matter and in the nucleus raphe magnus, naratriptan selectively activates inhibitory neurons which project to the trigeminal nucleus and spinal cord and which exert inhibitory influences on trigeminovascular sensory input. Naratriptan has also a therapeutic effect on the nausea of migraine, possibly exerting its action at the level of the nucleus tractus solitarius via the same mechanisms by which it inhibits trigeminovascular nociceptive input. The incidence of naratriptan-induced adverse effects in the CNS is low and it is not an analgesic for pain other than that of vascular headache. In patients receiving selective serotonin uptake inhibitors (SSRIs) naratriptan may cause serotonin syndrome-like behavioral side effects. The mechanism of action involved in the production of behavioral and other CNS side effects of naratriptan is unknown.

Event-related potentials in the auditory oddball as a function of EEG alpha phase at stimulus onset

OBJECTIVE

We aimed to examine the relation between the phase of electroencephalogram (EEG) alpha activity at stimulus onset and event-related potentials (ERPs) in a fixed-inter-stimulus interval auditory 'oddball' task, using a novel conceptualisation of orthogonal phase effects (cortical negativity versus positivity, negative driving versus positive driving, waxing versus waning).

METHODS

EEG responses to button-press targets, from 14 subjects presented with 4 blocks of 150 stimuli (50% target probability), were examined. Pre-stimulus alpha activity (8-13 Hz) at Pz was assessed for each trial by digital filtering of the EEG. The alpha cycle at Pz, starting from a negative-going zero crossing, was used to sort trials into 4 phases, for which ERPs were derived from both the filtered and unfiltered EEG activity at Fz, Cz, and Pz.

RESULTS

Preferred brain states in this paradigm were indicated by an 8% greater occurrence of negative driving than positive driving, and a 33% greater occurrence of waxing than waning phases. Negative driving phases were associated with increased N1 latencies and decreased N2 amplitudes. Latencies of N1 and P2 were reduced in waxing phases. These reflected systematic changes in alpha frequency and amplitude at stimulus onset.

CONCLUSIONS

In a fixed-inter-stimulus interval paradigm, component frequencies of the EEG are dynamically adjusted in order to provide brain states at the moment of stimulus presentation which differentially affect the EEG correlates of stimulus processing.

SIGNIFICANCE

The results add to our understanding of the genesis of the ERP, indicating the importance of the dynamic interplay between instantaneous EEG activity and stimulus processing reflected in the ERP.

Serotonin and dopamine transporter availabilities correlate with the loudness dependence of auditory evoked potentials in patients with obsessive-compulsive disorder

Brain monoaminergic function is involved in the pathophysiology of psychiatric disorders. The loudness dependence (LD) of the N1/P2 component of auditory evoked potentials has been proposed as a noninvasive indicator of central serotonergic function, whereas single photon emission computed tomography (SPECT) and [123I]beta-CIT can be used to visualize both serotonin (SERT) and dopamine transporters (DAT). The aim of the study was to correlate LD and SPECT measures in patients with obsessive-compulsive disorder, a condition with evidence for a serotonergic dysfunction. A total of 10 subjects received both neurophysiological and imaging investigations. Evoked potentials were recorded following the application of acoustic stimuli with increasing intensities. The LD of the relevant subcomponents (tangential dipoles) was investigated using dipole source analysis. SPECT was performed 20-24 h after injection of a mean 140 MBq [123I]beta-CIT. As a measure of brain SERT and DAT availabilities, a ratio of specific to nonspecific [123I]beta-CIT binding for the midbrain . pons region (SERT) and the striatum (DAT) was used. The LD of the right tangential dipole correlated significantly with both SERT and DAT availabilities (Pearson's correlations: rho = 0.69, p < 0.05, and rho = 0.80, p < 0.01, respectively). The correlations remained significant after controlling for the effects of age, gender, and severity of clinical symptoms. Associations between LD and both SERT and DAT availabilities further validate the use of neurophysiological approaches as noninvasive indirect measures of neurochemical brain function and point at a hypothesized interconnection of central monoaminergic systems.

Inhibitory processing during the Go/NoGo task: an ERP analysis of children with attention-deficit/hyperactivity disorder

OBJECTIVE

Previous event-related potential (ERP) research on inhibitory functioning in attention-deficit/hyperactivity disorder (AD/HD) has often failed to use tasks which optimally assess inhibition. We report on an improved measure of inhibitory function, involving inhibition of a prepotent response, in children with AD/HD.

METHODS

Twelve males with AD/HD and 12 control males, aged 7-12 years, completed a cued Go/NoGo task where Go stimuli were presented on 70% of trials. ERP and behavioural measures were collected, together with reading, spelling and full-scale IQ scores.

RESULTS

The behavioural performance of children with AD/HD was not significantly different from normal controls, although children with AD/HD made faster responses and more errors. Group differences were apparent in the early processing components (P1, N1, P2) of responses to Warning, Go and NoGo stimuli. For the frontally maximal N2, a NoGo>Go effect was found, consistent with previous work linking this component with inhibitory processing. In control children this effect was particularly strong in the right frontal region, while children with AD/HD showed a much larger NoGo>Go effect, and an earlier N2 peak, than controls, with a focal shift to the left frontal region.

CONCLUSIONS

Compared with normal controls, children with AD/HD demonstrate early stimulus processing atypicalities, suggesting problems with sensory registration and identification of stimuli. Further, N2 results suggest that children with AD/HD must trigger the inhibition process earlier and more strongly than controls to perform at a comparable behavioural level.

SIGNIFICANCE

The results support the theory that behavioural inhibition is deficient in AD/HD, as children with AD/HD show abnormalities in inhibitory ERP components relating to the effort involved in inhibiting a prepotent response.

Inhibitory motor control in children with attention-deficit/hyperactivity disorder: event-related potentials in the stop-signal paradigm

BACKGROUND

The aim of the study was to investigate the inhibitory control of an ongoing motor response and to identify underlying neural deficiencies, manifested in event-related potentials, that cause poorer inhibitory performance in children with attention-deficit/hyperactivity disorder.

METHODS

A stop-signal paradigm with a primary visual task and auditory stop signal was used to compare performance in 13 children with attention-deficit/hyperactivity disorder and 13 control children, while event-related potentials were recorded simultaneously.

RESULTS

Children with attention-deficit/hyperactivity disorder showed poorer inhibitory performance through a slower inhibitory process. Inhibitory processing of auditory stop signals was marked by a frontal N2 component that was reduced in the attention-deficit/hyperactivity disorder group relative to controls. A central positive component (P3) was associated with the success of inhibiting a response, but there were no group differences in its amplitude or latency.

CONCLUSIONS

Findings support the hypothesis of deficient inhibitory control in children with attention-deficit/hyperactivity disorder. Slower inhibitory processing appears to be due to a specific neural deficiency that manifests in the processing of the stop signal as attenuated negativity in the N2 latency range.

Serotonergic dysfunction in schizophrenia assessed by the loudness dependence measure of primary auditory cortex evoked activity

Increased serotonergic activity is discussed as an important pathogenetic factor in schizophrenia. Further support for this hypothesis is difficult to obtain due to the lack of valid indicators of the brain's serotonin system. A great deal of evidence discovered through human and animal studies suggests that a weak loudness dependence of auditory evoked potentials (LDAEP) indicates high serotonergic activity and vice versa. The LDAEP is a measure of auditory cortex activity, reflecting increase or decrease of auditory evoked potential amplitudes with increasing tone loudness, which is probably modulated by the serotonergic innervation there. This is true only for the LDAEP of the primary auditory cortex, since this region is more highly innervated by serotonergic fibers than the secondary auditory cortex. The LDAEP (N1/P2 component) of 25 inpatients with schizophrenia free of medication and 25 healthy controls matched by age and gender, were recorded. Using dipole source analysis, the LDAEP of primary (tangential dipole) and this of secondary auditory cortex (radial dipole) was separately analyzed. Following a 4-week treatment with the 5-HT(2) antagonists clozapine or olanzapine, patients were once again studied. The LDAEP of the primary, but not of the secondary auditory cortex, was significantly weaker in the patients with schizophrenia than in healthy volunteers, indicating enhanced serotonergic neurotransmission. After treatment with the 5-HT(2) antagonists, the LDAEP (of the right hemisphere) tended to be increased, indicating normalization of serotonergic function in the patients with schizophrenia. These results suggest that the loudness dependence of primary auditory cortex evoked activity is well suitable to assess serotonergic dysfunction in schizophrenia.