Light and alcohol evoked electro-oculograms in cystic fibrosis

Retinal electrophysiology in central nervous system disorders. A review of human and mouse studies

The retina and brain share similar neurochemistry and neurodevelopmental origins, with the retina, often viewed as a "window to the brain." With retinal measures of structure and function becoming easier to obtain in clinical populations there is a growing interest in using retinal findings as potential biomarkers for disorders affecting the central nervous system. Functional retinal biomarkers, such as the electroretinogram, show promise in neurological disorders, despite having limitations imposed by the existence of overlapping genetic markers, clinical traits or the effects of medications that may reduce their specificity in some conditions. This narrative review summarizes the principal functional retinal findings in central nervous system disorders and related mouse models and provides a background to the main excitatory and inhibitory retinal neurotransmitters that have been implicated to explain the visual electrophysiological findings. These changes in retinal neurochemistry may contribute to our understanding of these conditions based on the findings of retinal electrophysiological tests such as the flash, pattern, multifocal electroretinograms, and electro-oculogram. It is likely that future applications of signal analysis and machine learning algorithms will offer new insights into the pathophysiology, classification, and progression of these clinical disorders including autism, attention deficit/hyperactivity disorder, bipolar disorder, schizophrenia, depression, Parkinson's, and Alzheimer's disease. New clinical applications of visual electrophysiology to this field may lead to earlier, more accurate diagnoses and better targeted therapeutic interventions benefiting individual patients and clinicians managing these individuals and their families.

The Clinical Biology of Cystic Fibrosis Transmembrane Regulator Protein: Its Role and Function in Extrapulmonary Disease

Normal cystic fibrosis (CF) transmembrane regulator (CFTR) protein has multiple functions in health and disease. Many mutations in the CFTR gene produce abnormal or absent protein. CFTR protein dysfunction underlies the classic CF phenotype of progressive pulmonary and GI pathology but may underlie diseases not usually associated with CF. This review highlights selected extrapulmonary disease that may be associated with abnormal CFTR. Increasing survival in CF is associated with increasing incidence of diseases associated with aging. CFTR dysfunction in older individuals may have novel effects on glucose metabolism, control of insulin release, regulation of circadian rhythm, and cancer cell pathophysiology. In individuals who have cancers with acquired CFTR suppression, their tumors may more likely exhibit rapid expansion, epithelial-to-mesenchymal transformation, abnormally reduced apoptosis, and increased metastatic potential. The new modulators of CFTR protein synthesis could facilitate the additional exploration needed to better understand the unfolding clinical biology of CFTR in human disease, even as they revolutionize treatment of patients with CF.

The slow light and dark oscillation of the clinical electro-oculogram

BACKGROUND

The standing potential of the eye exhibits a slow damped oscillation under light and dark conditions that continues for at least 80 minutes. However, our understanding of the relationship between the slow dark and light oscillation has not been previously studied. The aim of this study was to explore through regression analysis a model of these oscillations in order to establish if they may have the same underlying cellular generators.

METHODS

Healthy participants undertook recordings of the standing potential using the electro-oculogram for 100 minutes. To explore the light oscillation, participants (n = 8) were dilated and performed an extended electro-oculogram protocol consisting of 15 minutes dark adaptation and 85 minutes of white light adaptation at 100 cd/m² . For the dark oscillation, participants (n = 11) undertook the electro-oculogram for 100 minutes in complete darkness. Both sessions began with pre-adaptation to 30 cd/m² of white light for five minutes. Non-parametric statistics were used to evaluate all data.

RESULTS

Ratios of the dark and light oscillations showed a significantly greater dampening of the dark oscillation compared to the light oscillation (p < 0.000). Regression analysis using a five-factor damped sine function revealed significant differences in the parameters governing the dampening (p = 0.005) and period (p = 0.009) of the functions (R² > 0.874). There were no significant differences in the dark trough amplitude.

CONCLUSION

The results support a different underlying physiological mechanism for the light and dark oscillation of the clinical electro-oculogram. Future work will need to establish how the dark oscillation and dark trough of the clinical electro-oculogram arise.

A meta-analysis of clinical electro-oculography values

BACKGROUND

The aim of the meta-analysis was to derive a range of mean normal clinical electrooculogram (EOG) values from a systematic review of published EOG studies that followed the guidelines of the ISCEV standard for clinical electro-oculography.

METHODS

A systematic literature review was performed using four relevant databases limited to peer-reviewed articles in English between 1967 and February 2017. Studies reporting clinical EOG or FO normal values were included when the report used a standard 30° horizontal saccade, a retinal luminance of between 100 and 250 cd m^-2, and had > 10 subjects in their normative values. The search identified 1145 articles after duplicates were removed with subsequent screening of the abstracts excluding a further 1098, resulting in 47 full-text articles that were then assessed by the author (PC) with a final nine articles meeting the inclusion criteria. An overall effect estimate using inverse variance-weighted meta-analysis was performed to estimate the mean values for the light peak/dark trough ratio (LP:DT ratio) (dilated and undilated), the time to the LP, the amplitude of the LP, dark trough (DT) and the fast oscillation (FO) peak-to-trough ratio from the included studies.

RESULTS

The mean dilated LP:DT ratio was 2.35 (95% CI 2.28-2.42); undilated LP:DT ratio was 2.37 (95% CI 2.28-2.45); LP amplitude was 835 (95% CI 631-1039) µV and the mean time to the LP being 8.2 (95% CI 7.7-8.7) min. The mean DT amplitude was 358 (95% CI 292-424) µV, and the mean FO peak-to-trough ratio was 1.13 (95% CI 1.11-1.16). The results of the LP/DT ratio are drawn from studies with a mean ± standard deviation (SD) age of 34.08 ± 12.93 years for dilated and 33.65 ± 12.28 years for undilated LP/DT ratios.

CONCLUSIONS

The meta-analysis of EOG studies has generated a reference range of normal mean values for clinicians to refer to when using the ISCEV clinical EOG. It provides a potential method to generate similar data sets from published normal values in related visual electrophysiology tests.

Sleep Phase Delay in Cystic Fibrosis: A Potential New Manifestation of Cystic Fibrosis Transmembrane Regulator Dysfunction

BACKGROUND

Cystic fibrosis (CF) transmembrane regulator (CFTR) protein dysfunction causes CF. Improving survival allows detection of increasingly subtle disease manifestations. CFTR dysfunction in the central nervous system (CNS) may disturb circadian rhythm and thus sleep phase. We studied sleep in adults to better understand potential CNS CFTR dysfunction.

METHODS

We recruited participants from April 2012 through April 2015 and administered the Munich Chronotype Questionnaire (MCTQ). We compared free-day sleep measurements between CF and non-CF participants and investigated associations with CF survival predictors.

RESULTS

We recruited 23 female and 22 male adults with CF aged 18 to 46 years and 26 female and 22 male volunteers aged 18 to 45 years. Compared with volunteers without CF, patients with CF had delayed sleep onset (0.612 h; P = .015), midsleep (1.11 h; P < .001), and wake (1.15 h; P < .001) times and prolonged sleep latency (7.21 min; P = .05) and duration (0.489 h; P = .05). Every hour delay in sleep onset was associated with shorter sleep duration by 0.29 h in patients with CF and 0.75 h in subjects without CF (P = .007) and longer sleep latency by 7.51 min in patients with CF and 1.6 min in volunteers without CF (P = .035). Among patients with CF, FEV₁ % predicted, prior acute pulmonary exacerbations, and weight were independent of all free-day sleep measurements.

CONCLUSIONS

CF in adults is associated with marked delays in sleep phase consistent with circadian rhythm phase delays. Independence from disease characteristics predictive of survival suggests that sleep phase delay is a primary manifestation of CFTR dysfunction in the CNS.

The effects of gender and age on the range of the normal human electro-oculogram

PURPOSE

To define the normal ranges for the slow oscillations (SO) and fast oscillations (FO) of the electro-oculogram (EOG) recorded to International Society for Clinical Electrophysiology of Vision (ISCEV) standards. The effects of age and gender on the EOG ranges were examined.

METHODS

ISCEV standard SOs and FOs were recorded from 121 subjects (51 % male) aged from 7 to 72 years. Study variables for the SO were dark trough (DT) and light peak (LP) amplitudes (µV), times to DT and LP (min), and the Arden ratio (LP/DT amplitude). The FO was fit by a sine wave and peak-to-peak amplitude (µV), phase (°), and peak-to-trough (PT) ratios derived. The effects of age, gender and pupil size on EOG parameters were examined by multiple regression analysis.

RESULTS

The average Arden ratio was 2.5. Arden ratio decreased with age at a rate of 0.13 per decade of age (R (2) = 0.14, P < 0.0001). The 5th percentile of the Arden ratio decreased from 2.0 to 1.7 between 10 and 60 years of age. Median time to LP was 9 min (interquartile range 8-9 min). Time to LP was age-dependent and increased by 2 min for subjects over 55 years of age compared with those less than 25 years. EOG amplitudes were greater in women than in men (P < 0.005). The average PT ratio was 1.18, which was not affected by age or gender. Time to reach the light trough of the FO was 40 s, which increased with age (1.1 s/decade). No correlation was observed between Arden ratio and PT ratio.

CONCLUSIONS

The major strength of this study is the definition of the normal range and associated lower limits of ISCEV standard EOGs based on recordings from 121 subjects balanced by gender and spanning the 1st through 8th decades of life. Decreased Arden ratio and increased time to LP are associated with aging, which is likely due to the intricate mechanisms involved in generation of the light rise. Differences between the FO and SO with respect to the effects of aging are consistent with separate generation of these two EOG signals.