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Kung YC, Li CW, Hsu AL, Liu CY, Wu CW, Chang WC, Lin CP. Neurovascular coupling in eye-open-eye-close task and resting state: Spectral correspondence between concurrent EEG and fMRI. Neuroimage 2024; 289:120535. [PMID: 38342188 DOI: 10.1016/j.neuroimage.2024.120535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024] Open
Abstract
Neurovascular coupling serves as an essential neurophysiological mechanism in functional neuroimaging, which is generally presumed to be robust and invariant across different physiological states, encompassing both task engagement and resting state. Nevertheless, emerging evidence suggests that neurovascular coupling may exhibit state dependency, even in normal human participants. To investigate this premise, we analyzed the cross-frequency spectral correspondence between concurrently recorded electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) data, utilizing them as proxies for neurovascular coupling during the two conditions: an eye-open-eye-close (EOEC) task and a resting state. We hypothesized that given the state dependency of neurovascular coupling, EEG-fMRI spectral correspondences would change between the two conditions in the visual system. During the EOEC task, we observed a negative phase-amplitude-coupling (PAC) between EEG alpha-band and fMRI visual activity. Conversely, in the resting state, a pronounced amplitude-amplitude-coupling (AAC) emerged between EEG and fMRI signals, as evidenced by the spectral correspondence between the EEG gamma-band of the midline occipital channel (Oz) and the high-frequency fMRI signals (0.15-0.25 Hz) in the visual network. This study reveals distinct scenarios of EEG-fMRI spectral correspondence in healthy participants, corroborating the state-dependent nature of neurovascular coupling.
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Affiliation(s)
- Yi-Chia Kung
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Wei Li
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ai-Ling Hsu
- Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chi-Yun Liu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Changwei W Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Hsinchu, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
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2
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Ruby P, Evangelista E, Bastuji H, Peter-Derex L. From physiological awakening to pathological sleep inertia: Neurophysiological and behavioural characteristics of the sleep-to-wake transition. Neurophysiol Clin 2024; 54:102934. [PMID: 38394921 DOI: 10.1016/j.neucli.2023.102934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 02/25/2024] Open
Abstract
Sleep inertia refers to the transient physiological state of hypoarousal upon awakening, associated with various degrees of impaired neurobehavioral performance, confusion, a desire to return to sleep and often a negative emotional state. Scalp and intracranial electro-encephalography as well as functional imaging studies have provided evidence that the sleep inertia phenomenon is underpinned by an heterogenous cerebral state mixing local sleep and local wake patterns of activity, at the neuronal and network levels. Sleep inertia is modulated by homeostasis and circadian processes, sleep stage upon awakening, and individual factors; this translates into a huge variability in its intensity even under physiological conditions. In sleep disorders, especially in hypersomnolence disorders such as idiopathic hypersomnia, sleep inertia may be a daily, serious and long-lasting symptom leading to severe impairment. To date, few tools have been developed to assess sleep inertia in clinical practice. They include mainly questionnaires and behavioral tests such as the psychomotor vigilance task. Only one neurophysiological protocol has been evaluated in hypersomnia, the forced awakening test which is based on an event-related potentials paradigm upon awakening. This contrasts with the major functional consequences of sleep inertia and its potentially dangerous consequences in subjects required to perform safety-critical tasks soon after awakening. There is a great need to identify reproducible biomarkers correlated with sleep inertia-associated cognitive and behavioral impairment. These biomarkers will aim at better understanding and measuring sleep inertia in physiological and pathological conditions, as well as objectively evaluating wake-promoting treatments or non-pharmacological countermeasures to reduce this phenomenon.
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Affiliation(s)
- Perrine Ruby
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France
| | - Elisa Evangelista
- Sleep disorder Unit, Carémeau Hospital, Centre Hospitalo-universitaire de Nîmes, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Hélène Bastuji
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France; Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - Laure Peter-Derex
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France; Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France.
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3
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Wang ZJ, Lee HC, Chuang CH, Hsiao FC, Lee SH, Hsu AL, Wu CW. Traces of EEG-fMRI coupling reveals neurovascular dynamics on sleep inertia. Sci Rep 2024; 14:1537. [PMID: 38233587 PMCID: PMC10794702 DOI: 10.1038/s41598-024-51694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024] Open
Abstract
Upon emergence from sleep, individuals experience temporary hypo-vigilance and grogginess known as sleep inertia. During the transient period of vigilance recovery from prior nocturnal sleep, the neurovascular coupling (NVC) may not be static and constant as assumed by previous neuroimaging studies. Stemming from this viewpoint of sleep inertia, this study aims to probe the NVC changes as awakening time prolongs using simultaneous EEG-fMRI. The time-lagged coupling between EEG features of vigilance and BOLD-fMRI signals, in selected regions of interest, was calculated with one pre-sleep and three consecutive post-awakening resting-state measures. We found marginal changes in EEG theta/beta ratio and spectral slope across post-awakening sessions, demonstrating alterations of vigilance during sleep inertia. Time-varying EEG-fMRI coupling as awakening prolonged was evidenced by the changing time lags of the peak correlation between EEG alpha-vigilance and fMRI-thalamus, as well as EEG spectral slope and fMRI-anterior cingulate cortex. This study provides the first evidence of potential dynamicity of NVC occurred in sleep inertia and opens new avenues for non-invasive neuroimaging investigations into the neurophysiological mechanisms underlying brain state transitions.
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Affiliation(s)
- Zhitong John Wang
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, 5 Floor, 301, Yuantong Rd., Zhonghe Dist, New Taipei, 235040, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Hsiang Chuang
- Research Center for Education and Mind Sciences, College of Education, National Tsing Hua University, Hsinchu, Taiwan
| | - Fan-Chi Hsiao
- Department of Counseling, Clinical and Industrial/Organizational Psychology, Ming Chuan University, Taoyuan, Taiwan
| | - Shwu-Hua Lee
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, 259, Wenhua 1St Rd., Guishan Dist., Taoyuan, 33302, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ai-Ling Hsu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, 259, Wenhua 1St Rd., Guishan Dist., Taoyuan, 33302, Taiwan.
- Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan.
| | - Changwei W Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, 5 Floor, 301, Yuantong Rd., Zhonghe Dist, New Taipei, 235040, Taiwan.
- Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
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4
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Hsu AL, Li MK, Kung YC, Wang ZJ, Lee HC, Li CW, Huang CWC, Wu CW. Temporal consistency of neurovascular components on awakening: preliminary evidence from electroencephalography, cerebrovascular reactivity, and functional magnetic resonance imaging. Front Psychiatry 2023; 14:1058721. [PMID: 37215667 PMCID: PMC10196490 DOI: 10.3389/fpsyt.2023.1058721] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Sleep inertia (SI) is a time period during the transition from sleep to wakefulness wherein individuals perceive low vigilance with cognitive impairments; SI is generally identified by longer reaction times (RTs) in attention tasks immediately after awakening followed by a gradual RT reduction along with waking time. The sluggish recovery of vigilance in SI involves a dynamic process of brain functions, as evidenced in recent functional magnetic resonance imaging (fMRI) studies in within-network and between-network connectivity. However, these fMRI findings were generally based on the presumption of unchanged neurovascular coupling (NVC) before and after sleep, which remains an uncertain factor to be investigated. Therefore, we recruited 12 young participants to perform a psychomotor vigilance task (PVT) and a breath-hold task of cerebrovascular reactivity (CVR) before sleep and thrice after awakening (A1, A2, and A3, with 20 min intervals in between) using simultaneous electroencephalography (EEG)-fMRI recordings. If the NVC were to hold in SI, we hypothesized that time-varying consistencies could be found between the fMRI response and EEG beta power, but not in neuron-irrelevant CVR. Results showed that the reduced accuracy and increased RT in the PVT upon awakening was consistent with the temporal patterns of the PVT-induced fMRI responses (thalamus, insula, and primary motor cortex) and the EEG beta power (Pz and CP1). The neuron-irrelevant CVR did not show the same time-varying pattern among the brain regions associated with PVT. Our findings imply that the temporal dynamics of fMRI indices upon awakening are dominated by neural activities. This is the first study to explore the temporal consistencies of neurovascular components on awakening, and the discovery provides a neurophysiological basis for further neuroimaging studies regarding SI.
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Affiliation(s)
- Ai-Ling Hsu
- Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ming-Kang Li
- Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chia Kung
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan
| | - Zhitong John Wang
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chia-Wei Li
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | | | - Changwei W. Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
- Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
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Hosni SMI, Borgheai SB, McLinden J, Zhu S, Huang X, Ostadabbas S, Shahriari Y. A Graph-Based Nonlinear Dynamic Characterization of Motor Imagery Toward an Enhanced Hybrid BCI. Neuroinformatics 2022; 20:1169-1189. [PMID: 35907174 DOI: 10.1007/s12021-022-09595-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 12/31/2022]
Abstract
Decoding neural responses from multimodal information sources, including electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS), has the transformative potential to advance hybrid brain-computer interfaces (hBCIs). However, existing modest performance improvement of hBCIs might be attributed to the lack of computational frameworks that exploit complementary synergistic properties in multimodal features. This study proposes a multimodal data fusion framework to represent and decode synergistic multimodal motor imagery (MI) neural responses. We hypothesize that exploiting EEG nonlinear dynamics adds a new informative dimension to the commonly combined EEG-fNIRS features and will ultimately increase the synergy between EEG and fNIRS features toward an enhanced hBCI. The EEG nonlinear dynamics were quantified by extracting graph-based recurrence quantification analysis (RQA) features to complement the commonly used spectral features for an enhanced multimodal configuration when combined with fNIRS. The high-dimensional multimodal features were further given to a feature selection algorithm relying on the least absolute shrinkage and selection operator (LASSO) for fused feature selection. Linear support vector machine (SVM) was then used to evaluate the framework. The mean hybrid classification performance improved by up to 15% and 4% compared to the unimodal EEG and fNIRS, respectively. The proposed graph-based framework substantially increased the contribution of EEG features for hBCI classification from 28.16% up to 52.9% when introduced the nonlinear dynamics and improved the performance by approximately 2%. These findings suggest that graph-based nonlinear dynamics can increase the synergy between EEG and fNIRS features for an enhanced MI response representation that is not dominated by a single modality.
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Affiliation(s)
- Sarah M I Hosni
- Department of Electrical, Computer & Biomedical Engineering, University of Rhode Island (URI), Kingston, RI, 02881, USA
| | - Seyyed B Borgheai
- Department of Electrical, Computer & Biomedical Engineering, University of Rhode Island (URI), Kingston, RI, 02881, USA
| | - John McLinden
- Department of Electrical, Computer & Biomedical Engineering, University of Rhode Island (URI), Kingston, RI, 02881, USA
| | - Shaotong Zhu
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, 02115, USA
| | - Xiaofei Huang
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, 02115, USA
| | - Sarah Ostadabbas
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, 02115, USA
| | - Yalda Shahriari
- Department of Electrical, Computer & Biomedical Engineering, University of Rhode Island (URI), Kingston, RI, 02881, USA.
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Alyan E, Saad NM, Kamel N, Rahman MA. Workplace design-related stress effects on prefrontal cortex connectivity and neurovascular coupling. APPLIED ERGONOMICS 2021; 96:103497. [PMID: 34139374 DOI: 10.1016/j.apergo.2021.103497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 06/12/2023]
Abstract
This study aims to evaluate the effect of workstation type on the neural and vascular networks of the prefrontal cortex (PFC) underlying the cognitive activity involved during mental stress. Workstation design has been reported to affect the physical and mental health of employees. However, while the functional effects of ergonomic workstations have been documented, there is little research on the influence of workstation design on the executive function of the brain. In this study, 23 healthy volunteers in ergonomic and non-ergonomic workstations completed the Montreal imaging stress task, while their brain activity was recorded using the synchronized measurement of electroencephalography and functional near-infrared spectroscopy. The results revealed desynchronization in alpha rhythms and oxygenated hemoglobin, as well as decreased functional connectivity in the PFC networks at the non-ergonomic workstations. Additionally, a significant increase in salivary alpha-amylase activity was observed in all participants at the non-ergonomic workstations, confirming the presence of induced stress. These findings suggest that workstation design can significantly impact cognitive functioning and human capabilities at work. Therefore, the use of functional neuroimaging in workplace design can provide critical information on the causes of workplace-related stress.
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Affiliation(s)
- Emad Alyan
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Seri Iskandar, 32610, Malaysia.
| | - Naufal M Saad
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Seri Iskandar, 32610, Malaysia
| | - Nidal Kamel
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Seri Iskandar, 32610, Malaysia
| | - Mohammad Abdul Rahman
- Faculty of Medicine, Universiti Kuala Lumpur Royal College of Medicine Perak, 30450, Perak, Malaysia
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7
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Deligani RJ, Borgheai SB, McLinden J, Shahriari Y. Multimodal fusion of EEG-fNIRS: a mutual information-based hybrid classification framework. BIOMEDICAL OPTICS EXPRESS 2021; 12:1635-1650. [PMID: 33796378 PMCID: PMC7984774 DOI: 10.1364/boe.413666] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 05/26/2023]
Abstract
Multimodal data fusion is one of the current primary neuroimaging research directions to overcome the fundamental limitations of individual modalities by exploiting complementary information from different modalities. Electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) are especially compelling modalities due to their potentially complementary features reflecting the electro-hemodynamic characteristics of neural responses. However, the current multimodal studies lack a comprehensive systematic approach to properly merge the complementary features from their multimodal data. Identifying a systematic approach to properly fuse EEG-fNIRS data and exploit their complementary potential is crucial in improving performance. This paper proposes a framework for classifying fused EEG-fNIRS data at the feature level, relying on a mutual information-based feature selection approach with respect to the complementarity between features. The goal is to optimize the complementarity, redundancy and relevance between multimodal features with respect to the class labels as belonging to a pathological condition or healthy control. Nine amyotrophic lateral sclerosis (ALS) patients and nine controls underwent multimodal data recording during a visuo-mental task. Multiple spectral and temporal features were extracted and fed to a feature selection algorithm followed by a classifier, which selected the optimized subset of features through a cross-validation process. The results demonstrated considerably improved hybrid classification performance compared to the individual modalities and compared to conventional classification without feature selection, suggesting a potential efficacy of our proposed framework for wider neuro-clinical applications.
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Affiliation(s)
- Roohollah Jafari Deligani
- Department of Electrical, Computer and
Biomedical Engineering; University of Rhode
Island, Kingston, RI 02881, USA
| | - Seyyed Bahram Borgheai
- Department of Electrical, Computer and
Biomedical Engineering; University of Rhode
Island, Kingston, RI 02881, USA
| | - John McLinden
- Department of Electrical, Computer and
Biomedical Engineering; University of Rhode
Island, Kingston, RI 02881, USA
| | - Yalda Shahriari
- Department of Electrical, Computer and
Biomedical Engineering; University of Rhode
Island, Kingston, RI 02881, USA
- Interdisciplinary Neuroscience Program;
University of Rhode Island, Kingston, RI
02881, USA
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8
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Othman MH, Bhattacharya M, Møller K, Kjeldsen S, Grand J, Kjaergaard J, Dutta A, Kondziella D. Resting-State NIRS-EEG in Unresponsive Patients with Acute Brain Injury: A Proof-of-Concept Study. Neurocrit Care 2020; 34:31-44. [PMID: 32333214 DOI: 10.1007/s12028-020-00971-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Neurovascular-based imaging techniques such as functional MRI (fMRI) may reveal signs of consciousness in clinically unresponsive patients but are often subject to logistical challenges in the intensive care unit (ICU). Near-infrared spectroscopy (NIRS) is another neurovascular imaging technique but low cost, can be performed serially at the bedside, and may be combined with electroencephalography (EEG), which are important advantages compared to fMRI. Combined NIRS-EEG, however, has never been evaluated for the assessment of neurovascular coupling and consciousness in acute brain injury. METHODS We explored resting-state oscillations in eight-channel NIRS oxyhemoglobin and eight-channel EEG band-power signals to assess neurovascular coupling, the prerequisite for neurovascular-based imaging detection of consciousness, in patients with acute brain injury in the ICU (n = 9). Conscious neurological patients from step-down units and wards served as controls (n = 14). Unsupervised adaptive mixture-independent component analysis (AMICA) was used to correlate NIRS-EEG data with levels of consciousness and clinical outcome. RESULTS Neurovascular coupling between NIRS oxyhemoglobin (0.07-0.13 Hz) and EEG band-power (1-12 Hz) signals at frontal areas was sensitive and prognostic to changing consciousness levels. AMICA revealed a mixture of five models from EEG data, with the relative probabilities of these models reflecting levels of consciousness over multiple days, although the accuracy was less than 85%. However, when combined with two channels of bilateral frontal neurovascular coupling, weighted k-nearest neighbor classification of AMICA probabilities distinguished unresponsive patients from conscious controls with > 90% accuracy (positive predictive value 93%, false discovery rate 7%) and, additionally, identified patients who subsequently failed to recover consciousness with > 99% accuracy. DISCUSSION We suggest that NIRS-EEG for monitoring of acute brain injury in the ICU is worthy of further exploration. Normalization of neurovascular coupling may herald recovery of consciousness after acute brain injury.
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Affiliation(s)
- Marwan H Othman
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mahasweta Bhattacharya
- Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Kirsten Møller
- Department of Neuroanesthesiology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Kjeldsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johannes Grand
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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