Changes in quantitative EEG and blood flow velocity due to standardized hyperventilation; a model of transient ischaemia in young human subjects

Recent advances in understanding the neurobiology of pediatric functional neurological disorder

INTRODUCTION

Functional neurological disorder (FND) is a neuropsychiatric disorder that manifests in a broad array of functional motor, sensory, or cognitive symptoms, which arise from complex interactions between brain, mind, body, and context. Children with FND make up 10%-20% of presentations to neurology services in children's hospitals and up to 20% of adolescents admitted to hospital for the management of intractable seizures.

AREAS COVERED

The current review focuses on the neurobiology of pediatric FND. The authors present an overview of the small but growing body of research pertaining to the biological, emotion-processing, cognitive, mental health, physical health, and social system levels.

EXPERT OPINION

Emerging research suggests that pediatric FND is underpinned by aberrant changes within and between neuron-glial (brain) networks, with a variety of factors - on multiple system levels - contributing to brain network changes. In pediatric practice, adverse childhood experiences (ACEs) are commonly reported, and activation or dysregulation of stress-system components is a frequent finding. Our growing understanding of the neurobiology of pediatric FND has yielded important flow-on effects for assessing and diagnosing FND, for developing targeted treatment interventions, and for improving the treatment outcomes of children and adolescents with FND.

Optimum duration of hyperventilation during electroencephalography

Hyperventilation (HV) is carried out for 3 minutes as a standard activation procedure in most routine electroencephalographic (EEG) procedures. The cerebral blood flow (CBF) reduction and the accompanying cerebral vasoconstriction caused by HV is believed to be the mechanism of EEG activation during HV. Some advocate for 5 minutes of HV, although the optimum duration is unknown. In this study, we measured the CBF continuously over the anterior temporal lobes using subdural probes, which use thermal diffusion flowmetry to measure CBF directly from the cerebral cortex. We sought to determine the duration of HV that produces the maximum reduction in CBF during routine HV in our epilepsy monitoring unit and prolonged the procedure for an additional 2 minutes for this study. Flowtronics^® CBF probes were placed over the anterior temporal lobes in addition to the standard subdural strip placement for localization of their seizure focus in six patients who were candidates for epilepsy surgery. CBF was measured continuously for 2 minutes before and 5 minutes during HV for each patient. Time to reach maximum reduction of CBF for each attempt (11 temporal lobes) was computed. At 3 minutes, CBF reduction ranged from 11.6% to 40.0% from the pre-HV CBF level (mean 23.9%). At 5 minutes, CBF ranged from 14.3% to 42.0% (mean 25.7%). Six of the 11 measurements were steady or decreased slightly, and in the five other measurements, CBF showed a reverse trend after 3 minutes. A significant CBF reduction was attained in 3 minutes of HV in all trials. Continued HV after 3 minutes resulted in only a marginal (mean 1.8%) additional CBF reduction after 3 minutes. Thus, we propose that 3 minutes of HV is sufficient for EEG activation by the CBF criterion.

Continuous non-invasive estimates of cerebral blood flow using electrocardiography signals: a feasibility study

This paper describes a potential method to detect changes in cerebral blood flow (CBF) using electrocardiography (ECG) signals, measured across scalp electrodes with reference to the same signal across the chest—a metric we term the Electrocardiography Brain Perfusion index (EBPi). We investigated the feasibility of EBPi to monitor CBF changes in response to specific tasks. Twenty healthy volunteers wore a head-mounted device to monitor EBPi and electroencephalography (EEG) during tasks known to alter CBF. Transcranial Doppler (TCD) ultrasound measurements provided ground-truth estimates of CBF. Statistical analyses were applied to EBPi, TCD right middle cerebral artery blood flow velocity (rMCAv) and EEG relative Alpha (rAlpha) data to detect significant task-induced changes and correlations. Breath-holding and aerobic exercise induced highly significant increases in EBPi and TCD rMCAv (p < 0.01). Verbal fluency also increased both measures, however the increase was only significant for EBPi (p < 0.05). Hyperventilation induced a highly significant decrease in TCD rMCAv (p < 0.01) but EBPi was unchanged. Combining all tasks, EBPi exhibited a highly significant, weak positive correlation with TCD rMCAv (r = 0.27, p < 0.01) and the Pearson coefficient between EBPi and rAlpha was r = − 0.09 (p = 0.05). EBPi appears to be responsive to dynamic changes in CBF and, can enable practical, continuous monitoring. CBF is a key parameter of brain health and function but is not easily measured in a practical, continuous, non-invasive fashion. EBPi may have important clinical implications in this context for stroke monitoring and management. Additional studies are required to support this claim.

Central and peripheral nervous system responses to chronic and paced hyperventilation in anxious and healthy subjects

The aim of the present study was to examine self-report, peripheral nervous system, and central nervous system correlates of naturally-occurring, chronic hyperventilation (HV, assessed by hypocapnia or low resting state low end-tidal CO2), and to examine the additional effect of acute, experimentally-induced HV in anxious and healthy participants. By identifying the biomarkers of anxiety-related chronic HV and examining responses to acute HV, we hope to identify meaningful, mechanistic targets for further treatment development. Seventy anxious patients and 34 healthy control participants completed electroencephalogram (EEG) and peripheral nervous system recording at baseline and following a paced breathing task. Diagnosis x baseline hypnocapnia group analyses indicated that anxious/hypocapnic patients exhibited greater nonspecific skin conductance response amplitude than did anxious/normocapnic patients, and the anxious group reported greater HV-related symptoms and anxiety sensitivity than did the control group. However, no EEG abnormalities were noted as a function of anxiety group or baseline hypocapnia status. Following paced HV, anxious patients (but not controls) exhibited an increase in left-frontal alpha 1 power. Hypocapnic, but not normocapnic, participants exhibited an increase in skin conductance levels. Anxious patients reported an increase in negative cognitive appraisals of HV symptoms, and anxious/hypocapnic participants reported an increase in affective responses to HV. Thus, chronic HV is associated with greater arousal, and increased self-reported and physiological sensitivity to paced HV. Patients who chronically hyperventilate appear to be more sensitive to respiratory distress, responding with higher levels of anxiety and poorer tolerance of the physiological sensations accompanying acute HV.

Reduction of autonomic regulation in children and adolescents with conversion disorders

OBJECTIVE

Conversion symptoms--functional neurological disturbances of body function--occur in association with extreme arousal, often in the context of emotional distress. The mechanisms that determine how and why such symptoms occur remain unknown. In this study, we used cardiac measures to assess arousal and cardiac autonomic regulation in children and adolescents who presented with acute conversion symptoms.

METHODS

Heart rate was recorded in 57 children and adolescents (41 girls; 8.5-18 years old) with acute conversion symptoms and 57 age- and sex-matched healthy controls, during a resting condition and then during tasks involving cognitive and emotional activation. Arousal and autonomic regulation were assessed by measures of heart rate and heart rate variability. Psychological measures included attachment and emotional distress.

RESULTS

Children and adolescents with conversion symptoms displayed higher autonomic arousal than did the controls, both at baseline and during task conditions (higher heart rate: baseline mean [standard deviation] = 82 [9.49] versus 74 [10.79] beats/min, p < .001; lower root mean squared successive differences-heart rate variability: 45.35 [27.97] versus 58.62 [25.69] ms(2), p = .012; and lower high-frequency heart rate variability: 6.50 [1.19] versus 7.01 [0.95] ln[ms(2)] p = .017), and decreased autonomic regulation (attenuation of heart rate increases across tasks). The baseline pattern of increased autonomic arousal was especially pronounced in children with coercive-preoccupied patterns of attachment. Autonomic measures were not correlated with measures of emotional distress.

CONCLUSIONS

High autonomic arousal may be a precondition for generating conversion symptoms. Functional dysregulations of the cardiac, respiratory, and circulatory systems may mediate fainting episodes and nonepileptic seizures, and aberrant patterns of functional connectivity between motor areas and central arousal systems may be responsible for generating motor conversion symptoms.

Effects of physical exercise on individual resting state EEG alpha peak frequency

Previous research has shown that both acute and chronic physical exercises can induce positive effects on brain function and this is associated with improvements in cognitive performance. However, the neurophysiological mechanisms underlying the beneficial effects of exercise on cognitive processing are not well understood. This study examined the effects of an acute bout of physical exercise as well as four weeks of exercise training on the individual resting state electroencephalographic (EEG) alpha peak frequency (iAPF), a neurophysiological marker of the individual's state of arousal and attention, in healthy young adults. The subjects completed a steady state exercise (SSE) protocol or an exhaustive exercise (EE) protocol, respectively, on two separate days. EEG activity was recorded for 2 min before exercise, immediately after exercise, and after 10 min of rest. All assessments were repeated following four weeks of exercise training to investigate whether an improvement in physical fitness modulates the resting state iAPF and/or the iAPF response to an acute bout of SSE and EE. The iAPF was significantly increased following EE (P = 0.012) but not following SSE. It is concluded that the iAPF is increased following intense exercise, indicating a higher level of arousal and preparedness for external input.

Cortical sources of EEG rhythms in congestive heart failure and Alzheimer's disease

INTRODUCTION

The brain needs continuous oxygen supply even in resting-state. Hypoxia enhances resting-state electroencephalographic (EEG) rhythms in the delta range, and reduces those in the alpha range, with a pattern similar to that observed in Alzheimer's disease (AD). Here we tested whether resting-state cortical EEG rhythms in patients with congestive heart failure (CHF), as a model of acute hypoxia, present frequency similarities with AD patients, comparable by cognitive status revealed by the mini mental state examination (MMSE).

METHODS

Eyes-closed EEG data were recorded in 10 CHF patients, 20 AD patients, and 20 healthy elderly subjects (Nold) as controls. LORETA software estimated cortical EEG generators.

RESULTS

Compared to Nold, both AD and CHF groups presented higher delta (2-4Hz) and lower alpha (8-13Hz) temporal sources. The highest delta and lowest alpha sources were observed in CHF subjects. In these subjects, the global amplitude of delta sources correlated with brain natriuretic peptide (BNP) level in the blood, as a marker of disease severity.

CONCLUSIONS

Resting-state delta and alpha rhythms suggest analogies between the effects of acute hypoxia and AD neurodegeneration on the cortical neurons' synchronization.

SIGNIFICANCE

Acute ischemic hypoxia could affect the mechanisms of cortical neural synchronization generating resting state EEG rhythms, inducing the "slowing" of EEG rhythms typically observed in AD patients.

EEG delta oscillations as a correlate of basic homeostatic and motivational processes

Functional significance of delta oscillations is not fully understood. One way to approach this question would be from an evolutionary perspective. Delta oscillations dominate the EEG of waking reptiles. In humans, they are prominent only in early developmental stages and during slow-wave sleep. Increase of delta power has been documented in a wide array of developmental disorders and pathological conditions. Considerable evidence on the association between delta waves and autonomic and metabolic processes hints that they may be involved in integration of cerebral activity with homeostatic processes. Much evidence suggests the involvement of delta oscillations in motivation. They increase during hunger, sexual arousal, and in substance users. They also increase during panic attacks and sustained pain. In cognitive domain, they are implicated in attention, salience detection, and subliminal perception. This evidence shows that delta oscillations are associated with evolutionary old basic processes, which in waking adults are overshadowed by more advanced processes associated with higher frequency oscillations. The former processes rise in activity, however, when the latter are dysfunctional.

Changes in visual-evoked potential habituation induced by hyperventilation in migraine

Hyperventilation is often associated with stress, an established trigger factor for migraine. Between attacks, migraine is associated with a deficit in habituation to visual-evoked potentials (VEP) that worsens just before the attack. Hyperventilation slows electroencephalographic (EEG) activity and decreases the functional response in the occipital cortex during visual stimulation. The neural mechanisms underlying deficient-evoked potential habituation in migraineurs remain unclear. To find out whether hyperventilation alters VEP habituation, we recorded VEPs before and after experimentally induced hyperventilation lasting 3 min in 18 healthy subjects and 18 migraine patients between attacks. We measured VEP P100 amplitudes in six sequential blocks of 100 sweeps and habituation as the change in amplitude over the six blocks. In healthy subjects, hyperventilation decreased VEP amplitude in block 1 and abolished the normal VEP habituation. In migraine patients, hyperventilation further decreased the already low block 1 amplitude and worsened the interictal habituation deficit. Hyperventilation worsens the habituation deficit in migraineurs possibly by increasing dysrhythmia in the brainstem-thalamo-cortical network.

Patterns of Hypocapnia on Tilt in Patients with Fibromyalgia, Chronic Fatigue Syndrome, Nonspecific Dizziness, and Neurally Mediated Syncope

OBJECTIVES

To assess whether head-up tilt-induced hyperventilation is seen more often in patients with chronic fatigue syndrome (CFS), fibromyalgia, dizziness, or neurally mediated syncope (NMS) as compared to healthy subjects or those with familial Mediterranean fever (FMF).

PATIENTS AND METHODS

A total of 585 patients were assessed with a 10-minute supine, 30-minute head-up tilt test combined with capnography. Experimental groups included CFS (n = 90), non-CFS fatigue (n = 50), fibromyalgia (n = 70), nonspecific dizziness (n = 75), and NMS (n =160); control groups were FMF (n = 90) and healthy (n = 50). Hypocapnia, the objective measure of hyperventilation, was diagnosed when end-tidal pressure of CO2 (PETCO2) less than 30 mm Hg was recorded consecutively for 10 minutes or longer. When tilting was discontinued because of syncope, one PETCO2 measurement of 25 or less was accepted as hyperventilation.

RESULTS

Hypocapnia was diagnosed on tilt test in 9% to 27% of patients with fibromyalgia, CFS, dizziness, and NMS versus 0% to 2% of control subjects. Three patterns of hypocapnia were recognized: supine hypocapnia (n = 14), sustained hypocapnia on tilt (n = 76), and mixed hypotensive-hypocapnic events (n = 80). Hypocapnia associated with postural tachycardia syndrome (POTS) occurred in 8 of 41 patients.

CONCLUSIONS

Hyperventilation appears to be the major abnormal response to postural challenge in sustained hypocapnia but possibly merely an epiphenomenon in hypotensive-hypocapnic events. Our study does not support an essential role for hypocapnia in NMS or in postural symptoms associated with POTS. Because unrecognized hypocapnia is common in CFS, fibromyalgia, and nonspecific dizziness, capnography should be a part of the evaluation of patients with such conditions.

QEEG changes during carotid clamping in carotid endarterectomy: spectral edge frequency parameters and relative band power parameters

Intraoperative monitoring is needed to identify accurately those patients in need of a shunt during carotid endarterectomy. EEG can be used for this purpose, but there is no consensus on the variables to use. Using a database consisting of 149 EEGs recorded from patients during carotid endarterectomy under isoflurane (n=61) or propofol (n=88) anesthesia and who did or did not receive a shunt, the authors investigated which of 16 derivations (common reference, Cz) and 12 parameters (relative and absolute powers and spectral edge frequencies [SEFs]) singly or in combination could best distinguish between the shunt and the nonshunt groups for the two anesthesia regimens. Receiver operating characteristic curves were used to select derivation/parameter combinations for three types of trend computation: (1) values of relative powers and SEFs during clamping (C) only, (2) clamp minus preclamp (baseline) differences (C-B), and (3) C-B differences in absolute logarithmic power (DeltalogP). For both anesthesia regimens, C-B computation distinguished best between the shunt and nonshunt groups. For isoflurane anesthesia, SEF parameters were the best, and for propofol anesthesia the relative power parameters. Discriminant analysis, in which additional derivation/parameter combinations were added, increased the discriminative power of the DeltalogP computation but not of the C or C-B computations. For isoflurane anesthesia, SEF 90% was the best single parameter for distinguishing between patients who did and did not need a shunt and the four best derivations were F3-Cz, P4-Cz, C4-Cz, and F7-Cz. For the propofol anesthesia, the relative power (C or C-B computations) of the delta band was the best and the four best derivations were F8-Cz, T4-Cz, C4-Cz, and F4-Cz.

Increase in alpha rhythm frequency after carotid endarterectomy

OBJECTIVES

Besides preventing stroke, carotid endarterectomy (CEA) is reported to improve cerebral circulation and brain function. We tested whether this improvement is reflected by changes in the qEEG.

METHODS

qEEG changes in 166 patients with a >70% stenosis of the internal carotid artery (ICA) were assessed after subtraction of the preoperative and postoperative spectra (eyes closed condition) before and 3 months after CEA. The mean frequency of the alpha band (MFA), the peak frequency of the alpha band (F alpha), and bands with limits relative to each patient's F alpha were studied in relation to neurological symptoms, patency or occlusion of the contralateral ICA, shunt requirement, and side of surgery.

RESULTS

MFA and F alpha significantly increased over both hemispheres. After alignment on F alpha, a decrease of spectral band power was seen below F alpha, and a band power increase above F alpha. The group of patients with a contralateral ICA occlusion showed significantly more improvement than the group without. The group of patients with neurological deficits showed a tendency for improvement. No differences were found concerning shunt requirement or the side of surgery.

CONCLUSIONS

After CEA the alpha rhythm frequency increases. In general, patients with a contralateral ICA occlusion improve more than other patients, in agreement with data from the literature on cerebral circulation and brain function.

Hypocapnia and cerebral hypoperfusion in orthostatic intolerance

BACKGROUND AND PURPOSE

Orthostatic and other stresses trigger tachycardia associated with symptoms of tremulousness, shortness of breath, dizziness, blurred vision, and, often, syncope. It has been suggested that paradoxical cerebral vasoconstriction during head-up tilt might be present in patients with orthostatic intolerance. We chose to study middle cerebral artery (MCA) blood flow velocity (BFV) and cerebral vasoregulation during tilt in patients with orthostatic intolerance (OI).

METHODS

Beat-to-beat BFV from the MCA, heart rate, CO2, blood pressure (BP), and respiration were measured in 30 patients with OI (25 women and 5 men; age range, 21 to 44 years; mean age, 31.3+/-1.2 years) and 17 control subjects (13 women and 4 men; age range, 20 to 41 years; mean age, 30+/-1.6 years); ages were not statistically different. These indices were monitored during supine rest and head-up tilt (HUT). We compared spontaneous breathing and hyperventilation and evaluated the effect of CO2 rebreathing in these 2 positions.

RESULTS

The OI group had higher supine heart rates (P<0.001) and cardiac outputs (P<0.01) than the control group. In response to HUT, OI patients underwent a greater heart rate increment (P<0.001) and greater reductions in pulse pressure (P<0.01) and CO2 (P<0.001), but total systemic resistance failed to show an increment. Among the cerebrovascular indices, all BFVs (systolic, diastolic, and mean) decreased significantly more, and cerebrovascular resistance (CVR) was increased in OI patients (P<0.01) compared with control subjects. In both groups, hyperventilation induced mild tachycardia (P<0.001), a significant reduction of BFV, and a significant increase of CVR associated with a fall in CO2. Hyperventilation during HUT reproduced hypocapnia, BFV reduction, and tachycardia and worsened symptoms of OI; these symptoms and indices were improved within 2 minutes of CO2 rebreathing. The relationships between CO2 and BFV and heart rate were well described by linear regressions, and the slope was not different between control subjects and patients with OI.

CONCLUSIONS

Cerebral vasoconstriction occurs in OI during orthostasis, which is primarily due to hyperventilation, causing significant hypocapnia. Hypocapnia and symptoms of orthostatic hypertension are reversible by CO2 rebreathing.

Quantitative EEG in long-term survivors of acute lymphoblastic leukemia

Conventional and quantitative aspects of electroencephalographic recordings obtained during a follow-up surveillance study in long-term survivors of acute lymphoblastic leukemia in childhood were investigated with respect to differences in central nervous system prophylaxis given during antileukemic therapy and compared with data derived from healthy controls. Central nervous system prophylaxis consisted either of cranial irradiation (18 Gray, group A, n = 8) or intermediate high-dose methotrexate (2000 mg/m2; group B, n = 5), each combined with intrathecal methotrexate. Conventional electroencephalographic analysis revealed comparable results in all three study groups. However, quantitative electroencephalography showed significantly increased absolute power scores for all frequency bands in both long-term survivor groups. Relative power estimates revealed a significant increase in delta/tau activities in both prophylaxis groups compared to healthy controls, which were countered by decreased percentage power scores in the alpha-range. Quantitative electroencephalographic comparisons between both central nervous system prophylaxis groups revealed only small differences in quantity, not quality, of the observed power disturbances with slightly higher deviations in irradiated long-term survivors than in nonirradiated ones. Topographical distributions of spectral band power were comparable between all three study groups without evidence for therapy-related topographical differences.

Hyperventilation activation on EEG recording in children with epilepsy

In 20 patients with epilepsy, electroencephalography (EEG) slowing was quantitatively characterized during standardized hyperventilation activation (respiratory rate: 30/min, threefold elevation of total expiratory volume, duration: 4 min) and changes in cerebral blood flow and velocity in the right common carotid artery were monitored with the Doppler ultrasonic method. Thirteen age-matched normal children served as controls. The results were as follows: (1) EEG slowing in the epilepsy group was greater compared with controls. (2) There was a significant decrease in mean frequency (decrease in alpha power and increase in delta power) during hyperventilation in the epilepsy group, but no significant change in the controls. (3) The decrease in cerebral blood flow (CBF) was greater in the epilepsy group at the beginning of hyperventilation, possibly related to the greater EEG slowing. (4) The percentage of CBF at the end of hyperventilation was similar in the epilepsy and control groups. The difference in EEG response to hyperventilation between the 2 groups may be due to differences in the decrease in CBF volume and the sensitivity of the change in CBF.

Topographic EEG changes due to hypobaric hypoxia at simulated high altitude

Multichannel human EEG signals were studied topographically in subjects exposed to an atmosphere of reduced air pressure in a chamber in which high-altitude conditions were simulated. EEG signals from 16 electrodes placed on the scalp were recorded simultaneously with electrocardiography and vertical eye movement. Baseline records were first obtained at sea level (PRE 0 m), and then at reduced air pressures corresponding to the altitudes of 3000 m, 4000 m, and 6000 m, respectively, and after returning to sea level (POST 0 m). A complete set of EEG records under all 6 conditions was obtained in 5 of the 15 subjects, and under 5 conditions (all except the 6000 m condition) in 3 other subjects. The spectral powers of 1 min epochs of the multichannel EEG signal under each altitude condition were compared to that at PRE 0 m using analysis of variance. Under the 3000 m condition, the spectral power of the 10-11 Hz components was significantly decreased and, with increasing altitude, significant decrease of spectral power was observed in a wider range of the alpha frequency band. Under the 6000 m condition, the decrease of spectral power of the alpha band in the posterior brain areas was -7 dB compared to the baseline. In contrast, the spectral power of the theta frequency band in anterior brain areas increased significantly in the 5000 m and 6000 m conditions. At the POST 0 m condition after return from the 5000 m condition (without exposure to the 6000 m condition), the EEG showed recovery to the level of the baseline PRE 0 m condition.(ABSTRACT TRUNCATED AT 250 WORDS)

A neurosynaptic model of state-dependent EEG wave generation in the subcortico-cortical system

A neurosynaptic model of the subcortico-cortical system is presented in order to analyze the mechanism for the generation of EEG rhythms with specific state-dependent spectral patterns. The model is based on the interaction among the infraslow, as well as basic, rhythms of the PSP's (postsynaptic potentials) trains from which CSD's (current source densities) or cortical surface potentials emerge. The model system was simulated by two trains of positive and negative cortical surface potentials within the same period, according to the thalamic clock as modulated by the infraslow rhythms of the midbrain reticular system. The simulated EEG's showed rhythmic waxing and waning sawtooth-like waves with no frequency fluctuation, but with some spectral broadband peaks at the basic repetitive frequency, as well as its harmonics.

Antihypoxic treatment at an early stage of diabetic neuropathy: an electrophysiological study with sabeluzole

Thirty-seven non-IDDM patients at an early stage of polyneuropathy, defined as the presence of symptoms for less than two years, as well as an abnormal perception threshold and/or abnormal thermal discrimination threshold, were treated with sabeluzole, a new antihypoxic drug, or placebo for 1 year in a double-blind, placebo-controlled study. They were examined neurophysiologically every 3 months, when motor (tibial, ulnar) nerve and sensory (sural, ulnar) nerve conduction velocities, H-reflex of the soleus muscle, SF-EMG of the anterior tibial muscle, static and dynamic pupillometry were measured. Statistical analysis did not show significant differences in nerve function between the sabeluzole group and the placebo group. There were also no significant changes within each group over the 1-year period. The results of the present study show no beneficial effect of sabeluzole on peripheral nerve function in patients at an early stage of diabetic polyneuropathy.

Management of pediatric head injury

This article on management of pediatric head injury reviews the pathophysiology and current therapy for traumatic brain injury in children. There is an emphasis on clinical protocols and algorithms that guide therapy to prevent or attenuate the deleterious effects of secondary brain injury as intracranial hypertension, hypotension, and hypoxia.

Quantitative EEG changes due to cerebral vasoconstriction. Indomethacin versus hyperventilation-induced reduction in cerebral blood flow in normal subjects

Hyperventilation leads to an increase in slow EEG activity as well as to a decrease in alpha activity. These effects may be considered a result of reduction in cerebral blood flow due to vasoconstriction, but metabolic factors, such as alkalosis and the increased formation of cerebral lactate, may also have to be taken into account. As indomethacin decreases cerebral blood flow it is possible to study cerebral vasoconstriction, without concomitant metabolic alkalosis or cerebral lactate formation. Two parallel groups of 12 healthy male subjects (age 20-25) were studied with quantitative EEG (qEEG) and cerebral blood flow velocity as parameters. In the first group the effect of 100 mg indomethacin was studied. In the parallel group a standardized hyperventilation procedure was performed. In the indomethacin group the blood flow velocity decreased to 60% of the initial value; the qEEG showed a 0.5 Hz slowing of the alpha peak frequency (P less than 0.01) and a decrease in the power of the alpha band without any change in the delta or theta band. In the hyperventilation group the blood flow velocity decreased to 63% of the initial value and the qEEG showed a marked increase in delta and theta activity (P less than 0.01), but a non-significant change in alpha peak frequency. Indomethacin and hyperventilation caused similar degrees of vasoconstriction; however, the increase in qEEG slow wave activity, which was observed only in the hyperventilation group, is apparently related to metabolic rather than haemodynamic factors.

Quantitative EEG during progressive hypocarbia and hypoxia. Hyperventilation-induced EEG changes reconsidered

To investigate the role of cerebral hypoxia as a causative factor in the alteration of the qEEG during hyperventilation, qEEG changes caused by progressive hypocapnia were compared with qEEG changes due to progressive normobaric hypoxia in two parallel groups of 12 and 10 healthy male subjects (age 20-27 years), respectively. In the first group, qEEG records were obtained before and during hyperventilation to pCO2 levels of 4.0, 3.0 and 2.0 kPa. In the second group, the qEEG samples were taken before and during hypoxia with hemoglobin oxygen saturations of 80, 70 and 60%. In both groups, blood flow velocity in the middle cerebral artery was also recorded. Hyperventilation caused an exponential increase in slow activity and a decrease in alpha power. No shift in the alpha mean frequency and alpha peak frequency was observed, except with the pCO2 level of 4.0 kPa, which caused an increase in both variables. Hypoxia with a hemoglobin oxygen saturation of 60% caused a much less pronounced increase in slow activity. No change in total power in the alpha band was found, but both the alpha peak frequency and alpha mean frequency decreased. Lesser degrees of hypoxia caused only minimal EEG changes. Blood flow velocity was decreased by hyperventilation but increased by hypoxia. It is concluded that the EEG changes observed during hyperventilation must mainly or totally be attributed to factors other than cerebral hypoxia.

Quantitative EEG changes under various conditions of hyperventilation in the sensorimotor cortex of the anaesthetized cat

The effects on the EEG rhythms recorded from the sensorimotor cortex (post-sigmoid gyrus) of anaesthetized cats were studied under 4 conditions of artificial mechanical hyperventilation (HV) before and after cervical bilateral vagotomy. In animals with intact vagus nerves, using visual examination, EEG changes were only observed within the 2nd min during HV produced by increased stroke volume (delta V) with associated hypocapnia. Quantitative EEG (qEEG) showed that, for the same increase in minute ventilation and the same degree of hypocapnia, delta V induced a greater and earlier relative decrease (2nd min) in the power density of delta, theta and alpha bands, than increased pump frequency (delta F). The delta F tests produced a fall only in the theta band and within the 3rd min. With constant paCO2, transient modifications occurred only with delta V and were limited to the first 30 sec. In bivagotomized cats, moderate EEG responses to delta V plus associated hypocapnia persisted partly in the alpha band. Finally, no changes appeared with delta V or delta F when the vagus nerves were cut and paCO2 was maintained constant. The present data suggest strongly that, in anaesthetized cats, peripheral vagal afferents from the respiratory system play a major role in the EEG changes caused by artificial hyperventilation.

Influence of a twofold voluntary hyperventilation on visually evoked cortical potentials and human pupillogram

We studied the direct and aftereffects of twofold hyperventilation (HV) on pattern reversing VEPs and pupillograms (PGs) of 19 healthy volunteers. The VEP-N80 and P100 latencies increased during HV. Both peak times were maintained for a longer period, up to 20 minutes after HV-2 ended. In addition, the PG-latency time during HV and the PG-construction time during and after HV were increased. The results indicated a temporary delay of neural afferent transmission in the visual system during and after HV. A similar delay of the nervous transmission appeared in the efferent part of the system regulating the pupillary movements after HV ended. The observed changes of the VEP and PG parameters most probably resulted from the hypocapnia cased by HV and its effect on the brain vessels, although other explanations for the changes of the VEP- and PG-parameters may have been possible.

Nimodipine tested in a human model of cerebral ischaemia. Electroencephalographic and transcranial Doppler ultrasound investigations in normal subjects during standardized hyperventilation

The anti-ischaemic properties of nimodipine 30 mg and 60 mg t.i.d. for 4 days has been tested in a double-blind, placebo-controlled, cross-over study based on the use of hyperventilation to reduce flow velocity in cerebral arteries. Whether the anti-ischaemic properties were due to a vasodilatator action on cerebral blood vessels or to an anti-ischaemic effect on cerebral neurons was studied. There was a slight cardiovascular effect, without any significant change in the EEG at rest. During standardized hyperventilation, there was no difference in the reduction in the blood flow velocity in the nimodipine and placebo groups (namely 56%, 56% and 59%). Both doses of nimodipine, however, significantly attenuated the hyperventilation-induced increase in slow EEG activity in the 1.5-6.0 Hz range. It is concluded that the anti-ischaemic properties of nimodipine are due to an effect on the central nervous system rather than to an effect on cerebral blood flow.

Hyperventilation as a model for acute ischaemic hypoxia of the brain: effects on cortical auditory evoked potentials

Controlled hyperventilation (HV) may be used as an experimental procedure to produce transient ischaemic hypoxia of the brain. The effect of HV on the cortical auditory evoked potential (AEP) components N1 and P2 was studied in ten healthy adult subjects. AEP were recorded before HV, during 3 min of controlled HV, and 1 min and 5 min after the end of HV. The P2 amplitude was significantly reduced by HV and regained its initial value 1 min after the end of HV. The P2 amplitude decrease probably reflects an impairment of synaptic function produced by cerebral hypoxia. Thus, the investigation of cortical AEP components may provide a useful parameter in the study of anti-ischaemic or anti-hypoxic therapies.

Hyperventilation-induced EEG changes in humans and their modulation by an anticonvulsant drug

Surface-negative DC shifts, arising from depolarization of apical dendrites of cortical pyramidal cells, represent excitability of cortical neuronal networks. Hyperventilation, used in epilepsy diagnosis to provoke epileptiform discharges, is thought to increase excitability of neuronal tissue; correspondingly, hyperventilation produces negative DC shifts. Extreme negative DC shifts, accompanying epileptiform EEG patterns, have been observed in epileptic patients during hyperventilation. Anticonvulsants, supposed to dampen cortical excitability, should inhibit the development of overexcitability and, hence, also of pronounced negative DC shifts. The present study examined DC shifts induced by hyperventilation in healthy human subjects under the influence of the benzodiazepine, clonazepam, which is used as anticonvulsant. In a double-blind setting, 36 male student volunteers received 4.5 mg clonazepam or the equivalent amount of placebo. DC-EEG and respiration rate were measured during 3 periods each of 3 min: baseline, hyperventilation, and recovery. Compared to baseline, hyperventilation produced a negative DC shift of an average 36 +/- 8 microV under placebo conditions. Clonazepam reduced the hyperventilation-induced negativity to 13 +/- 5 microV. Negativity suppression became weakened with increasing blood plasma levels of the drug. Respiration depth and frequency, increasing under hyperventilation, did not differ among the groups. Clonazepam treatment gave rise to beta-waves and prevented the increase in alpha and theta activity that was found in placebo subjects during the recording period; this was only true, however, for low to moderate plasma concentrations of clonazepam. Results are consistent with the notion that a hyperventilation-induced increase in neuronal excitability can be measured by cortical DC shifts. The reduction of negative shifts under anticonvulsants might indicate dampening of cortical neuronal excitability which is intended by antiepileptic drugs.

The hyperventilation-induced ischaemia model in human neuropharmacology: neurophysiological and psychometric studies of aniracetam and 3-OH aniracetam

Standardized hyperventilation in young subjects induces changes in the EEG, a decrease in the velocity of the cerebral blood flow and a decline in cognitive performance, which are comparable to those occurring in patients with cerebral ischaemia. The anti-ischaemic properties of aniracetam and 3-OH aniracetam were tested in this model. A single oral dose of 3-OH aniracetam 1500 mg appeared to have the most pronounced effect on hyperventilation-induced EEG changes and cognitive deterioration. The test drugs had no effect on the heart rate or blood flow velocity. The effects agree with those of other drugs classified as noötropics.

1H and 31P NMR measurement of cerebral lactate, high-energy phosphate levels, and pH in humans during voluntary hyperventilation: associated EEG, capnographic, and Doppler findings

In order to explore the sensitivity of spatially resolved 1H and 31P NMR spectroscopy on a whole-body NMR instrument, cerebral metabolic changes in human volunteers were measured during hyperventilation provocation. During hyperventilation the flow velocity in the middle cerebral artery decreased significantly and the EEG showed a marked increase in slow activity. 1H NMR spectra revealed an increase in cerebral lactate concentration. 31P NMR spectra showed no changes in ATP or PCr peak heights, but a shift toward tissue alkalosis was derived from changes in Pi chemical shift. During subsequent recovery, lactate concentration decreased and a slight intracellular acidosis was detected. In three experiments broadening of the lactate resonance peak resulted in separation into two components at 1.32 and 1.48 ppm, in which the latter signal possibly arose from alanine.