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Hernandez H, Baez S, Medel V, Moguilner S, Cuadros J, Santamaria-Garcia H, Tagliazucchi E, Valdes-Sosa PA, Lopera F, OchoaGómez JF, González-Hernández A, Bonilla-Santos J, Gonzalez-Montealegre RA, Aktürk T, Yıldırım E, Anghinah R, Legaz A, Fittipaldi S, Yener GG, Escudero J, Babiloni C, Lopez S, Whelan R, Lucas AAF, García AM, Huepe D, Caterina GD, Soto-Añari M, Birba A, Sainz-Ballesteros A, Coronel C, Herrera E, Abasolo D, Kilborn K, Rubido N, Clark R, Herzog R, Yerlikaya D, Güntekin B, Parra MA, Prado P, Ibanez A. Brain health in diverse settings: How age, demographics and cognition shape brain function. Neuroimage 2024; 295:120636. [PMID: 38777219 DOI: 10.1016/j.neuroimage.2024.120636] [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: 02/08/2024] [Revised: 04/17/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Diversity in brain health is influenced by individual differences in demographics and cognition. However, most studies on brain health and diseases have typically controlled for these factors rather than explored their potential to predict brain signals. Here, we assessed the role of individual differences in demographics (age, sex, and education; n = 1298) and cognition (n = 725) as predictors of different metrics usually used in case-control studies. These included power spectrum and aperiodic (1/f slope, knee, offset) metrics, as well as complexity (fractal dimension estimation, permutation entropy, Wiener entropy, spectral structure variability) and connectivity (graph-theoretic mutual information, conditional mutual information, organizational information) from the source space resting-state EEG activity in a diverse sample from the global south and north populations. Brain-phenotype models were computed using EEG metrics reflecting local activity (power spectrum and aperiodic components) and brain dynamics and interactions (complexity and graph-theoretic measures). Electrophysiological brain dynamics were modulated by individual differences despite the varied methods of data acquisition and assessments across multiple centers, indicating that results were unlikely to be accounted for by methodological discrepancies. Variations in brain signals were mainly influenced by age and cognition, while education and sex exhibited less importance. Power spectrum activity and graph-theoretic measures were the most sensitive in capturing individual differences. Older age, poorer cognition, and being male were associated with reduced alpha power, whereas older age and less education were associated with reduced network integration and segregation. Findings suggest that basic individual differences impact core metrics of brain function that are used in standard case-control studies. Considering individual variability and diversity in global settings would contribute to a more tailored understanding of brain function.
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Affiliation(s)
- Hernan Hernandez
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | - Sandra Baez
- Universidad de los Andes, Bogota, Colombia; Global Brain Health Institute (GBHI), University of California, San Francisco, US Trinity College Dublin, Dublin, Ireland
| | - Vicente Medel
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | - Sebastian Moguilner
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile; Harvard Medical School, Boston, MA, USA
| | - Jhosmary Cuadros
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile; Advanced Center for Electrical and Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile; Grupo de Bioingeniería, Decanato de Investigación, Universidad Nacional Experimental del Táchira, San Cristóbal 5001, Venezuela
| | - Hernando Santamaria-Garcia
- Pontificia Universidad Javeriana (PhD Program in Neuroscience) Bogotá, San Ignacio, Colombia; Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio Bogotá, San Ignacio, Colombia
| | - Enzo Tagliazucchi
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile; University of Buenos Aires, Argentina
| | - Pedro A Valdes-Sosa
- The Clinical Hospital of Chengdu Brain Sciences, University of Electronic Sciences Technology of China, Chengdu, China; Cuban Neuroscience Center, La Habana, Cuba
| | - Francisco Lopera
- Grupo de Neurociencias de Antioquia, University of Antioquia, Medellín, Colombia
| | | | | | | | | | - Tuba Aktürk
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylül University, Izmir, Turkey
| | - Ebru Yıldırım
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylül University, Izmir, Turkey
| | - Renato Anghinah
- Reference Center of Behavioural Disturbances and Dementia, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Traumatic Brain Injury Cognitive Rehabilitation Out-Patient Center, University of Sao Paulo, Sao Paulo, Brazil
| | - Agustina Legaz
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile; Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Sol Fittipaldi
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile; Global Brain Health Institute (GBHI), University of California, San Francisco, US Trinity College Dublin, Dublin, Ireland; School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Görsev G Yener
- Faculty of Medicine, Izmir University of Economics, 35330, Izmir, Turkey; Brain Dynamics Multidisciplinary Research Center, Dokuz Eylul University, Izmir, Turkey; Izmir Biomedicine and Genome Center, Izmir, Turkey
| | - Javier Escudero
- School of Engineering, Institute for Imaging, Data and Communications, University of Edinburgh, Scotland, UK
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy; Hospital San Raffaele Cassino, Cassino, (FR), Italy
| | - Susanna Lopez
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Robert Whelan
- Global Brain Health Institute (GBHI), University of California, San Francisco, US Trinity College Dublin, Dublin, Ireland; Department of Legal Medicine, Psychiatry and Pathology at the Complutense University of Madrid, Madrid, Spain
| | - Alberto A Fernández Lucas
- Department of Legal Medicine, Psychiatry and Pathology at the Complutense University of Madrid, Madrid, Spain
| | - Adolfo M García
- Global Brain Health Institute (GBHI), University of California, San Francisco, US Trinity College Dublin, Dublin, Ireland; Cognitive Neuroscience Center, Universidad de San Andréss, Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - David Huepe
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez
| | - Gaetano Di Caterina
- Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow, UK
| | | | - Agustina Birba
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | | | - Carlos Coronel
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile; Global Brain Health Institute (GBHI), University of California, San Francisco, US Trinity College Dublin, Dublin, Ireland; Centro Interdisciplinario de Neurociencia de Valparaíso (CINV), Universidad de Valparaíso, Valparaíso, Chile
| | - Eduar Herrera
- Departamento de Estudios Psicológicos, Universidad ICESI, Cali, Colombia
| | - Daniel Abasolo
- Centre for Biomedical Engineering, School of Mechanical Engineering Sciences, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Kerry Kilborn
- School of Psychology, University of Glasgow, Glasgow, Scotland, UK
| | - Nicolás Rubido
- Institute for Complex Systems and Mathematical Biology, University of Aberdeen, Aberdeen, AB24 3UE, UK
| | - Ruaridh Clark
- Centre for Signal and Image Processing, Department of Electronic and Electrical Engineering, University of Strathclyde, UK
| | - Ruben Herzog
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile; Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris 75013, France
| | - Deniz Yerlikaya
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylül University, Izmir, Turkey
| | - Bahar Güntekin
- Health Sciences and Technology Research Institute (SABITA), Istanbul Medipol University, Istanbul, Turkey; Department of Biophysics, School of Medicine, Istanbul Medipol University, Turkey
| | - Mario A Parra
- Department of Psychological Sciences and Health, University of Strathclyde, United Kingdom and Associate Researcher of the Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Pavel Prado
- Escuela de Fonoaudiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
| | - Agustin Ibanez
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile; Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA; Cognitive Neuroscience Center, Universidad de San Andrés and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina; Trinity College Dublin, The University of Dublin, Dublin, Ireland.
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Estarellas M, Huntley J, Bor D. Neural markers of reduced arousal and consciousness in mild cognitive impairment. Int J Geriatr Psychiatry 2024; 39:e6112. [PMID: 38837281 DOI: 10.1002/gps.6112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES People with Alzheimer's Disease (AD) experience changes in their level and content of consciousness, but there is little research on biomarkers of consciousness in pre-clinical AD and Mild Cognitive Impairment (MCI). This study investigated whether levels of consciousness are decreased in people with MCI. METHODS A multi-site site magnetoencephalography (MEG) dataset, BIOFIND, comprising 83 people with MCI and 83 age matched controls, was analysed. Arousal (and drowsiness) was assessed by computing the theta-alpha ratio (TAR). The Lempel-Ziv algorithm (LZ) was used to quantify the information content of brain activity, with higher LZ values indicating greater complexity and potentially a higher level of consciousness. RESULTS LZ was lower in the MCI group versus controls, indicating a reduced level of consciousness in MCI. TAR was higher in the MCI group versus controls, indicating a reduced level of arousal (i.e. increased drowsiness) in MCI. LZ was also found to be correlated with mini-mental state examination (MMSE) scores, suggesting an association between cognitive impairment and level of consciousness in people with MCI. CONCLUSIONS A decline in consciousness and arousal can be seen in MCI. As cognitive impairment worsens, measured by MMSE scores, levels of consciousness and arousal decrease. These findings highlight how monitoring consciousness using biomarkers could help understand and manage impairments found at the preclinical stages of AD. Further research is needed to explore markers of consciousness between people who progress from MCI to dementia and those who do not, and in people with moderate and severe AD, to promote person-centred care.
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Affiliation(s)
- Mar Estarellas
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
- Experimental Psychology Department, University College London, London, UK
- Department of Psychology, Cambridge University, Cambridge, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Daniel Bor
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
- Department of Psychology, Cambridge University, Cambridge, UK
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Zhu J, Shan Y, Li Y, Wu X, Gao G. Predicting the Severity and Discharge Prognosis of Traumatic Brain Injury Based on Intracranial Pressure Data Using Machine Learning Algorithms. World Neurosurg 2024; 185:e1348-e1360. [PMID: 38519020 DOI: 10.1016/j.wneu.2024.03.085] [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: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE This study aimed to explore the potential of employing machine learning algorithms based on intracranial pressure (ICP), ICP-derived parameters, and their complexity to predict the severity and short-term prognosis of traumatic brain injury (TBI). METHODS A single-center prospectively collected cohort of neurosurgical intensive care unit admissions was analyzed. We extracted ICP-related data within the first 6 hours and processed them using complex algorithms. To indicate TBI severity and short-term prognosis, Glasgow Coma Scale score on the first postoperative day and Glasgow Outcome Scale-Extended score at discharge were used as binary outcome variables. A univariate logistic regression model was developed to predict TBI severity using only mean ICP values. Subsequently, 3 multivariate Random Forest (RF) models were constructed using different combinations of mean and complexity metrics of ICP-related data. To avoid overfitting, five-fold cross-validations were performed. Finally, the best-performing multivariate RF model was used to predict patients' discharge Glasgow Outcome Scale-Extended score. RESULTS The logistic regression model exhibited limited predictive ability with an area under the curve (AUC) of 0.558. Among multivariate models, the RF model, combining the mean and complexity metrics of ICP-related data, achieved the most robust ability with an AUC of 0.815. Finally, in terms of predicting discharge Glasgow Outcome Scale-Extended score, this model had a consistent performance with an AUC of 0.822. Cross-validation analysis confirmed the performance. CONCLUSIONS This study demonstrates the clinical utility of the RF model, which integrates the mean and complexity metrics of ICP data, in accurately predicting the TBI severity and short-term prognosis.
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Affiliation(s)
- Jun Zhu
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingchi Shan
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yihua Li
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Wu
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoyi Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Schmierer T, Li T, Li Y. Harnessing machine learning for EEG signal analysis: Innovations in depth of anaesthesia assessment. Artif Intell Med 2024; 151:102869. [PMID: 38593683 DOI: 10.1016/j.artmed.2024.102869] [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: 09/28/2023] [Revised: 01/31/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
Anaesthesia, crucial to surgical practice, is undergoing renewed scrutiny due to the integration of artificial intelligence in its medical use. The precise control over the temporary loss of consciousness is vital to ensure safe, pain-free procedures. Traditional methods of depth of anaesthesia (DoA) assessment, reliant on physical characteristics, have proven inconsistent due to individual variations. In response, electroencephalography (EEG) techniques have emerged, with indices such as the Bispectral Index offering quantifiable assessments. This literature review explores the current scope and frontier of DoA research, emphasising methods utilising EEG signals for effective clinical monitoring. This review offers a critical synthesis of recent advances, specifically focusing on electroencephalography (EEG) techniques and their role in enhancing clinical monitoring. By examining 117 high-impact papers, the review delves into the nuances of feature extraction, model building, and algorithm design in EEG-based DoA analysis. Comparative assessments of these studies highlight their methodological approaches and performance, including clinical correlations with established indices like the Bispectral Index. The review identifies knowledge gaps, particularly the need for improved collaboration for data access, which is essential for developing superior machine learning models and real-time predictive algorithms for patient management. It also calls for refined model evaluation processes to ensure robustness across diverse patient demographics and anaesthetic agents. The review underscores the potential of technological advancements to enhance precision, safety, and patient outcomes in anaesthesia, paving the way for a new standard in anaesthetic care. The findings of this review contribute to the ongoing discourse on the application of EEG in anaesthesia, providing insights into the potential for technological advancement in this critical area of medical practice.
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Affiliation(s)
- Thomas Schmierer
- School of Mathematics, Physics and Computing, University of Southern Queensland, Australia.
| | - Tianning Li
- School of Mathematics, Physics and Computing, University of Southern Queensland, Australia.
| | - Yan Li
- School of Mathematics, Physics and Computing, University of Southern Queensland, Australia.
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Ostertag J, Zanner R, Schneider G, Kreuzer M. Permutation Entropy Does Not Track the Electroencephalogram-Related Manifestations of Paradoxical Excitation During Propofol-Induced Loss of Responsiveness: Results From a Prospective Observational Cohort Study. Anesth Analg 2024:00000539-990000000-00770. [PMID: 38412114 DOI: 10.1213/ane.0000000000006919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND During the anesthetic-induced loss of responsiveness (LOR), a "paradoxical excitation" with activation of β-frequencies in the electroencephalogram (EEG) can be observed. Thus, spectral parameters-as widely used in commercial anesthesia monitoring devices-may mistakenly indicate that patients are awake when they are actually losing responsiveness. Nonlinear time-domain parameters such as permutation entropy (PeEn) may analyze additional EEG information and appropriately reflect the change in cognitive state during the transition. Determining which parameters correctly track the level of anesthesia is essential for designing monitoring algorithms but may also give valuable insight regarding the signal characteristics during state transitions. METHODS EEG data from 60 patients who underwent general anesthesia were extracted and analyzed around LOR. We derived the following information from the power spectrum: (i) spectral band power, (ii) the spectral edge frequency as well as 2 parameters known to be incorporated in monitoring systems, (iii) beta ratio, and (iv) spectral entropy. We also calculated (v) PeEn as a time-domain parameter. We used Friedman's test and Bonferroni correction to track how the parameters change over time and the area under the receiver operating curve to separate the power spectra between time points. RESULTS Within our patient collective, we observed a "paradoxical excitation" around the time of LOR as indicated by increasing beta-band power. Spectral edge frequency and spectral entropy values increased from 19.78 [10.25-34.18] Hz to 25.39 [22.46-30.27] Hz (P = .0122) and from 0.61 [0.54-0.75] to 0.77 [0.64-0.81] (P < .0001), respectively, before LOR, indicating a (paradoxically) higher level of high-frequency activity. PeEn and beta ratio values decrease from 0.78 [0.77-0.82] to 0.76 [0.73-0.81] (P < .0001) and from -0.74 [-1.14 to -0.09] to -2.58 [-2.83 to -1.77] (P < .0001), respectively, better reflecting the state transition into anesthesia. CONCLUSIONS PeEn and beta ratio seem suitable parameters to monitor the state transition during anesthesia induction. The decreasing PeEn values suggest a reduction of signal complexity and information content, which may very well describe the clinical situation at LOR. The beta ratio mainly focuses on the loss of power in the gamma-band. PeEn, in particular, may present a single parameter capable of tracking the LOR transition without being affected by paradoxical excitation.
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Affiliation(s)
- Julian Ostertag
- From the Department of Anesthesiology & Intensive Care, School of Medicine, Technical University of Munich, Munich, Germany
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Liang Z, Lan Z, Wang Y, Bai Y, He J, Wang J, Li X. The EEG complexity, information integration and brain network changes in minimally conscious state patients during general anesthesia. J Neural Eng 2023; 20:066030. [PMID: 38055962 DOI: 10.1088/1741-2552/ad12dc] [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: 05/06/2023] [Accepted: 12/06/2023] [Indexed: 12/08/2023]
Abstract
Objective.General anesthesia (GA) can induce reversible loss of consciousness. Nonetheless, the electroencephalography (EEG) characteristics of patients with minimally consciousness state (MCS) during GA are seldom observed.Approach.We recorded EEG data from nine MCS patients during GA. We used the permutation Lempel-Ziv complexity (PLZC), permutation fluctuation complexity (PFC) to quantify the type I and II complexities. Additionally, we used permutation cross mutual information (PCMI) and PCMI-based brain network to investigate functional connectivity and brain networks in sensor and source spaces.Main results.Compared to the preoperative resting state, during the maintenance of surgical anesthesia state, PLZC decreased (p< 0.001), PFC increased (p< 0.001) and PCMI decreased (p< 0.001) in sensor space. The results for these metrics in source space are consistent with sensor space. Additionally, node network indicators nodal clustering coefficient (NCC) (p< 0.001) and nodal efficiency (NE) (p< 0.001) decreased in these two spaces. Global network indicators normalized average path length (Lave/Lr) (p< 0.01) and modularity (Q) (p< 0.05) only decreased in sensor space, while the normalized average clustering coefficient (Cave/Cr) and small-world index (σ) did not change significantly. Moreover, the dominance of hub nodes is reduced in frontal regions in these two spaces. After recovery of consciousness, PFC decreased in the two spaces, while PLZC, PCMI increased. NCC, NE, and frontal region hub node dominance increased only in the sensor space. These indicators did not return to preoperative levels. In contrast, global network indicatorsLave/LrandQwere not significantly different from the preoperative resting state in sensor space.Significance.GA alters the complexity of the EEG, decreases information integration, and is accompanied by a reconfiguration of brain networks in MCS patients. The PLZC, PFC, PCMI and PCMI-based brain network metrics can effectively differentiate the state of consciousness of MCS patients during GA.
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Affiliation(s)
- Zhenhu Liang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, People's Republic of China
| | - Zhilei Lan
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, People's Republic of China
| | - Yong Wang
- Zhuhai UM Science & Technology Research Institute, Zhuhai 519031, People's Republic of China
| | - Yang Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, People's Republic of China
- Rehabilitation Medicine Clinical Research Center of Jiangxi Province, Nanchang 330006, Jiangxi, People's Republic of China
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Juan Wang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, People's Republic of China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, People's Republic of China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, People's Republic of China
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Medel V, Irani M, Crossley N, Ossandón T, Boncompte G. Complexity and 1/f slope jointly reflect brain states. Sci Rep 2023; 13:21700. [PMID: 38065976 PMCID: PMC10709649 DOI: 10.1038/s41598-023-47316-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Abstract
Characterization of brain states is essential for understanding its functioning in the absence of external stimuli. Brain states differ on their balance between excitation and inhibition, and on the diversity of their activity patterns. These can be respectively indexed by 1/f slope and Lempel-Ziv complexity (LZc). However, whether and how these two brain state properties relate remain elusive. Here we analyzed the relation between 1/f slope and LZc with two in-silico approaches and in both rat EEG and monkey ECoG data. We contrasted resting state with propofol anesthesia, which directly modulates the excitation-inhibition balance. We found convergent results among simulated and empirical data, showing a strong, inverse and non trivial monotonic relation between 1/f slope and complexity, consistent at both ECoG and EEG scales. We hypothesize that differentially entropic regimes could underlie the link between the excitation-inhibition balance and the vastness of the repertoire of brain systems.
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Affiliation(s)
- Vicente Medel
- Latin American Health Brain Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile.
| | - Martín Irani
- Department of Psychology, University of Illinois Urbana-Champaign, IL, USA
| | - Nicolás Crossley
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tomás Ossandón
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Gonzalo Boncompte
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Zhang Y, Wang Y, Cheng H, Yan F, Li D, Song D, Wang Q, Huang L. EEG spectral slope: A reliable indicator for continuous evaluation of consciousness levels during propofol anesthesia. Neuroimage 2023; 283:120426. [PMID: 37898378 DOI: 10.1016/j.neuroimage.2023.120426] [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: 07/11/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023] Open
Abstract
The level of consciousness undergoes continuous alterations during anesthesia. Prior to the onset of propofol-induced complete unconsciousness, degraded levels of behavioral responsiveness can be observed. However, a reliable index to monitor altered consciousness levels during anesthesia has not been sufficiently investigated. In this study, we obtained 60-channel EEG data from 24 healthy participants during an ultra-slow propofol infusion protocol starting with an initial concentration of 1 μg/ml and a stepwise increase of 0.2 μg/ml in concentration. Consecutive auditory stimuli were delivered every 5 to 6 s, and the response time to the stimuli was used to assess the responsiveness levels. We calculated the spectral slope in a time-resolved manner by extracting 5-second EEG segments at each auditory stimulus and estimated their correlation with the corresponding response time. Our results demonstrated that during slow propofol infusion, the response time to external stimuli increased, while the EEG spectral slope, fitted at 15-45 Hz, became steeper, and a significant negative correlation was observed between them. Moreover, the spectral slope further steepened at deeper anesthetic levels and became flatter during anesthesia recovery. We verified these findings using an external dataset. Additionally, we found that the spectral slope of frontal electrodes over the prefrontal lobe had the best performance in predicting the response time. Overall, this study used a time-resolved analysis to suggest that the EEG spectral slope could reliably track continuously altered consciousness levels during propofol anesthesia. Furthermore, the frontal spectral slope may be a promising index for clinical monitoring of anesthesia depth.
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Affiliation(s)
- Yun Zhang
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Yubo Wang
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Huanhuan Cheng
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Fei Yan
- Department of Anesthesiology & Center for Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China
| | - Dingning Li
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Dawei Song
- Department of Anesthesiology & Center for Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China
| | - Qiang Wang
- Department of Anesthesiology & Center for Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China.
| | - Liyu Huang
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China.
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Sepúlveda PO, Vera R, Fernández MS, Lobo FA. Linear thinking does not reflect the newer 21st-century anesthesia concepts. A narrative review. J Clin Monit Comput 2023; 37:1133-1144. [PMID: 37129792 DOI: 10.1007/s10877-023-01021-5] [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: 12/03/2022] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
The brain constitutes a good example of a chaotic, nonlinear biological system where large neuronal networks operate chaotically with random connectivity. This critical state is significantly affected by the anesthetic loss of consciousness induced by drugs whose pharmacological behavior has been classically based on linear kinetics and dynamics. Recent developments in pharmacology and brain monitoring during anesthesia suggest a different view that we tried to explore in this article. The concepts of effect-site for hypnotic drugs modeling a maximum effect, electroencephalographic dynamics during induction, maintenance, and recovery from anesthesia are discussed, integrated into this alternative view, and how it may be applied in daily clinical practice.
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Affiliation(s)
- Pablo O Sepúlveda
- Hospital Base San José de Osorno, Chile, Universidad Austral de Chile, Osorno, Chile.
| | - Rodrigo Vera
- Ing. Civil Industrial, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Silvia Fernández
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Francisco A Lobo
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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10
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Zhang S, Liu A, Zhou Z, Huang Z, Cheng J, Chen D, Zhong Q, Yu Q, Peng Z, Hong M. Clinical features and power spectral entropy of electroencephalography in Wilson's disease with dystonia. Brain Behav 2022; 12:e2791. [PMID: 36282481 PMCID: PMC9759124 DOI: 10.1002/brb3.2791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/28/2022] [Accepted: 10/02/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To study the clinical features and power spectral entropy (PSE) of electroencephalography signals in Wilson's disease (WD) patients with dystonia. METHODS Several scale evaluations were performed to assess the clinical features of WD patients. Demographic information and electroencephalography signals were obtained in all subjects. RESULTS 34 WD patients with dystonia were recruited in the case group and 24 patients without dystonia were recruited in the control group. 20 healthy individuals were included in the healthy control group. The mean body mass index (BMI) in the case group was significantly lower than that in the controls (p < .05). The case group had significantly higher SAS, SDS, and Bucco-Facial-Apraxia Assessment scores (p < .05). Total BADS scores in the case group were lower than those in the control group (p < .01). Note that 94.11% of the case group presented with dysarthria and 70.59% of them suffered from dysphagia. Dysphagia was mainly related to the oral preparatory stage and oral stage. Mean power spectral entropy (PSE) values in the case group were significantly different (p < .05) from those in the control group and the healthy group across the different tasks. CONCLUSIONS The patients with dystonia were usually accompanied with low BMI, anxiety, depression, apraxia, executive dysfunction, dysarthria and dysphagia. The cortical activities of the WD patients with dystonia seemed to be more chaotic during the eyes-closed and reading tasks but lower during the swallowing stages than those in the control group.
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Affiliation(s)
- Shaoru Zhang
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Aiqun Liu
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Zhihua Zhou
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Zheng Huang
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Jing Cheng
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Danping Chen
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Qizhi Zhong
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Qingyun Yu
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Zhongxing Peng
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Mingfan Hong
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
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11
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Biggs D, Boncompte G, Pedemonte JC, Fuentes C, Cortinez LI. The effect of age on electroencephalogram measures of anesthesia hypnosis: A comparison of BIS, Alpha Power, Lempel-Ziv complexity and permutation entropy during propofol induction. Front Aging Neurosci 2022; 14:910886. [PMID: 36034131 PMCID: PMC9404504 DOI: 10.3389/fnagi.2022.910886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Improving anesthesia administration for elderly population is of particular importance because they undergo considerably more surgical procedures and are at the most risk of suffering from anesthesia-related complications. Intraoperative brain monitors electroencephalogram (EEG) have proved useful in the general population, however, in elderly subjects this is contentious. Probably because these monitors do not account for the natural differences in EEG signals between young and older patients. In this study we attempted to systematically characterize the age-dependence of different EEG measures of anesthesia hypnosis. Methods We recorded EEG from 30 patients with a wide age range (19–99 years old) and analyzed four different proposed indexes of depth of hypnosis before, during and after loss of behavioral response due to slow propofol infusion during anesthetic induction. We analyzed Bispectral Index (BIS), Alpha Power and two entropy-related EEG measures, Lempel-Ziv complexity (LZc), and permutation entropy (PE) using mixed-effect analysis of variances (ANOVAs). We evaluated their possible age biases and their trajectories during propofol induction. Results All measures were dependent on anesthesia stages. BIS, LZc, and PE presented lower values at increasing anesthetic dosage. Inversely, Alpha Power increased with increasing propofol at low doses, however this relation was reversed at greater effect-site propofol concentrations. Significant group differences between elderly patients (>65 years) and young patients were observed for BIS, Alpha Power, and LZc, but not for PE. Conclusion BIS, Alpha Power, and LZc show important age-related biases during slow propofol induction. These should be considered when interpreting and designing EEG monitors for clinical settings. Interestingly, PE did not present significant age differences, which makes it a promising candidate as an age-independent measure of hypnotic depth to be used in future monitor development.
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Affiliation(s)
- Daniela Biggs
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Boncompte
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Neurodynamics of Cognition Lab, Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan C. Pedemonte
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Programa de Farmacología y Toxicología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- *Correspondence: Juan C. Pedemonte,
| | - Carlos Fuentes
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis I. Cortinez
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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12
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Evaluation of Anesthetic Specific EEG Dynamics during State Transitions between Loss and Return of Responsiveness. Brain Sci 2021; 12:brainsci12010037. [PMID: 35053781 PMCID: PMC8773581 DOI: 10.3390/brainsci12010037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: electroencephalographic (EEG) information is used to monitor the level of cortical depression of a patient undergoing surgical intervention under general anesthesia. The dynamic state transitions into and out of anesthetic-induced loss and return of responsiveness (LOR, ROR) present a possibility to evaluate the dynamics of the EEG induced by different substances. We evaluated changes in the EEG power spectrum during anesthesia emergence for three different anesthetic regimens. We also assessed the possible impact of these changes on processed EEG parameters such as the permutation entropy (PeEn) and the cerebral state index (CSI). Methods: we analyzed the EEG from 45 patients, equally assigned to three groups. All patients were induced with propofol and the groups differed by the maintenance anesthetic regimen, i.e., sevoflurane, isoflurane, or propofol. We evaluated the EEG and parameter dynamics during LOR and ROR. For the emergence period, we focused on possible differences in the EEG dynamics in the different groups. Results: depending on the substance, the EEG emergence patterns showed significant differences that led to a substance-specific early activation of higher frequencies as indicated by the “wake” CSI values that occurred minutes before ROR in the inhalational anesthetic groups. Conclusion: our results highlight substance-specific differences in the emergence from anesthesia that can influence the EEG-based monitoring that probably have to be considered in order to improve neuromonitoring during general anesthesia.
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Sleigh J, Hight D. Is complexity complicated? Br J Anaesth 2021; 127:173-174. [PMID: 34147246 DOI: 10.1016/j.bja.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- J Sleigh
- Department of Anaesthesia, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand.
| | - D Hight
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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