Nonlinear and linear EEG complexity changes caused by gustatory stimuli in anorexia nervosa

Consciousness as a multidimensional phenomenon: implications for the assessment of disorders of consciousness

Disorders of consciousness (DoCs) pose a significant clinical and ethical challenge because they allow for complex forms of conscious experience in patients where intentional behaviour and communication are highly limited or non-existent. There is a pressing need for brain-based assessments that can precisely and accurately characterize the conscious state of individual DoC patients. There has been an ongoing research effort to develop neural measures of consciousness. However, these measures are challenging to validate not only due to our lack of ground truth about consciousness in many DoC patients but also because there is an open ontological question about consciousness. There is a growing, well-supported view that consciousness is a multidimensional phenomenon that cannot be fully described in terms of the theoretical construct of hierarchical, easily ordered conscious levels. The multidimensional view of consciousness challenges the utility of levels-based neural measures in the context of DoC assessment. To examine how these measures may map onto consciousness as a multidimensional phenomenon, this article will investigate a range of studies where they have been applied in states other than DoC and where more is known about conscious experience. This comparative evidence suggests that measures of conscious level are more sensitive to some dimensions of consciousness than others and cannot be assumed to provide a straightforward hierarchical characterization of conscious states. Elevated levels of brain complexity, for example, are associated with conscious states characterized by a high degree of sensory richness and minimal attentional constraints, but are suboptimal for goal-directed behaviour and external responsiveness. Overall, this comparative analysis indicates that there are currently limitations to the use of these measures as tools to evaluate consciousness as a multidimensional phenomenon and that the relationship between these neural signatures and phenomenology requires closer scrutiny.

The effect of photic stimulation alone and in combination with sleep deprivation after a seizure-like event - reappraisal by using linear and nonlinear EEG methods

ObjectivesThe present study aimed to compare the effectiveness of different provocation tests used for the study of the 'susceptibility to seizure' by quantitative electroencephalography (EEG) analysis.MethodsEight subjects with a history of a seizure-like disturbed consciousness participated in this preliminary study. A routine EEG was carried out with photic stimulation (eyes closed and after eyes open) at the beginning of the investigation. Some days later, a sleep-deprived EEG was recorded with the same protocol. Selected epochs (in eyes closed condition) after the stimulations were analysed with Point(wise) Correlation Dimension (PD2i) and Synchronization Likelihood (SL) methods. The results were compared to those obtained by similar analysis of the resting state (control) epochs with Wilcoxon Signed Rank Test (p ≤ 0.05).ResultsIn our study, significantly lower grand mean PD2i and higher delta SL values were found in sleep-deprived state after stimulation with eyes closed compared to the control. Our results indicated a lower-dimensional, hypersynchronous state of the brain as a consequence of these combined provocations.DiscussionThis may correspond to a possible 'preictal' state of the brain. Accordingly, it is suggested that photic stimulation together with sleep deprivation seems to be more effective in provocation - especially when the stimulation was made with eyes closed.

Clinical and Neurophysiological Correlates of Emotion and Food Craving Regulation in Patients with Anorexia Nervosa

Background: Difficulties in emotion regulation and craving regulation have been linked to eating symptomatology in patients with anorexia nervosa (AN), contributing to the maintenance of their eating disorder. Methods: To investigate clinical and electrophysiological correlates of these processes, 20 patients with AN and 20 healthy controls (HC) completed a computerized task during EEG recording, where they were instructed to down-regulate negative emotions or food craving. Participants also completed self-report measures of emotional regulation and food addiction. The P300 and Late Positive Potential (LPP) ERPs were analysed. Results: LPP amplitudes were significantly smaller during down-regulation of food craving among both groups. Independent of task condition, individuals with AN showed smaller P300 amplitudes compared to HC. Among HC, the self-reported use of re-appraisal strategies positively correlated with LPP amplitudes during emotional regulation task, while suppressive strategies negatively correlated with LPP amplitudes. The AN group, in comparison to the HC group, exhibited greater food addiction, greater use of maladaptive strategies, and emotional dysregulation. Conclusions: Despite the enhanced self-reported psychopathology among AN, both groups indicated neurophysiological evidence of food craving regulation as evidenced by blunted LPP amplitudes in the relevant task condition. Further research is required to delineate the mechanisms associated with reduced overall P300 amplitudes among individuals with AN.

A Systematic Review of Taste Differences Among People With Eating Disorders

BACKGROUND

Eating disorders are a significant cause of morbidity and mortality. The etiology and maintenance of eating-disorder symptoms are not well understood. Evidence suggests that there may be gustatory alterations in patients with eating disorders.

OBJECTIVE

This article systematically reviews research assessing gustatory differences in patients with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).

METHOD

A systematic review was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, examining taste and eating disorders. We reviewed electronic databases and identified 1,490 peer-reviewed English-language studies. Of these, 49 met inclusion criteria.

RESULTS

Studies employed psychophysical measures (n = 27), self-reported questionnaires (n = 5), and neuroimaging techniques (i.e., electroencephalography, functional magnetic resonance imaging; n = 17). Psychophysical studies showed that individuals with BN, in general, had greater preference for sweetness than healthy controls, and those with AN had a greater aversion for fat than controls. In neuroimaging studies, findings suggested that predictable administration of sweet-taste stimuli was associated with reduced activation in taste-reward regions of the brain among individuals with AN (e.g., insula, ventral, and dorsal striatum) but increased activation in BN and BED.

DISCUSSION

To our knowledge, this systematic review is the first to synthesize literature on taste differences in AN, BN, and BED. The inconsistency and variability in methods used across studies increased difficulties in comparing studies and disease processes. Further studies with well-defined population parameters are warranted to better understand how taste varies in patients with eating disorders.

How Does Food Taste in Anorexia and Bulimia Nervosa? A Protocol for a Quasi-Experimental, Cross-Sectional Design to Investigate Taste Aversion or Increased Hedonic Valence of Food in Eating Disorders

Background: Despite on-going efforts to better understand dysregulated eating, the olfactory-gustatory deficits and food preferences in eating disorders (ED), and the mechanisms underlying the perception of and responses to food properties in anorexia nervosa (AN) and bulimia nervosa (BN) remain largely unknown; both during the course of the illness and compared to healthy populations. It is, therefore, necessary to systematically investigate the gustatory perception and hedonics of taste in patients with AN and BN. To this end, we will examine whether aversions to the taste of high-calorie food is related to the suppression of energy intake in restricting-type AN, and whether an increased hedonic valence of sweet, caloric-dense foods may be part of the mechanisms triggering binge-eating episodes in BN. In addition, the role of cognitions influencing these mechanisms will be examined.

Method: In study 1, four mixtures of sweet-fat stimuli will be presented in a sensory two-alternative forced-choice test involving signal detection analysis. In study 2, a full-scale taste reactivity test will be carried out, including psychophysiological and behavioral measures to assess subtle and covert hedonic changes. We will compare the responses of currently-ill AN and BN patients to those who have recovered from AN and BN, and also to those of healthy normal-weight and underweight individuals without any eating disorder pathology.

Discussion: If taste response profiles are differentially linked to ED types, then future studies should investigate whether taste responsiveness represents a useful diagnostic measure in the prevention, assessment and treatment of EDs. The expected results on cognitive mechanisms in the top-down processes of food hedonics will complement current models and contribute to the refinement of interventions to change cognitive aspects of taste aversions, to establish functional food preferences and to better manage food cravings associated with binge-eating episodes. No trial registration was required for this protocol, which was approved by the Swiss ethics committee (CER-VD, n° 2016-02150) and the Ethics Review Panel of the University of Luxembourg.

Classification of Obsessive Compulsive Disorder by EEG Complexity and Hemispheric Dependency Measurements

In the present study, both single channel electroencephalography (EEG) complexity and two channel interhemispheric dependency measurements have newly been examined for classification of patients with obsessive–compulsive disorder (OCD) and controls by using support vector machine classifiers. Three embedding entropy measurements (approximate entropy, sample entropy, permutation entropy (PermEn)) are used to estimate single channel EEG complexity for 19-channel eyes closed cortical measurements. Mean coherence and mutual information are examined to measure the level of interhemispheric dependency in frequency and statistical domain, respectively for eight distinct electrode pairs placed on the scalp with respect to the international 10–20 electrode placement system. All methods are applied to short EEG segments of 2 s. The classification performance is measured 20 times with different 2-fold cross-validation data for both single channel complexity features (19 features) and interhemispheric dependency features (eight features). The highest classification accuracy of 85 ±5.2% is provided by PermEn at prefrontal regions of the brain. Even if the classification success do not provided by other methods as high as PermEn, the clear differences between patients and controls at prefrontal regions can also be obtained by using other methods except coherence. In conclusion, OCD, defined as illness of orbitofronto-striatal structures [Beucke et al., JAMA Psychiatry 70 (2013) 619–629; Cavedini et al., Psychiatry Res. 78 (1998) 21–28; Menzies et al., Neurosci. Biobehav. Rev. 32(3) (2008) 525–549], is caused by functional abnormalities in the pre-frontal regions. Particularly, patients are characterized by lower EEG complexity at both pre-frontal regions and right fronto-temporal locations. Our results are compatible with imaging studies that define OCD as a sub group of anxiety disorders exhibited a decreased complexity (such as anorexia nervosa [Toth et al., Int. J. Psychophysiol. 51(3) (2004) 253–260] and panic disorder [Bob et al., Physiol. Res. 55 (2006) S113–S119]).

Complexity of spontaneous brain activity in mental disorders

Recent reports of functional and anatomical studies have provided evidence that aberrant neural connectivity lies at the heart of many mental disorders. Information related to neural networks has elucidated the nonlinear dynamical complexity in brain signals over a range of temporal scales. The recent advent of nonlinear analytic methods, which have served for the quantitative description of the brain signal complexity, has provided new insights into aberrant neural connectivity in many mental disorders. Although many studies have underpinned aberrant neural connectivity, findings related to complexity behavior are still inconsistent. This inconsistency might result from (i) heterogeneity in mental disorders, (ii) analytical issues, (iii) interference of typical development and aging. First, most mental disorders are heterogeneous in their clinical feature or intrinsic pathological mechanisms. Second, neurophysiologic output signals from complex brain connectivity might be characterized with multiple time scales or frequencies. Finally, age-related brain complexity changes must be considered when investigating pathological brain because typical brain complexity is not constant across generations. Future systematic studies addressing these issues will greatly expand our knowledge of neural connections and dynamics related to mental disorders.

Electroencephalography in eating disorders

Clinical applications of electroencephalography (EEG) are used with different objectives, EEG being a noninvasive and painless procedure. In respect of eating disorders, in the 1950s a new line of study about the neurological bases of anorexia nervosa was started and has since been developed. The purpose of this review is to update the existing literature data on the main findings in respect of EEG in eating disorders by means of a search conducted in PubMed. Despite the fact that weight gain tends to normalize some brain dysfunctions assessed by means of EEG, the specific effect of gaining weight remains controversial. Different studies have reported that cortical dysfunctions can be found in patients with anorexia nervosa even after weight gain, whereas others have reported a normalization of EEG in respect of the initial reduced alpha/ increased beta power in those patients with refeeding. Findings of studies that have analyzed the possible relationship between eating disorders and depression, based on sleep EEG disturbances, do not support the idea of eating disorders as a variant of depression or affective disorders. Some EEG findings are very consistent with previous neuroimaging results on patients with anorexia nervosa, reporting neural disturbances in response to stimuli that are relevant to the pathology (eg, stimuli like food exposure, different emotional situations, or body images).

Taste reactivity deficit in anorexia nervosa

AIM

Anorexia nervosa is a complex psychiatric disorder posing a rapidly increasing burden on modern societies. Our purpose was to clarify perceptual-motivational aspects of gustatory disturbances in the disease.

METHODS

A taste reactivity test, with the use of all five primary qualities in two concentrations, was performed in restrictive-type anorexic patients, and their hedonic evaluations were compared to those of age-matched healthy control subjects.

RESULTS

The patients gave significantly lower pleasantness scores for pleasant taste stimuli compared with controls. The differences were the greatest for the lower concentration sucrose, umami and sodium chloride. Ratings given for the aversive taste stimuli were similar in both experimental groups.

CONCLUSION

Our findings contribute to a better understanding of complex symptoms of anorexia nervosa, and may also help to develop more effective cognitive-behavioral therapies.

Modified sham feeding of sweet solutions in women with anorexia nervosa

Anorexia Nervosa (AN) is a disorder of self-starvation characterized by decreased meal size and food intake. While it is possible that reduced food intake in AN reflects an excess of inhibitory factors, e.g., cognitive inhibition related to fear of weight gain or abnormal postingestive negative feedback, it is also possible that decreased intake reflects diminished orosensory stimulation of food intake. This has been difficult to test directly because the amount of food ingested during a test meal by patients with AN reflects an integration of orosensory excitatory, and cognitive, learned, and postingestive inhibitory controls of eating. To begin to dissociate these controls, we adapted the modified sham feeding technique (MSF) to measure the intake of a series of sweetened solutions in the absence of postingestive stimulation. Subjects with AN (n=24) and normal controls (NC, n=10) were randomly presented with cherry Kool Aid solutions sweetened with five concentrations of aspartame (0, 0.01, 0.03, 0.08 and 0.28%) in a closed opaque container fitted with a straw. They were instructed to sip as much as they wanted of the solution during 15 1-minute trials and to spit the fluid out into another opaque container. Subjects with AN sipped less unsweetened solution than NC (p<0.05). Because this difference appeared to account completely for the smaller intakes of sweetened solutions by AN, responsiveness of intake to sweet taste per se was not different in AN and NC. Since MSF eliminated postingestive and presumably cognitive inhibitory controls, and the orosensory response to sweet taste was not different in AN than NC, we conclude that decreased intake by AN subjects under these conditions reflects the increased inhibition characteristic of this disorder that is presumably learned, with a possible contribution of decreased potency of orosensory stimulation by the sipped solutions.

Reward and neurocomputational processes

The neurobiology of eating disorders (EDs) is largely unknown. However, brain imaging studies over the past decade have identified neurotransmitter alterations that could be part of dysfunctional behavior characteristics of EDs. In this chapter we focus on a specific behavioral construct, the brain reward system, and demonstrate a functional brain imaging approach toward identifying dopamine function in anorexia nervosa (AN). We demonstrate how human brain reward activation can be used in a translational approach to test whether computer models, based on basic science research, can predict expected in vivo reward system activation, and how such an approach can identify specific biologic alterations in a psychiatric population.

Non-linear quantitative electroencephalographic (qEEG) changes during processing of chemo-sensory stimulations: a preliminary study

The present study was to investigate the processing of pleasant smell and taste stimuli by non-linear EEG measures. Point correlation dimension (PD2i) has been used for studying the local, and synchronization likelihood (SL) the global dynamical organization. Nine healthy subjects participated in this study. After a baseline period of 30s the patients were given a perfume cap or a chocolate taste for 30s. The analysis was performed off-line on 16 channels. After smell stimulation an immediate bilateral but short response was seen. First a decrease and afterwards an increase were found in the mean PD2i. In contrast, the taste stimulation resulted in a later reaction mainly on the right side. The SL in the slow alpha band decreased during the first 15s after both stimulations. In the second 15s, however, a remarkable SL increase was seen mainly in the 7-14Hz and in every frequency band. The decreased mean PD2i and SL values could be interpreted by the simplified network preparation to cognitive data processing. The PD2i and SL methods detected subtle dynamical changes during olfactory and gustatory processes suitable for collection normative database to pathological conditions.

On the meaning and interpretation of global descriptors of brain electrical activity. Including a reply to X. Pei et al

Global descriptors of the brain's electrical activity, Sigma, Phi, and Omega, provide a comprehensive characterisation of brain functional states. Recently, Pei et al. [Pei, X., Zheng, C., Zhang, A., Duan, F., Bin, G., 2005. Discussion on "Towards a quantitative characterisation of functional states of the brain: from the nonlinear methodology to the global linear description" by J. Wackermann. Int. J. Psychophysiol. 56, 201-207] discussed the effects of signal power on the global measure of spatial complexity, Omega, and suggested a modification consisting in epoch-wise and channel-wise normalisation of input data to unit power. In the present paper, the basic principles of the global approach are reviewed, and the issues of Pei et al.'s approach are assessed. The original and the modified measures of spatial complexity are compared in two case studies. Numerical simulation shows that both methods veridically estimate small numbers of signal sources, but systematically underestimate as the number increases; the modified method yields a minor relative improvement. A study on real EEG data shows that the two measures sensibly differ only where artefactual inhomogeneities in channel variances affect the data; a combined procedure, consisting in record-wise equalisation of channel variances before Omega calculations, is suggested as the optimal strategy. Differences between the original objectives of the global methodology and the proposed modifications are pointed out and critically discussed.

Increased omega complexity and decreased microstate duration in nonmedicated schizophrenic patients

To explore brain functions in schizophrenic patients, the global analytic strategy of multichannel EEG was performed that combines measures of global complexity (Omega), total power (Sigma) and generalized frequency (Phi), and EEG microstate analysis was applied to multichannel EEG data for 24 nonmedicated patients and 24 healthy subjects. The patients had higher Omega and Sigma values, and lower Phi values compared with healthy subjects. Three topographical classes were obtained from all EEG data by EEG microstate analysis. The mean duration of one topographical class in the patients was shortened compared to healthy subjects. These results indicated looser cooperativity, or decreased connectivity of the active brain process and deviant brain information processing in schizophrenic patients.

Nonlinear dynamical analysis of EEG and MEG: review of an emerging field

Many complex and interesting phenomena in nature are due to nonlinear phenomena. The theory of nonlinear dynamical systems, also called 'chaos theory', has now progressed to a stage, where it becomes possible to study self-organization and pattern formation in the complex neuronal networks of the brain. One approach to nonlinear time series analysis consists of reconstructing, from time series of EEG or MEG, an attractor of the underlying dynamical system, and characterizing it in terms of its dimension (an estimate of the degrees of freedom of the system), or its Lyapunov exponents and entropy (reflecting unpredictability of the dynamics due to the sensitive dependence on initial conditions). More recently developed nonlinear measures characterize other features of local brain dynamics (forecasting, time asymmetry, determinism) or the nonlinear synchronization between recordings from different brain regions. Nonlinear time series has been applied to EEG and MEG of healthy subjects during no-task resting states, perceptual processing, performance of cognitive tasks and different sleep stages. Many pathologic states have been examined as well, ranging from toxic states, seizures, and psychiatric disorders to Alzheimer's, Parkinson's and Cre1utzfeldt-Jakob's disease. Interpretation of these results in terms of 'functional sources' and 'functional networks' allows the identification of three basic patterns of brain dynamics: (i) normal, ongoing dynamics during a no-task, resting state in healthy subjects; this state is characterized by a high dimensional complexity and a relatively low and fluctuating level of synchronization of the neuronal networks; (ii) hypersynchronous, highly nonlinear dynamics of epileptic seizures; (iii) dynamics of degenerative encephalopathies with an abnormally low level of between area synchronization. Only intermediate levels of rapidly fluctuating synchronization, possibly due to critical dynamics near a phase transition, are associated with normal information processing, whereas both hyper-as well as hyposynchronous states result in impaired information processing and disturbed consciousness.