Long-term stability of frontal electroencephalographic asymmetry in adults with a history of depression and controls

Closed-loop neurostimulation for the treatment of psychiatric disorders

Despite increasing prevalence and huge personal and societal burden, psychiatric diseases still lack treatments which can control symptoms for a large fraction of patients. Increasing insight into the neurobiology underlying these diseases has demonstrated wide-ranging aberrant activity and functioning in multiple brain circuits and networks. Together with varied presentation and symptoms, this makes one-size-fits-all treatment a challenge. There has been a resurgence of interest in the use of neurostimulation as a treatment for psychiatric diseases. Initial studies using continuous open-loop stimulation, in which clinicians adjusted stimulation parameters during patient visits, showed promise but also mixed results. Given the periodic nature and fluctuations of symptoms often observed in psychiatric illnesses, the use of device-driven closed-loop stimulation may provide more effective therapy. The use of a biomarker, which is correlated with specific symptoms, to deliver stimulation only during symptomatic periods allows for the personalized therapy needed for such heterogeneous disorders. Here, we provide the reader with background motivating the use of closed-loop neurostimulation for the treatment of psychiatric disorders. We review foundational studies of open- and closed-loop neurostimulation for neuropsychiatric indications, focusing on deep brain stimulation, and discuss key considerations when designing and implementing closed-loop neurostimulation.

The within-person association of relative left frontal activity and vagally mediated heart rate variability not moderated by history of depression

Motivated by the Neurovisceral Integration Model (NVI) of cardiac vagal control, we investigated the relationship between relative left frontal activity (rLFA) and vagally mediated heart rate variability or respiratory sinus arrhythmia (RSA) in 287 participants, half of whom had a history of depression. We hypothesized that there would be a within-person association of rLFA and RSA such that when RSA is lower rLFA would also be lower (Hypothesis I). Moreover, it was hypothesized that this within-subject association would be moderated by a history of depression (Hypothesis II). Metrics of rLFA and RSA were derived from concurrent electroencephalogram and electrocardiogram recordings. The logarithmic difference in EEG alpha power between the homologous right and left electrodes (Ln (Right/Left)) in the frontal region was used to index rLFA. A Hilbert transform was applied to the mean-centered and bandpass-filtered (0.12-.40 Hz) inter-beat interval (IBI) time series to get a fine-grained measure (in the time domain) of RSA. A linear mixed ANOVA model with rLFA as the dependent variable and RSA as the main fixed effect found that participants had less rLFA during epochs when they had lower RSA, which was consistent with the prediction from Hypothesis I. Contrary to the prediction from Hypothesis II, the within-person association of RSA and rLFA was not moderated by a history of depression. However, the association between RSA and rLFA varied across the four pairs of frontal electrodes that we examined. Thus, more research is needed to determine the spatial extent of this association, e.g., examining the relationship between source-localized rLFA and RSA.

Network analysis of frontal lobe alpha asymmetry confirms the neurophysiological basis of four subtypes of depressive behavior

Introduction

Although depression is widespread carries a major disease burden, current treatments remain non-universally effective, arguably due to the heterogeneity of depression, and leading to the consideration of depressive "subtypes" or "depressive behavior subtypes." One such model of depressive behavior (DB) subtypes was investigated for its associations with frontal lobe asymmetry (FLA), using a different data analytic procedure than in previous research in this field.

Methods

100 community volunteers (54 males, 46 females) aged between 18 yr. and 75 years (M = 32.53 yr., SD = 14.13 yr) completed the Zung Self-rating Depression Scale (SDS) and underwent 15 min of eyes closed EEG resting data collection across 10 frontal lobe sites. DB subtypes were defined on the basis of previous research using the SDS, and alpha-wave (8-13 Hz) data produced an index of FLA. Data were examined via network analysis.

Results

Several network analyses were conducted, producing two models of the association between DB subtypes and FLA, confirming unique neurophysiological profiles for each of the four DB subtypes.

Discussion

As well as providing a firm basis for using these DB subtypes in clinical settings, these findings provide a reasonable explanation for the inconsistency in previous FLA-depression research.

EEG frontal lobe asymmetry as a function of sex, depression severity, and depression subtype

To investigate possible contributors to the inconsistent association between frontal lobe asymmetry (FLA) and depression, EEG data were collected across five frontal sites, and examined for their associations with four subtypes of depression (Depressed mood, Anhedonia, Cognitive depression, Somatic depression). One hundred community volunteers (54 males, 46 females) aged at least 18 yr completed standardized scales for depression and anxiety, and gave EEG data under Eyes Open and Eyes Closed conditions. Results indicated that, although there was no significant correlation between the differences in EEG power across each of the five pairs of frontal sites and total depression scores, there were several meaningful correlations (accounting for at least 10% of the variance) between specific EEG site differences data and each of the four depression subtypes. There were also different patterns of association between FLA and the depression subtypes according to sex, and total depression severity. These findings help to explain the apparent inconsistency in previous FLA-depression results, and argue for a more nuanced approach to this hypothesis.

Functional role of frontal electroencephalogram alpha asymmetry in the resting state in patients with depression: A review

Depression is a psychological disorder that affects the general public worldwide. It is particularly important to make an objective and accurate diagnosis of depression, and the measurement methods of brain activity have gradually received increasing attention. Resting electroencephalogram (EEG) alpha asymmetry in patients with depression shows changes in activation of the alpha frequency band of the left and right frontal cortices. In this paper, we review the findings of the relationship between frontal EEG alpha asymmetry in the resting state and depression. Based on worldwide studies, we found the following: (1) Compared with individuals without depression, those with depression showed greater right frontal EEG alpha asymmetry in the resting state. However, the pattern of frontal EEG alpha asymmetry in the resting state in depressive individuals seemed to disappear with age; (2) Compared with individuals without maternal depression, those with maternal depression showed greater right frontal EEG alpha asymmetry in the resting state, which indicated that genetic or experience-based influences have an impact on frontal EEG alpha asymmetry at rest; and (3) Frontal EEG alpha asymmetry in the resting state was stable, and little or no change occurred after antidepressant treatment. Finally, we concluded that the contrasting results may be due to differences in methodology, clinical characteristics, and participant characteristics.

Handedness and depression: A meta-analysis across 87 studies

Alterations in functional brain lateralization, often indicated by an increased prevalence of left- and/or mixed-handedness, have been demonstrated in several psychiatric and neurodevelopmental disorders like schizophrenia or autism spectrum disorder. For depression, however, this relationship is largely unclear. While a few studies found evidence that handedness and depression are associated, both the effect size and the direction of this association remain elusive. Here, we collected data from 87 studies totaling 35,501 individuals to provide a precise estimate of differences in left-, mixed- and non-right-handedness between depressed and healthy samples and computed odds ratios (ORs) between these groups. Here, an OR > 1 signifies higher rates of atypical handedness in depressed compared to healthy samples. We found no differences in left- (OR = 1.04, 95% CI = [0.95, 1.15], p = .384), mixed- (OR = 1.64, 95% CI = [0.98, 2.74], p = .060) or non-right-handedness (OR = 1.05, 95% CI = [0.96, 1.15], p = .309) between the two groups. We could thus find no link between handedness and depression on the meta-analytical level.

Frontal and parietal EEG alpha asymmetry: a large-scale investigation of short-term reliability on distinct EEG systems

EEG resting-state alpha asymmetry is one of the most widely investigated forms of functional hemispheric asymmetries in both basic and clinical neuroscience. However, studies yield inconsistent results. One crucial prerequisite to obtain reproducible results is the reliability of the index of interest. There is a body of research suggesting a moderate-to-good reliability of EEG resting-state alpha asymmetry, but unfortunately sample sizes in these studies are typically small. This study presents the first large-scale short-term reliability study of frontal and parietal EEG resting-state alpha asymmetry. We used the Dortmund Vital Study data set containing 370 participants. In each participant, EEG resting state was recorded eight times, twice with their eyes opened, twice with their eyes-closed, each on two different EEG systems. We found good reliability of EEG alpha power and alpha asymmetry on both systems for electrode pairs. We also found that alpha power asymmetry reliability is higher in the eyes-closed condition than in the eyes-open condition. The frontomedial electrode pair showed weaker reliability than the frontolateral and parietal electrode pairs. Interestingly, we found no population-level alpha asymmetry in frontal electrodes, one of the most investigated electrode sites in alpha asymmetry research. In conclusion, our results suggest that while EEG alpha asymmetry is an overall reliable measure, frontal alpha asymmetry should be assessed using multiple electrode pairs.

Longitudinal investigation of shyness and physiological vulnerability: Moderating influences of attention biases to threat and safety

Shyness has long been identified as a vulnerability factor to developing psychosocial problems, but there is heterogeneity in these observed outcomes. One potential factor underlying these relations is individual differences in threat sensitivity. Using a longitudinal design, we examined whether attentional biases toward social threat and safety measured during adulthood moderated the association between shyness measured in emerging adulthood (N = 83, n_female = 48; M_age = 23.56 years, SD_age = 1.09 years) and frontal electroencephalogram (EEG) asymmetry at rest, a physiological index of vulnerability to psychopathology, measured nearly a decade later in adulthood (M_age = 31.68 years, SD_age = 2.27 years). We found that only biases to threat moderated the association between shyness and resting frontal EEG asymmetry longitudinally. In individuals who displayed relative vigilance to social threat, shyness was associated with greater relative right frontal EEG activity at rest (i.e., increased physiological vulnerability). These findings suggest that attentional biases to threat may play a role in understanding the relation between shyness and some known physiological vulnerabilities to psychopathology in adults.

No relationship between frontal alpha asymmetry and depressive disorders in a multiverse analysis of five studies

For decades, the frontal alpha asymmetry (FAA) - a disproportion in EEG alpha oscillations power between right and left frontal channels - has been one of the most popular measures of depressive disorders (DD) in electrophysiology studies. Patients with DD often manifest a left-sided FAA: relatively higher alpha power in the left versus right frontal lobe. Recently, however, multiple studies failed to confirm this effect, questioning its reproducibility. Our purpose is to thoroughly test the validity of FAA in depression by conducting a multiverse analysis - running many related analyses and testing the sensitivity of the effect to changes in the analytical approach - on data from five independent studies. Only 13 of the 270 analyses revealed significant results. We conclude the paper by discussing theoretical assumptions underlying the FAA and suggest a list of guidelines for improving and expanding the EEG data analysis in future FAA studies.

Transcranial alternating current stimulation (tACS): from basic mechanisms towards first applications in psychiatry

Transcranial alternating current stimulation (tACS) is a unique form of non-invasive brain stimulation. Sinusoidal alternating electric currents are delivered to the scalp to affect mostly cortical neurons. tACS is supposed to modulate brain function and, in turn, cognitive processes by entraining brain oscillations and inducing long-term synaptic plasticity. Therefore, tACS has been investigated in cognitive neuroscience, but only recently, it has been also introduced in psychiatric clinical trials. This review describes current concepts and first findings of applying tACS as a potential therapeutic tool in the field of psychiatry. The current understanding of its mechanisms of action is explained, bridging cellular neuronal activity and the brain network mechanism. Revisiting the relevance of altered brain oscillations found in six major psychiatric disorders, putative targets for the management of mental disorders using tACS are discussed. A systematic literature search on PubMed was conducted to report findings of the clinical studies applying tACS in patients with psychiatric conditions. In conclusion, the initial results may support the feasibility of tACS in clinical psychiatric populations without serious adverse events. Moreover, these results showed the ability of tACS to reset disturbed brain oscillations, and thus to improve behavioural outcomes. In addition to its potential therapeutic role, the reactivity of the brain circuits to tACS could serve as a possible tool to determine the diagnosis, classification or prognosis of psychiatric disorders. Future double-blind randomised controlled trials are necessary to answer currently unresolved questions. They may aim to detect response predictors and control for various confounding factors.

Consistency of EEG asymmetry patterns in infants of depressed mothers

We evaluated frontal electroencephalogram (EEG) asymmetry across multiple contexts as an index of a general affective response predisposition in 12-month-old infants whose mothers were at elevated risk for perinatal depression due to their mother's history of depression. We further examined mothers' prenatal, postnatal, and concurrent depressive symptom levels in relation to infants' frontal EEG asymmetry consistency. Mothers (n = 132) with a history of depression prior to pregnancy completed depressive symptom scales repeatedly during pregnancy and the first year postpartum. Their 12-month-old infants' frontal EEG asymmetry was recorded across five contexts (baseline/bubbles, peek-a-boo, play, feeding, and distract). Frontal EEG asymmetries showed small to moderate correlations across contexts. Mothers' prenatal depression symptom levels (not postnatal or concurrent) were associated with infants having consistent right, rather than left, frontal EEG asymmetry, even after controlling for infants' observed affect. These findings demonstrate the consistency of EEG asymmetry scores across contexts in 12-month-old infants at risk for the development of psychopathology, providing support for relative right frontal EEG asymmetry as a trait marker of vulnerability to depression. Findings also suggest the importance of mothers' prenatal, rather than postnatal or concurrent depression, in predicting infants' consistent patterns of relative right frontal EEG asymmetry across contexts.

Exploring approach motivation: Correlating self-report, frontal asymmetry, and performance in the Effort Expenditure for Rewards Task

Frontal EEG asymmetry has been investigated as a physiological metric of approach motivation, with higher left frontal activity (LFA) suggested to reflect approach motivation. However, correlations between LFA and traditional metrics of approach motivation (e.g., scores from the behavioral inhibition system/behavioral approach system [BIS/BAS] survey) are inconsistent. It is also not clear how LFA correlates to approach motivation on an observable, behavioral level. Here, we tested correlations between BIS/BAS scores, LFA, and performance in the Effort Expenditure for Rewards Task (EEfRT). In our sample (n = 49), BIS/BAS results did not correlate to LFA values (resting or task states), and were also unrelated to EEfRT performance variables. We found evidence of significant and distinct correlations between LFA and EEfRT performance. Resting-state LFA positively correlated to effort expenditure on lower utility trials, where reward size and/or probability were suboptimal. Task-onset LFA captured in the first 5 min of the task was related to overall behavioral performance in the EEfRT. High task-onset LFA correlated to high trial completion rates, high-effort trial selection percentages, and overall monetary earnings. One interpretation of these initial findings is that resting-state LFA reflects approach tendencies to expend effort, but that this extends to suboptimal situations, whereas task-state LFA better reflects effortful approach toward high-utility goals. Given the relatively small sample size and the risk of Type I/II errors, we present the study as exploratory and the results as preliminary. However, the findings highlight interesting initial links between LFA and EEfRT performance. The need for larger replication studies is discussed.

Real-Time Stress Assessment Using Sliding Window Based Convolutional Neural Network

Mental stress has been identified as a significant cause of several bodily disorders, such as depression, hypertension, neural and cardiovascular abnormalities. Conventional stress assessment methods are highly subjective and tedious and tend to lack accuracy. Machine-learning (ML)-based computer-aided diagnosis systems can be used to assess the mental state with reasonable accuracy, but they require offline processing and feature extraction, rendering them unsuitable for real-time applications. This paper presents a real-time mental stress assessment approach based on convolutional neural networks (CNNs). The CNN-based approach afforded real-time mental stress assessment with an accuracy as high as 96%, the sensitivity of 95%, and specificity of 97%. The proposed approach is compared with state-of-the-art ML techniques in terms of accuracy, time utilisation, and quality of features.

Brainwaves Oscillations as a Potential Biomarker for Major Depression Disorder Risk

Major depressive disorder (MDD) is a multidimensional disorder that is characterized by the presence of alterations in mood, cognitive capacity, sensorimotor, and homeostatic functions. Given that about half of the patients diagnosed with MDD do not respond to the various current treatments, new techniques are being sought to predict not only the course of the disease but also the characteristics that differentiate responders from non-responders. Using the electroencephalogram, a noninvasive and inexpensive tool, most studies have proposed that patients with MDD have some lateralization in brain electrical activity, with alterations in alpha and theta rhythms being observed, which would be related to dysfunctions in emotional capacity such as the absence or presence of responses to the different existing treatments. These alterations help in the identification of subjects at high risk of suffering from depression, in the differentiation into responders and nonresponders to various therapies (pharmacological, electroconvulsive therapy, and so on), as well as to establish in which period of the disease the treatment will be more effective. Although the data are still inconclusive and more research is needed, these alpha and theta neurophysiological markers could support future clinical practice when it comes to establishing an early diagnosis and treating state disorders more successfully and accurately of mood disorders.

Stability of frontal alpha asymmetry in depressed patients during antidepressant treatment

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Frontal alpha asymmetry (FAA) is moderately stable over time.

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Antidepressant response prediction with FAA remains consistent, even after 8 weeks of treatment.

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FAA is a differential predictor of antidepressant response robust to state and drug effects.

Introduction

Frontal alpha asymmetry (FAA) is a proposed prognostic biomarker in major depressive disorder (MDD), conventionally acquired with electroencephalography (EEG). Although small studies attributed trait-like properties to FAA, a larger sample is needed to reliably asses this characteristic. Furthermore, to use FAA to predict treatment response, determining its stability, including the potential dependency on depressive state or medication, is essential.

Methods

In the international Study to Predict Optimized Treatment in Depression (iSPOT-D), a multi-center, randomized, prospective open-label trial, 1008 MDD participants were randomized to treatment with escitalopram, sertraline or venlafaxine-extended release. Treatment response was established eight weeks after treatment initiation and resting state EEG was measured both at baseline and after eight weeks (n = 453).

Results

FAA did not change significantly after eight weeks of treatment (n = 453, p = .234), nor did we find associations with age, sex, depression severity, or change in depression severity. After randomizing females to escitalopram or sertraline, for whom treatment response could be predicted in an earlier study, FAA after eight weeks resulted in equivalent response prediction as baseline FAA (one tailed p = .028).

Conclusion

We demonstrate that FAA is a stable trait, robust to time, state and pharmacological status. This confirms FAA stability. Furthermore, as prediction of treatment response is irrespective of moment of measurement and use of medication, FAA can be used as a state-invariant prognostic biomarker with promise to optimize MDD treatments.

No Alterations of Brain Structural Asymmetry in Major Depressive Disorder: An ENIGMA Consortium Analysis

OBJECTIVE

Asymmetry is a subtle but pervasive aspect of the human brain, and it may be altered in several psychiatric conditions. MRI studies have shown subtle differences of brain anatomy between people with major depressive disorder and healthy control subjects, but few studies have specifically examined brain anatomical asymmetry in relation to this disorder, and results from those studies have remained inconclusive. At the functional level, some electroencephalography studies have indicated left fronto-cortical hypoactivity and right parietal hypoactivity in depressive disorders, so aspects of lateralized anatomy may also be affected. The authors used pooled individual-level data from data sets collected around the world to investigate differences in laterality in measures of cortical thickness, cortical surface area, and subcortical volume between individuals with major depression and healthy control subjects.

METHODS

The authors investigated differences in the laterality of thickness and surface area measures of 34 cerebral cortical regions in 2,256 individuals with major depression and 3,504 control subjects from 31 separate data sets, and they investigated volume asymmetries of eight subcortical structures in 2,540 individuals with major depression and 4,230 control subjects from 32 data sets. T1-weighted MRI data were processed with a single protocol using FreeSurfer and the Desikan-Killiany atlas. The large sample size provided 80% power to detect effects of the order of Cohen's d=0.1.

RESULTS

The largest effect size (Cohen's d) of major depression diagnosis was 0.085 for the thickness asymmetry of the superior temporal cortex, which was not significant after adjustment for multiple testing. Asymmetry measures were not significantly associated with medication use, acute compared with remitted status, first episode compared with recurrent status, or age at onset.

CONCLUSIONS

Altered brain macro-anatomical asymmetry may be of little relevance to major depression etiology in most cases.

Beyond frontal alpha: investigating hemispheric asymmetries over the EEG frequency spectrum as a function of sex and handedness

Frontal alpha EEG asymmetry, an indirect marker of asymmetries in relative frontal brain activity, are widely used in research on lateralization of emotional processing. While most authors focus on frontal electrode pairs (e.g., F3/F4 or F7/F8), several recent studies have indicated that EEG asymmetries can also be observed outside the frontal lobe and in frequency bands other than alpha. Because the focus of most EEG asymmetry research is on the correlations between asymmetry and other traits, much less is known about the distribution of patterns of asymmetry at the population level. To systematically assess these asymmetries in a representative sample, we determined EEG asymmetries across the head in the alpha, beta, delta and theta frequency bands in 235 healthy adults. We found significant asymmetries in all four frequency bands and across several brain areas, indicating that EEG asymmetries are not limited to frontal alpha. Asymmetries were not modulated by sex. They were modulated by direction of hand preference, with stronger right-handedness predicting greater right (relative to left) alpha power, or greater left (relative to right) activity. Taken together, the present results show that EEG asymmetries other than frontal alpha represent markers of asymmetric brain function that should be explored further.

Frontal alpha asymmetry as a diagnostic marker in depression: Fact or fiction? A meta-analysis

BACKGROUND

Frontal alpha asymmetry (FAA) has frequently been reported as potential discriminator between depressed and healthy individuals, although contradicting results have been published. The aim of the current study was to provide an up to date meta-analysis on the diagnostic value of FAA in major depressive disorder (MDD) and to further investigate discrepancies in a large cross-sectional dataset.

METHODS

SCOPUS database was searched through February 2017. Studies were included if the article reported on both MDD and controls, provided an FAA measure involving EEG electrodes F3/F4, and provided data regarding potential covariates. Hedges' d was calculated from FAA means and standard deviations (SDs). Potential covariates, such as age and gender, were explored. Post hoc analysis was performed to elucidate interindividual differences that could explain interstudy discrepancies.

RESULTS

16 studies were included (MDD: n = 1883, controls: n = 2161). After resolving significant heterogeneity by excluding studies, a non-significant Grand Mean effect size (ES) was obtained (d = - 0.007;CI = [- 0.090]-[0.075]). Crosssectional analyses showed a significant three-way interaction for Gender × Age × Depression severity in the depressed group, which was prospectively replicated in an independent sample.

CONCLUSIONS

The main result was a non-significant, negligible ES, demonstrating limited diagnostic value of FAA in MDD. The high degree of heterogeneity across studies indicates covariate influence, as was confirmed by crosssectional analyses, suggesting future studies should address this Gender × Age × Depression severity interaction. Upcoming studies should focus more on prognostic and research domain usages of FAA rather than a pure diagnostic tool.

The effects of gender and depression severity on the association between alpha asymmetry and depression across four brain regions

Data describing the association between EEG asymmetry and depression status have been equivocal. Effects from brain regions involved, depression severity, and the generalisability of findings across genders, have been inconsistently examined and/or verified. This study investigated these issues within a community sample to potentially expand the asymmetry hypothesis to non-severe depression participants. The singular effects of brain region and electrode site, gender, and depression severity, plus the interaction between gender and depression severity across brain regions were investigated in a study of alpha asymmetry among 46 males and 54 females (M age=32.5 yr, SD=14.13 yr) using the Self-rating Depression Scale (Zung, 1973). There was no significant difference across genders or age for depression severity. Dichotomous classification of depressed state produced similar but slightly different results from analysis of the whole range of depression status, although the frontal region was the only area where depression was consistently significantly associated with EEG asymmetry, and then only for females. However, the direction of those differences for females was opposite of that predicted by the EEG asymmetry-depression hypothesis. Several methodological issues that may have contributed to these findings are discussed, with suggestions made for future research that focusses upon individual depression symptom profiles rather than dichotomous or total depression scores in order to assist in developing a clinically-relevant model of EEG asymmetry in depressed persons.

Developmental changes in electroencephalographic frontal asymmetry in young children at risk for depression

BACKGROUND

A number of studies have reported that depression is associated with lower relative left frontal activity in the alpha band (i.e. frontal asymmetry, or FA), as measured by electroencephalogram. FA has also been hypothesized to be a vulnerability marker for depression. If this is the case, FA should be evident in offspring of depressed mothers, a group at elevated risk for depression. However, the results of previous offspring studies have been inconsistent and none of these studies has considered whether the relationship between FA and risk changes over development in children.

METHOD

We assessed FA twice, at ages 3 and 6, in 253 never depressed children from a community sample. Maternal history of depressive disorders was determined by a diagnostic interview completed by the mothers at the first assessment.

RESULTS

There was a significant interaction between maternal depression and offspring age at assessment, indicating that FA exhibits different developmental trajectories depending on level of familial risk for depression. Offspring of depressed mothers exhibited a decreasing relative left FA over the course of early childhood, while offspring of nondepressed mothers exhibited relatively similar, symmetrical, levels of frontal alpha activity at both assessment points.

CONCLUSIONS

These results suggest that changes in FA from early to middle childhood distinguish those at risk for depression and that cross-sectional assessment of FA may have limited value in understanding risk. These results highlight the importance of considering development in understanding the role of FA in depression.

The relation of hedonic hunger and restrained eating to lateralized frontal activation

Asymmetrical alpha activation in the prefrontal cortex (frontal asymmetry) in electroencephalography (EEG) has been related to eating behavior. Prior studies linked dietary restraint with right frontal asymmetry [1] and disinhibition with left frontal asymmetry [2]. The current study simultaneously assessed restrained eating and hedonic hunger (drive for food reward in the absence of hunger) in relation to frontal asymmetry. Resting-state EEG and measures of restrained eating (Revised Restraint Scale; RRS) and hedonic hunger (Power of Food Scale; PFS) were assessed in 61 non-obese adults. Individually, hedonic hunger predicted left asymmetry. However, PFS and RRS were correlated (r=0.48, p<0.05) and there was a significant interaction between PFS and RRS on frontal asymmetry, p<0.01. Results indicated that those high in hedonic hunger exhibited left asymmetry irrespective of RRS scores; among those low in PFS, only those high in RRS showed right asymmetry. Results were consistent with literature linking avoidant behaviors (restraint) with right-frontal asymmetry and approach behaviors (binge eating) with left-frontal asymmetry. It appears that a strong drive toward palatable foods predominates at a neural level even when restraint is high. Findings suggest that lateralized frontal activity is an indicator of motivation both to consume and to avoid consuming highly palatable foods.

Analysis of the Complexity Measures in the EEG of Schizophrenia Patients

Complexity measures have been enormously used in schizophrenia patients to estimate brain dynamics. However, the conflicting results in terms of both increased and reduced complexity values have been reported in these studies depending on the patients' clinical status or symptom severity or medication and age status. The objective of this study is to investigate the nonlinear brain dynamics of chronic and medicated schizophrenia patients using distinct complexity estimators. EEG data were collected from 22 relaxed eyes-closed patients and age-matched healthy controls. A single-trial EEG series of 2 min was partitioned into identical epochs of 20 s intervals. The EEG complexity of participants were investigated and compared using approximate entropy (ApEn), Shannon entropy (ShEn), Kolmogorov complexity (KC) and Lempel-Ziv complexity (LZC). Lower complexity values were obtained in schizophrenia patients. The most significant complexity differences between patients and controls were obtained in especially left frontal (F3) and parietal (P3) regions of the brain when all complexity measures were applied individually. Significantly, we found that KC was more sensitive for detecting EEG complexity of patients than other estimators in all investigated brain regions. Moreover, significant inter-hemispheric complexity differences were found in the frontal and parietal areas of schizophrenics' brain. Our findings demonstrate that the utilizing of sensitive complexity estimators to analyze brain dynamics of patients might be a useful discriminative tool for diagnostic purposes. Therefore, we expect that nonlinear analysis will give us deeper understanding of schizophrenics' brain.

Regional electroencephalogram (EEG) alpha power and asymmetry in older adults: a study of short-term test-retest reliability

Although regional alpha power and asymmetry measures have been widely used as indices of individual differences in emotional processing and affective style in younger populations, there have been relatively few studies that have examined these measures in older adults. Here, we examined the short-term test-retest reliability of resting regional alpha power (7.5-12.5 Hz) and asymmetry in a sample of 38 active, community-dwelling older adults (M age = 71.2, SD = 6.5 years). Resting electroencephalogram recordings were made before and after a perceptual computer task. Pearson and intra-class correlations indicated acceptable test-retest reliability for alpha power and asymmetry measures in all regions. Interestingly, alpha asymmetry appeared to be less affected by the task than was alpha power. Findings suggest that alpha asymmetry may reflect more enduring, "trait-like" characteristics, while alpha power may reflect more "state-like" processes in older adults.

Resting electroencephalographic correlates of the clinical response to repetitive transcranial magnetic stimulation: A preliminary comparison between unipolar and bipolar depression

BACKGROUND

Major depressive disorder (MDD) and bipolar disorder (BP) are two different types of mood disorders, sometimes difficult to distinguish from their depressive symptoms, and for which repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) has been proposed to treat refractory patients. Here we studied whether the electroencephalogram (EEG) at rest could be used to predict the therapeutic response to left DLPFC 10 Hz rTMS, and to which extent BP and MDD patients show similar correlation between the clinical response and the cortical networks at rest.

METHODS

Eight MDD (6 females) and 10 BP patients (6 females) were included. The rTMS therapy consisted of 10 to 20 neuronavigated sessions, with 2000 pulses continuously applied at 120% motor threshold for each session. RTMS sessions at the beginning, middle and end of the therapy were performed while recording EEG signals. EEG spectral power was partitioned using the common physiological frequency bands and was statistically analysed at the scalp level and after cortical source reconstruction.

RESULTS

We found significantly higher power in theta and beta bands in BP patients than in MDD patients, mainly localised in the prefrontal cortex. In addition, responders showed higher power in delta and theta bands in parietal regions and weaker frontal alpha power, when compared to non-responders.

DISCUSSION

These preliminary findings on a small cohort suggest that pre-treatment EEG oscillatory patterns may have some predictive value regarding rTMS therapy, both for MDD and BP disorders.

Altered resting-state EEG source functional connectivity in schizophrenia: the effect of illness duration

Despite the increasing body of evidence supporting the hypothesis of schizophrenia as a disconnection syndrome, studies of resting-state EEG Source Functional Connectivity (EEG-SFC) in people affected by schizophrenia are sparse. The aim of the present study was to investigate resting-state EEG-SFC in 77 stable, medicated patients with schizophrenia (SCZ) compared to 78 healthy volunteers (HV). In order to study the effect of illness duration, SCZ were divided in those with a short duration of disease (SDD; n = 25) and those with a long duration of disease (LDD; n = 52). Resting-state EEG recordings in eyes closed condition were analyzed and lagged phase synchronization (LPS) indices were calculated for each ROI pair in the source-space EEG data. In delta and theta bands, SCZ had greater EEG-SFC than HV; a higher theta band connectivity in frontal regions was observed in LDD compared with SDD. In the alpha band, SCZ showed lower frontal EEG-SFC compared with HV whereas no differences were found between LDD and SDD. In the beta1 band, SCZ had greater EEG-SFC compared with HVs and in the beta2 band, LDD presented lower frontal and parieto-temporal EEG-SFC compared with HV. In the gamma band, SDD had greater connectivity values compared with LDD and HV. This study suggests that resting state brain network connectivity is abnormally organized in schizophrenia, with different patterns for the different EEG frequency components and that EEG can be a powerful tool to further elucidate the complexity of such disordered connectivity.

Frontal asymmetry index in Williams syndrome: Evidence for altered emotional brain circuitry?

Asymmetrical frontal electroencephalography (EEG) activity is associated with motivational neural systems of approach/withdrawal behaviors. Greater left frontal EEG has been linked to increased appetitive tendencies whereas increased right frontal activity is related to the activation of avoidance mechanisms. Williams syndrome (WS) is a genetic condition characterized by a highly sociable personality manifested by a propensity to approach strangers and decreased social fear. Consequently, the current study was designed to investigate the frontal cortical activity during resting state, indexed by relative alpha power, in adults with WS as compared to typically developing (TD) controls, and a subgroup of TD extraverts. Results indicated that participants with WS produced attenuated left frontal activity relative to TD peers, or TD extraverts in particular; yet, no groups differed in their degree of right frontal activity. Finally, while both TD group and the extravert subset showed trends of greater left over right frontal activity, the WS participants demonstrated opposing effect of increased right over left frontal EEG. Importantly, individuals with WS produced deviating frontal activity patterns compared to TD extraverts despite exhibiting common social-affiliative tendencies, underscoring that neural mechanisms that give rise to extraversion in WS may not function similarly to those subserving this personality trait expressed in TD.

A review of selected candidate endophenotypes for depression

Endophenotypes are proposed to occupy an intermediate position in the pathway between genotype and phenotype in genetically complex disorders such as depression. To be considered an endophenotype, a construct must meet a set of criteria proposed by Gottesman and Gould (2003). In this qualitative review, we summarize evidence for each criterion for several putative endophenotypes for depression: neuroticism, morning cortisol, frontal asymmetry of cortical electrical activity, reward learning, and biases of attention and memory. Our review indicates that while there is strong support for some depression endophenotypes, other putative endophenotypes lack data or have inconsistent findings for core criteria.

Drug Treated Schizophrenia, Schizoaffective and Bipolar Disorder Patients Evaluated by qEEG Absolute Spectral Power and Mean Frequency Analysis

Objective

Research of electroencephalograph (EEG) power spectrum and mean frequency has shown inconsistent results in patients with schizophrenic, schizoaffective and bipolar disorders during medication when compared to normal subjects thus; the characterization of these parameters is an important task.

Methods

We applied quantitative EEG (qEEG) to investigate 38 control, 15 schizophrenic, 7 schizoaffective and 11 bipolar disorder subjects which remaine under the administration of psychotropic drugs (except control group). Absolute spectral power (ASP), mean frequency and hemispheric electrical asymmetry were measured by 19 derivation qEEG. Group mean values were compared with non parametrical Mann-Whitney test and spectral EEG maps with z-score method at p < 0.05.

Results

Most frequent drug treatments for schizophrenic patients were neuroleptic+antiepileptic (40% of cases) or 2 neuroleptics (33.3%). Schizoaffective patients received neuroleptic+benzodiazepine (71.4%) and for bipolar disorder patients neuroleptic+antiepileptic (81.8%). Schizophrenic (at all derivations except for Fp1, Fp2, F8 and T6) and schizoaffective (only at C3) show higher values of ASP (+57.7% and +86.1% respectively) compared to control group. ASP of bipolar disorder patients did not show differences against control group. The mean frequency was higher at Fp1 (+14.2%) and Fp2 (+17.4%) in bipolar disorder patients than control group, but no differences were found in frequencies between schizophrenic or schizoaffective patients against the control group. Majority of spectral differences were found at the left hemisphere in schizophrenic and schizoaffective but not in bipolar disorder subjects.

Conclusion

The present report contributes to characterize quantitatively the qEEG in drug treated schizophrenic, schizoaffective or bipolar disorder patients.

Resting and task-elicited prefrontal EEG alpha asymmetry in depression: support for the capability model

The capability model of frontal electroencephalographic (EEG) asymmetry suggests that brain activity during emotional challenge will be a more powerful indicator of predispositions toward psychopathology than activity observed at rest. EEG data were assessed during a resting baseline and a facial emotion task, wherein individuals with (n = 143) and without (n = 163) lifetime major depressive disorder (MDD) made approach (angry and happy) and withdrawal (afraid and sad) facial expressions. EEG asymmetry during emotional challenge was a more powerful indicator of MDD status than resting asymmetry for average, Cz, and linked mastoid references, results in support of the capability model. However, current-source-density (CSD) transformed asymmetry was indicative of lifetime MDD status under resting and task-elicited conditions. Findings suggest that CSD-transformed data may be more robust indicators of trait frontal EEG asymmetry.

Validity and reliability of electroencephalographic frontal alpha asymmetry and frontal midline theta as biomarkers for depression

Electroencephalographic (EEG) frontal alpha asymmetry (FAA) and frontal midline (FM) theta have been suggested as biomarkers for depression and anxiety, but have mostly been assessed in small and non-clinical studies. In a clinical sample of 79 adults with depression (ICD-10: F32), resting EEG and scales of depression (MADRS) and anxiety (HADS-A) were measured at intake and after 3 months. FAA and FM theta values were referenced to a normative population database. Internal consistency, test-retest reliability, and correlations with psychiatric tests were examined. Reliability was sufficient. However, FAA and FM theta values were close to the general population, and correlations with psychiatric tests were mostly small and non-significant, with the exception of FAA on F7-F8 z-scores and HADS-A. We conclude that the validity of FAA and FM theta and therefore their potential as biomarkers for depression and anxiety remain unclear.

An integrative assessment of the psychophysiologic alterations in young women with recurrent major depressive disorder

OBJECTIVE

Alterations in neuroelectrical activities coincide with major depressive disorder (MDD). This study examines the pattern of cerebral activity and cardiac autonomic parameters of euthymic women with recurrent MDD.

METHODS

Resting electroencephalograms and electrocardiograms were recorded from 20 women with MDD receiving escitalopram and 40 matched and healthy women. We computed frontal alpha asymmetry to evaluate the interhemispheric balance. Parameters of heart rate variability were extracted to assess cardiac autonomic control. Sample entropy was used to assess the complexity of neurocardiac dynamics. The relationship between cardiovagal activity and alpha electroencephalogram was examined with a coherence analysis.

RESULTS

Multivariable analysis of variance revealed a differential pattern of psychophysiologic variables between MDD patients and controls (p = .03). MDD was associated with a tendency toward lower left frontal activity (-0.06 [standard deviation = 0.14] versus 0.04 [0.17] lnμV(2), p = .04). Discriminant analysis demonstrated more right frontal activation, a lower high-frequency heart rate power spectrum, and a higher ratio of the low- to high-frequency heart rate power spectrum in patients with MDD compared with controls. Residual depressive symptoms (r = -0.09 to 0.11, p = .63-.99) and escitalopram dosage (r = -0.09 to 0.28, p = .22-.84) were not correlated with autonomic measures. Coherence between normalized high-frequency component of the heart rate power spectrum and alpha power was not significant (F3, p = .27; F4, p = .16).

CONCLUSIONS

Euthymic women with recurrent MDD have a distinctive psychophysiologic profile. This profile may reflect altered frontal activation and a reduced cardiovagal tone in depression.

Adverse rearing environments and neural development in children: the development of frontal electroencephalogram asymmetry

BACKGROUND

Children raised in institutional settings experience marked deprivation in social and environmental stimulation. This deprivation may disrupt brain development in ways that increase risk for psychopathology. Differential hemispheric activation of the frontal cortex is an established biological substrate of affective style that is associated with internalizing psychopathology. Previous research has never characterized the development of frontal electroencephalogram asymmetry in children or evaluated whether adverse rearing environments alter developmental trajectories.

METHODS

A sample of 136 children (mean age = 23 months) residing in institutions in Bucharest, Romania, and a sample of community control subjects (n = 72) participated. Half of institutionalized children were randomized to a foster care intervention. Electroencephalogram data were acquired at study entry and at ages 30, 42, and 96 months. A structured diagnostic interview of psychiatric disorders was completed at 54 months.

RESULTS

Children exhibited increases in right relative to left hemisphere frontal activation between the second and fourth years of life, followed by an increase in left relative to right hemisphere activation. Children reared in institutions experienced a prolonged period of increased right hemisphere activation and a blunted rebound in left frontal activation. Foster care placement was associated with improved developmental trajectories but only among children placed before 24 months. The development trajectory of frontal electroencephalogram asymmetry in early childhood predicted internalizing symptoms at 54 months.

CONCLUSIONS

Exposure to adverse rearing environments can alter brain development, culminating in heightened risk for psychopathology. Interventions delivered early in life have the greatest potential to mitigate the long-term effects of these environments.

The oft-neglected role of parietal EEG asymmetry and risk for major depressive disorder

Relatively less right parietal activity may reflect reduced arousal and signify risk for major depressive disorder (MDD). Inconsistent findings with parietal electroencephalographic (EEG) asymmetry, however, suggest issues such as anxiety comorbidity and sex differences have yet to be resolved. Resting parietal EEG asymmetry was assessed in 306 individuals (31% male) with (n=143) and without (n=163) a DSM-IV diagnosis of lifetime MDD and no comorbid anxiety disorders. Past MDD+ women displayed relatively less right parietal activity than current MDD+ and MDD- women, replicating prior work. Recent caffeine intake, an index of arousal, moderated the relationship between depression and EEG asymmetry for women and men. Findings suggest that sex differences and arousal should be examined in studies of depression and regional brain activity.

Anxiety and depression severity are related to right but not left onset Parkinson's disease duration

Depression and anxiety have both been associated with relative left frontal hypoactivation and the motor symptoms of Parkinson's disease typically begin in a lateral or asymmetrical fashion. Hence, PD patients with right hemibody onset may experience heightened depression and anxiety. However, research is mixed regarding whether right or left hemibody onset PD is associated with elevated levels of depression and anxiety. This literature, though, has not considered the potential moderating variable of disease duration. We hypothesized that disease duration would be positively correlated with measures of depression and anxiety in right but not left hemibody onset PD patients. The results indicated that scores on the Geriatric Depression Scale, Beck Depression Inventory-II, and the State Trait Anxiety Scale - State correlated positively with disease duration, but only in the right hemibody onset group of PD patients. Thus, right hemibody onset PD is associated with more severe depressive and anxiety symptoms, but only when disease duration is considered.

EEG frontal asymmetry in the depressed and remitted elderly: is it related to the trait or to the state of depression?

BACKGROUND

Over the last 30 years, frontal EEG asymmetry has been investigated with regards to the study of emotion, motivation, and psychopathology.

METHOD

We analyzed the frontal alpha asymmetry, depressive symptoms with a Beck Depression Inventory (BDI) and quality of life with a Short Form Health Survey-36® (SF-36®) in depressed (n=12), remitted (n=8) and non-depressed (n=7) elderly subjects. We also evaluated the correlation between the frontal EEG asymmetry and physical and mental aspects of SF-36®.

RESULTS

The groups showed no difference regarding the frontal alpha asymmetry (F=0.37; p=0.69). Moreover, there was no significant correlation between frontal asymmetry and quality of life (mental and physical aspects).

CONCLUSION

The results showed no evidence of a relationship between frontal asymmetry, quality of life and depression in the elderly. Future studies on frontal asymmetry should carefully consider the effects of age.

ERP Correlates of Word Production before and after Stroke in an Aphasic Patient

Changes in brain activity characterizing impaired speech production after brain damage have usually been investigated by comparing aphasic speakers with healthy subjects because prestroke data are normally not available. However, when interpreting the results of studies of stroke patients versus healthy controls, there is an inherent difficulty in disentangling the contribution of neuropathology from other sources of between-subject variability. In the present work, we had an unusual opportunity to study an aphasic patient with severe anomia who had incidentally performed a picture naming task in an ERP study as a control subject one year before suffering a left hemisphere stroke. The fortuitous recording of this patient's brain activity before his stroke allows direct comparison of his pre- and poststroke brain activity in the same language production task. The subject did not differ from other healthy subjects before his stroke, but presented major electrophysiological differences after stroke, both in comparison to himself before stroke and to the control group. ERP changes consistently appeared after stroke in a specific time window starting about 250 msec after picture onset, characterized by a single divergent but stable topographic configuration of the scalp electric field associated with a cortical generator abnormally limited to left temporal posterior perilesional areas. The patient's pattern of anomia revealed a severe lexical–phonological impairment and his ERP responses diverged from those of healthy controls in the time window that has previously been associated with lexical–phonological processes during picture naming. Given that his prestroke ERPs were indistinguishable from those of healthy controls, it seems highly likely that the change in his poststroke ERPs is due to changes in language production processes as a consequence of stroke. The patient's neurolinguistic deficits, combined with the ERPs results, provide unique evidence for the role of left temporal cortex in lexical–phonological processing from about 250 to 450 msec during word production.