Shaping the visual system: cortical and subcortical plasticity in the intact and the lesioned brain

Synaptic Plasticity in the Injured Brain Depends on the Temporal Pattern of Stimulation

Neurostimulation protocols are increasingly used as therapeutic interventions, including for brain injury. In addition to the direct activation of neurons, these stimulation protocols are also likely to have downstream effects on those neurons' synaptic outputs. It is well known that alterations in the strength of synaptic connections (long-term potentiation, LTP; long-term depression, LTD) are sensitive to the frequency of stimulation used for induction; however, little is known about the contribution of the temporal pattern of stimulation to the downstream synaptic plasticity that may be induced by neurostimulation in the injured brain. We explored interactions of the temporal pattern and frequency of neurostimulation in the normal cerebral cortex and after mild traumatic brain injury (mTBI), to inform therapies to strengthen or weaken neural circuits in injured brains, as well as to better understand the role of these factors in normal brain plasticity. Whole-cell (WC) patch-clamp recordings of evoked postsynaptic potentials in individual neurons, as well as field potential (FP) recordings, were made from layer 2/3 of visual cortex in response to stimulation of layer 4, in acute slices from control (naive), sham operated, and mTBI rats. We compared synaptic plasticity induced by different stimulation protocols, each consisting of a specific frequency (1 Hz, 10 Hz, or 100 Hz), continuity (continuous or discontinuous), and temporal pattern (perfectly regular, slightly irregular, or highly irregular). At the individual neuron level, dramatic differences in plasticity outcome occurred when the highly irregular stimulation protocol was used at 1 Hz or 10 Hz, producing an overall LTD in controls and shams, but a robust overall LTP after mTBI. Consistent with the individual neuron results, the plasticity outcomes for simultaneous FP recordings were similar, indicative of our results generalizing to a larger scale synaptic network than can be sampled by individual WC recordings alone. In addition to the differences in plasticity outcome between control (naive or sham) and injured brains, the dynamics of the changes in synaptic responses that developed during stimulation were predictive of the final plasticity outcome. Our results demonstrate that the temporal pattern of stimulation plays a role in the polarity and magnitude of synaptic plasticity induced in the cerebral cortex while highlighting differences between normal and injured brain responses. Moreover, these results may be useful for optimization of neurostimulation therapies to treat mTBI and other brain disorders, in addition to providing new insights into downstream plasticity signaling mechanisms in the normal brain.

Electrophysiological correlates of temporal numerosity adaptation

Introduction

Much research has revealed the human visual system is capable to estimate numerical quantities, rapidly and reliably, in both the spatial and the temporal domain. This ability is highly susceptible to short-term plastic phenomena related to previous exposure to visual numerical information (i.e., adaptation). However, while determinants of spatial numerosity adaptation have been widely investigated, little is known about the neural underpinnings of short-term plastic phenomena related to the encoding of temporal numerical information. In the present study we investigated the electrophysiological correlates of temporal numerosity adaptation.

Methods

Participants were asked to estimate the numerosity of a test sequence of flashes after being exposed to either a high or low numerous adapting sequence. Behavioral results confirmed the expected underestimation of test stimulus when this was preceded by a high numerous sequence as compared to when preceded by a low numerous sequence.

Results

Electrophysiological data revealed that this behavior was tightly linked to the amplitude of the steady-state visual evoked (ssVEP) response elicited by the test stimulus. When preceded by a high numerous sequence, the test stimulus elicited larger ssVEP responses as compared to when preceded by a low numerous sequence with this pattern being robustly correlated with behavior. Finally, topographical maps showed that this difference was mostly evident across two antero-posterior distributed clusters of electrodes and correlated with changes in functional connectivity.

Discussion

Taken together, our results suggest that visual plastic phenomena related to the encoding of temporal numerosity information reflect changes in rhythmic evoked activity that are likely related to long range communications between distinct brain regions.

Abnormal Neurologic Findings in Patients With Sickle Cell Disease Without a History of Major Neurologic Events

Background and Objectives

Patients with sickle cell disease (SCD) are prone to symptomatic neurologic complications. Previous studies reported accrual of neural injury starting at early age, even without having symptomatic neurologic events. The aim of this study was to assess the prevalence and risk factors of abnormal neurologic findings in patients with SCD with no history of major symptomatic neurologic events.

Methods

Our study extracted patients diagnosed with SCD from the Cooperative Study of Sickle Cell Disease. Patients who underwent a neurologic evaluation were included in our analysis. Patients with previous documented major symptomatic neurologic events were excluded. We compared patients with SCD with abnormal neurologic findings with those without in terms of clinical and laboratory parameters using multivariate binary logistic regression.

Results

A total of 3,573 patients with SCD were included (median age = 11 [IQR = 19] years, male = 1719 [48.1%]). 519 (14.5%) patients had at least one abnormal neurologic finding. The most common findings in descending order were abnormal reflexes, gait abnormalities, cerebellar dysfunction, language deficits, nystagmus, abnormal muscle tone and strength, Romberg sign, Horner syndrome, and intellectual impairment. History of eye disease (odds ratio [OR] = 2.76, 95% confidence interval [CI] = 1.63-4.68) and history of osteomyelitis (OR = 2.55, 95% CI 1.34-4.84) were the strongest predictors of abnormal neurologic findings, followed by smoking (OR = 1.59, 95% CI 1.08-2.33), aseptic necrosis (OR = 1.57, 95% CI 1.06-2.33), hand-foot syndrome (OR = 1.48, 95% CI 1.04-2.12), and male sex (OR = 1.42, 95% CI 1.01-2.02).

Discussion

Neurologic deficits are relatively common in patients with SCD, even without documented major neurologic insults. They range from peripheral and ophthalmic deficits to central and cognitive disabilities. Patients with SCD should have early regular neurologic evaluations and risk factor modification, particularly actively promoting smoking cessation.

Electrophysiological and Behavioral Effects of Alpha-Band Sensory Entrainment: Neural Mechanisms and Clinical Applications

Alpha-band (7-13 Hz) activity has been linked to visuo-attentional performance in healthy participants and to impaired functionality of the visual system in a variety of clinical populations including patients with acquired posterior brain lesion and neurodevelopmental and psychiatric disorders. Crucially, several studies suggested that short uni- and multi-sensory rhythmic stimulation (i.e., visual, auditory and audio-visual) administered in the alpha-band effectively induces transient changes in alpha oscillatory activity and improvements in visuo-attentional performance by synchronizing the intrinsic brain oscillations to the external stimulation (neural entrainment). The present review aims to address the current state of the art on the alpha-band sensory entrainment, outlining its potential functional effects and current limitations. Indeed, the results of the alpha-band entrainment studies are currently mixed, possibly due to the different stimulation modalities, task features and behavioral and physiological measures employed in the various paradigms. Furthermore, it is still unknown whether prolonged alpha-band sensory entrainment might lead to long-lasting effects at a neural and behavioral level. Overall, despite the limitations emerging from the current literature, alpha-band sensory entrainment may represent a promising and valuable tool, inducing functionally relevant changes in oscillatory activity, with potential rehabilitative applications in individuals characterized by impaired alpha activity.

Quantification of retinal ganglion cell loss in patients with homonymous visual field defect due to stroke

BACKGROUND

To quantify the degree of ganglion cell degeneration through spectral domain optical coherence tomography (SD-OCT) in adult patients with post-stroke homonymous visual field defect.

METHODS

Fifty patients with acquired visual field defect due to stroke (mean age = 61 years) and thirty healthy controls (mean age = 58 years) were included. Mean deviation (MD) and pattern standard deviation (PSD), average peripapillary retinal nerve fibre layer thickness (pRNLF-AVG), average ganglion cell complex thickness (GCC-AVG), global loss volume (GLV) and focal loss volume (FLV) were measured. Patients were divided according to the damaged vascular territories (occipital vs. parieto-occipital) and stroke type (ischaemic vs. haemorrhagic). Group analysis was conducted with ANOVA and multiple regressions.

RESULTS

pRNFL-AVG was significantly decreased among patients with lesions in parieto-occipital territories compared to controls and to patients with lesions in occipital territories (p = .04), with no differences with respect to stroke type. GCC-AVG, GLV and FLV differed in stroke patients and controls, regardless of stroke type and involved vascular territories. Age and elapsed time from stroke had a significant effect on pRNFL-AVG and GCC-AVG (p < .01), but not on MD and PSD.

CONCLUSIONS

Reduction of SD-OCT parameters occurs following both ischaemic and haemorrhagic occipital stroke, but it is larger when the injury extends to parietal territories and increases as time since stroke increases. The size of visual field defect is unrelated to SD-OCT measurements. Macular GCC thinning appeared to be more sensitive than pRNFL in detecting retrograde retinal ganglion cell degeneration and its retinotopic pattern in stroke.

Visual P2p component responds to perceived numerosity

Numerosity perception is a key ability for human and non-human species, probably mediated by dedicated brain mechanisms. Electrophysiological studies revealed the existence of both early and mid-latency components of the Electrophysiological (EEG) signal sensitive to numerosity changes. However, it is still unknown whether these components respond to physical or perceived variation in numerical attributes. We here tackled this point by recording electrophysiological signal while participants performed a numerosity adaptation task, a robust psychophysical method yielding changes in perceived numerosity judgments despite physical numerosity invariance. Behavioral measures confirmed that the test stimulus was consistently underestimated when presented after a high numerous adaptor while perceived as veridical when presented after a neutral adaptor. Congruently, EEG results revealed a potential at around 200 ms (P2p) which was reduced when the test stimulus was presented after the high numerous adaptor. This result was much prominent over the left posterior cluster of electrodes and correlated significantly with the amount of adaptation. No earlier modulations were retrievable when changes in numerosity were illusory while both early and mid-latency modulations occurred for physical changes. Taken together, our results reveal that mid-latency P2p mainly reflects perceived changes in numerical attributes, while earlier components are likely to be bounded to the physical characteristics of the stimuli. These results suggest that short-term plastic mechanisms induced by numerosity adaptation may involve a relatively late processing stage of the visual hierarchy likely engaging cortical areas beyond the primary visual cortex. Furthermore, these results also indicate mid-latency electrophysiological correlates as a signature of the internal representation of numerical information.

Alterations in resting-state functional connectivity after brain posterior lesions reflect the functionality of the visual system in hemianopic patients

Emerging evidence suggests a role of the posterior cortices in regulating alpha oscillatory activity and organizing low-level processing in non-alpha frequency bands. Therefore, posterior brain lesions, which damage the neural circuits of the visual system, might affect functional connectivity patterns of brain rhythms. To test this hypothesis, eyes-closed resting state EEG signal was acquired from patients with hemianopia with left and right posterior lesions, patients without hemianopia with more anterior lesions and healthy controls. Left-lesioned hemianopics showed reduced intrahemispheric connectivity in the range of upper alpha only in the lesioned hemisphere, whereas right-lesioned hemianopics exhibited reduced intrahemispheric alpha connectivity in both hemispheres. In terms of network topology, these impairments were characterized by reduced local functional segregation, with no associated change in global functional integration. This suggests a crucial role of posterior cortices in promoting functional connectivity in the range of alpha. Right-lesioned hemianopics revealed also additional impairments in the theta range, with increased connectivity in this frequency band, characterized by both increased local segregated activity and decreased global integration. This indicates that lesions to right posterior cortices lead to stronger impairments in alpha connectivity and induce additional alterations in local and global low-level processing, suggesting a specialization of the right hemisphere in generating alpha oscillations and in coordinating complex interplays with lower frequency bands. Importantly, hemianopic patient's visual performance in the blind field was linked to alpha functional connectivity, corroborating the notion that alpha oscillatory patterns represent a biomarker of the integrity and the functioning of the underlying visual system.

Parvalbumin-Positive Interneurons Regulate Cortical Sensory Plasticity in Adulthood and Development Through Shared Mechanisms

Parvalbumin-positive neurons are the largest class of GABAergic, inhibitory neurons in the central nervous system. In the cortex, these fast-spiking cells provide feedforward and feedback synaptic inhibition onto a diverse set of cell types, including pyramidal cells, other inhibitory interneurons, and themselves. Cortical inhibitory networks broadly, and cortical parvalbumin-expressing interneurons (cPVins) specifically, are crucial for regulating sensory plasticity during both development and adulthood. Here we review the functional properties of cPVins that enable plasticity in the cortex of adult mammals and the influence of cPVins on sensory activity at four spatiotemporal scales. First, cPVins regulate developmental critical periods and adult plasticity through molecular and structural interactions with the extracellular matrix. Second, they activate in precise sequence following feedforward excitation to enforce strict temporal limits in response to the presentation of sensory stimuli. Third, they implement gain control to normalize sensory inputs and compress the dynamic range of output. Fourth, they synchronize broad network activity patterns in response to behavioral events and state changes. Much of the evidence for the contribution of cPVins to plasticity comes from classic models that rely on sensory deprivation methods to probe experience-dependent changes in the brain. We support investigating naturally occurring, adaptive cortical plasticity to study cPVin circuits in an ethologically relevant framework, and discuss recent insights from our work on maternal experience-induced auditory cortical plasticity.

Numerosity perception is tuned to salient environmental features

Numerosity perception is a key ability to guide behavior. However, current models propose that number units encode an abstract representation of numerosity regardless of the non-numerical attributes of the stimuli, suggesting rather coarse environmental tuning. Here we investigated whether numerosity systems spontaneously adapt to all visible items, or to subsets segregated by salient attributes such as color or pitch. We measured perceived numerosity after participants adapted to highly numerous stimuli with color either matched to or different from the test. Matched colors caused a 25% underestimation of numerosity, while different colors had virtually no effect. This was true both for physically different colors, and for the same colors perceived as different, via a color-assimilation illusion. A similar result occurred in the acoustic domain, where adaptation magnitude was halved when the adaptor and test differed in pitch. Taken together, our results support the idea that numerosity perception is selectively tuned to salient environmental attributes.

Implicit visuospatial attention shapes numerosity adaptation and perception

The perception of numerical quantities is susceptible to adaptation: after inspecting a numerous dot array for a few seconds a subsequent dot array is grossly underestimated. In a recent work we showed that the mere appearance of an additional numerically neutral stimulus significantly reduces the adaptation magnitude. Here we demonstrate that this reduction is likely due to a numerosity underestimation of the adaptor caused by a change of numerosity-related attentional resources deployed on the adapting stimulus. In Experiment 1 we replicated previous findings revealing a robust reduction of numerosity adaptation when an additional adaptor (even if neutral) was displayed. In Experiment 2 we used the method of magnitude estimation to demonstrate that numerosity is underestimated whenever a second task-irrelevant numerical stimulus appears on screen. Furthermore we demonstrated that the same experimental manipulations were not effective in modulating orientation adaptation magnitude as well as orientation estimation accuracy. Our results support the hypothesis of a tight relationship between numerosity perception and implicit visuospatial attention and corroborate the notion that numerosity adaptation depends on perceived rather than physical numerosity. However the lack of an effect of visuospatial attentional deployment for orientation perception suggests that attention might differently shape adaptation aftereffects for different features along the visual hierarchy.

Case Report: Visual Rehabilitation in Hemianopia Patients. Home-Based Visual Rehabilitation in Patients With Hemianopia Consecutive to Brain Tumor Treatment: Feasibility and Potential Effectiveness

Background/Objectives: Visual field loss is frequent in patients with brain tumors, worsening their daily life and exacerbating the burden of disease, and no supportive care strategies exist. In this case series, we sought to characterize the feasibility and potential effectiveness of a home-based visual rehabilitation program in hemianopia patients using immersive virtual-reality stimulation. Subjects/Methods: Two patients, one with homonymous hemianopia and the other with bitemporal hemianopia, consecutive to pediatric brain tumors, with no prior visual rehabilitation performed 15 min of home-based audiovisual stimulation every 2 days for 6 weeks (case 2) and 7 weeks (case 1) between February and August 2020. Patients used a virtual-reality, stand-alone, and remotely controlled device loaded with a non-commercial audiovisual stimulation program managed in real time from the laboratory. Standard visual outcomes assessed in usual care in visual rehabilitation were measured at the clinic. Following a mixed method approach in this pragmatic study of two cases, we collected quantitative and qualitative data on feasibility and potential effectiveness and compared the results pre- and post-treatment. Results: Implementation and wireless delivery of the audiovisual stimulation, remote data collection, and analysis for cases 1 and 2 who completed 19/20 and 20/20 audiovisual stimulation sessions at home, respectively, altogether indicated feasibility. Contrast sensitivity increased in both eyes for cases 1 and 2. Visual fields, measured by binocular Esterman and monocular Humphrey full-field analyses, improved in case 1. A minor increase was observed in case 2. Cases 1 and 2 enhanced reading speed. Case 2 strongly improved quality of life scores. Conclusion: This is the first report of a home-based virtual-reality visual rehabilitation program for adult patients with hemianopia consecutive to a pediatric brain tumor. We show the feasibility in real-world conditions and potential effectiveness of such technology on visual perception and quality of life.

Visual cortex changes in children with sickle cell disease and normal visual acuity: a multimodal magnetic resonance imaging study

The visual system is primarily affected in sickle cell disease (SCD), and eye examination is recommended starting in late childhood. So far, to our knowledge, all studies have focused on the retina, neglecting the changes that might be present in the cortical portion of the visual system. We performed a multimodal magnetic resonance imaging (MRI) evaluation of the visual cortex in 25 children with SCD (mean age: 12·3 ± 1·9 years) and 31 controls (mean age: 12·7 ± 1·6 years). At ophthalmologic examination, 3/25 SCD children had mild visual acuity deficits and 2/25 had mild tortuosity of the retinal vessels. None showed optic pathway infarcts at MRI or Transcranial Doppler abnormal blood velocities, and 6/25 disclosed posterior cerebral artery stenosis (five mild and one severe) at MR-angiography. Compared to controls, SCD children had increased posterior pericalcarine cortical thickness, with a different trajectory of cortical maturation and decreased connectivity within medial and ventral visual neural networks. Our findings suggest that SCD affects the development and the tuning of the visual cortex, leading to anatomical and functional changes in childhood even in the absence of retinopathy, and set the basis for future studies to determine if these changes can represent useful predictors of visual impairment in adulthood, biomarkers of disease progression or treatment response.