Specificity and sensitivity of visual evoked potentials in the diagnosis of schizophrenia: rethinking VEPs

Visual Neurophysiological Biomarkers for Patient Stratification and Treatment Development Across Neuropsychiatric Disorders

The human visual system begins in the retina and projects to cortex through both the thalamocortical and retinotectal visual pathways. The thalamocortical system is divided into separate magnocellular and parvocellular divisions, which engage separate layers of the lateral geniculate nucleus (LGN) and project preferentially to the dorsal and ventral visual streams, respectively. The retinotectal system, in contrast, projects to the superior colliculus, pulvinar nucleus of the thalamus and amygdala. The pulvinar nucleus also plays a critical role in the integration of information processing across early visual regions.The functions of the visual system can be assessed using convergent EEG- and functional brain imaging approaches, increasingly supplemented by simultaneously collected eye-tracking information. These approaches may be used for tracing the flow of information from retina through early visual regions, as well as the contribution of these regions to higher-order cognitive processing. A pathway of increasing interest in relationship to neuropsychiatric disorders is the primate-specific "third visual pathway" that relies extensively on motion-related input and contributes preferentially to social information processing. Thus, disturbances in the brain's responsiveness to motion stimuli may be especially useful as biomarkers for early visual dysfunction related to impaired social cognition.Visual event-related potentials (ERPs) can be collected with high-fidelity and have proven effective for the study of neuropsychiatric disorders such as schizophrenia and Alzheimer's disease, in which alterations in visual processing may occur early in the disorder, andautism-spectrum disorder (ASD), in which abnormal persistence of early childhood patterns may persist into adulthood, leading to impaired functioning of visual social pathways. The utility of visual ERPs as biomarkers for larger clinical studies is limited at present by the need for standardization of visual stimuli across laboratories, which requires specialized protocols and equipment. The development of optimized stimulation protocols as well as newer headset-based systems may increase the clinical utility of present stimulation approaches.

New portable device for an examination of visual cognitive evoked potentials might extend their diagnostic applications in psychiatry

Despite positive prior results obtained by using event-related potentials (ERPs) in psychiatric patients, they are not routinely used in the clinical setting. This may in part be due to problems regarding a lack of transportable equipment availability. It can be difficult for these patients to repeatedly visit electrophysiological laboratories. To address this issue, we propose using a new, fully portable device for visually evoked potentials (VEP) and cognitive function assessment, that can be used for quick examinations (https://www.veppeak.com). Our device, called "VEPpeak", is built into a headset with a color LED visual stimulator. It weighs 390 g and is connected to a notebook (PC) with evaluation software via USB. In this pilot study, we verified the device's usability in 31 patients with schizophrenia. We used the oddball paradigm with the recognition of colors for the P300 wave and choice reaction time evaluation. The examination lasted only about ten minutes. The results indicated good reproducibility of large cognitive potentials (P300) with prolonged P300 latencies and reduced amplitudes in patients compared to 15 control subjects. The P300 latency and reaction time prolongation in patients correlated with their age and the sedative effect of the pharmacotherapy.

Altered brain connectivity during visual stimulation in schizophrenia

Schizophrenia (SCZ) can be described as a functional dysconnectivity syndrome that affects brain connectivity and circuitry. However, little is known about how sensory stimulation modulates network parameters in schizophrenia, such as their small-worldness (SW) during visual processing. To address this question, we applied graph theory algorithms to multi-electrode EEG recordings obtained during visual stimulation with a checkerboard pattern-reversal stimulus. Twenty-six volunteers participated in the study, 13 diagnosed with schizophrenia (SCZ; mean age = 38.3 years; SD = 9.61 years) and 13 healthy controls (HC; mean age = 28.92 years; SD = 12.92 years). The visually evoked potential (VEP) showed a global amplitude decrease (p < 0.05) for SCZ patients as opposed to HC but no differences in latency (p > 0.05). As a signature of functional connectivity, graph measures were obtained from the Magnitude-Squared Coherence between signals from pairs of occipital electrodes, separately for the alpha (8-13 Hz) and low-gamma (36-55 Hz) bands. For the alpha band, there was a significant effect of the visual stimulus on all measures (p < 0.05) but no group interaction between SCZ and HZ (p > 0.05). For the low-gamma spectrum, both groups showed a decrease of Characteristic Path Length (L) during visual stimulation (p < 0.05), but, contrary to the HC group, only SCZ significantly lowered their small-world (SW) connectivity index during visual stimulation (SCZ p < 0.05; HC p > 0.05). This indicates dysconnectivity of the functional network in the low-gamma band of SCZ during stimulation, which might indirectly reflect an altered ability to react to new sensory input in patients. These results provide novel evidence about a possible electrophysiological signature of the global deficits revealed by the application of graph theory onto electroencephalography in schizophrenia.

Diffusion Basis Spectrum Imaging Detects Axonal Loss After Transient Dexamethasone Treatment in Optic Neuritis Mice

Optic neuritis is a frequent first symptom of multiple sclerosis (MS) for which corticosteroids are a widely employed treatment option. The Optic Neuritis Treatment Trial (ONTT) reported that corticosteroid treatment does not improve long-term visual acuity, although the evolution of underlying pathologies is unclear. In this study, we employed non-invasive diffusion basis spectrum imaging (DBSI)-derived fiber volume to quantify 11% axonal loss 2 months after corticosteroid treatment (vs. baseline) in experimental autoimmune encephalomyelitis mouse optic nerves affected by optic neuritis. Longitudinal DBSI was performed at baseline (before immunization), after a 2-week corticosteroid treatment period, and 1 and 2 months after treatment, followed by histological validation of neuropathology. Pathological metrics employed to assess the optic nerve revealed axonal protection and anti-inflammatory effects of dexamethasone treatment that were transient. Two months after treatment, axonal injury and loss were indistinguishable between PBS- and dexamethasone-treated optic nerves, similar to results of the human ONTT. Our findings in mice further support that corticosteroid treatment alone is not sufficient to prevent eventual axonal loss in ON, and strongly support the potential of DBSI as an in vivo imaging outcome measure to assess optic nerve pathology.