Pattern ERG and VEP maturation in schoolchildren

Early Alterations in Inner-Retina Neural and Glial Saturated Responses in Lens-Induced Myopia

Purpose

Myopic marmosets are known to exhibit significant inner retinal thinning compared to age-matched controls. The purpose of this study was to assess inner retinal activity in marmosets with lens-induced myopia compared to age-matched controls and evaluate its relationship with induced changes in refractive state and eye growth.

Methods

Cycloplegic refractive error (Rx), vitreous chamber depth (VCD), and photopic full-field electroretinogram were measured in 14 marmosets treated binocularly with negative contact lenses compared to 9 untreated controls at different stages throughout the experimental period (from 74 to 369 days of age). The implicit times of the a-, b-, d-, and photopic negative response (PhNR) waves, as well as the saturated amplitude (Vmax), semi-saturation constant (K), and slope (n) estimated from intensity-response functions fitted with Naka-Rushton equations were analyzed.

Results

Compared to controls, treated marmosets exhibited attenuated b-, d-, and PhNR waves Vmax amplitudes 7 to 14 days into treatment before compensatory changes in refraction and eye growth occurred. At later time points, when treated marmosets had developed axial myopia, the amplitudes and implicit times of the b-, d-, and PhNR waves were similar between groups. In controls, the PhNR wave saturated amplitude increased as the b + d-wave Vmax increased. This trend was absent in treated marmosets.

Conclusions

Marmosets induced with negative defocus exhibit early alterations in inner retinal saturated amplitudes compared to controls, prior to the development of compensatory myopia. These early ERG changes are independent of refraction and eye size and may reflect early changes in bipolar, ganglion, amacrine, or glial cell physiology prior to myopia development.

Translational Relevance

The early changes in retinal function identified in the negative lens-treated marmosets may serve as clinical biomarkers to help identify children at risk of developing myopia.

Developmental characteristics of visual evoked potentials to different stimulation in normal children

OBJECTIVE

To determine the developmental characteristics of flash visual evoked potentials (FVEP) and pattern-reversal visual evoked potentials (PVEP) of healthy children.

METHODS

The data were collected with a Keypoint Workstation 9033A07; 168 children (2 months-13 years) were tested with FVEP and 101 (4-13 years) were tested with PVEP.

RESULTS

A triphasic waveform with clear components (N2, P2, and N3) was recorded steadily after 1 year, with occurrence rates over 97% at all frequencies. FVEP latency significantly decreased with age. The amplitude difference of FVEP was greater for binocular than monocular fields. FVEP amplitude increased and amplitude differences decreased with stimulation frequency. The occurrence rate of PVEP was 100% after 4 years, and PVEP latency was significantly prolonged with age. N75 and P100 amplitudes and the N75-P100 amplitude difference increased with field of vision.

CONCLUSION

FVEP can be evoked in normal children at less than 2 Hz. Stimulation frequency can be adjusted to improve early detection and verification of subclinical lesions. The PVEP waveform is simple and stable, and its results are easier to analyze and interpret than FVEP, but it is limited by visual acuity and fixation force, whereas FVEP is affected less by visual acuity. but it is necessary to establish normal reference values of each age in each laboratory because of complicated analysis. According to the specific situation of the patient (vision, fixation) and clinical demand, we need to choose the right stimulation.

What can visual electrophysiology tell about possible visual-field defects in paediatric patients

Recognising a potential visual-field (VF) defect in paediatric patients might be challenging, especially in children before the age of 5 years and those with developmental delay or intellectual disability. Visual electrophysiological testing is an objective and non-invasive technique for evaluation of visual function in paediatric patients, which can characterise the location of dysfunction and differentiate between disorders of the retina, optic nerve and visual pathway. The recording of electroretinography (ERG) and visual-evoked potentials (VEP) is possible from early days of life and requires no subjective input from the patient. As the origins of ERG and VEP tests are known, the pattern of electrophysiological changes can provide information about the VF of a child unable to perform accurate perimetry. This review summarises previously published electrophysiological findings in several common types of VF defects that can be found in paediatric patients (generalised VF defect, peripheral VF loss, central scotoma, bi-temporal hemianopia, altitudinal VF defect, quadrantanopia and homonymous hemianopia). It also shares experience on using electrophysiological testing as additional functional evidence to other tests in the clinical challenge of diagnosing or excluding VF defects in complex paediatric patients. Each type of VF defect is illustrated with one or two clinical cases.

Developmental Effects on Pattern Visual Evoked Potentials Characterized by Principal Component Analysis

Purpose

Peak amplitude and peak latency in the pattern reversal visual evoked potential (prVEP) vary with maturation. We considered that principal component analysis (PCA) may be used to describe age-related variation over the entire prVEP time course and provide a means of modeling and removing variation due to developmental age.

Methods

PrVEP was recorded from 155 healthy subjects ages 11 to 19 years at two time points. We created a model of the prVEP by identifying principal components (PCs) that explained >95% of the variance in a “training” dataset of 40 subjects. We examined the ability of the PCs to explain variance in an age- and sex-matched “validation” dataset (n = 40) and calculated the intrasubject reliability of the PC coefficients between the two time points. We explored the effect of subject age and sex upon the PC coefficients.

Results

Seven PCs accounted for 96.0% of the variability of the training dataset and 90.5% of the variability in the validation dataset with good within-subject reliability across time points (R > 0.7 for all PCs). The PCA model revealed narrowing and amplitude reduction of the P100 peak with maturation, and a broader and smaller P100 peak in male subjects compared to female subjects.

Conclusions

PCA is a generalizable, reliable, and unbiased method of analyzing prVEP. The PCA model revealed changes across maturation and biological sex not fully described by standard peak analysis.

Translational Relevance

We describe a novel application of PCA to characterize developmental changes of prVEP in youths that can be used to compare healthy and pathologic pediatric cohorts.

Characterising the orientation-specific pattern-onset visual evoked potentials in children with bilateral refractive amblyopia and non-amblyopic controls

PURPOSE

An orientation-specific visual evoked potential (osVEP) protocol was developed to probe meridional anisotropies in children with refractive amblyopia. The aim was to characterise the osVEP response in children with bilateral refractive amblyopia, evaluate the intra-session repeatability of the main osVEP components (C1, C2 and C3), coefficient of repeatability (CoR) of the response to gratings in different meridians and determine if refractive amblyopes have poorer repeatability as compared with non-amblyopic controls.

METHODS

Children aged 4-7 years with newly diagnosed and untreated bilateral refractive amblyopia and non-amblyopic controls were recruited. Orientation-specific pattern-onset VEPs were recorded in response to an achromatic sinewave grating stimulus of 4 cycles per degree under monocular and binocular stimulation. The grating lines used for monocular stimulation were parallel with the subjects' most positive and negative astigmatic meridians when considered in sphero-minus cylinder form (Meridians 1 and 2, respectively). In subjects without astigmatism, meridians 1 and 2 were designated horizontal and vertical gratings, respectively. Binocular stimuli were presented with grating lines parallel to meridians 45, 90, 135 and 180°. The repeatability of latencies of the main osVEP components (C1, C2 and C3) were investigated using two successive osVEPs recordings for each stimulus meridian and the CoR for each component's latencies were assessed.

RESULTS

Seven amblyopic children (Visual acuity (VA) ranging from 0.08 to 0.40 LogMAR in the less amblyopic eye and 0.26-0.52 LogMAR in the more amblyopic eye) and 7 non-amblyopic controls (VA ranging from 0.00 to 0.02 LogMAR in either eye), with a median age of 4.6 and 7.0 years, respectively, completed the study. C1 had the highest CoR for most conditions assessed. Ratio of CoRs C1:C2 was > 2 for all binocular meridians in controls and the 90 and 180 meridians in the amblyopes; C1:C3 was > 2 for the binocularly assessed 45, 90 and 135 meridians in the controls and the 90 and 180 meridians in the amblyopes; C2:C3 were all < 2 for all meridians assessed in both groups.

CONCLUSIONS

The osVEP waveforms are reliable and useful for future investigations into the meridional anisotropies in children with refractive amblyopia, particularly the C3 component. Component C1 had the poorest repeatability, which consequentially affected C2 amplitude estimation. Only C3 amplitude and latency could be consistently estimated as C2 and C3 latencies were similarly repeatable. Coefficients of repeatability of osVEP latencies did not appear to systematically differ between non-amblyopic and amblyopic children.

Visual electrodiagnostics and eye movement recording - World Society of Pediatric Ophthalmology and Strabismus (WSPOS) consensus statement

Visual electrodiagnostics and eye movement recording are important additional clinical tools in evaluation, diagnosing and management of ophthalmic and neurological disorders. Due to their objectiveness and non-invasiveness they can play an important role in pediatric ophthalmology. The WSPOS (World Society of Pediatric Ophthalmology and Strabismus) consensus statement gives insight into basic principles and highlights the clinical application of both visual electrodiagnostic tests and eye movement recording.

Neurocognitive Markers During Prolonged Breath-Holding in Freedivers: An Event-Related EEG Study

Since little is known concerning the psychological, cognitive, and neurophysiological factors that are involved in and important for phases of prolonged breath-holding (pBH) in freedivers, the present study uses electroencephalography (EEG) to investigate event-related neurocognitive markers during pBH of experienced freedivers that regularly train pBH. The purpose was to determine whether the well-known neurophysiological modulations elicited by hypoxic and hypercapnic conditions can also be detected during pBH induced hypoxic hypercapnia. Ten experienced free-divers (all male, aged 35.10 ± 7.89 years) were asked to hold their breath twice for 4 min per instance. During the first pBH, a checker board reversal task was presented and in the second four-min pBH phase a classical visual oddball paradigm was performed. A visual evoked potential (VEP) as an index of early visual processing (i.e., latencies and amplitudes of N75, P100, and N145) and the latency and amplitude of a P300 component (visual oddball paradigm) as an index of cognitive processing were investigated. In a counter-balanced cross-over design, all tasks were once performed during normal breathing (B), and once during pBH. All components were then compared between an early pBH (0–2 min) and a later pBH stage (2–4 min) and with the same time phases without pBH (i.e., during normal breathing). Statistical analyses using analyses of variance (ANOVA) revealed that comparisons between B and pBH yielded no significant changes either in the amplitude and latency of the VEP or in the P300. This indicates that neurocognitive markers, whether in an early visual processing stream or at a later cognitive processing stage, were not affected by pBH in experienced free-divers.

Different Electrophysiological Responses to Informative Value of Feedback Between Children and Adults

The ability to learn from feedback is important for children's adaptive behavior and school learning. Feedback has two main components, informative value and valence. How to disentangle these two components and what is the developmental neural correlates of using the informative value of feedback is still an open question. In this study, 23 children (7-10 years old) and 19 adults (19-22 years old) were asked to perform a rule induction task, in which they were required to find a rule, based on the informative value of feedback. Behavioral results indicated that the likelihood of correct searching behavior under negative feedback was low for children. Event-related potentials showed that (1) the effect of valence was processed in a wide time window, particularly in the N2 component; (2) the encoding process of the informative value of negative feedback began later for children than for adults; (3) a clear P300 was observed for adults; for children, however, P300 was absent in the frontal region; and (4) children processed the informative value of feedback chiefly in the left sites during the P300 time window, whereas adults did not show this laterality. These results suggested that children were less sensitive to the informative value of negative feedback possibly because of the immature brain.

The Development and Aging of the Magnocellular and Parvocellular Visual Pathways as Indicated by VEP Recordings between 5 and 84 Years of Age

It is well known that pattern reversal visual evoked potentials (VEPs) are age-sensitive. Through the use of this technique, it is possible to assess both of the major visual pathways (i.e., the magnocellular and parvocellular ones) in terms of function and development. What developmental path these pathways follow, and if they develop/age in parallel across the human lifespan is a matter of ongoing debate, yet, only a few VEP studies have dealt with this issue. This cross-sectional study examined a sample of 115 healthy volunteers aged 5 to 84 years. Beyond the standard checkerboard pattern reversal stimulation at 97% contrast, we recorded pattern-reversal VEPs at 6% contrast to selectively stimulate the M pathway and isoluminant red and green checkerboard stimulation was also used to selectively stimulate the P pathway. Our results do not support the developmental advantage of any of the pathways. The development of both pathways appear to take a remarkably long time (well into the 30s), and the signs of aging become marked over 50 years of age, especially in the case of the magnocellular pathway.

Automatic Change Detection to Facial Expressions in Adolescents: Evidence from Visual Mismatch Negativity Responses

Adolescence is a critical period for the neurodevelopment of social-emotional processing, wherein the automatic detection of changes in facial expressions is crucial for the development of interpersonal communication. Two groups of participants (an adolescent group and an adult group) were recruited to complete an emotional oddball task featuring on happy and one fearful condition. The measurement of event-related potential was carried out via electroencephalography and electrooculography recording, to detect visual mismatch negativity (vMMN) with regard to the automatic detection of changes in facial expressions between the two age groups. The current findings demonstrated that the adolescent group featured more negative vMMN amplitudes than the adult group in the fronto-central region during the 120–200 ms interval. During the time window of 370–450 ms, only the adult group showed better automatic processing on fearful faces than happy faces. The present study indicated that adolescent’s posses stronger automatic detection of changes in emotional expression relative to adults, and sheds light on the neurodevelopment of automatic processes concerning social-emotional information.

An Influence of Birth Weight, Gestational Age, and Apgar Score on Pattern Visual Evoked Potentials in Children with History of Prematurity

Purpose. The objective of our study was to examine a possible influence of gestational age, birth weight, and Apgar score on amplitudes and latencies of P100 wave in preterm born school-age children. Materials and Methods. We examined the following group of school-age children: 28 with history of prematurity (mean age 10.56 ± 1.66 years) and 25 born at term (mean age 11.2 ± 1.94 years). The monocular PVEP was performed in all children. Results. The P100 wave amplitudes and latencies significantly differ between preterm born school-age children and those born at term. There was an essential positive linear correlation of the P100 wave amplitudes with birth weight, gestational age, and Apgar score. There were the negative linear correlations of P100 latencies in 15-minute stimulation from O1 and Oz electrode with Apgar score and O1 and O2 electrode with gestational age. Conclusions. PVEP responses vary in preterm born children in comparison to term. Low birth weight, early gestational age, and poor baseline output seem to be the predicting factors for the developmental rate of a brain function in children with history of prematurity. Further investigations are necessary to determine perinatal factors that can affect the modified visual system function in preterm born children.

Early childhood development of visual texture segregation in full-term and preterm children

To date, very little is known about the normal development trajectory of visual texture segregation, or how it is affected by preterm birth. The goal of this study was to characterize the development of visual texture segregation using texture segregation visual evoked potentials (tsVEPs) in children born full-term and children born preterm without major neurological impairment. Forty-five full-term and 43 preterm children were tested at either 12, 24 or 36 months of age (corrected age for prematurity at 12 and 24 months old). VEPs were obtained using two lower-level stimuli defined by orientation (oriVEP) and two higher-level stimuli defined by texture (texVEP). TsVEP was obtained by dividing by two the subtraction of oriVEP from texVEP. Results show a clear maturation of the processes underlying visual texture segregation in the full-term group, with a significant N2 latency reduction between 12 and 36 months of age for all conditions. Significant N2 amplitude reduction was observed for oriVEP between 12 and 24 months, as well as for texVEP between 12 and 24 months, and 12 and 36 months. Comparison between full-term and preterm children indicated significantly lower N2 amplitude for the preterm group at 12 months for oriVEP and texVEP. These differences were no longer apparent at 24 months of age, suggesting that children born preterm catch up with their full-term counterparts somewhere between 12 and 24 months of age. Our results appear to reflect a maturational delay in preterm children in both lower-level and higher-level visual processing during, at least, early childhood.

Role of visual evoked potentials in the assessment and management of optic pathway gliomas in children

OBJECTIVE

The aim of this study is to investigate the role of pattern reversal visual evoked potentials (pVEPs) in the screening and monitoring of optic pathway gliomas (OPGs) in children with and without neurofibromatosis type 1.

METHODS

A review of the English literature published between 1980 and 2012 was performed, with comparison of results of retro- and prospective studies.

RESULTS

Pattern reversal VEPs have a high sensitivity (85.7-100 %) for the diagnosis of OPGs, moreover they are safe and cost-effective. Conversely, they have a low specificity (43-83 %) and are not widely available. Besides, pattern reversal VEP results can be unreliable in young children, because of the need for a good cooperation. The studies that were analyzed have drawbacks, including the small sample size, the retrospective design, the differences in gold standard for diagnosis, the different interpretation of small changes in VEP results and the lack of control groups.

CONCLUSION

There is still debate about the gold standard for the screening and follow-up of OPGs. The added value of pVEPs to the ophthalmic examination is controversial. Randomized controlled trials or prospective multicentre studies are necessary to assess with sufficient accuracy the sensitivity and specificity of pattern reversal VEPs in the screening for OPGs and its follow-up.

Evidence for a magnocellular disadvantage in early-onset schizophrenic patients: a source analysis of the N80 visual-evoked component

BACKGROUND

Visual impairments in schizophrenia have been suggested to be partly caused by early processing deficits of the magnocellular (M) pathway. This might include disturbed interactions between the M and parvocellular (P) pathways and especially impaired M priming, which can disturb highlighting of relevant information. Such disorders may result from neurodevelopmental irregularities, which are assumed to be substantially involved in schizophrenia. This study sought to test the hypothesis that M priming is impaired in schizophrenia. In order to elucidate this neurodevelopmental aspect, we investigated patients with different ages of schizophrenia onset. This provided a useful design to integrate visual information processing in a neurodevelopmental model of schizophrenia.

METHOD

Nine stimulus conditions were used to investigate the M- and P-pathways and their interaction in a pattern reversal VEP paradigm. N80 generators were analyzed using source localization (Brain Electrical Source Analysis software: BESA). Forty schizophrenia patients (early-onset=19; adult-onset=21) were compared with age- and gender-matched healthy controls (early-onset controls=19; adult-onset controls=21). Hypotheses were tested using a bootstrap resampling procedure.

RESULTS

The N80 component was represented by a single dipole located in the occipital visual cortex. The bootstrap analysis yielded significant differences between early-onset schizophrenia patients and controls. We found lower amplitudes in response to mixed M-P conditions and normal amplitudes in response to isolated P- and M-biased stimulation. Concerning the latencies, significant differences were found between adult-onset subjects and their controls, with prolonged latencies for schizophrenia patients.

CONCLUSIONS

The early VEP component N80 evoked by mixed M-P conditions is assumed to be a correlate of M priming and showed reduced amplitude in early-onset schizophrenic patients but not in adult-onset patients. These findings point towards an M priming deficit in early-onset patients and are compatible with a neurodevelopmental hypothesis of schizophrenia, probably reflecting asynchronies in brain maturational abnormalities occurring at different ages of illness onset.

Electrophysiological correlates of category induction in children and adults

Category induction involves abstraction of features common to two or more stimuli. Event-related potentials (ERPs) during induction and non-induction tasks were recorded for 12 children and 12 adults. We found that (1) ERP waves, except P2 amplitude, decreased significantly with age, (2) Compared to non-induction tasks, induction tasks elicited larger fronto-central N2 components in both age groups, (3) The amplitude of the late positive component was significantly greater in the induction condition than in the non-induction condition, and (4) The difference wave suggested that category induction was mainly located in the left hemisphere in children but was not lateralized in adults.

Event-related potential alterations in fragile X syndrome

Fragile X Syndrome (FXS) is the most common form of X-linked intellectual disability (ID), associated with a wide range of cognitive and behavioral impairments. FXS is caused by a trinucleotide repeat expansion in the FMR1 gene located on the X-chromosome. FMR1 is expected to prevent the expression of the "fragile X mental retardation protein (FMRP)", which results in altered structural and functional development of the synapse, including a loss of synaptic plasticity. This review aims to unveil the contribution of electrophysiological signal studies for the understanding of the information processing impairments in FXS patients. We discuss relevant event-related potential (ERP) studies conducted with full mutation FXS patients and clinical populations sharing symptoms with FXS in a developmental perspective. Specific deviances found in FXS ERP profiles are described. Alterations are reported in N1, P2, Mismatch Negativity (MMN), N2, and P3 components in FXS compared to healthy controls. Particularly, deviances in N1 and P2 amplitude seem to be specific to FXS. The presented results suggest a cascade of impaired information processes that are in line with symptoms and anatomical findings in FXS.

Maturation of visual evoked potentials across adolescence

Adolescence represents the period of transition from childhood to adulthood and is characterized by significant changes in brain structure and function. We studied changes in the functional visual processing in the brain across adolescence. Visual evoked potentials (VEPs) to three types of pattern reversal checkerboard stimuli were measured in 90 adolescents (10-18 years) and 10 adults. Across adolescence, the N75 and P100 VEP peaks decreased in size while the N135 peak increased slightly in size. The latency of VEP peaks showed no reliable change across adolescence. The results suggest that even very basic visual sensory function continues to develop throughout adolescence. The results indicate significant changes in visual parvocellular and magnocellular pathways across adolescence.

Contrast adaptation reveals increased organizational complexity of chromatic processing in the visual evoked potential

Results from psychophysics and single-unit recordings suggest that color vision comprises multiple stages of processing. Postreceptoral channels appear to consist of both a stage of broadly tuned opponent channels that compare cone signals and a subsequent stage, which includes cells tuned to many different directions in color space. The chromatic visual evoked potential (crVEP) has demonstrated chromatic processing selective for cardinal axes of color space. However, crVEP evidence for higher-order color mechanisms is lacking. The present study aimed to assess the contribution of lower- and higher-order color mechanisms to the crVEP by using chromatic contrast adaptation. The results reveal the presence of mechanisms tuned to intermediate directions in color space in addition to those tuned to the fundamental cardinal axes.

When do asymmetrical full-field pattern reversal visual evoked potentials indicate visual pathway dysfunction in children?

Our study aimed to find out the association between full-field pattern reversal visual evoked potential (pVEP) transoccipital asymmetries and half-field pVEP transoccipital distributions in children. Over a six-month period, 46 patients (mean age: 9 years 9 months) had both monocular full-field and half-field pVEPs to test checks subtending 50 min of arc in a 35 degree full-field and 0-17.5 degree lateral half-field. Silver-silver chloride electrodes placed at Oz, O1 and O2 were referred to Fz. Monocular full-field data were categorised according to the degree of transoccipital asymmetry. Half-field data were measured and summated to see whether they explained any full-field asymmetry. In this cohort of 46 patients, eight (17%) patients had symmetrically distributed monocular full-field pVEPs for each eye. Four of these patients had normal half-field pVEP distributions for each eye, but the other four showed a half-field deficit in one or both eyes. Of the 38 patients with asymmetrically distributed full-field pVEPs in at least one eye, 17 (44%) patients showed a half-field deficit, 20 (53%) showed responsive, but symmetrically distributed half-field responses, and one patient (3%) showed typical half-field distributions. Half-field pVEPs can help explain full-field asymmetries and should be attempted in any child able to co-operate with testing and in whom visual pathway dysfunction is suspected.

Early Visually Evoked Electrophysiological Responses Over the Human Brain (P1, N170) Show Stable Patterns of Face-Sensitivity from 4 years to Adulthood

Whether the development of face recognition abilities truly reflects changes in how faces, specifically, are perceived, or rather can be attributed to more general perceptual or cognitive development, is debated. Event-related potential (ERP) recordings on the scalp offer promise for this issue because they allow brain responses to complex visual stimuli to be relatively well isolated from other sensory, cognitive and motor processes. ERP studies in 5- to 16-year-old children report large age-related changes in amplitude, latency (decreases) and topographical distribution of the early visual components, the P1 and the occipito-temporal N170. To test the face specificity of these effects, we recorded high-density ERPs to pictures of faces, cars, and their phase-scrambled versions from 72 children between the ages of 4 and 17, and a group of adults. We found that none of the previously reported age-dependent changes in amplitude, latency or topography of the P1 or N170 were specific to faces. Most importantly, when we controlled for age-related variations of the P1, the N170 appeared remarkably similar in amplitude and topography across development, with much smaller age-related decreases in latencies than previously reported. At all ages the N170 showed equivalent face-sensitivity: it had the same topography and right hemisphere dominance, it was absent for meaningless (scrambled) stimuli, and larger and earlier for faces than cars. The data also illustrate the large amount of inter-individual and inter-trial variance in young children's data, which causes the N170 to merge with a later component, the N250, in grand-averaged data. Based on our observations, we suggest that the previously reported “bi-fid” N170 of young children is in fact the N250. Overall, our data indicate that the electrophysiological markers of face-sensitive perceptual processes are present from 4 years of age and do not appear to change throughout development.

Early signs of visual perception and evoked potentials in radiologically asymptomatic boys with X-linked adrenoleukodystrophy

The aim was to identify the electrophysiological and psychological signs at a very early stage in asymptomatic boys with childhood cerebral X-linked adrenoleukodystrophy. Flash visual evoked potentials, pattern reversal, and visual event-related potentials were recorded in 6 radiologically asymptomatic boys with adrenoleukodystrophy and 22 control boys. The latency and amplitude of P100 of visual evoked potentials and P1 of event-related potentials were evaluated. Though all patients had normal intelligence quotient, performance intelligence quotient was significantly lower than verbal intelligence quotient in 2 patients. Both P100 and P1 amplitudes were significantly greater in adrenoleukodystrophy than in controls. The difference between performance intelligence quotient and verbal intelligence quotient exhibited significant correlation with P100 amplitude. Enlargement of visual evoked potentials might be a sign of cerebral involvement preceding the appearance of abnormalities on magnetic resonance imaging. Follow-up of asymptomatic boys with both electrophysiological and neuropsychological tests may serve as an aid for deciding the timing of therapeutic intervention.

Pediatric clinical visual electrophysiology: a survey of actual practice

PURPOSE

Survey the actual clinical practice of pediatric visual electrophysiology. The electrophysiologists surveyed were members of the International Society for Clinical Electrophysiology of Vision (ISCEV).

METHODS

A self-administered questionnaire with 55 items about visual evoked potential (VEP) and electroretinogram (ERG) testing of pediatric patients was sent to ISCEV members. The survey queried personnel, facilities, referral patterns and conduct of tests.

RESULTS

Nearly all respondents (94%) had advanced scientific or clinical degrees or both, and most (96%) worked in academic or medical facilities. Of the 71 respondents, 68 tested patients 12 years or younger, and nearly all of those performed both VEPs and ERGs. However, fewer than a third did high volume (>10/month) testing of infants and young children (< or =6 years). Eye care professionals and neurologists made the majority (57%) of the referrals, with the most common reason for referral being suspected visual impairment. Conduct of a pediatric test session often required more than one practitioner. For both VEP and ERG, more than 70% of respondents required at least 30 min for each test. The majority indicated that they followed the ISCEV standards for stimuli and data acquisition. Almost all (94%) reported using the ISCEV recommended VEP electrode configuration. For ERG, most (88%) used ocular contact electrodes (including contact lens, thread, foil and HK loop), but 12% used skin electrodes exclusively and some (17%) used skin electrodes at times.

CONCLUSIONS

Pediatric ERG and VEP testing is a labor intensive endeavor of highly trained professionals. ISCEV technical standards are typically met or exceeded, indicating that high quality testing of infants and children is feasible. Revision of the ISCEV ERG standard is necessary to bring actual practice into accord with evidence-based recommendations for infant testing.

Visual evoked potentials to red-green stimulation in schoolchildren

The aim is to study chromatic visual evoked potentials (VEP) to isoluminant red-green (R-G) stimulus in schoolchildren. Sixty children (7–19 years) with normal color vision were examined, 30 binocularly and 30 monocularly. The isoluminant point was determined for each child subjectively by using heterochromatic flicker photometry, and objectively from recordings. The stimulus was a 7° circle composed of horizontal sinusoidal gratings, with spatial frequency 2 cycles/degrees and 90% contrast, presented in onset-offset mode. VEP were recorded from Oz (mid-occipital) position. Age-dependent waveform changes and changes of the positive and negative wave were studied to both binocular and monocular R-G stimulation. Age-dependent waveform changes were observed to binocular and monocular R-G stimulation. In younger children the positive wave was prominent, whereas in older children also the negative wave became more evident. The latency of the positive wave decreased linearly with age to R-G binocular stimulation. To monocular stimulation no significant changes of the latency were observed. The amplitude of the positive wave dropped exponentially with age to binocular and monocular stimulation. The latency of the negative wave increased linearly with age to binocular and monocular stimulation, whereas the amplitude did not show age-dependent changes. These findings suggest that the chromatic VEP response undergoes evident age-dependent changes during the school-age period.

Maturation of luminance- and motion-defined form perception beyond adolescence: a combined ERP and fMRI study

Abilities to discriminate forms defined by motion continue to develop throughout childhood. To investigate late development of the visual motion system, we measured brain activity with event-related EEG potentials (ERPs) and functional magnetic resonance imaging (fMRI) in groups of adolescents (15-17 years) and adults (20-30 years) during a visual form discrimination task--with forms being either defined by motion or luminance contrast. We further explored whether possible developmental changes varied with the degree of motion coherence reflecting maturation specific to global motion processing. Both the fMRI activation patterns and ERP topographies were very similar between adolescents and adults, suggesting that the basic visual networks for processing motion and form are established by the age of 15-17. The ERP response to luminance- and motion-defined forms was dominated by a posterior negativity (N1: 120-270 ms). The N1 of the motion contrast was delayed in adolescents, whereas the N1 of the static condition did not differ between groups. Since the motion-evoked N1 is thought to arise in the middle temporal area MT/V5, our results indicate that visual motion processing in MT continues to get faster, becoming still more efficient during late development. Neither the ERP nor the fMRI results revealed maturation effects specific to motion coherence. This indicates that the specific mechanisms to process global dot motion are already mature in adolescence. The present findings support the view that static perception matures earlier than dynamic perception, and that these visual systems have different developmental courses.

Development of inner retinal function, evidenced by the pattern electroretinogram, in the rat

Though the rat is increasingly used as an animal model in ophthalmic research, including the study of glaucoma, little is known about age-related changes in its inner retinal function. The aim of this study was to evaluate these changes in the rat during the first 18 weeks of life. The pattern electroretinogram (PERG) was used to monitor inner retinal activity in 16 developing rats. In each animal, recordings were conducted at ages 3, 5, 7, 11, 14 and 18 weeks to assess age-related changes in function. Signals were evoked by five stimuli of progressively increasing check width (subtending 82-1312 arc minutes of visual angle) that were projected directly onto the fundus through a specially modified ophthalmoscope which allowed visual and manual control of stimulus quality. Poor signal:noise ratio prevented signal analysis at age 3 weeks. Subsequently, PERG amplitude increased significantly, up to 242% (depending on stimulus check width), during weeks 5-11. After peaking at 11 weeks, signal amplitude declined moderately. Signal latency mirrored that of amplitude, decreasing during the first 11 weeks, and then increasing steadily. Latency was not affected by stimulus check width. Age was highly correlated with P1 latency (R(2)=0.80) and moderately correlated with N2 latency (R(2)=0.52). Therefore, we propose that studies of inner retinal diseases (such as glaucoma) in the rat model should use age-matched controls, as electrophysiological results may be confounded by age-related changes. The rat PERG undergoes many of the age-related changes that have been reported in humans, and thus may serve as an animal model to study development of inner retinal function.

Motion-onset VEPs reflect long maturation and early aging of visual motion-processing system

Pattern-reversal and motion-onset visual evoked potentials (VEPs) were simultaneously tested in a group of 70 healthy subjects between the ages of 6-60 years to verify suspected differences in maturation and aging dynamics of the pattern and motion processing subsystems of the visual pathway. The motion-onset VEPs displayed dramatic configuration development and shortening of latencies up to 18 years of age (correl. coeff. -0.85; p < 0.001) and systematic prolongation from about 20 years of age (correl. coeff. 0.70; p < 0.001). This confirms long-lasting maturation of the magnocellular system and/or motion processing cortex and their early age related changes. Less significant changes of pattern-reversal VEPs in the tested age range can be interpreted as a sign of early maturation of the parvocellular system and its enhanced functional endurance in the elderly.

Auditory and visual refractory period effects in children and adults: An ERP study

OBJECTIVE

This developmental study was designed to investigate event-related potential (ERP) refractory period effects in the auditory and visual modalities in children and adults and to correlate these electrophysiological measures with standard behavioral measures.

METHODS

ERPs, accuracy, and reaction time were recorded as school-age children and adults monitored a stream of repetitive standard stimuli and detected occasional targets. Standards were presented at various interstimulus intervals (ISIs) in order to measure refractory period effects on early sensory components.

RESULTS

As has been reported previously in adults, larger components for standards with longer ISIs were observed for an auditory N1 and the visual occipital P1 and P2 in adults. Remarkably similar effects were observed in children. However, only children showed refractory effects on the amplitude of the visual N1 and P2 measured at anterior sites. Across groups, behavioral accuracy and reaction time were correlated with latencies of auditory N1 and visual P2 across ISI conditions.

CONCLUSIONS

The results establish a normal course of development for auditory and visual ERP refractory period effects across the 6- to 8-year-old age range and indicate similar refractoriness in the neural systems indexed by ERPs in these paradigms in typically developing children and adults. Further, the results suggest that electrophysiological measures and standard behavioral measures may at least in part index similar processing in the present paradigms.

SIGNIFICANCE

These findings provide a foundation for further investigation into atypical development, particularly in those populations for which processing time deficits have been implicated such as children with specific language impairment or dyslexia.

Motion and color processing in school-age children and adults: an ERP study

Stimuli designed to selectively elicit motion or color processing were used in a developmental event-related potential study with adults and children aged 6, 7 and 8. A positivity at posterior site INZ (P-INZ) was greater to motion stimuli only in adults. The P1 and N1 were larger to color stimuli in both adults and children, but earlier to motion stimuli only in adults. Finally, the P2 was larger to color stimuli in adults but larger to motion stimuli in children, and earlier to motion stimuli only in children. The findings across components indicate development from middle childhood to adulthood in aspects of both the motion and color processing systems indexed by this paradigm, but are consistent with an hypothesis of a more protracted time course of development for the motion as compared to the color processing system.

Age-related retinal degeneration in animal models of aging: possible involvement of taurine deficiency and oxidative stress

There is strong evidence that the retina degenerates with age. Electroretinogram deficits and photoreceptor cell death and structural abnormalities have been observed in both animal and human studies of aging. The mechanism behind this phenomenon is a very interesting area for scientific and medical study. Current data support the link between retinal degeneration and increased oxidative stress. Taurine is a free amino acid found in high millimolar concentrations in the retina, and age-related deficiency in retinal levels of taurine may contribute to the retinal degeneration associated with age. Taurine acts as an antioxidant and taurine replenishment is known to alleviate oxidative stress in the retina. Thus taurine supplementation may be useful in the treatment of age-related retinal dysfunction.

Multifocal VEP in children: its maturation and clinical application

AIM

To study the maturation of multifocal visual evoked potentials (multifocal VEP) in normal children between the ages of 5 and 16 years and to apply the results clinically in selected cases to the diagnosis of optic pathway diseases.

METHOD

70 normal children were recruited from the community and multifocal VEP (Accumap ObjectiVision, Sydney, Australia) was recorded. The waveform of the evoked responses, the latency and amplitude were analysed. Using these data, an age matched comparison was made with three children with advanced optic nerve disease; two had optic nerve glioma and one had congenital glaucoma.

RESULTS

The full field amplitude did not correlate with age and varied greatly within each age group (coefficient of variability 28%). When scaled with respect to the background electroencephalogram the intra-age group variability decreased to 15% and a sigmoid relation was found between amplitude and age. The scaled amplitude remained largely unchanged till 11 years, between 11 and 13 years there was a rapid increase (40%), and remained stable thereafter. This relation was seen at all eccentricities tested. The latency decreased gradually with age and plateaued at 13 years. In the three children with vision abnormalities this test was able to detect scotomas consistent with their condition.

CONCLUSION

Multifocal VEP perimetry shows an age related maturation in the visual pathway, characterised by distinctive timeframe of development for amplitude and latency. It can be performed by children as young as 5 years of age and holds promise as a diagnostic test capable of documenting children's visual fields objectively, even before they are able to perform subjective field tests.

Visual electrophysiological screening in diagnosing infants with congenital nystagmus

OBJECTIVE

To determine the value of visual electrophysiological screening in evaluating retinal and postretinal visual pathway function in infants with congenital nystagmus.

METHODS

In 28 infants with congenital nystagmus electroretinogram (ERG) was recorded with skin electrodes and, since the infants were alert, visual evoked potentials (VEP) were simultaneously recorded. The first recording was performed before the age of 1 year (age 2-11 months, mean age 6.8 months). Follow-up was performed between the ages of 7 months and 6 years (mean age 2.7 years). ERG was detected to flash stimulus and VEP to flash and/or pattern-reversal stimulus.

RESULTS

In infants less than 1 year of age, retinal dysfunction was recognised in 36% of infants who had been diagnosed as Leber's congenital amaurosis, achromatopsia and retinal dystrophy; postretinal dysfunction was recognised in 32% of infants who had been diagnosed with ocular albinism, optic nerve hypoplasia and neurological nystagmus; retinal or postretinal function was normal in 7% of infants that had been diagnosed as congenital idiopathic nystagmus, while retinal function was normal and postretinal function was undefined in 25% of infants that had been diagnosed as optic nerve hypoplasia, neurological nystagmus and congenital idiopathic nystagmus. At follow-up the findings were: retinal dysfunction in 36%, postretinal dysfunction in 50% and normal retinal and postretinal function in 14% of children. All those children with normal retinal and postretinal function had been diagnosed as congenital idiopathic nystagmus.

CONCLUSIONS

Visual electrophysiological screening of infants with congenital nystagmus can establish or exclude retinal and postretinal pathway dysfunction. Therefore simultaneous skin ERG and VEP which is a non-invasive approach for infants enables an objective means for identifying the basis of congenital nystagmus, thereby assisting in its classification.