Quantifying interhemispheric symmetry of somatosensory evoked potentials with the intraclass correlation coefficient

Methods for measuring swallowing pressure variability using high-resolution manometry

Any movement performed repeatedly will be executed with inter-trial variability. Oropharyngeal swallowing is a complex sensorimotor action, and swallow-to-swallow variability can have consequences that impact swallowing safety. Our aim was to determine an appropriate method to measure swallowing pressure waveform variability. An ideal variability metric must be sensitive to known deviations in waveform amplitude, duration, and overall shape, without being biased by waveforms that have both positive and sub-atmospheric pressure profiles. Through systematic analysis of model waveforms, we found a coefficient of variability (CV) parameter on waveforms adjusted such that the overall mean was 0 to be best suited for swallowing pressure variability analysis. We then investigated pharyngeal swallowing pressure variability using high-resolution manometry data from healthy individuals to assess impacts of waveform alignment, pharyngeal region, and number of swallows investigated. The alignment that resulted in the lowest overall swallowing pressure variability was when the superior-most sensor in the upper esophageal sphincter reached half its maximum pressure. Pressures in the tongue base region of the pharynx were least variable and pressures in the hypopharynx region were most variable. Sets of 3 - 10 consecutive swallows had no overall difference in variability, but sets of 2 swallows resulted in significantly less variability than the other dataset sizes. This study identified variability in swallowing pressure waveform shape throughout the pharynx in healthy adults; we discuss implications for swallowing motor control.

A surface-based technique for mapping homotopic interhemispheric connectivity: Development, characterization, and clinical application

The functional organization of the human brain consists of a high degree of connectivity between interhemispheric homologous regions. The degree of homotopic organization is known to vary across the cortex and homotopic connectivity is high in regions that share cross-hemisphere structural connections or are activated by common input streams (e.g., the visual system). Damage to one or both regions, as well as damage to the connections between homotopic regions, could disrupt this functional organization. Here were introduce and test a computationally efficient technique, surface-based homotopic interhermispheric connectivity (sHIC), that leverages surface-based registration and processing techniques in an attempt to improve the spatial specificity and accuracy of cortical interhemispheric connectivity estimated with resting state functional connectivity. This technique is shown to be reliable both within and across subjects. sHIC is also characterized in a dataset of nearly 1000 subjects. We confirm previous results showing increased interhemispheric connectivity in primary sensory regions, and reveal a novel rostro-caudal functionally defined network level pattern of sHIC across the brain. In addition, we demonstrate a structural-functional relationship between sHIC and atrophy of the corpus callosum in multiple sclerosis (r = 0.2979, p = 0.0461). sHIC presents as a sensitive and reliable measure of cortical homotopy that may prove useful as a biomarker in neurologic disease. Hum Brain Mapp 37:2849-2868, 2016. © 2016 Wiley Periodicals, Inc.

Quantification of LLAEP interhemispheric symmetry by the intraclass correlation coefficient as a measure of cortical reorganization after cochlear implantation

OBJECTIVE

Electrical stimulation by a cochlear implant (CI) induces maturation of the auditory system and reorganization of the auditory cortex in deaf children. Cortical reorganization produces an interhemispheric asymmetry in auditory evoked brain potentials associated with sound stimulation after unilateral implantation. To objectively determine the onset of this phenomenon and follow this process over time, the interhemispheric symmetry needs to be quantified. In this paper, the intraclass correlation coefficient (ICC) between mean global field powers (MGFPs) of each hemisphere is proposed to quantify long latency auditory evoked potential (LLAEP) interhemispheric symmetries as a measure of auditory cortex reorganization in CI recipients.

DESIGN

An LLAEP, in response to a simple tone, was recorded in 5 juvenile unilateral CI recipients at less and at more than two years post-implantation and the ICC between MGFPs was calculated for both recordings. The cross correlation coefficients (CC) between MGFPs of each hemisphere were also calculated and compared with the ICC.

RESULTS

The experience-related visually observed increases in amplitude and shape asymmetries of the LLAEP topographic map (around the LLAEP P(1) peak), were reflected in a considerable reduction of ICC values (on average 41.4%), at more than two years post-implantation surgery. In contrast, CC values only showed much smaller decreases (on average 20.0%), at more than two years post-implantation.

CONCLUSIONS

The ICC is a better descriptor of symmetry than the CC because it reflects both shape and amplitude similarity between left and right LLAEP MGFPs instead of only shape similarity. The decrease in ICC values at more than two years post-implantation is likely associated with a lateralization of the auditory response as a result of cortical reorganization. Our results show that the ICC between the MGFPs for each hemisphere can be useful to objectively determine the auditory cortex reorganization process and also to evaluate the performance of cochlear implant users without the necessity to use expensive technologies such as high density EEG recordings and/or fMRI scans.

Sensory handedness is not reflected in cortical responses after basic nerve stimulation: a MEG study

Motor dominance is well established, but sensory dominance is much less clear. We therefore studied the cortical evoked magnetic fields using magnetoencephalography (MEG) in a group of 20 healthy right handed subjects in order to examine whether standard electrical stimulation of the median and ulnar nerve demonstrated sensory lateralization. The global field power (GFP) curves, as an indication of cortical activation, did not depict sensory lateralization to the dominant left hemisphere. Comparison of the M20, M30, and M70 peak latencies and GFP values exhibited no statistical differences between the hemispheres, indicating no sensory hemispherical dominance at these latencies for each nerve. Field maps at these latencies presented a first and second polarity reversal for both median and ulnar stimulation. Spatial dipole position parameters did not reveal statistical left-right differences at the M20, M30 and M70 peaks for both nerves. Neither did the dipolar strengths at M20, M30 and M70 show a statistical left-right difference for both nerves. Finally, the Laterality Indices of the M20, M30 and M70 strengths did not indicate complete lateralization to one of the hemispheres. After electrical median and ulnar nerve stimulation no evidence was found for sensory hand dominance in brain responses of either hand, as measured by MEG. The results can provide a new assessment of patients with sensory dysfunctions or perceptual distortion when sensory dominance occurs way beyond the estimated norm.

Correlation of transcranial color Doppler to n20 somatosensory evoked potential detects ischemic penumbra in subarachnoid hemorrhage

Background:

Normal subjects present interhemispheric symmetry of middle cerebral artery (MCA) mean flow velocity and N20 cortical somatosensory evoked potential (SSEP). Subarachnoid haemorrhage (SAH) can modify this pattern, since high regional brain vascular resistances increase blood flow velocity, and impaired regional brain perfusion reduces N20 amplitude. The aim of the study is to investigate the variability of MCA resistances and N20 amplitude between hemispheres in SAH.

Methods:

Measurements of MCA blood flow velocity (vMCA) by transcranial color-Doppler and median nerve SSEP were bilaterally performed in sixteen patients. MCA vascular changes on the compromised hemisphere were calculated as a ratio of the reciprocal of mean flow velocity (1/vMCA) to contralateral value and correlated to the simultaneous variations of interhemispheric ratio of N20 amplitude, within each subject. Data were analysed with respect to neuroimaging of MCA supplied areas.

Results:

Both interhemispheric ratios of 1/vMCA and N20 amplitude were detected >0.65 (p <0,01) in patients without neuroimages of injury. Both ratios became <0.65 (p <0.01) when patients showed unilateral images of ischemic penumbra and returned >0.65 if penumbra disappeared. The two ratios no longer correlated after structural lesion developed, as N20 detected in the damaged side remained pathological (ratio <0.65), whereas 1/vMCA reverted to symmetric interhemispheric state (ratio >0.65), suggesting a luxury perfusion.

Conclusion:

Variations of interhemispheric ratios of MCA resistance and cortical N20 amplitude correlate closely in SAH and allow identification of the reversible ischemic penumbra threshold, when both ratios become <0.65. The correlation is lost when structural damage develops.