Electrical and Hemodynamic Neural Functions in People With ALS: An EEG-fNIRS Resting-State Study

The cortical neurophysiological signature of amyotrophic lateral sclerosis

The progressive loss of motor function characteristic of amyotrophic lateral sclerosis is associated with widespread cortical pathology extending beyond primary motor regions. Increasing muscle weakness reflects a dynamic, variably compensated brain network disorder. In the quest for biomarkers to accelerate therapeutic assessment, the high temporal resolution of magnetoencephalography is uniquely able to non-invasively capture micro-magnetic fields generated by neuronal activity across the entire cortex simultaneously. This study examined task-free magnetoencephalography to characterize the cortical oscillatory signature of amyotrophic lateral sclerosis for having potential as a pharmacodynamic biomarker. Eight to ten minutes of magnetoencephalography in the task-free, eyes-open state was recorded in amyotrophic lateral sclerosis (n = 36) and healthy age-matched controls (n = 51), followed by a structural MRI scan for co-registration. Extracted magnetoencephalography metrics from the delta, theta, alpha, beta, low-gamma, high-gamma frequency bands included oscillatory power (regional activity), 1/f exponent (complexity) and amplitude envelope correlation (connectivity). Groups were compared using a permutation-based general linear model with correction for multiple comparisons and confounders. To test whether the extracted metrics could predict disease severity, a random forest regression model was trained and evaluated using nested leave-one-out cross-validation. Amyotrophic lateral sclerosis was characterized by reduced sensorimotor beta band and increased high-gamma band power. Within the premotor cortex, increased disability was associated with a reduced 1/f exponent. Increased disability was more widely associated with increased global connectivity in the delta, theta and high-gamma bands. Intra-hemispherically, increased disability scores were particularly associated with increases in temporal connectivity and inter-hemispherically with increases in frontal and occipital connectivity. The random forest model achieved a coefficient of determination (R2) of 0.24. The combined reduction in cortical sensorimotor beta and rise in gamma power is compatible with the established hypothesis of loss of inhibitory, GABAergic interneuronal circuits in pathogenesis. A lower 1/f exponent potentially reflects a more excitable cortex and a pathology unique to amyotrophic lateral sclerosis when considered with the findings published in other neurodegenerative disorders. Power and complexity changes corroborate with the results from paired-pulse transcranial magnetic stimulation. Increased magnetoencephalography connectivity in worsening disability is thought to represent compensatory responses to a failing motor system. Restoration of cortical beta and gamma band power has significant potential to be tested in an experimental medicine setting. Magnetoencephalography-based measures have potential as sensitive outcome measures of therapeutic benefit in drug trials and may have a wider diagnostic value with further study, including as predictive markers in asymptomatic carriers of disease-causing genetic variants.

Multimodal pre-screening can predict BCI performance variability: A novel subject-specific experimental scheme

BACKGROUND

Brain-computer interface (BCI) systems currently lack the required robustness for long-term daily use due to inter- and intra-subject performance variability. In this study, we propose a novel personalized scheme for a multimodal BCI system, primarily using functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG), to identify, predict, and compensate for factors affecting competence-related and interfering factors associated with performance.

METHOD

11 (out of 13 recruited) participants, including five participants with motor deficits, completed four sessions on average. During the training sessions, the subjects performed a short pre-screening phase, followed by three variations of a novel visou-mental (VM) protocol. Features extracted from the pre-screening phase were used to construct predictive platforms using stepwise multivariate linear regression (MLR) models. In the test sessions, we employed a task-correction phase where our predictive models were used to predict the ideal task variation to maximize performance, followed by an interference-correction phase. We then investigated the associations between predicted and actual performances and evaluated the outcome of correction strategies.

RESULT

The predictive models resulted in respective adjusted R-squared values of 0.942, 0.724, and 0.939 for the first, second, and third variation of the task, respectively. The statistical analyses showed significant associations between the performances predicted by predictive models and the actual performances for the first two task variations, with rhos of 0.7289 (p-value = 0.011) and 0.6970 (p-value = 0.017), respectively. For 81.82 % of the subjects, the task/workload correction stage correctly determined which task variation provided the highest accuracy, with an average performance gain of 5.18 % when applying the correction strategies.

CONCLUSION

Our proposed method can lead to an integrated multimodal predictive framework to compensate for BCI performance variability, particularly, for people with severe motor deficits.

Brain Connectivity and Network Analysis in Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with no effective treatment or cure. ALS is characterized by the death of lower motor neurons (LMNs) in the spinal cord and upper motor neurons (UMNs) in the brain and their networks. Since the lower motor neurons are under the control of UMN and the networks, cortical degeneration may play a vital role in the pathophysiology of ALS. These changes that are not apparent on routine imaging with CT scans or MRI brain can be identified using modalities such as diffusion tensor imaging, functional MRI, arterial spin labelling (ASL), electroencephalogram (EEG), magnetoencephalogram (MEG), functional near-infrared spectroscopy (fNIRS), and positron emission tomography (PET) scan. They can help us generate a representation of brain networks and connectivity that can be visualized and parsed out to characterize and quantify the underlying pathophysiology in ALS. In addition, network analysis using graph measures provides a novel way of understanding the complex network changes occurring in the brain. These have the potential to become biomarker for the diagnosis and treatment of ALS. This article is a systematic review and overview of the various connectivity and network-based studies in ALS.

Resting-state EEG reveals four subphenotypes of amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis is a devastating disease characterized primarily by motor system degeneration, with clinical evidence of cognitive and behavioural change in up to 50% of cases. Amyotrophic lateral sclerosis is both clinically and biologically heterogeneous. Subgrouping is currently undertaken using clinical parameters, such as site of symptom onset (bulbar or spinal), burden of disease (based on the modified El Escorial Research Criteria) and genomics in those with familial disease. However, with the exception of genomics, these subcategories do not take into account underlying disease pathobiology, and are not fully predictive of disease course or prognosis.

Recently, we have shown that resting-state EEG can reliably and quantitatively capture abnormal patterns of motor and cognitive network disruption in amyotrophic lateral sclerosis. These network disruptions have been identified across multiple frequency bands, and using measures of neural activity (spectral power) and connectivity (comodulation of activity by amplitude envelope correlation and synchrony by imaginary coherence) on source-localized brain oscillations from high-density EEG. Using data-driven methods (similarity network fusion and spectral clustering), we have now undertaken a clustering analysis to identify disease subphenotypes and to determine whether different patterns of disruption are predictive of disease outcome.

We show that amyotrophic lateral sclerosis patients (n = 95) can be subgrouped into four phenotypes with distinct neurophysiological profiles. These clusters are characterized by varying degrees of disruption in the somatomotor (α-band synchrony), frontotemporal (β-band neural activity and γ_l-band synchrony) and frontoparietal (γ_l-band comodulation) networks, which reliably correlate with distinct clinical profiles and different disease trajectories. Using an in-depth stability analysis, we show that these clusters are statistically reproducible and robust, remain stable after reassessment using a follow-up EEG session, and continue to predict the clinical trajectory and disease outcome.

Our data demonstrate that novel phenotyping using neuroelectric signal analysis can distinguish disease subtypes based exclusively on different patterns of network disturbances. These patterns may reflect underlying disease neurobiology. The identification of amyotrophic lateral sclerosis subtypes based on profiles of differential impairment in neuronal networks has clear potential in future stratification for clinical trials. Advanced network profiling in amyotrophic lateral sclerosis can also underpin new therapeutic strategies that are based on principles of neurobiology and designed to modulate network disruption.

A Human-Computer Control System Based on Intelligent Recognition of Eye Movements and Its Application in Wheelchair Driving

This paper presents a practical human-computer interaction system for wheelchair motion through eye tracking and eye blink detection. In this system, the pupil in the eye image has been extracted after binarization, and the center of the pupil was localized to capture the trajectory of eye movement and determine the direction of eye gaze. Meanwhile, convolutional neural networks for feature extraction and classification of open-eye and closed-eye images have been built, and machine learning was performed by extracting features from multiple individual images of open-eye and closed-eye states for input to the system. As an application of this human-computer interaction control system, experimental validation was carried out on a modified wheelchair and the proposed method proved to be effective and reliable based on the experimental results.