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Whitehead K, Papadelis C, Laudiano-Dray MP, Meek J, Fabrizi L. The Emergence of Hierarchical Somatosensory Processing in Late Prematurity. Cereb Cortex 2020; 29:2245-2260. [PMID: 30843584 PMCID: PMC6458926 DOI: 10.1093/cercor/bhz030] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/30/2019] [Accepted: 02/11/2019] [Indexed: 12/21/2022] Open
Abstract
The somatosensory system has a hierarchical organization. Information processing increases in complexity from the contralateral primary sensory cortex to bilateral association cortices and this is represented by a sequence of somatosensory-evoked potentials recorded with scalp electroencephalographies. The mammalian somatosensory system matures over the early postnatal period in a rostro-caudal progression, but little is known about the development of hierarchical information processing in the human infant brain. To investigate the normal human development of the somatosensory hierarchy, we recorded potentials evoked by mechanical stimulation of hands and feet in 34 infants between 34 and 42 weeks corrected gestational age, with median postnatal age of 3 days. We show that the shortest latency potential was evoked for both hands and feet at all ages with a contralateral somatotopic source in the primary somatosensory cortex (SI). However, the longer latency responses, localized in SI and beyond, matured with age. They gradually emerged for the foot and, although always present for the hand, showed a shift from purely contralateral to bilateral hemispheric activation. These results demonstrate the rostro-caudal development of human somatosensory hierarchy and suggest that the development of its higher tiers is complete only just before the time of normal birth.
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Affiliation(s)
- K Whitehead
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - C Papadelis
- Laboratory of Children's Brain Dynamics, Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - M P Laudiano-Dray
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - J Meek
- Neonatal Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London, UK
| | - L Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
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Pittet-Metrailler MP, Almazrooei AM, Tam EW. Sensory assessment: Neurophysiology in neonates and neurodevelopmental outcome. HANDBOOK OF CLINICAL NEUROLOGY 2020; 174:183-203. [DOI: 10.1016/b978-0-444-64148-9.00014-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Historically, newborns, and especially premature newborns, were thought to "feel nothing." However, over the past decades, a growing body of evidence has shown that newborns are aware of their environment, but the extent and the onset of some sensory capacities remain largely unknown. The goal of this review is to update our current knowledge concerning newborns' perceptual world and how ready they are to cope with an entirely different sensory environment following birth. We aim to establish not only how and when each sensory ability arises during the pre-/postbirth period but also discuss how senses are studied. We conclude that although many studies converge to show that newborns are clearly sentient beings, much is still unknown. Further, we identify a series of internal and external factors that could explain discrepancies between studies, and we propose perspectives for future studies. Finally, through examples from animal studies, we illustrate the importance of this detailed knowledge to pursue the enhancement of newborns' daily living conditions. Indeed, this is a prerequisite for assessing the effects of the physical environment and routine procedures on newborns' welfare.
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Donadio A, Whitehead K, Gonzalez F, Wilhelm E, Formica D, Meek J, Fabrizi L, Burdet E. A novel sensor design for accurate measurement of facial somatosensation in pre-term infants. PLoS One 2018; 13:e0207145. [PMID: 30444872 PMCID: PMC6239299 DOI: 10.1371/journal.pone.0207145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/25/2018] [Indexed: 11/18/2022] Open
Abstract
Facial somatosensory feedback is critical for breastfeeding in the first days of life. However, its development has never been investigated in humans. Here we develop a new interface to measure facial somatosensation in newborn infants. The novel system allows to measure neuronal responses to touching the face of the subject by synchronously recording scalp electroencephalography (EEG) and the force applied by the experimenter. This is based on a dedicated force transducer that can be worn on the finger underneath a clinical nitrile glove and linked to a commercial EEG acquisition system. The calibrated device measures the pressure applied by the investigator when tapping the skin concurrently with the resulting brain response. With this system, we were able to demonstrate that taps of 192 mN (mean) reliably elicited facial somatosensory responses in 7 pre-term infants. These responses had a time course similar to those following limbs stimulation, but more lateral topographical distribution consistent with body representations in primary somatosensory areas. The method introduced can therefore be used to reliably measure facial somatosensory responses in vulnerable infants.
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Affiliation(s)
- Alessandro Donadio
- Department of Engineering, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Kimberley Whitehead
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, United Kingdom
| | - Franck Gonzalez
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, South Kensington Campus, London, United Kingdom
| | - Elisabeth Wilhelm
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, South Kensington Campus, London, United Kingdom
| | - Domenico Formica
- Department of Engineering, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals, United Kingdom
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, United Kingdom
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, South Kensington Campus, London, United Kingdom
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Verriotis M, Jones L, Whitehead K, Laudiano-Dray M, Panayotidis I, Patel H, Meek J, Fabrizi L, Fitzgerald M. The distribution of pain activity across the human neonatal brain is sex dependent. Neuroimage 2018; 178:69-77. [PMID: 29763673 PMCID: PMC6062722 DOI: 10.1016/j.neuroimage.2018.05.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/30/2018] [Accepted: 05/11/2018] [Indexed: 12/12/2022] Open
Abstract
In adults, there are differences between male and female structural and functional brain connectivity, specifically for those regions involved in pain processing. This may partly explain the observed sex differences in pain sensitivity, tolerance, and inhibitory control, and in the development of chronic pain. However, it is not known if these differences exist from birth. Cortical activity in response to a painful stimulus can be observed in the human neonatal brain, but this nociceptive activity continues to develop in the postnatal period and is qualitatively different from that of adults, partly due to the considerable cortical maturation during this time. This research aimed to investigate the effects of sex and prematurity on the magnitude and spatial distribution pattern of the long-latency nociceptive event-related potential (nERP) using electroencephalography (EEG). We measured the cortical response time-locked to a clinically required heel lance in 81 neonates born between 29 and 42 weeks gestational age (median postnatal age 4 days). The results show that heel lance results in a spatially widespread nERP response in the majority of newborns. Importantly, a widespread pattern is significantly more likely to occur in females, irrespective of gestational age at birth. This effect is not observed for the short latency somatosensory waveform in the same infants, indicating that it is selective for the nociceptive component of the response. These results suggest the early onset of a greater anatomical and functional connectivity reported in the adult female brain, and indicate the presence of pain-related sex differences from birth.
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Affiliation(s)
- Madeleine Verriotis
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Laura Jones
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Kimberley Whitehead
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Maria Laudiano-Dray
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Ismini Panayotidis
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Hemani Patel
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals, London, WC1E6DB, United Kingdom
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology, and Pharmacology, University College London, London, WC1E6BT, United Kingdom.
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Abstract
Cortical posterior tibial somatosensory (SSEP) responses were reliably recorded from 67 infants of 33 weeks gestation or less who had normal neurological outcome at 24 months corrected age. Cross-sectional and longitudinal data did not show a change in waveform morphology with advancing gestation or postnatal age. The latency of the first cortical component shortened as maturation increased. This study provides normative data for the peak component waveforms of the response in very preterm infants. The role of the posterior tibial SSEP in the prediction of functional brain injury in this high risk population can now be determined.
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Affiliation(s)
- A A Pike
- Department of Child Health, St. Michael's Hospital, Bristol, UK
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Minami T, Gondo K, Nakayama H, Ueda K. Cortical somatosensory evoked potentials to posterior tibial nerve stimulation in newborn infants. Brain Dev 1996; 18:294-8. [PMID: 8879648 DOI: 10.1016/0387-7604(96)00027-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Successful cortical recordings of somatosensory-evoked potentials (SEPs) to posterior tibial nerve (PTN) stimulation were obtained in 21 (87.5%) for P1 and 22 (91.7%) for N1 of 24 infants who were followed up for at least 3 years and had a normal outcome. There were linear decreases with increasing post menstrual age in both P1 and N1 peak latency. Of the four cases with diplegia later, three showed definite abnormalities, no responses and delayed latency in PTN SEPs respectively, however, the other case showed normal responses. Of the three cases with mental retardation, two showed relatively long latency and borderline responses respectively, and the other case showed normal responses. As the pathway of PTN SEPs traverses the periventricular area of the brain likely to be affected by ischemic lesions in premature infants, abnormalities in the responses might indicate a later motor disorder.
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Affiliation(s)
- T Minami
- Department of Pediatrics, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Abstract
This paper has reviewed the techniques used for recording evoked potentials in the premature infant and the early developmental changes. The maturational changes in the evoked potentials, including morphological changes, and the very rapid latency changes within the first months of life, provide an invaluable means for assessing and monitoring development within the central nervous system. The maturational changes are such that normative values are requisite, and the norms must take into account both the infant's gestational age at birth as well as the postnatal age. These norms can then be used to aid in the assessment of gestational age, and whether there has or has not been normal maturational development, either in utero or during the postnatal preterm period. Evoked potentials are of increasing value clinically in preterm neonates, primarily because of the difficulty in obtaining reliable neurological evaluation of these infants. Median nerve SEPs may provide reliable information in preterm infants at risk of PVL, and when recorded in the second week of life, predict cerebral palsy. PTN SEPs seem to be even more reliable indicators of outcome, but the difficulty in obtaining them in preterm infants needs to be taken into consideration. Further study is needed in some areas, such as in apnoeic preterm babies clearly to establish the role that evoked potentials (in this case BAEPs) may have in understanding both the aetiology and the clinical course of this dysfunction. In other conditions, such as delayed intrauterine growth, that may lead to neurological sequelae, evoked potentials can provide objective CNS assessment. Evoked potentials may also prove useful in the monitoring of treatment modalities for preterm infants. The evoked potentials are a valuable adjunct in the assessment of preterm neonates and, as their value is recognised, we expect their use to increase.
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Affiliation(s)
- M J Taylor
- INSERM Unité 316, et Centre de Pédiatrie Gatien de Clocheville, Tours, France
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White CP, Cooke RW. Somatosensory evoked potentials following posterior tibial nerve stimulation predict later motor outcome. Dev Med Child Neurol 1994; 36:34-40. [PMID: 8132112 DOI: 10.1111/j.1469-8749.1994.tb11763.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Posterior tibial nerve somatosensory evoked potentials (PTN-SEPs) were performed on 50 neonates at high risk of future neurodevelopmental impairment just before their discharge from the neonatal intensive-care unit. The close association of sensory pathways with motor tracts and the need for sensory input and integration for normal motor functioning would indicate that CNS lesions producing motor deficits may be detected by this method. Follow-up of these infants revealed a highly significant relationship between bilaterally abnormal PTN-SEPs and the presence of cerebral palsy at three years of age. Normal PTN-SEPs were associated with a normal outcome in 24 of 25 infants. In this group of neonates, PTN-SEPs were more predictive than cranial ultrasound.
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Affiliation(s)
- C P White
- Department of Neurology, Royal Liverpool Children's Hospital, UK
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Abstract
Near infrared spectroscopy is a non-invasive bedside technique which allows cotside observation of cerebral haemodynamics and oxygenation in sick newborn infants. Methods have been described for measurement of cerebral blood flow and volume, as well as other tests of the cerebral circulation. The techniques is still under intensive development and further advances and refinements can be expected, but a present it is essentially a technique for research and investigations rather than a clinical tool.
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Affiliation(s)
- A D Edwards
- Department of Paediatrics, Royal Postgraduate Medical School, London, U.K
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