1
|
Herrera-Diaz A, Boshra R, Tavakoli P, Lin CYA, Pajankar N, Bagheri E, Kolesar R, Fox-Robichaud A, Hamielec C, Reilly JP, Connolly JF. Tracking auditory mismatch negativity responses during full conscious state and coma. Front Neurol 2023; 14:1111691. [PMID: 36970526 PMCID: PMC10036371 DOI: 10.3389/fneur.2023.1111691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
The mismatch negativity (MMN) is considered the electrophysiological change-detection response of the brain, and therefore a valuable clinical tool for monitoring functional changes associated with return to consciousness after severe brain injury. Using an auditory multi-deviant oddball paradigm, we tracked auditory MMN responses in seventeen healthy controls over a 12-h period, and in three comatose patients assessed over 24 h at two time points. We investigated whether the MMN responses show fluctuations in detectability over time in full conscious awareness, or whether such fluctuations are rather a feature of coma. Three methods of analysis were utilized to determine whether the MMN and subsequent event-related potential (ERP) components could be identified: traditional visual analysis, permutation t-test, and Bayesian analysis. The results showed that the MMN responses elicited to the duration deviant-stimuli are elicited and reliably detected over the course of several hours in healthy controls, at both group and single-subject levels. Preliminary findings in three comatose patients provide further evidence that the MMN is often present in coma, varying within a single patient from easily detectable to undetectable at different times. This highlights the fact that regular and repeated assessments are extremely important when using MMN as a neurophysiological predictor of coma emergence.
Collapse
Affiliation(s)
- Adianes Herrera-Diaz
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
- *Correspondence: Adianes Herrera-Diaz
| | - Rober Boshra
- Princenton Neuroscience Institute, Princeton University, Princeton, NJ, United States
| | - Paniz Tavakoli
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
| | - Chia-Yu A. Lin
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
| | - Netri Pajankar
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Elham Bagheri
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Richard Kolesar
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Critical Care Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Cindy Hamielec
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Critical Care Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | - James P. Reilly
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - John F. Connolly
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
- VoxNeuro, Inc., Toronto, ON, Canada
| |
Collapse
|
2
|
Zhou L, Wang J, Wu Y, Liu ZY, Yu Y, Liu JF, Chen X. Clinical significance of mismatch negativity in predicting the awakening of comatose patients after severe brain injury. J Neurophysiol 2021; 126:140-147. [PMID: 34038175 DOI: 10.1152/jn.00658.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We assessed the clinical significance of mismatch negativity (MMN) in predicting the awakening of comatose patients with severe brain injury. The clinical data of patients with severe brain injury, admitted to the neurosurgical intensive care unit of Xiangya Hospital of Central South University from July 2018 to March 2020, who underwent auditory MMN examinations within 28 days after coma onset, were reviewed. Correlations between clinical factors and prognosis [Glasgow Outcome Scale (GCS) for 3 mo] were analyzed. Fifty-three patients were included; 37 (69.8%) had favorable outcomes. A univariate analysis revealed the Glasgow Coma Scale (GCS) and absolute MMN amplitudes at electrodes Fz and Cz were significantly correlated with prognosis. Only GCS scores and MMN amplitude at Fz were independent predictors in multivariate logistic regression analysis (area under the curve 0.744 vs. 0.753, respectively); both combined, improved accuracy to 84.6%. MMN amplitudes at Fz were dichotomized at a value of 1.08 μV with a sensitivity and specificity of 81.1% and 68.7%, respectively, for predicting comatose patients' awakening. In conclusion, MMN amplitude at Fz is a reliable prognostic indicator for comatose patients with severe brain injury; the prediction value improved when combined with GCS. Thus, an event-related potential component with a clear site and cutoff value may support prognostication in severe brain injury.NEW & NOTEWORTHY Mismatch negativity (MMN) can assess the prognosis of comatose patients after severe brain injury, especially for MMN amplitude. In addition, MMN analysis at electrode Fz best predicts recovery of consciousness in patients with severe brain injury. Importantly, a quantitative approach (cutoff value of 1.08 μV) may improve the use of MMN for prognostication.
Collapse
Affiliation(s)
- Liang Zhou
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Jian Wang
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Yun Wu
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Zi-Yuan Liu
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Yang Yu
- College of Intelligence Science and Technology, National University of Defense Technology, Changsha, Hunan Province, China
| | - Jin-Fang Liu
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Xin Chen
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| |
Collapse
|
3
|
Ruiter KI, Boshra R, DeMatteo C, Noseworthy M, Connolly JF. Neurophysiological markers of cognitive deficits and recovery in concussed adolescents. Brain Res 2020; 1746:146998. [PMID: 32574566 DOI: 10.1016/j.brainres.2020.146998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study sought to determine: 1) whether concussed adolescents exhibited deficits in neurocognitive functioning as reflected by neurophysiological alterations; 2) if neurophysiological alterations could be linked to supplementary data such as the number of previous concussions and days since injury; and 3) if deficits in psychological health and behavioural tests increased during diagnosis duration. METHODS Twenty-six concussed adolescents were compared to twenty-eight healthy controls with no prior concussions. Self-report inventories evaluated depressive and concussive symptomatology, while behavioral tests evaluated cognitive ability qualitatively. To assess neurophysiological markers of cognitive function, two separate auditory oddball tasks were employed: 1) an active oddball task measuring executive control and attention as reflected by the N2b and P300, respectively; and 2) a passive oddball task assessing the early, automatic pre-conscious awareness processes as reflected by the MMN. RESULTS Concussed adolescents displayed delayed N2b and attenuated P300 responses relative to controls; showed elevated levels of depressive and concussive symptomatology; scored average-to- low-average in behavioral tests; and exhibited N2b response latencies that correlated with number of days since injury. CONCLUSION These findings demonstrate that concussed adolescents exhibit clear deficiencies in neurocognitive function, and that N2b response latency may be a marker of concussion recovery.
Collapse
Affiliation(s)
- Kyle I Ruiter
- McMaster University - ARiEAL Research Centre, L.R. Wilson Hall, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4M2, Canada; McMaster University - Department of Linguistics and Languages, Canada.
| | - Rober Boshra
- McMaster University - ARiEAL Research Centre, L.R. Wilson Hall, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4M2, Canada; McMaster University - School of Biomedical Engineering, McMaster University, ETB-406, 1280 Main St., West, Hamilton, ON L8S 4K1, Canada; MaRS Centre - Vector Institute, Canada.
| | - Carol DeMatteo
- McMaster University - School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON L8S 1C7, Canada.
| | - Michael Noseworthy
- McMaster University - School of Biomedical Engineering, McMaster University, ETB-406, 1280 Main St., West, Hamilton, ON L8S 4K1, Canada.
| | - John F Connolly
- McMaster University - ARiEAL Research Centre, L.R. Wilson Hall, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4M2, Canada; McMaster University - Department of Linguistics and Languages, Canada; McMaster University - School of Biomedical Engineering, McMaster University, ETB-406, 1280 Main St., West, Hamilton, ON L8S 4K1, Canada; McMaster University - Department of Psychology, Neuroscience and Behaviour, Canada; MaRS Centre - Vector Institute, Canada.
| |
Collapse
|
4
|
Boshra R, Ruiter KI, DeMatteo C, Reilly JP, Connolly JF. Neurophysiological Correlates of Concussion: Deep Learning for Clinical Assessment. Sci Rep 2019; 9:17341. [PMID: 31758044 PMCID: PMC6874583 DOI: 10.1038/s41598-019-53751-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/04/2019] [Indexed: 01/16/2023] Open
Abstract
Concussion has been shown to leave the afflicted with significant cognitive and neurobehavioural deficits. The persistence of these deficits and their link to neurophysiological indices of cognition, as measured by event-related potentials (ERP) using electroencephalography (EEG), remains restricted to population level analyses that limit their utility in the clinical setting. In the present paper, a convolutional neural network is extended to capitalize on characteristics specific to EEG/ERP data in order to assess for post-concussive effects. An aggregated measure of single-trial performance was able to classify accurately (85%) between 26 acutely to post-acutely concussed participants and 28 healthy controls in a stratified 10-fold cross-validation design. Additionally, the model was evaluated in a longitudinal subsample of the concussed group to indicate a dissociation between the progression of EEG/ERP and that of self-reported inventories. Concordant with a number of previous studies, symptomatology was found to be uncorrelated to EEG/ERP results as assessed with the proposed models. Our results form a first-step towards the clinical integration of neurophysiological results in concussion management and motivate a multi-site validation study for a concussion assessment tool in acute and post-acute cases.
Collapse
Affiliation(s)
- Rober Boshra
- ARiEAL Research Centre, McMaster University, Hamilton, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, Canada.
- Vector Institute, MaRS Centre, Toronto, Canada.
| | - Kyle I Ruiter
- ARiEAL Research Centre, McMaster University, Hamilton, Canada
- Linguistics and Languages, McMaster University, Hamilton, Canada
| | - Carol DeMatteo
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - James P Reilly
- ARiEAL Research Centre, McMaster University, Hamilton, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, Canada
- Vector Institute, MaRS Centre, Toronto, Canada
- Electrical and Computer Engineering, McMaster University, Hamilton, Canada
| | - John F Connolly
- ARiEAL Research Centre, McMaster University, Hamilton, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, Canada.
- Vector Institute, MaRS Centre, Toronto, Canada.
- Linguistics and Languages, McMaster University, Hamilton, Canada.
- Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada.
| |
Collapse
|