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Lithgow BJ, Moussavi Z. Measuring anxiety disorder in bipolar disorder using EVestG: broad impact of medication groups. Front Neurol 2024; 14:1303287. [PMID: 38292032 PMCID: PMC10824993 DOI: 10.3389/fneur.2023.1303287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024] Open
Abstract
Objectives Anxiety disorder is present in approximately half of all bipolar disorder (BD) patients. There are neurologic bases for the comorbidity of balance (vestibular) disorders and anxiety. Our objective is to use electrovestibulography (EVestG), which is predominantly a measure of vestibular neural activity to not only quantitatively detect and measure comorbid anxiety disorder but also to quantitatively measure the impacts of anti-depressant, anti-psychotic, and mood stabilizer medication groups on anxiety measures in BD patients. Methods In a population of 50 (24 with anxiety disorder) depressive phase BD patients, EVestG signals were measured. Participants were labeled depression-wise as anxious or non-anxious using standard questionnaires. Analyses were conducted on the whole dataset as well as on matched (age/gender/MADRS) and "modeled medication-free" subsets. Modulations of the low-frequency EVestG firing pattern data were measured. Findings For BD, the main anxious minus non-anxious difference was the presence of an increase in spectral power proximal to 8-9 Hz, which was best attenuated by mood stabilizers. Novelty This is the first study to use an oto-acoustic physiological measure to quantify anxiety disorder in BD wherein it appears to manifest as a peak proximal to 8-9 Hz which we hypothesize as likely linked to hippocampal theta.
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Affiliation(s)
- Brian J. Lithgow
- Diagnostic and Neurosignal Processing Research Laboratory, Biomedical Engineering Program, University of Manitoba, Riverview Health Centre, Winnipeg, MB, Canada
- Monash Alfred Psychiatry Research Centre, Prahran, VIC, Australia
| | - Zahra Moussavi
- Diagnostic and Neurosignal Processing Research Laboratory, Biomedical Engineering Program, University of Manitoba, Riverview Health Centre, Winnipeg, MB, Canada
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Dastgheib ZA, Lithgow BJ, Moussavi ZK. Evaluating the Diagnostic Value of Electrovestibulography (EVestG) in Alzheimer's Patients with Mixed Pathology: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2091. [PMID: 38138194 PMCID: PMC10744488 DOI: 10.3390/medicina59122091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Diagnosis of dementia subtypes caused by different brain pathophysiologies, particularly Alzheimer's disease (AD) from AD mixed with levels of cerebrovascular disease (CVD) symptomology (AD-CVD), is challenging due to overlapping symptoms. In this pilot study, the potential of Electrovestibulography (EVestG) for identifying AD, AD-CVD, and healthy control populations was investigated. Materials and Methods: A novel hierarchical multiclass diagnostic algorithm based on the outcomes of its lower levels of binary classifications was developed using data of 16 patients with AD, 13 with AD-CVD, and 24 healthy age-matched controls, and then evaluated on a blind testing dataset made up of a new population of 12 patients diagnosed with AD, 9 with AD-CVD, and 8 healthy controls. Multivariate analysis was run to test the between population differences while controlling for sex and age covariates. Results: The accuracies of the multiclass diagnostic algorithm were found to be 85.7% and 79.6% for the training and blind testing datasets, respectively. While a statistically significant difference was found between the populations after accounting for sex and age, no significant effect was found for sex or age covariates. The best characteristic EVestG features were extracted from the upright sitting and supine up/down stimulus responses. Conclusions: Two EVestG movements (stimuli) and their most informative features that are best selective of the above-populations' separations were identified, and a hierarchy diagnostic algorithm was developed for three-way classification. Given that the two stimuli predominantly stimulate the otholithic organs, physiological and experimental evidence supportive of the results are presented. Disruptions of inhibition associated with GABAergic activity might be responsible for the changes in the EVestG features.
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Affiliation(s)
| | | | - Zahra K. Moussavi
- Diagnostic and Neurological Processing Research Laboratory, Biomedical Engineering Program, University of Manitoba, Riverview Health Centre, Winnipeg, MB R3L 2P4, Canada; (Z.A.D.); (B.J.L.)
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Blakley B, Ashiri M, Moussavi Z, Lithgow B. Verification EVestG recordings are vestibuloacoustic signals. Laryngoscope Investig Otolaryngol 2022; 7:1171-1177. [PMID: 36000057 PMCID: PMC9392376 DOI: 10.1002/lio2.862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/24/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Neural dysfunction is associated with aberrant nerve firing; thus, electrodiagnosis has the potential for objective diagnosis and quantification of neural dysfunction. Electrical stimulation alters nerve firing and may also have treatment potential. This article outlines some findings related to electrodiagnosis and electrical stimulation of the ear. The quasi‐synchronous firing of many vestibuloacoustic nerve fibers can produce an extracellular potential defined as a field potential (FP). Electrovestibulography (EVestG) is a method to record vestibuloacoustic signals and detect the associated FPs. A clear picture of the muscle‐, EEG‐, saccade‐related, or other artefactual origins, and the physiologic basis of FPs recorded with EVestG, is evolving. EVestG was applied to demonstrate the effect of electrical stimulation on spontaneous FPs in the ear canal. Methods Bilateral EVestG recordings were conducted on 14 guinea pigs before and after stimulation with 3–0.5 mA ipsilateral anodal electrical pulses before and after ablation via unilateral Scarpa's ganglionectomy to elucidate the origin of the EVestG recorded spontaneous FPs. Results Anodal electrical stimulation suppresses the recorded activity. There was a significant reduction of the level of recorded signal observed following anodal stimulation on the ablated but not the intact side. Conclusion Electrical stimulation of the external auditory canal reduces spontaneous electrical activity in the ear canal, some of which is due to central nervous system activity. The EVestG recorded FPs have a major vestibuloacoustic component.
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Affiliation(s)
- Brian Blakley
- Department of Otolaryngology Health Sciences Center, University of Manitoba St. Winnipeg Manitoba Canada
| | | | - Zahra Moussavi
- University of Manitoba Winnipeg Manitoba Canada
- Monash Alfred Psychiatry Research Center Monash University Melbourne Victoria Australia
- Monash Alfred Psychiatry Research Center Prahran Victoria Australia
| | - Brian Lithgow
- University of Manitoba Winnipeg Manitoba Canada
- Monash Alfred Psychiatry Research Center Monash University Melbourne Victoria Australia
- Monash Alfred Psychiatry Research Center Prahran Victoria Australia
- Department of Electrical and Computer Engineering University of Manitoba Winnipeg Manitoba Canada
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Comparing Vestibular Responses to Linear and Angular Whole-Body Accelerations in Real and Immersive Environments. Ann Biomed Eng 2022; 50:575-586. [PMID: 35325362 DOI: 10.1007/s10439-022-02947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/09/2022] [Indexed: 11/01/2022]
Abstract
The vestibular end organs differ in terms of anatomical and physiological characteristics. Sensory modalities' stimuli including visual stimuli and vestibular sensation can influence these organs differently. This paper explores differences between vestibular responses to axial tilts in physical and virtual environments. Four passive whole-body movements (linear: up-down, and angular: yaw, pitch, and roll) were applied to twenty-seven healthy participants once using a hydraulic chair (physical) and once visually using a head-mounted display (virtual). Electrovestibulography (EVestG) was used as the outcome measure to investigate the magnitude of vestibular-response-change in both ears for physical and virtual stimuli. Three features including average action potential (AP) area, AP amplitude, and mean detected firing rate change were used as indices of response. The results show that for both physical and virtual stimuli (1) generally the pitch and roll tilts produce the largest EVestG changes compared to other tilts (2) roll and pitch tilt responses are not significantly different from each other and (3) right side and left side roll tilts' responses are not significantly different. The findings indicate although visually- and physically-induced vestibular responses are different in terms of afferent activity, visual stimuli can still result in distinct responses when exposed to different axial tilts.
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Jacobson N, Lithgow B, Jafari Jozani M, Moussavi Z. Investigating the Effect of Cognitive Training paired with active and sham Transcranial Alternating Current Stimulation on the Executive Brain Functions in Dementia Populations: Protocol for a Cross-Over, Randomized Control Trial (Preprint). JMIR Res Protoc 2022; 11:e37282. [PMID: 35475789 PMCID: PMC9096654 DOI: 10.2196/37282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although memory and cognitive declines are associated with normal brain aging, they may also be precursors to dementia. Objective We aim to offer a novel approach to prevent or slow the progress of neurodegenerative dementia, or plausibly, improve the cognitive functions of individuals with dementia. Methods We will recruit and enroll 75 participants (older than 50 years old with either mild cognitive impairment or probable early or moderate dementia) for this double-blind randomized controlled study to estimate the efficacy of active transcranial alternating current stimulation with cognitive treatment (in comparison with sham transcranial alternating current stimulation). This will be a crossover study; a cycle consists of sham or active treatment for a period of 4 weeks (5 days per week, in two 30-minute sessions with a half-hour break in between), and participants are randomized into 2 groups, with stratification by age, sex, and cognitive level (measured with the Montreal Cognitive Assessment). Outcomes will be assessed before and after each treatment cycle. The primary outcomes are changes in Wechsler Memory Scale Older Adult Battery and Alzheimer Disease Assessment Scale scores. Secondary outcomes are changes in performance on tests of frontal lobe functioning (verbal fluency), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire), mood changes (Montgomery-Åsberg Depression Rating Scale), and short-term recall (visual 1-back task). Exploratory outcome measures will also be assessed: static and dynamic vestibular response using electrovestibulography, neuronal changes using functional near-infrared spectroscopy, and change in spatial orientation using virtual reality navigation. Results As of February 10, 2022, the study is ongoing: 7 patients have been screened, and all were deemed eligible for and enrolled in the study; 4 participants have completed baseline assessments. Conclusions We anticipate that transcranial alternating current stimulation will be a well-tolerated treatment, with no serious side effects and with considerable short- and long-term cognitive improvements. Trial Registration Clinicaltrials.gov NCT05203523; https://clinicaltrials.gov/show/NCT05203523 International Registered Report Identifier (IRRID) DERR1-10.2196/37282
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Affiliation(s)
- Natasha Jacobson
- Department of Electrical and Computer Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Brian Lithgow
- Department of Electrical and Computer Engineering, University of Manitoba, Winnipeg, MB, Canada
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Melbourne, Australia
| | | | - Zahra Moussavi
- Department of Electrical and Computer Engineering, University of Manitoba, Winnipeg, MB, Canada
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Lithgow BJ, Dastgheib Z, Moussavi Z. Baseline Prediction of rTMS efficacy in Alzheimer patients. Psychiatry Res 2022; 308:114348. [PMID: 34952254 DOI: 10.1016/j.psychres.2021.114348] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) with extensive 2-6-week protocols are applied to improve cognition and/or slow the cognitive decline seen in Alzheimer's Disease (AD). To date, there are no means to predict the response of a patient to rTMS treatment at baseline. Electrovestibulography (EVestG) biomarkers can be used to predict, at baseline, the efficacy of rTMS when applied to AD individuals. In a population of 27 AD patients (8 with significant cerebrovascular symptomatology, labelled ADcvd) EVestG signals were measured before and after rTMS treatment, and then compared with 16 age-matched healthy controls. MoCA was measured at baseline, whilst ADAS-Cog was the primary outcome measure. AD severity and comorbid cerebrovascular disease were treated as covariates. Using ADAS-Cog total score change, 13/27 AD/ADcvd patients improved with rTMS and 14/27 showed no-improvement. Leave-one-out-cross-validated linear-discriminant-analysis using two EVestG features yielded a blind accuracy of 75% for separating the improved and non-improved populations. Three-way separation of improved/non-improved/control accuracy was 91.9% using MoCA (67% alone) and one EVestG feature (66% alone). AD severity affects the rTMS treatment efficacy. The effect of existing significant cerebrovascular symptomatology on the efficacy of rTMS treatment remains unresolved. Baseline EVestG features can be predictive of the efficacy of rTMS treatment.
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Affiliation(s)
- Brian J Lithgow
- Diagnostic and Neurosignal Processing Research Laboratory, Biomedical Engineering Program, University of Manitoba, Riverview Health Centre, Manitoba, Canada; Monash Alfred Psychiatry Research Centre, Victoria, Australia.
| | - Zeinab Dastgheib
- Diagnostic and Neurosignal Processing Research Laboratory, Biomedical Engineering Program, University of Manitoba, Riverview Health Centre, Manitoba, Canada
| | - Zahra Moussavi
- Diagnostic and Neurosignal Processing Research Laboratory, Biomedical Engineering Program, University of Manitoba, Riverview Health Centre, Manitoba, Canada
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An unbiased algorithm for objective separation of Alzheimer's, Alzheimer's mixed with cerebrovascular symptomology, and healthy controls from one another using electrovestibulography (EVestG). Med Biol Eng Comput 2022; 60:797-810. [PMID: 35102489 DOI: 10.1007/s11517-022-02507-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
Diagnosis of Alzheimer's disease (AD) from AD with cerebrovascular disease pathology (AD-CVD) is a rising challenge. Using electrovestibulography (EVestG) measured signals, we develop an automated feature extraction and selection algorithm for an unbiased identification of AD and AD-CVD from healthy controls as well as their separation from each other. EVestG signals of 24 healthy controls, 16 individuals with AD, and 13 with AD-CVD were analyzed within two separate groupings: One-versus-One and One-versus-All. A multistage feature selection process was conducted over the training dataset using linear support vector machine (SVM) classification with 10-fold cross-validation, k nearest neighbors/averaging imputation, and exhaustive search. The most frequently selected features that achieved highest classification performance were selected. 10-fold cross-validation was applied via a linear SVM classification on the entire dataset. Multivariate analysis was run to test the between population differences while controlling for the covariates. Classification accuracies of ≥ 80% and 78% were achieved for the One-versus-All classification approach and AD versus AD-CVD separation, respectively. The results also held true after controlling for the effect of covariates. AD/AD-CVD participants showed smaller/larger EVestG averaged field potential signals compared to healthy controls and AD-CVD/AD participants. These characteristics are in line with our previous study results.
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Physiological separation of Alzheimer's disease and Alzheimer's disease with significant levels of cerebrovascular symptomology and healthy controls. Med Biol Eng Comput 2021; 59:1597-1610. [PMID: 34263439 DOI: 10.1007/s11517-021-02409-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 07/04/2021] [Indexed: 01/14/2023]
Abstract
Most dementia patients with a mixed dementia (MxD) diagnosis have a mix of Alzheimer's disease (AD) and vascular dementia. Electrovestibulography (EVestG) records vestibuloacoustic afferent activity. We hypothesize EVestG recordings of AD and MxD patients are different. All patients were assessed with the Montreal cognitive assessment (MoCA) and Hachinski ischemic scale (HIS) (> 4 HIS score < 7 is representative of MxD cerebrovascular symptomology). EVestG recordings were made from 26 AD, 21 MxD and 44 healthy (control) participants. Features were derived from the EVestG recordings of the average field potential and field potential interval histogram to classify the AD, MxD and control groups. Multivariate analysis was used to test the features' significance. Using a leave-one-out cross-validated linear discriminant analysis with 3 EVestG features yielded accuracies > 80% for separating pairs of AD/MxD/control. Using the MoCA assessment and 2 EVestG features, a best accuracy of 81 to 91% depending on the classifier was obtained for the 3-way identification of AD, MxD and controls. EVestG measures provide a physiological basis for identifying AD from MxD. EVestG measures are hypothesized to be partly related to channelopathies and changes in the descending input to the vestibular periphery. Four of the five AD or MxD versus control features used had significant correlations with the MoCA. This supports assertions that the pathologic changes associated with AD impact the vestibular system and further are suggestive that the postulated physiological changes behind these features have an association with cognitive decline severity.
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Ashiri M, Lithgow B, Suleiman A, Mansouri B, Moussavi Z. Electrovestibulography (EVestG) application for measuring vestibular response to horizontal pursuit and saccadic eye movements. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Suleiman A, Lithgow BJ, Anssari N, Ashiri M, Moussavi Z, Mansouri B. Correlation between Ocular and Vestibular Abnormalities and Convergence Insufficiency in Post-Concussion Syndrome. Neuroophthalmology 2020; 44:157-167. [PMID: 32395167 PMCID: PMC7202416 DOI: 10.1080/01658107.2019.1653325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 12/23/2022] Open
Abstract
The vestibular and oculomotor/visual systems are commonly affected in post-concussion syndrome (PCS). Convergence insufficiency (CI) is the most common ocular abnormality after concussion. Electrovestibulography (EVestG) is a relatively new non-invasive method that measures the peripheral vestibular responses; it has shown abnormal vestibular responses in a PCS. Here, we report the results of investigating the correlation between the vestibular and oculomotor systems in PCS population using EVestG and CI measures. Forty-eight PCS patients were tested using EVestG, out of which 20 also completed the Rivermead post-concussion questionnaire (RPQ). An EVestG feature (Field Potential (FP)-area) was extracted from the stationary part of the EVestG signals. A neuro-ophthalmologist (author BM) measured participants' CI at near vision using cross-cover examination and a prism-bar. Results indicate: (1) vestibular abnormality (i.e. FP-area) and CI values are significantly correlated in PCS (R = 0.68, p < .01), and (2) there are significant correlations between severity of concussion (i.e. RPQ3) and CI (R = 0.70, p < .01) and between RPQ3 and FP-area (R = -0.56, p < .02). To the best of our knowledge, this is the first study that objectively demonstrates a significant positive correlation between the CI and vestibular systems' abnormality. These findings are scientifically important as they help localise the pathology of PCS, and are clinically valuable as they help physicians in their decision-making about PCS diagnosis and rehabilitation strategies.
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Affiliation(s)
- Abdelbaset Suleiman
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
| | - Brian J. Lithgow
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
- Monash Alfred Psychiatry Research Center, Monash University, Melbourne, Australia
| | - Neda Anssari
- Department of Internal Medicine, Section of Neurology, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Mehrangiz Ashiri
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
| | - Zahra Moussavi
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
| | - Behzad Mansouri
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Section of Neurology, University of Manitoba, Winnipeg, MB, Canada
- Department of Ophthalmology, University of Manitoba, Winnipeg, MB, Canada
- iScope Concussion and Pain Clinic, Toronto, ON, Canada
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Differences Between Physical vs. Virtual Evoked Vestibular Responses. Ann Biomed Eng 2020; 48:1241-1255. [PMID: 31916127 DOI: 10.1007/s10439-019-02446-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
Electrovestibulography (EVestG), a technology purported to measure vestibular activity at the vestibular periphery, was used to compare the vestibular responses to two sensory inputs: (1) back-forward physical tilt (with eyes-open and eyes-closed) and (2) virtual reality replica of the back-forward tilt (eyes-open, physically static). Twenty-seven healthy participants (10 females) were tested. From each of the EVestG recordings, two feature curves: (1) average field potential (FP), and (2) distribution of time intervals between the detected FPs were extracted. For the eyes-closed physical tilt, except for the background segment, the FP response curve was generally wider compared to that evoked during the virtual replica tilt (p < 0.05). Moreover, the eyes-closed physical tilt produced longer time intervals between FP's compared to the virtual stimulus. For this measure, for the background segment, the eyes closed and open physical tilt responses were significantly different (p < 0.05) in both ears (repeated measure experimental design). The results support: (1) both vestibular and visual inputs evoking a measurably different EVestG response, (2) the differences between physical and virtual vestibular responses are dependent on the eyes being either open or closed, and (3) for the stimuli used, the modulation of vestibular afferent activity was measurably smaller for virtual than physical stimulation.
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Lithgow BJ, Moussavi Z, Fitzgerald PB. Quantitative separation of the depressive phase of bipolar disorder and major depressive disorder using electrovestibulography. World J Biol Psychiatry 2019; 20:799-812. [PMID: 30912461 DOI: 10.1080/15622975.2019.1599143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives: No electrophysiological, neuroimaging or genetic markers have been established that strongly relate to the diagnostic separation of bipolar disorder (BD) and major depressive disorder (MDD). This paper's objective is to describe the potential of features, extracted from the recording of electrical activity from the outer ear canal, in a process called electrovestibulography (EVestG), for identifying depressed and partly remitted/remitted MDD and BD patients from each other.Methods: From EVestG data four sensory vestibulo-acoustic features were extracted from both background (no movement) and using a single supine-vertical translation stimulus to distinguish 27 controls, 39 MDD and 43 BD patients.Results: Using leave-one-out-cross-validation, unbiased parametric and non-parametric classification routines resulted in 78-83% (2-3 features), 80-81% (1-2 features) and 66-68% (3 features) accuracies for separation of MDD from BD, controls from depressed (BD & MDD) and the 3-way separation of BD from MDD from control groups, respectively. The main limitations of this study were the inability to fully disentangle the impact of prescribed medication from the responses and also the limited sample size.Conclusions: EVestG features can reliably identify depressed and partly remitted/remitted MDD and BD patients from each other.
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Affiliation(s)
- Brian J Lithgow
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and the Alfred Hospital, Melbourne, Australia.,Diagnostic and Neurosignal Processing Research Laboratory, Riverview Health Centre, University of Manitoba, Winnipeg, Canada
| | - Zahra Moussavi
- Diagnostic and Neurosignal Processing Research Laboratory, Riverview Health Centre, University of Manitoba, Winnipeg, Canada
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and the Alfred Hospital, Melbourne, Australia.,Epworth Centre for Innovation in Mental Health, Epworth Healthcare, Camberwell, Australia
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Lithgow BJ, Moussavi Z, Gurvich C, Kulkarni J, Maller JJ, Fitzgerald PB. Bipolar disorder in the balance. Eur Arch Psychiatry Clin Neurosci 2019; 269:761-775. [PMID: 30083956 DOI: 10.1007/s00406-018-0935-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 07/30/2018] [Indexed: 12/27/2022]
Abstract
Bipolar disorder (BD) is a severe mood disorder that lacks established electrophysiological, neuroimaging or biological markers to assist with both diagnosis and monitoring disease severity. This study's aim is to describe the potential of new neurophysiological features assistive in BD diagnosis and severity measurement utilizing the recording of electrical activity from the outer ear canal called Electrovestibulography (EVestG). From EVestG data sensory vestibulo-acoustic features were extracted from a single supine-vertical translation stimulus to distinguish 50 depressed and partly remitted/remitted bipolar disorder patients [18 symptomatic (BD-S, MADRS > 19), 32 reduced symptomatic (BD-R, MADRS ≤ 19)] and 31 age and gender matched healthy individuals (controls). Six features were extracted from the measured firing pattern interval histogram and the extracted shape of the average field potential response. Five of the six features had low but significant correlations (p < 0.05) with the MADRS assessment. Using leave-one-out-cross-validation, unbiased parametric and non-parametric classification routines resulted in 75-79%, 84-86%, 76-85% and 79-82% accuracy for separation of control from BD, BD-S and BD-R as well as BD-S from BD-R groups, respectively. The main limitation of this study was the inability to fully disentangle the impact of prescribed medication from the responses recorded. A mix of stationary and movement evoked EVestG features produced good discrimination between control and BD patients whether BD-S or BD-R. Moreover, BD-S and BD-R appear to have measurably different pathophysiological manifestations. The firing pattern features used were dissimilar to those observed in a prior major depressive disorder study.
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Affiliation(s)
- Brian J Lithgow
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, 607 St Kilda Rd, Melbourne, VIC, Australia.
- Diagnostic and Neurosignal Processing Research Laboratory, Riverview Health Centre, University of Manitoba, Winnipeg, MB, Canada.
| | - Zahra Moussavi
- Diagnostic and Neurosignal Processing Research Laboratory, Riverview Health Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, 607 St Kilda Rd, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, 607 St Kilda Rd, Melbourne, VIC, Australia
| | - Jerome J Maller
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, 607 St Kilda Rd, Melbourne, VIC, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, 607 St Kilda Rd, Melbourne, VIC, Australia
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Mulligan EM, Hajcak G, Klawohn J, Nelson B, Meyer A. Effects of menstrual cycle phase on associations between the error-related negativity and checking symptoms in women. Psychoneuroendocrinology 2019; 103:233-240. [PMID: 30721837 PMCID: PMC6450738 DOI: 10.1016/j.psyneuen.2019.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/25/2019] [Accepted: 01/27/2019] [Indexed: 12/22/2022]
Abstract
The menstrual cycle is known to impact mood and cognitive function and has been shown to lead to variability in symptoms of obsessive-compulsive disorders and anxiety. Using a within-subject design, the present study examined ovarian hormones, the error-related negativity (ERN), and self-reported checking symptoms in both the mid-follicular and mid-luteal phases of the menstrual cycle. ERN amplitude and checking symptom severity did not vary between the follicular and luteal phases. However, a more negative ERN was associated with greater checking symptoms in the luteal phase of the menstrual cycle, even when controlling for ERN amplitude in the follicular phase. Moreover, changes in checking symptoms between phases were associated with phase-related changes in the ERN. Finally, a significant mediation model was found such that the ERN measured in the luteal phase mediated the association between progesterone in the luteal phase and checking symptoms in the luteal phase. Collectively, the present findings suggest that levels of progesterone in the luteal phase could impact checking symptoms by modulating response monitoring and sensitivity to errors, and that fluctuation in the ERN between menstrual cycle phases may play an important role in the expression of anxious and obsessive-compulsive symptoms.
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Affiliation(s)
- Elizabeth M. Mulligan
- Department of Psychology, Florida State University Tallahassee, FL 32304,Correspondence concerning this article should be addressed to: Department of Psychology, Florida State University, 1107 West Call Street Tallahassee, FL 32304. Phone: (954) 691-7826
| | - Greg Hajcak
- Department of Psychology, Florida State University Tallahassee, FL 32304,Department of Biomedical Sciences, Florida State University Tallahassee, FL 32306
| | - Julia Klawohn
- Department of Psychology, Florida State University Tallahassee, FL 32304
| | - Brady Nelson
- Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Alexandria Meyer
- Department of Psychology, Florida State University Tallahassee, FL 32304
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15
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Moussavi Z, Suleiman A, Rutherford G, Ranjbar Pouya O, Dastgheib Z, Zhang W, Salter J, Wang X, Mansouri B, Lithgow B. A Pilot Randomised Double-Blind Study of the Tolerability and efficacy of repetitive Transcranial Magnetic Stimulation on Persistent Post-Concussion Syndrome. Sci Rep 2019; 9:5498. [PMID: 30940870 PMCID: PMC6445141 DOI: 10.1038/s41598-019-41923-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/19/2019] [Indexed: 12/13/2022] Open
Abstract
This study investigates the effect of Repetitive Transcranial Magnetic Stimulation (rTMS) on persistent post-concussion syndrome (PCS). The study design was a randomized (coin toss), placebo controlled, and double-blind study. Thirty-seven participants with PCS were assessed for eligibility; 22 were randomised and 18 completed the study requirements. Half the participants with PCS were given an Active rTMS intervention and the other half given Sham rTMS over 3 weeks. Follow ups were at the end of treatment and at 30 and 60 days. The primary outcome measure was the Rivermead Post-Concussion Symptoms Questionnaire (RPQ3 & RPQ13). The results indicate participants with more recent injuries (<12 month), who received Active rTMS, showed significant improvements compared to those of: 1) the same subgroup who received Sham, and 2) those with a longer duration of injury (>14 months) who received Active rTMS. This improvement predominantly manifested in RPQ13 in the follow up periods 1 and 2 months after the intervention (RPQ13 change (mean ± SD): at 1 month, Active = −21.8 ± 6.6, Sham = −2.2 ± 9.8; at 2 months, Active = −21.2 ± 5.3, Sham = −5.4 ± 13.7). No improvement was found in the subgroup with longer duration injuries. The results support rTMS as a tolerable and potentially effective treatment option for individuals with a recent (<1 year) concussion.
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Affiliation(s)
- Zahra Moussavi
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada. .,Riverview Health Centre, Winnipeg, Canada.
| | | | - Grant Rutherford
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada
| | | | - Zeinab Dastgheib
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada
| | - Weijia Zhang
- Statistics Department, University of Manitoba, Winnipeg, Canada
| | | | - Xikui Wang
- Statistics Department, University of Manitoba, Winnipeg, Canada
| | - Behzad Mansouri
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada.,Neurology Department, University of Manitoba, Winnipeg, Canada
| | - Brian Lithgow
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada.,Riverview Health Centre, Winnipeg, Canada.,Monash Alfred Psychiatry Research Center, Melbourne, Australia
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16
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Investigating the validity and reliability of Electrovestibulography (EVestG) for detecting post-concussion syndrome (PCS) with and without comorbid depression. Sci Rep 2018; 8:14495. [PMID: 30262840 PMCID: PMC6160464 DOI: 10.1038/s41598-018-32808-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/10/2018] [Indexed: 11/08/2022] Open
Abstract
Features from Electrovestibulography (EVestG) recordings have been used to classify and measure the severity of both persistent post-concussion syndrome (PCS) and major depressive disorder. Herein, we examined the effect of comorbid depression on the detection of persistent PCS using EVestG. To validate our previously developed EVestG classifier for PCS detection, the classifier was tested with a new blind dataset (N = 21). The unbiased accuracy for identifying the new PCS from controls was found to be >90%. Next, the PCS group (N = 59) was divided into three subgroups: PCS with no-depression (n = 18), PCS with mild-depression (n = 27) and PCS with moderate/severe-depression (n = 14). When moderate/severe depression was present, PCS classification accuracy dropped to 83%. By adding an EVestG depression feature from a previous study, separation accuracy of each PCS subgroup from controls was >90%. A four and three-group (excluding mild-depression subgroup) classification, achieved an accuracy of 74% and 81%, respectively. Correlation analysis indicated a significant correlation (R = 0.67) between the depression feature and the MADRS depression score as well as between the PCS-specific feature and Rivermead Post-Concussion Questionnaire (RPQ) (R = −0.48). No significant correlation was found between the PCS-specific feature and the MADRS score (R = 0.20) or between RPQ and the depression feature (R = 0.12). The (PCS-specific and depression-specific) EVestG features used herein have the potential to robustly detect and monitor changes, relatively independently, in both persistent PCS and its depression comorbidity. Clinically, this can be particularly advantageous.
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17
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Lithgow BJ, Moussavi Z. Physiological Differences in the Follicular, Luteal, and Menstrual Phases in Healthy Women Determined by Electrovestibulography: Depression, Anxiety, or Other Associations? Neuropsychobiology 2018; 76:72-81. [PMID: 29871000 DOI: 10.1159/000487771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/17/2018] [Indexed: 11/19/2022]
Abstract
Electrovestibulography (EVestG) recordings have been previously applied toward classifying and/or measuring the severity of several neurological disorders including depression with and without anxiety. This study's objectives were to: (1) extract EVestG features representing physiological differences of healthy women during their menses, and follicular and luteal phases of their menstrual cycle, and (2) compare these features to those observed in previous studies for depression with and without anxiety. Three EVestG recordings were made on 15 young healthy menstruating females during menses, and follicular and luteal phases. Three features were extracted, using the shape and timing of the detected spontaneously evoked vestibulo-acoustic field potentials. Using these features, a 3-way separation of the 3 phases was achieved, with a leave-one-out cross-validation, resulting in accuracy of > 72%. Using an EVestG shape feature, separation of the follicular and luteal phases was achieved with a leave-one-out cross-validation accuracy of > 93%. The mechanism of separation was not like that in previous depression analyses, and is postulated to be more akin to a form of anxiety and/or progesterone sensitivity.
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Affiliation(s)
- Brian J Lithgow
- Monash Alfred Psychiatry Research Center, Monash University, Melbourne, Victoria, Australia.,Riverview Health Center, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zahra Moussavi
- Riverview Health Center, University of Manitoba, Winnipeg, Manitoba, Canada
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18
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Ashiri M, Lithgow B, Suleiman A, Moussavi Z, Mansouri B. Visio-Vestibular Interaction in Humans: Changes in the Vestibular Response Following Visual Stimuli of Different Colors. J Med Biol Eng 2018. [DOI: 10.1007/s40846-018-0425-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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19
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Blakley B, Suleiman A, Rutherford G, Moussavi Z, Lithgow B. EVestG Recordings are Vestibuloacoustic Signals. J Med Biol Eng 2018. [DOI: 10.1007/s40846-018-0398-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Suleiman A, Lithgow B, Dastgheib Z, Mansouri B, Moussavi Z. Quantitative measurement of post-concussion syndrome Using Electrovestibulography. Sci Rep 2017; 7:16371. [PMID: 29180620 PMCID: PMC5703984 DOI: 10.1038/s41598-017-15487-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/27/2017] [Indexed: 12/27/2022] Open
Abstract
In this study, a noninvasive quantitative measure was used to identify short and long term post-concussion syndrome (PCS) both from each other and from healthy control populations. We used Electrovestibulography (EVestG) for detecting neurophysiological PCS consequent to a mild traumatic brain injury (mTBI) in both short-term (N = 8) and long-term (N = 30) (beyond the normal recovery period) symptomatic individuals. Peripheral, spontaneously evoked vestibuloacoustic signals incorporating - and modulated by - brainstem responses were recorded using EVestG, while individuals were stationary (no movement stimulus). Tested were 38 individuals with PCS in comparison to those of 33 age-and-gender-matched healthy controls. The extracted features were based on the shape of the averaged extracted field potentials (FPs) and their detected firing pattern. Linear discriminant analysis classification, incorporating a leave-one-out routine, resulted in (A) an unbiased 84% classification accuracy for separating healthy controls from a mix of long and short-term symptomatology PCS sufferers and (B) a 79% classification accuracy for separating between long and short-term symptomatology PCS sufferers. Comparatively, short-term symptomatology PCS was generally detected as more distal from controls. Based on the results, the EVestG recording shows promise as an assistive objective tool for detecting and monitoring individuals with PCS after normal recovery periods.
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Affiliation(s)
- Abdelbaset Suleiman
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
| | - Brian Lithgow
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
- Monash Alfred Psychiatry Research Center, Monash University, Melbourne, Australia
| | - Zeinab Dastgheib
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
| | - Behzad Mansouri
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine (Neurology), University of Manitoba, Winnipeg, MB, Canada
| | - Zahra Moussavi
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada.
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21
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Suleiman A, Lithgow B, Mansouri B, Moussavi Z. Investigating the feasibility of EVestG assessment for screening concussion. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:3375-8. [PMID: 26737016 DOI: 10.1109/embc.2015.7319116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Electrovestibulography (EVestG™) is a new technology that objectively measures the vestibular response. It has the potential to objectively, quickly and cost-effectively screen concussion. EVestG signals are recorded painlessly and non-invasively from the external ear in response to vestibular stimuli, and consist of brainstem and peripheral sensory oto-acoustic signals modulated by the cortical responses. In this study, we investigated the relationship between characteristic features of the extracted field potentials (FPs) of EVestG signals in people with side-impact concussion in comparison with those of control participants. 10 side-impact concussed individuals (4 Right and 6 left side-impact) and 10 age-and-gender-matched controls were tested by EVestG. The participants also completed comprehensive neuropsychological assessments. Characteristic features were extracted from the FPs during side tilt, and linear discriminant analysis (LDA) classification was applied to the extracted features using a leave-one-out routine. The results show the difference between the left and right FP area was significantly (P<0.05) different. The LDA classification resulted a sensitivity of 85% and specificity of 69% for separating concussed individuals from controls. EVestG appears to have diagnostic potential in diagnosing side impact concussion.
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