Local neuronal excitation and global inhibition during epileptic fast ripples in humans

Understanding the neuronal basis of epileptic activity is a major challenge in neurology. Cellular integration into larger scale networks is all the more challenging. In the local field potential, interictal epileptic discharges can be associated with fast ripples (200-600 Hz), which are a promising marker of the epileptogenic zone. Yet, how neuronal populations in the epileptogenic zone and in healthy tissue are affected by fast ripples remain unclear. Here, we used a novel 'hybrid' macro-micro depth electrode in nine drug-resistant epileptic patients, combining classic depth recording of local field potentials (macro-contacts) and two or three tetrodes (four micro-wires bundled together) enabling up to 15 neurons in local circuits to be simultaneously recorded. We characterized neuronal responses (190 single units) with the timing of fast ripples (2233 fast ripples) on the same hybrid and other electrodes that target other brain regions. Micro-wire recordings reveal signals that are not visible on macro-contacts. While fast ripples detected on the closest macro-contact to the tetrodes were always associated with fast ripples on the tetrodes, 82% of fast ripples detected on tetrodes were associated with detectable fast ripples on the nearest macro-contact. Moreover, neuronal recordings were taken in and outside the epileptogenic zone of implanted epileptic subjects and they revealed an interlay of excitation and inhibition across anatomical scales. While fast ripples were associated with increased neuronal activity in very local circuits only, they were followed by inhibition in large-scale networks (beyond the epileptogenic zone, even in healthy cortex). Neuronal responses to fast ripples were homogeneous in local networks but differed across brain areas. Similarly, post-fast ripple inhibition varied across recording locations and subjects and was shorter than typical inter-fast ripple intervals, suggesting that this inhibition is a fundamental refractory process for the networks. These findings demonstrate that fast ripples engage local and global networks, including healthy tissue, and point to network features that pave the way for new diagnostic and therapeutic strategies. They also reveal how even localized pathological brain dynamics can affect a broad range of cognitive functions.

Memory for complex visual objects but not for allocentric locations during the first year of life

Although human infants demonstrate early competence to retain visual information, memory capacities during infancy remain largely undocumented. In three experiments, we used a Visual Paired Comparison (VPC) task to examine abilities to encode identity (Experiment 1) and spatial properties (Experiments 2a and 2b) of unfamiliar complex visual patterns during the first year of life. In the first experiment, 6- and 9-month-old infants were familiarized with visual arrays composed of four abstract patterns arranged in a square configuration. Recognition memory was evaluated by presenting infants with the familiarized array paired with a novel array composed of four new patterns. The second couple of experiments aimed to examine infant ability to encode the spatial relationships between each pattern of the array (e.g., where is A in the square configuration). The 6-, 9- and 12-month-old infants were tested on a spatial version of the VPC task, in which the novel array was composed of the same patterns than the familiarized array but arranged differently within the square configuration. Results indicated that infants retained the identity of the patterns but not their specific spatial relationships within the square configuration (i.e., allocentric location of the patterns), suggesting either an immaturity of the processes involved in object-to-location binding, or the inappropriateness of unfamiliar complex objects to reveal such early allocentric abilities.

White matter disruption at the prodromal stage of Alzheimer's disease: relationships with hippocampal atrophy and episodic memory performance

White matter tract alterations have been consistently described in Alzheimer's disease (AD). In particular, limbic fronto-temporal connections, which are critical to episodic memory function, may degenerate early in the course of the disease. However the relation between white matter tract degeneration, hippocampal atrophy and episodic memory impairment at the earliest stages of AD is still unclear. In this magnetic resonance imaging study, white matter integrity and hippocampal volumes were evaluated in patients with amnestic mild cognitive impairment due to AD (Albert et al., 2011) (n = 22) and healthy controls (n = 15). Performance in various episodic memory tasks was also evaluated in each participant. Relative to controls, patients showed a significant reduction of white matter fractional anisotropy (FA) and increase of radial diffusivity (RD) in the bilateral uncinate fasciculus, parahippocampal cingulum and fornix. Within the patient group, significant intra-hemispheric correlations were notably found between hippocampal grey matter volume and FA in the uncinate fasciculus, suggesting a relationship between atrophy and disconnection of the hippocampus. Moreover, episodic recognition scores were related with uncinate fasciculus FA across patients. These results indicate that fronto-hippocampal connectivity is reduced from the earliest pre-demential stages of AD. Disruption of fronto-hippocampal connections may occur progressively, in parallel with hippocampal atrophy, and may specifically contribute to early initial impairment in episodic memory.

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Limbic fronto-temporal connections (cingulum, uncinate fasciculus and fornix) are altered from the prodromal stage of AD.

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In prodromal AD patients, intra-hemispheric correlations were found between uncinate fasciculus FA and hippocampal atrophy.

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In prodromal AD patients, uncinate fasciculus FA was correlated with scores on episodic recognition.

Ganser-like syndrome after loss of psychic self-activation syndrome: psychogenic or organic?

Very few data are available on the long-term changes in the cognitive abilities of patients with loss of psychic self-activation syndrome (LPSAS). Here, we present a 25-year follow-up study on a case of LPSAS resulting from bilateral pallidal lesions caused by carbon monoxide intoxication. Typical signs of LPSAS were observed, showing no changes in severity, but Ganser syndrome (GS) gradually developed and worsened during the follow-up period. GS is generally assumed to be a psychogenic syndrome, but an organic etiology has been suspected by the authors of several case reports. Here, atypical features of GS plead against the independence of GS and LPSAS. DaTSCAN and brain 18FDG-PET were performed. Since left hippocampal hypometabolism has been previously described in patients with functional amnesia, it is possible that long periods of mental inactivity may have psychological consequences, but the atypical features of GS also suggest that an organic mechanism may be involved.

Recognition memory and the medial temporal lobe: from monkey research to human pathology

This review provides a historical overview of decades of research on recognition memory, the process that allows both humans and animals to tell familiar from novel items. The emphasis is put on how monkey research improved our understanding of the medial temporal lobe (MTL) role and how tasks designed for monkeys influenced research in humans. The story starts in the early 1950s. Back then, memory was not a fashionable scientific topic. It was viewed as a function of the whole brain and not of specialized brain areas. All that changed in 1957-1958 when Brenda Milner, a neuropsychologist from Montreal, described patient H.M. He forgot all events as he lived them despite a fully preserved intelligence. He had received a MTL resection to relieve epilepsy. H.M. (1926-2008) would become the most influential patient in brain science. Which structures among those included in H.M.'s large lesion were important for recognition memory could not be evaluated in humans. It was gradually understood only after the successful development of a monkey model of human amnesia by Mishkin in 1978. Selective lesions and two behavioral tasks, delayed nonmatching-to-sample and visual paired comparison, were used to distinguish the contribution of the hippocampus from that of adjacent cortical areas. Driven by findings in non-human primates, human research on recognition memory is now trying to solve the question of whether the different structures composing MTL contributes to familiarity and recollection, the two possible forms taken by recognition. We described in particular two French patients, FRG and JMG, whose deficits support the currently dominant model attributing to the perirhinal cortex a critical role in recognition memory. Research on recognition memory has implications for the clinician as it may help understanding the cognitive deficits observed in different diseases. An illustration of such approach, linking basic and applied research, is provided for Alzheimer's disease.

Basal functional connectivity within the anterior temporal network is associated with performance on declarative memory tasks

Spontaneous fluctuations in the blood oxygenation level-dependent (BOLD) signal, as measured by functional magnetic resonance imaging (fMRI) at rest, exhibit a temporally coherent activity thought to reflect functionally relevant networks. Antero-mesial temporal structures are the site of early pathological changes in Alzheimer's disease and have been shown to be critical for declarative memory. Our study aimed at exploring the functional impact of basal connectivity of an anterior temporal network (ATN) on declarative memory. A heterogeneous group of subjects with varying performance on tasks assessing memory was therefore selected, including healthy subjects and patients with isolated memory complaint, amnestic Mild Cognitive Impairment (aMCI) and mild Alzheimer's disease (AD). Using Independent Component Analysis on resting-state fMRI, we extracted a relevant anterior temporal network (ATN) composed of the perirhinal and entorhinal cortex, the hippocampal head, the amygdala and the lateral temporal cortex extending to the temporal pole. A default mode network and an executive-control network were also selected to serve as control networks. We first compared basal functional connectivity of the ATN between patients and control subjects. Relative to controls, patients exhibited significantly increased functional connectivity in the ATN during rest. Specifically, voxel-based analysis revealed an increase within the inferior and superior temporal gyrus and the uncus. In the patient group, positive correlations between averaged connectivity values of ATN and performance on anterograde and retrograde object-based memory tasks were observed, while no correlation was found with other evaluated cognitive measures. These correlations were specific to the ATN, as no correlation between performance on memory tasks and the other selected networks was found. Taken together, these findings provide evidence that basal connectivity inside the ATN network has a functional role in object-related, context-free memory. They also suggest that increased connectivity at rest within the ATN could reflect compensatory mechanisms that occur in response to early pathological insult.

Impaired visual recognition memory in amnestic mild cognitive impairment is associated with mesiotemporal metabolic changes on magnetic resonance spectroscopic imaging

In the early stages of Alzheimer's disease (AD), neurofibrillary tangles develop in the mesial temporal lobe (MTL), first in the anterior subhippocampal (perirhinal/entorhinal) cortex and then in the hippocampal formation. This region plays a key role in visualrecognition memory (VRM). VRM has been reported to be impaired in patients with amnestic mild cognitive impairment (aMCI). The aim of the present study was to determine if an impairment of VRM is associated with metabolic changes in the MTL using magnetic resonance spectroscopic imaging and if evaluating VRM can contribute to the early diagnosis of AD. 28 patients with aMCI and 28 controls underwent a full neuropsychological assessment including an evaluation of VRM using the DMS48. NAA/mIno ratios, reduced in patients with AD and associated with the severity of pathological changes, were determined in the MTL. aMCI-patients were further divided into two subgroups according to their VRM performance. aMCI-patients showed decreased NAA/mIno levels in the right hippocampus compared with controls. aMCI-patients with impaired VRM showed decreased NAA/mIno ratios in the MTL bilaterally, including a region that sampled the left anterior subhippocampal cortex, compared to controls. No changes were found in aMCI patients with normal VRM. Performance on the DMS48 correlated with NAA/mIno levels in the anterior MTL. Clinical 6-year follow-up data (available for 78.6% of the aMCI-patients) indicates that impaired performance on the DMS48 could predict conversion to AD with a sensitivity and specificity of 81.8%. These findings provide further evidence that impaired VRM, as a hallmark of MTL dysfunction, may contribute to the early diagnosis of AD.

Organized labor, public health, and tobacco control policy: a dialogue toward action

An action-oriented conference, Organized Labor, Public Health, and Tobacco Control Policy, was held in September 2000 in Boston, Massachusetts. Labor union leaders, tobacco control and public health activists, researchers, and practitioners met for two days to: 1) learn about existing labor-based tobacco control initiatives; 2) educate one another about resources, barriers, and opportunities for labor-public health joint action on tobacco policy; 3) and identify where agendas overlap and form the basis for specific next steps in collaborative efforts in tobacco-related research, training, and advocacy. This report summarizes presentations and participant discussions to inform readers of the information exchanged and of the enthusiasm shared by conference participants translated into a set of joint recommendations for increased labor-based and joint labor-public health action to reduce the burden of tobacco on working people.

The right temporal lobe variant of frontotemporal dementia

The right temporal variant of frontotemporal lobar degeneration (Rtv-FTLD) is a focal degenerative condition affecting predominantly the right temporal lobe. The aim of this study was to further characterize the profile of cognitive impairment and the neuroanatomical basis of Rtv-FTLD patients without behavioural disturbances. A group of three patients with this syndrome had a detailed neuropsychological assessment, along with Voxel-Based Morphometry (VBM) of their brain to determine location of cortical atrophy. VBM analyses showed a pattern of atrophy that was predominant in the right hemisphere and concerned primarily the right anterior temporal lobe region. Patients carried out a test of famous people in which their ability to recognize, name and provide semantic information about famous persons from their faces, their voices and their names was investigated. They all showed a severe defect in recognizing, naming and identifying famous people irrespective of modality. Therefore, their inability to recognize famous people resulted from a multimodal defect (semantic). These results highlight the semantic nature of the defect, and suggest that the anterior right temporal lobe may have a prominent role in processing person-based semantic knowledge. This study helps in further understanding the neuropsychological profile of patients with Rtv-FTLD.

Cortical stimulation study of the role of rhinal cortex in déjà vu and reminiscence of memories

OBJECTIVE

To study the role of perirhinal (PC) and entorhinal cortices (EC) in dreamy state symptoms (déjà vu and reminiscence of scenes). These phenomena have been attributed to functional alteration of memory networks supported by the medial temporal lobes, principally involving the amygdala and hippocampus. The role of sub-hippocampal structures (EC and PC) in inducing these phenomena has not previously been addressed.

METHODS

The authors studied the symptoms evoked by direct electrical stimulations of PC and EC in comparison with those obtained after stimulation of the amygdala and hippocampus. Stimulations were performed in a group of 24 patients with epilepsy, during stereoelectroencephalographic (SEEG) recordings in the setting of presurgical evaluation. All patients had electrodes that sampled the rhinal cortices, amygdala, and hippocampus.

RESULTS

A total of 280 stimulations were analyzed. Entorhinal and perirhinal stimulations induced classic mesial temporal lobe responses (emotional, dysautonomic) but also more specific responses, particularly the déjà vu phenomenon and reminiscence of scenes. Such déjà vu or déjà vécu type responses were produced proportionately more often by stimulation of the EC than by stimulation of the amygdala and hippocampus. In particular, déjà vu was associated with stimulation of the EC and reminiscence of memories with PC stimulation.

CONCLUSION

This study strongly suggests that experiential symptoms are largely dependent upon functional modification of the physiology of the rhinal cortices.

Recollection of vivid memories after perirhinal region stimulations: synchronization in the theta range of spatially distributed brain areas

Electrical stimulation of the temporal cortex in patients with epilepsy sometimes elicits experiential phenomena such as recollection of vivid memories. The neurophysiological substrate of such phenomena is poorly understood. Furthermore, the relation between the site of stimulation and the type of memory elicited has only recently started to be investigated. We investigated these issues in patient FGA who had intracerebral electrodes stereotaxically implanted in the right temporal lobe for investigation of drug-resistant epilepsy. We report the results of electrical stimulations of the perirhinal region. Two stimulations elicited experiential phenomena consisting of visual memories that belonged to FGA's past, but which were not related to any particular episode. These visual memories consisted of objects or of details of objects. These two stimulations were contrasted with other stimulations in the same subhippocampal region. Cross-correlation analysis of the depth-EEG signals filtered in frequency sub-bands revealed that experiential phenomena occurred only when the various brain structures involved in the after-discharge were synchronized in the theta range. These structures included the perirhinal region, the hippocampus, other limbic structures as well as a primary visual area. Our results suggest that recollection of vivid memory after electric stimulation of the cortex may rely on wide networks of brain areas that transiently synchronize. These results also highlight the role of the perirhinal region in human memory. Experiential phenomena are rarely obtained after brain stimulation. Replication of these results is thus required due to the small number of observations reported.

Progressive prosopagnosia: Clinical and neuroimaging results

The authors report the longitudinal case study of a patient with the right temporal variant of frontotemporal lobar degeneration. His deficit, initially limited to visuoperceptual disturbances, progressed 2 years later to a severe semantic breakdown. Neuroimaging data indicate that the underlying degenerative process, initially confined to unimodal visual associative cortices, progressed along the ventral pathways to multimodal areas in charge of integrating knowledge from various modalities (the anterior temporal lobes).

[The human perirhinal cortex]

The perirhinal cortex is a structure that lies within the medial temporal lobe. In the present paper, we review current knowledge of the anatomical boundaries and functional correlates of this structure. In the past decade, numerous animal studies have attempted to understand the contribution of the perirhinal cortex to memory. Taken together, they suggest that the perirhinal cortex is crucially involved in recognition memory. This function appears to be independent from those assumed to be subserved by the hippocampus. In humans, data are scarce but tend to corroborate results found in the animal literature. The perirhinal cortex appears to support context-free (non-episodic) knowledge, such as general knowledge about the world and "item-specific" memories. Models of declarative memory that take into account the specific contribution of the perirhinal cortex are discussed, along with their potential application to early cortical neurodegenerative disorders.

Assessing and intervening on OSH programmes: effectiveness evaluation of the Wellworks-2 intervention in 15 manufacturing worksites

AIMS

(1) To develop a transparent and broadly applicable method for assessing occupational safety and health (OSH) programmes or management systems; (2) to assess OSH programmes in a sample of manufacturing worksites; and (3) to determine whether a management focused occupational health intervention results in greater improvement in OSH programmes compared to minimal intervention controls.

METHODS

OSH programmes were assessed using an adaptation of the US Occupational Safety & Health Administration's 1995 Program Evaluation Profile. Scores were generated from 91 binary indicator variables grouped under four "Essential Elements". Essential Element scores were weighted to contribute to an overall programme score on a 100 point scale. Seventeen large manufacturing worksites were assessed at baseline; 15 sites completed the 16 month intervention and follow up assessments.

RESULTS

There was considerable variation in Essential Element scores across sites at baseline as judged by our instrument, particularly in "management commitment and employee participation" and "workplace analysis". Most sites scored highly on "hazard prevention and control" and "training and education". For overall OSH programme scores, most sites scored in the 60-80% range at baseline, with four sites scoring below 60%, suggesting weak programmes. Intervention sites showed greater improvements than controls in the four programme elements and in overall programme scores, with significantly greater improvements in "management commitment and employee participation".

CONCLUSIONS

The OSH programme assessment method used is broadly applicable to manufacturing work settings, and baseline profiles suggest needs for improvement in OSH programmes in most such worksites. Despite a small sample size, results showed that sustained management focused intervention can result in improvement in these OSH programme measures.

The role of context in remembering familar persons: insights from semantic dementia

Semantic dementia (SD) is a progressive condition characterized by an insidious and gradual breakdown in semantic knowledge. Patients suffering from this condition gradually lose their knowledge of objects and their attributes, concepts, famous persons, and public events. In contrast, these patients maintain a striking preservation of autobiographical memory. The aim of the present study was to examine in a patient suffering from SD the role of context in the ability to recall knowledge of familiar persons. In an experiment, patient J.M. was asked to name and identify familiar persons that appeared on family photographs from recent and remote periods of her life. In the first experimental condition, the pictures represented personally familiar persons present in a specific spatial and temporal context. In a second experimental condition, the pictures showed personally familiar persons who were presented without any specific episodic context. Results indicate that the patient was able to name and identify familiar persons irrespective of the context of presentation (with/without context) and of the time period (recent/remote). No temporal gradient was found using family photographs. Finally, in contrast with familiar persons, J.M. presented a severe anomia for celebrities. Results are discussed in light of recent research in the field.

Evaluation of visual recognition memory in MCI patients

BACKGROUND

Neurofibrillary tangles seen early in Alzheimer disease (AD) initially appear in a subregion of the perirhinal cortex. In the monkey, damage to the perirhinal cortex impairs performance on visual recognition memory tasks. The authors evaluated impairment of visual recognition memory as a potential early diagnostic marker of AD.

METHODS

The authors developed a visual delayed matching-to-sample task (DMS48) designed to assess visual recognition memory in humans. Twenty-three patients fulfilling the criteria of amnestic mild cognitive impairment (MCI) (mean Mini-Mental State Examination [MMSE]: 26.6, SD = 1.6) were recruited. All underwent a full neuropsychological evaluation, which included the Free and Cued Selective Reminding (FCSR) test. Their performance was compared with that of 10 patients with mild AD, 20 patients with moderate AD, 20 patients with Parkinson disease (PD), and 40 age-matched controls.

RESULTS

Control subjects and patients with PD performed close to ceiling. Patients with mild AD had very low scores, while patients with moderate AD answered at random. MCI patients obtained scores that were between those of control subjects and patients with mild AD (78%, SD = 16%). MCI patients who failed on the DMS48 had lower scores on free recall (p < 0.05) and received less benefit from cueing (p < 0.01) on the FCSR than the other MCI, suggesting a profile of genuine memory impairment related to medial temporal lobe lesions.

CONCLUSION

The DMS48, a test of visual recognition memory, is impaired early in the course of patients with MCI. Further studies are necessary to determine whether the evaluation of visual recognition memory may contribute to the identification of patients with AD.

A single case-study of diagonistic dyspraxia

Diagonistic dyspraxia is a clinical syndrome usually characterized by involuntary and conflicting behaviors between the hands following corpus callosum lesions. In the present study, we report the case of a patient who presents such symptoms, along with a series of complex abnormal behaviors, such as carrying out an action and subsequently doing the exact opposite, or being unable to choose between two alternative decisions. The data reported in this study indicate that, at least in some patients, diagonistic dyspraxia can be associated with abnormal, antagonistic, behaviors not limited to the hands. In our view, diagonistic dyspraxia result from lesion of the posterior corpus callosum while associated complex abnormal behaviors result from concomitant anterior lesions.

Category-specific visual agnosia: lesion to semantic memory versus extra-lesional variables in a case study and a connectionist model

There is a current debate on the causes of category-specific agnosia. The aim of this study was to examine the effects of lesional and extra-lesional variables on object recognition. Extra-lesional variables, such as visual complexity or familiarity, are factors that influence recognition. Using a connectionist model based on study, we provide evidence that extra-lesional variables can yield dissociations in the recognition rate of different categories. Furthermore, it is shown that lesional and extra-lesional variables can interact (p < .01) when both are simultaneously modeled. Category-specific agnosia might thus result from complex interactions.

Preservation of autobiographical memory in a case of pure progressive amnesia

G.D., a 79 year-old female, presents with a severe and slowly progressive amnesia although she remains entirely independent in daily life and is perfectly well spatially oriented. Her amnesia is relatively isolated and her deficit does not embrace other cognitive domains. G.D. underwent extensive neuropsychological evaluation including language, executive functions, perceptual, and memory tests. Based on clinical observation, the purpose of this study was to determine whether there was a dissociation between her autobiographical and semantic memory. Results point out a severely degraded semantic knowledge of famous public events and persons while autobiographical memory of personally experienced and relevant information remains intact. Results from this study and from previous studies seem to suggest that relative sparing of hippocampal structures may be related to the preservation of autobiographical memory.