Simultaneous electroencephalography-functional MRI at 3 T: an analysis of safety risks imposed by performing anatomical reference scans with the EEG equipment in place

PURPOSE

To describe heating effects to be expected in simultaneous electroencephalography (EEG) and magnetic resonance imaging (MRI) when deviating from the EEG manufacturer's instructions; to test which anatomical MRI sequences have a sufficiently low specific absorption rate (SAR) to be performed with the EEG equipment in place; and to suggest precautions to reduce the risk of heating.

MATERIALS AND METHODS

Heating was determined in vivo below eight EEG electrodes, using both head and body coil transmission and sequences covering the whole range of SAR values.

RESULTS

Head transmit coil: temperature increases were below 2.2°C for low SAR sequences, but reached 4.6°C (one subject, clavicle) for high SAR sequences; the equilibrium temperature T(eq) remained below 39°C. Body transmit coil: temperature increases were higher and more frequent over subjects and electrodes, with values below 2.6°C for low SAR sequences, reaching 6.9°C for high SAR sequences (T8 electrode) with T(eq) exceeding a critical level of 40°C.

CONCLUSION

Anatomical imaging should be based on T1-weighted sequences (FLASH, MPRAGE, MDEFT) with an SAR below values for functional MRI sequences based on gradient echo planar imaging. Anatomical sequences with a high SAR can pose a significant risk, which is reduced by using head coil transmission.

Safety of injectable opioid maintenance treatment for heroin dependence

BACKGROUND

There is a growing debate about injectable opioid treatment programs in many Western countries. This is the first placebo-controlled study of the safety of injectable opioids in a controlled treatment setting.

METHODS

Twenty-five opioid-dependent patients on intravenous (IV) heroin or IV methadone maintenance treatment were randomly assigned to either their individual prescribed IV maintenance dose or placebo. Acute drug effects were recorded, focusing on electrocardiography, respiratory movements, arterial blood oxygen saturation, and electroencephalography (EEG).

RESULTS

After heroin injection, marked respiratory depression progressing to a Cheyne-Stokes pattern occurred. Peripheral arterial blood oxygenation decreased to 78.9 +/- 8.7% (mean +/- SD) ranging from 52%-90%. During hypoxia, 7 of the 16 subjects experienced intermittent and somewhat severe bradycardia. Five subjects exhibited paroxysmal EEG patterns. After methadone injection, respiratory depression was less pronounced than after heroin injection. No relevant bradycardia was noted.

CONCLUSIONS

Opioid doses commonly prescribed in IV opioid treatment induce marked respiratory and circulatory depression, as well as occasionally irregular paroxysmal EEG activity. Further studies are needed to optimize the clinical practice of IV opioid treatment to prevent serious complications. Moreover, the extent of the observed effects raises questions about the appropriateness of IV opioid treatment in the present form.

Ethical codes and values in a virtual world

Some members of the so-called virtual world deny that technology such as the virtual environment (VE) is value-laden. But there are a variety of complex issues which arise in VE that make it necessary to think about ethics and values in VE applications. Using VE in therapy and psychotherapy research or diagnostics leads to several ethical concerns. VE can impoverish those aspects of life that are essential to social development, interpersonal relations, and emotional growth. This paper will focus on the concept called "virtual world," a question of metaphysics. After reviewing general ethical principles, ethics in applied sciences will be described. Ethical decision-making, code of conduct, and specific issues in VE will be discussed. The VE community is challenged to set guidelines around VE, and its ethics and values. A set of measurement tools around ethical codes and values in a virtual world ought to be discursively gained in this virtual world and in real society as a whole.

Real-time monitoring of brain activity in patients with specific phobia during exposure therapy, employing a stereoscopic virtual environment

Exposure therapy is a behavioral technique that is reported to be the most effective, long-lasting treatment for patients suffering from specific phobia. During the performance in enclosed spaces, the patients show a strong psychophysiological response to the phobic stimulus that is normally avoided. This psychophysiological response changes characteristically during the course of exposure. We implemented an electroencephalographic monitoring focusing on event-related potentials to resolve the modulation of preattentive information processing by the anxiety state of the subject. Therefore, mismatch-negativity (MMN) was chosen as parameter using a passive auditory oddball paradigm that does not interfere with performance in the virtual environment. The results of this neurophysiological monitoring are demonstrated in one patient suffering from claustrophobia.

Immersive virtual environments in cue exposure

Cue reactivity to drug-related stimuli is a frequently observed phenomenon in drug addiction. Cue reactivity refers to a classical conditioned response pattern that occurs when an addicted subject is exposed to drug-related stimuli. This response consists of physiological and cognitive reactions. Craving, a subjective desire to use the drug of choice, is believed to play an important role in the occurrence of relapse in the natural setting. Besides craving, other subjective cue-elicited reactions have been reported, including withdrawal symptoms, drug-agonistic effects, and mood swings. Physiological reactions that have been investigated include skin conductance, heart rate, salivation, and body temperature. Conditioned reactivity to cues is an important factor in addiction to alcohol, nicotine, opiates, and cocaine. Cue exposure treatment (CET) refers to a manualized, repeated exposure to drug-related cues, aimed at the reduction of cue reactivity by extinction. In CET, different stimuli are presented, for example, slides, video tapes, pictures, or paraphernalia in nonrealistic, experimental settings. Most often assessments consist in subjective ratings by craving scales. Our pilot study will show that immersive virtual reality (IVR) is as good or even better in eliciting subjective and physiological craving symptoms as classical devices.