Intracranial electrical stimulation of corticolimbic sites modulates arousal in humans

BACKGROUND

Humans routinely shift their sleepiness and wakefulness levels in response to emotional factors. The diversity of emotional factors that modulates sleep-wake levels suggests that the ascending arousal network may be intimately linked with networks that mediate mood. Indeed, while animal studies have identified select limbic structures that play a role in sleep-wake regulation, the breadth of corticolimbic structures that directly modulates arousal in humans remains unknown.

OBJECTIVE

We investigated whether select regional activation of the corticolimbic network through direct electrical stimulation can modulate sleep-wake levels in humans, as measured by subjective experience and behavior.

METHODS

We performed intensive inpatient stimulation mapping in two human participants with treatment resistant depression, who underwent intracranial implantation with multi-site, bilateral depth electrodes. Stimulation responses of sleep-wake levels were measured by subjective surveys (i.e. Stanford Sleepiness Scale and visual-analog scale of energy) and a behavioral arousal score. Biomarker analyses of sleep-wake levels were performed by assessing spectral power features of resting-state electrophysiology.

RESULTS

Our findings demonstrated three regions whereby direct stimulation modulated arousal, including the orbitofrontal cortex (OFC), subgenual cingulate (SGC), and, most robustly, ventral capsule (VC). Modulation of sleep-wake levels was frequency-specific: 100Hz OFC, SGC, and VC stimulation promoted wakefulness, whereas 1Hz OFC stimulation increased sleepiness. Sleep-wake levels were correlated with gamma activity across broad brain regions.

CONCLUSIONS

Our findings provide evidence for the overlapping circuitry between arousal and mood regulation in humans. Furthermore, our findings open the door to new treatment targets and the consideration of therapeutic neurostimulation for sleep-wake disorders.

Single neuron evidence of inattentional blindness in humans

Recording directly from the brain of a patient undergoing neurosurgery with electrodes implanted deep in her skull, we identified neurons that change their properties when the patient became consciously aware of content. Specifically, we showed the patient an established clip of a gorilla passing through the screen, unnoticeable, in a classic inattentional blindness task, and identified a neuron in the right amygdala that fired only when the patient was aware of the gorilla. A different neuron coded the moment of insight, when the patient realized that she had missed the salient gorilla in previous trials. A third cluster of neurons fired when the patient was exposed to a post-clip question ("How many passes did you count?") and reflected on the content. Neurons in this cluster altered their response behavior between unaware and aware states. To investigate the interplay between the neurons' activity and characterize the potential cascade of information flow in the brain that leads to conscious awareness, we looked at the neurons' properties change, their activities' alignment and the correlation across the cells. Examining the coherence between the spiking activity of the responsive neurons and the field potentials in neighboring sites we identified an alignment in the alpha and theta bands. This spike-field coherence hints at an involvement of attention and memory circuits in the perceptual awareness of the stimulus. Taken together, our results suggest that conscious awareness of content emerges when there is alignment between individual neurons' activity and the local field potentials. Our work provides direct neural correlate for the psychological process by which one can look at things directly but fail to perceive them with the "mind's eye".

Disparity in Context: Understanding how monocular image content interacts with disparity processing in human visual cortex

Horizontal disparities between the two eyes' retinal images are the primary cue for depth. Commonly used random ot tereograms (RDS) intentionally camouflage the disparity cue, breaking the correlations between monocular image structure and the depth map that are present in natural images. Because of the nonlinear nature of visual processing, it is unlikely that simple computational rules derived from RDS will be sufficient to explain binocular vision in natural environments. In order to understand the interplay between natural scene structure and disparity encoding, we used a depth-image-based-rendering technique and a library of natural 3D stereo pairs to synthesize two novel stereogram types in which monocular scene content was manipulated independent of scene depth information. The half-images of the novel stereograms comprised either random-dots or scrambled natural scenes, each with the same depth maps as the corresponding natural scene stereograms. Using these stereograms in a simultaneous Event-Related Potential and behavioral discrimination task, we identified multiple disparity-contingent encoding stages between 100 ~ 500 msec. The first disparity sensitive evoked potential was observed at ~100 msec after an earlier evoked potential (between ~50-100 msec) that was sensitive to the structure of the monocular half-images but blind to disparity. Starting at ~150 msec, disparity responses were stereogram-specific and predictive of perceptual depth. Complex features associated with natural scene content are thus at least partially coded prior to disparity information, but these features and possibly others associated with natural scene content interact with disparity information only after an intermediate, 2D scene-independent disparity processing stage.

Human-based approaches to pharmacology and cardiology: an interdisciplinary and intersectorial workshop

Both biomedical research and clinical practice rely on complex datasets for the physiological and genetic characterization of human hearts in health and disease. Given the complexity and variety of approaches and recordings, there is now growing recognition of the need to embed computational methods in cardiovascular medicine and science for analysis, integration and prediction. This paper describes a Workshop on Computational Cardiovascular Science that created an international, interdisciplinary and inter-sectorial forum to define the next steps for a human-based approach to disease supported by computational methodologies. The main ideas highlighted were (i) a shift towards human-based methodologies, spurred by advances in new in silico, in vivo, in vitro, and ex vivo techniques and the increasing acknowledgement of the limitations of animal models. (ii) Computational approaches complement, expand, bridge, and integrate in vitro, in vivo, and ex vivo experimental and clinical data and methods, and as such they are an integral part of human-based methodologies in pharmacology and medicine. (iii) The effective implementation of multi- and interdisciplinary approaches, teams, and training combining and integrating computational methods with experimental and clinical approaches across academia, industry, and healthcare settings is a priority. (iv) The human-based cross-disciplinary approach requires experts in specific methodologies and domains, who also have the capacity to communicate and collaborate across disciplines and cross-sector environments. (v) This new translational domain for human-based cardiology and pharmacology requires new partnerships supported financially and institutionally across sectors. Institutional, organizational, and social barriers must be identified, understood and overcome in each specific setting.

Effect of mental stress on dynamic electrophysiological properties of the endocardium and epicardium in humans

BACKGROUND

Striking temporal associations exist between ventricular arrhythmia and acute mental stress, for example, during natural disasters, or defibrillator shocks associated with stressful events. We hypothesized that electrophysiological changes in response to mental stress may be exaggerated at short coupling intervals and hence relevant to arrhythmia initiation.

OBJECTIVE

The aim of this study was to determine the dynamic response in human electrophysiology during mental stress.

METHODS

Patients with normal hearts and supraventricular tachycardia underwent electrophysiological studies avoiding sedation. Conditions of relaxation and stress were induced with standardized psychometric protocols (mental arithmetic and anger recall) during decremental S1S2 right ventricular (RV) pacing. Unipolar electrograms were acquired simultaneously from the RV endocardium, left ventricular (LV) endocardium (LV endo), and epicardium (LV epi), and activation-recovery intervals (ARIs) computed.

RESULTS

Twelve patients ( 9 women; median age 34 years) were studied. During stress, effective refractory period (ERP) reduced from 228 ± 23 to 221 ± 21 ms (P < .001). ARIs reduced during mental stress (P < .001), with greater reductions in LV endocardium than in the epicardium or RV endocardium (LV endo -8 ms; LV epi -5 ms; RV endo -4 ms; P < .001). Mental stress depressed the entire electrical restitution curve, with minimal effect on slope. A substantial reduction in minimal ARIs on the restitution curve in LV endo occurred, commensurate with the reduction in ERP (LV endo ARI 195 ± 31 ms at rest to 182 ± 32 ms during mental stress; P < .001). Dispersion of repolarization increased sharply at coupling intervals approaching ERP during stress but not at rest.

CONCLUSION

Mental stress induces significant electrophysiological changes. The increase in dispersion of repolarization at short coupling intervals may be relevant to observed phenomena of arousal-associated arrhythmia.

Failure of temporal selectivity: Electrophysiological evidence for (mis)selection of distractors during the attentional blink

The attentional blink (AB) refers to the impairment in accurate report of a second target (T2) when presented shortly after a first target (T1) in a rapid serial visual presentation of distractors. The goal of the present study was to determine whether the AB is caused by a failure in early selection processes, which leads to the selection and consolidation of the wrong item in working memory, by measuring the frequency-related P3 to T2 and to T2 + 1. During the AB, an attenuation of the P3 to T2 was observed, as well as an increase in the amplitude of the P3 to T2 + 1. Whereas the P3 to T2 was observed only when T2 was correctly reported, the P3 to T2 + 1 was observed only in trials where T2 was incorrectly reported, and its amplitude was correlated to individual differences in misselection rate. These results support the claim that failure of temporal selection underlies the AB.

Task switching mediates direct interference of intertarget distractors in the attentional blink: An event-related potential study

The attentional blink (AB) refers to the difficulty in reporting a second target (T2) presented shortly after a first target (T1) in a stream of distractors. The goal of the present study was to investigate distractor-based interference in the AB by recording the P3 component of the event-related potential to both targets. An intertarget distractor was presented at lag 1 (T1+1), at lag 2 (T1+2), or at neither of these two lags (no distractor). T2 was always presented at lag 3, as the last item in the stream. In two experiments, the P3 from T1 was attenuated in the T1+1 condition compared to the two other distractor conditions. In absence of a task switch (Experiment 1), the P3 from T2 was delayed in both the T1+1 and T1+2 conditions. In the presence of a task switch (Experiment 2), the P3 from T2 was delayed only in the T1+1 condition. Results demonstrate that intertarget distractors can modulate the AB directly but only in absence of a task switch.