Laboratory cost control and financial management software

Event-related potentials (ERPs) evoked by light flashes and auditory tones in a standard odd-ball procedure were recorded from Fz, Cz and Pz scalp sites. Tonic pain was evoked by immersion of the hand in cold water (5 degrees C). Significant effects of pain were found in responses to target stimuli but not in responses to non-target stimuli. P300 wave was affected more than the earlier P200 component. The reduction of P300 amplitude was the strongest effect, both in auditory and visual tests. P300 latency was not significantly affected. Difference curves (target minus non-target ERPs) showed the additional effects: latency of P200 component was elongated and its amplitude enlarged but only in auditory experiments. In control experiments with warm water stimulation no significant alterations of P300 or P200 components were found. The results show that the effect of tonic pain is specific: it predominantly affects the processes that manifest themselves as amplitude changes of P300 components in responses to target stimuli.     

Discriminative power of visual evoked potential characteristics in multiple sclerosis

To investigate the discriminative power of pattern-reversal visual evoked potential characteristics (peak latencies and amplitude) and to test whether the addition of visual evoked potential amplitude can increase the power of the visual evoked potential in the diagnosis of multiple sclerosis, we retrospectively studied visual evoked potentials in 59 patients with definite multiple sclerosis and 126 control subjects. Two check sizes (17' and 10') were used. Females had significantly higher amplitudes and shorter latencies than males. N80 latency showed a gradual increase and P100 amplitude a decrease with age. P100 latency was stable between the ages of 20 and 55 years but was increased in childhood and the elderly. The significance of visual evoked potential peak latencies and amplitude in separating the two groups was investigated by means of a (multivariate) discriminant analysis. The visual evoked potential with a pattern of 10' could be measured in 58% of patients with multiple sclerosis. The exclusive use of the P100 amplitude in the discriminant analysis resulted in a percentage of correctly classified cases of 84%, whereas for P100 and N80 latency it was 85% and 90%, respectively. With the 17' pattern, the N80 latency yielded also a higher correct percentage than did the P100 latency. Although N80 latency is, to a greater extent than P100 latency, influenced by age, sex and size of stimulus pattern, when these influences are accounted for, the N80 latency is a more sensitive measure than P100 latency in the classification of multiple sclerosis. Combined use of latency and amplitude for discriminant analysis yielded no significant improvement of the percentage of correctly classified cases.     

Pattern-reversal visual evoked potentials in migraineurs with or without visual aura

To determine the possible electrophysiologic changes in migraineurs with or without visual aura, we investigated pattern-reversal visual evoked potentials in 39 patients. We compared the mean P100 latency and amplitude of 16 patients with aura, 23 patients without aura, and 17 age- and sex-matched normal subjects. There were no significant differences between groups. There was no correlation between age and the parameters in any group. However, in 7 of 23 patients without aura, the P100 latency was longer than the mean control value +2 SD. The mean disease duration in this subgroup was significantly longer than the means of the remaining 16 patients without aura or the patients with aura (P < 0.05 for each). This suggests the possibility that P100 latency prolongation is a consequence, but not an entity caused by the pathogenetic mechanism of the disease from the beginning.     

P300 latency: abnormal in sleep apnea with somnolence and idiopathic hypersomnia, but normal in narcolepsy

To evaluate cognitive abnormalities in excessive daytime sleepiness (EDS) using cognitive evoked potentials (P300), and to evaluate if P300 measures differentiate among disorders of EDS, a series of EDS subjects were administered a polysomnogram, auditory and visual P300 testing using 31 scalp electrodes, and a multiple sleep latency test. P300 variables were compared with those of normal subjects. Forty normal subjects ages 16 to 65 years, and 69 EDS patients ages 16 to 65 years were used. Of these, 39 had profound obstructive sleep apnea (OSA, Respiratory Disturbance Index or RDI > 80/h sleep) with severe somnolence (Mean Sleep Latency < 5 min). Twenty-two had idiopathic hypersomnia (IH). Eight had narcolepsy. The normals and the three EDS groups did not differ in age. IH and profound OSA patients had longer visual P300 latency than normals or narcolepsy patients (p < 0.05). (p < 0.05). IH and profound OSA patients had longer auditory P300 latency than normals. They had smaller auditory P300 amplitude than narcolepsy patients. There were visual P300 latency topographic differences between normals and profound OSA patients. In conclusion, IH and profound OSA patients show cognitive evoked potential evidence of cognitive dysfunction. Narcolepsy patients do not show such evidence. Visual P300 latency differentiates among disorders of EDS.     

Pattern reversal visual evoked potentials in minor head injury

Pattern reversal visual evoked potentials (PR-VEPs) have been recorded in 50 patients with minor head injury (MHI) on days 1 and 30 after trauma and the data compared to 20 normals. None of the patients had visual complaints. The aim was to investigate a possible visual pathway affection in MHI and test the usefulness of PR-VEPs as an objective noninvasive tool in the detection of a possible subclinical affection of the visual system in MHI. P100 latency and amplitude had no significant difference compared to normals. Comparison of patient data on days 1 and 30 after trauma showed a significant latency decrease and amplitude increase on day 30, compared to day 1. These alterations were not age dependent. Our data suggest affection of the human visual pathway in MHI. PR-VEP recording seems to be a useful, objective, noninvasive tool, helping to identify possible subclinical affections of the visual pathway in MHI.     

Effects of the civil war in central Mozambique and evaluation of the intervention of the International Committee of the Red Cross

Visual evoked potentials to pattern reversal and diffuse flash stimulation were recorded from 520 consecutive pediatric patients and 11 normal infants between the ages of 27 weeks post-conception and 24 months. The latency and peak-to-peak amplitude of the first reproducible positive peak of the binocular pattern visual evoked potential (P100) were measured for five check sizes subtending from 15' to 4 degrees of arc. Three developmental trends were noted: 1) a rapid increase in pattern resolution near term, 2) a subsequent decrease in the latency of P100, and 3) a gradual increase in the amplitude of P100. These three trends reflect the multiplicity of early maturation and are discussed in terms of changes in receptor growth and density, pathway myelination, and cortical synaptivity.     

Event-related potentials (P300) in primary headache in childhood and adolescence

There is strong evidence for a loss of habituation during cognitive processing in migraine as measured by P300 and contingent negative variation in adults. Event-related potentials evoked by an oddball paradigm have not yet been studied in children and adolescents suffering from different primary headache types. We recorded visually evoked event-related potentials (two consecutive trials, 200 stimuli each) in 48 children and adolescents suffering from migraine without or with aura, from episodic tension-type headache, and from ergotamine-induced headache and analyzed the latencies, amplitudes, and reaction times. No statistically significant differences were noted between all headache types and healthy controls analyzing the averaged parameters for the whole measurement. However, a highly significant loss of cortical habituation as measured by P300 amplitude and latency could be observed in migraine without and with aura by analyzing the first and the second trial of measurement separately. This phenomenon increased with age and could not be seen in healthy controls, or patients with tension-type headache or ergotamine-induced headache. Our data suggest a specific cognitive processing in migraine even in children and adolescents. Measurement of the habituation effect in P300 latency and amplitude provides a specific method to differentiate between primary headache types in childhood and adolescence.     

Effect of isoflurane and sevoflurane on evoked potentials and EEG

Evoked potentials and EEG are used to monitor the central nervous system and the depth of anesthesia in anesthetized patients. In this study, we examined EEG, VEP, SEP and ABR at various concentrations of isoflurane or sevoflurane, and evaluated the influence of volatile agents and their usefulness for the monitoring of the depth of anesthesia. With increasing concentrations of isoflurane and sevoflurane, AE (frequency which account for 80% of total voltage) showed dose-related reduction and EEG showed a trend toward a slower wave and higher amplitude. With increasing concentrations of isoflurane and sevoflurane, P100 of VEP showed a significant dose-related reduction in its amplitude and increase in its latency. So we could not record P100 at the level of the anesthesia of 1.0 MAC with 66% N2O. N20 of SEP can be easily recorded at any depth of anesthesia. And the trend showed consistent dose-related changes in amplitude and latency. With increasing concentrations of isoflurane and sevoflurane, wave III and V of ABR increased significantly in latency, but the changes were very small. In conclusion, the effect of isoflurane and that of sevoflurane on evoked potentials and EEG are similar with each other and with other volatile agents. SEP is the most consistent and reliable factor to monitor the depth of anesthesia neurophysiologically.     

Somatosensory evoked potentials during hypoxia and hypocapnia in conscious humans

PURPOSE: The objective of the study was to evaluate the effects of moderate hypoxia and hypocapnia on the latency and amplitude of cortical somatosensory evoked potentials (SSEPs) in conscious human subjects. METHODS: In ten volunteers the amplitude and latency of the cortical somatosensory evoked potentials were recorded during stimulation of the left posterior tibial nerve. Measurements of SSEPs and respiratory variables were made breathing ambient air, air containing a reduced oxygen percentage (17% O2, 14% O2 (n = 6) or 11% O2 (n = 10)), and again during voluntary hyperventilation breathing ambient air (PETCO2 = 20 mmHg, n = 10). RESULTS: Hypoxia (11% O2) caused mild stimulation of ventilation (P < 0.05) but had no effects on the latency or amplitude of the SSEP. Lesser degrees of hypoxia had no effects. Hyperventilation caused a small (2-4%) decrease) in the latency of the SSEP and an increase in the amplitude of the SSEP (P < 0.05). CONCLUSIONS: These findings in conscious subjects were consistent with previous observations in anaesthetized humans and anaesthetized dogs and show that the decrease in latency of the SSEP associated with hypocapnia is not due to changes in the depth of anaesthesia. These effects of hypocapnia may contribute to small variations in the latency of the SSEP when monitoring is performed during surgery, but are unlikely to be large enough to be of clinical concern.     

Speech-evoked cognitive P300 potentials in cochlear implant recipients

The cognitive P300 evoked potential was elicited by speech stimuli in successful cochlear implant recipients, and the resulting P300 morphology was remarkably similar to that of normal-hearing individuals. The P300 was elicited by the synthesized speech pair/da/and/di/ presented using an oddball paradigm to nine "good" Nucleus cochlear implant users and nine age-matched normal-hearing subjects (34-81 yr old). There were no significant differences in P300 amplitude and latency between the two groups. Moreover, the N1 and P2 potentials occurred at similar latencies in the two groups, although the N1 amplitude was significantly smaller in the cochlear implant users. The P300 was absent in one "poor" cochlear implant user. The results suggest that the P300 may serve as a useful tool for evaluating the cognitive aspects of auditory processing in cochlear implant recipients, and that it may aid in assessing the success of cochlear implantation.     

The effect of motion on pattern-onset visual evoked potentials in adults and children

Visual evoked potentials can be elicited by a variety of visual stimuli, including pattern-onset and motion-onset. It may be desirable to combine pattern-onset with motion-onset stimuli, for example, to make a direct comparison between optokinetic nystagmus and visual evoked potential acuity thresholds. Both procedures employ grating stimuli; however, the gratings must be moving to produce optokinetic nystagmus. We compared pattern-onset visual evoked potentials with both a static and a moving pattern to investigate the effect of motion on the pattern-onset visual evoked potential waveform. Visual evoked potential recordings were made from 10 adults (aged 20-37 years) and 10 children (aged 5-7 years) with the active electrode at Oz. Stimuli consisted of onset of high-contrast vertical bars of three sizes (12', 30' and 60') both with and without motion (3 cycles/s). In a subgroup of subjects, visual evoked potentials were recorded to motion onset of constantly present gratings. Motion of the pattern had no significant effect on any of the latency components of the visual evoked potential waveform in adults or children. The amplitude of the C2-C3 component was significantly increased (p < 0.001) in adults. The motion appears to add a late negative component to the visual evoked potential similar to that produced by the motion-only stimulus. The latency of the early components of the pattern-onset visual evoked potential was unaffected by the presence of motion. Therefore, pattern-onset visual evoked potentials with moving gratings could be used to estimate visual acuity, and direct comparisons could be made between visual evoked potential and optokinetic nystagmus acuity thresholds with the use of the same stimulus parameters.     

Brain evoked potential in schizophrenic patients

The authors reviewed the literature on evoked potentials in mentally ill patients, with particular emphasis on schizphreniacs. The commonly observed abnormalities were as follows: 1) higher SEPs amplitudes with less waveshape variability during first 100 ms in non-depressed chronic, paranoid or undifferentiated patients with florid psychotic symptoms; normal SEPs amplitudes in acute or latent schizophrenics and in chronic depressed schizophrenics but without florid psychotic symptoms; 2) reduced SEPs and VEPs amplitude recovery and faster latency recovery; 3) reduced AEPs amplitude and latency; 4) greater VEPs waveshape variability and tendency to be "reducers" in hallucinating patients; reduced amplitude and latency recovery; prolonged latencies in patients with positive family history (schizophrenia or affective disorders in close relatives); prolonged N2 latency in motor responses to "easy" and "difficult" stimuli; reduced activity of "late potentials"; 5) greater waveshape variability in all modalities in chronic schizophrenics, abnormal P300 (reduced amplitude, lack of P300 or negative "effect of uncertainty") and abnormal CNV (less "readiness" potential, prolonged negativity with motor responses).     

Effect of phenactil (chlorpromazine) on cortical visual evoked potentials in clinically healthy subjects with normal and abnormal electroencephalograms

The results of a study of averaged cortical visual evoked potentials in healthy subjects with abnormal EEG records and in subjects with normal EEG are presented. The investigations were performed at rest and after activation with chlorpromazine. The potentials were recorded from typical sites in the visual cortex (O2--CZ and O1--CZ). Stimulation with flashes at 1 c/sec., 40 msec. duration, 2000 lux light intensity at a distance of 60 cm from the eyes was applied. The pupils were dilated with homatropine. The mean amplitudes of potential components measured by the method peak-to-peak, the mean latency time, and the mean duration of components were measured. It was found that at rest the inter-group differences included an amplitude rise at the time of change of the specific part into non-specific and the change of the evoked potential to the after-discharge, and the duration of positive components in the non-specific part prevailed over the negative ones. Chlorpromazine changed somewhat the amplitude of components (fall in the specific part and rise in the non-spefific one) but the differences were statistically not significant. Similar changes were observed in the latency time of various components (prolongation of latency time of late components was statistically not significant). The results suggest differences in the reactivity of cerebral structures of these groups at rest as well as after chlorpromazine activation.     

Auditory event related potentials in major depression: prolonged P300 latency and increased P200 amplitude

BACKGROUND: Some studies have shown disturbances in auditory event related potentials (AERPs) in patients with major depression. METHODS: In this exploratory study, the late AERP components, N100 (latency), P200 (amplitude and latency) and P300 (amplitude and latency) were recorded in 68 subjects, i.e. 39 major depressed subjects, with (n=4) or without (n=35) cognitive deterioration, 18 patients with Alzheimer's dementia (SDAT) and 11 normal volunteers. Twenty-five major depressed patients had repeated measurements of AERPs both before and after treatment with antidepressants. RESULTS: Major depressed subjects without cognitive deterioration had significantly higher P300 latency and P200 amplitude than normal volunteers. SDAT patients and major depressed patients with cognitive impairment had a significantly higher P300 latency than depressed patients without cognitive impairment. In the latter, no significant alterations in any of the AERP components upon subchronic treatment with antidepressants were recorded. Nonresponders to antidepressant therapy had significantly higher pretreatment P300 latency and P200 amplitude than responders to treatment (P=0.006) and normal volunteers (P=0.0004). CONCLUSIONS: The findings may suggest that delayed P300 latency as well as increased P200 amplitude accompany major depression and may predict a nonresponse to subsequent antidepressive therapy.     

Parkinson's dementia and Alzheimer's dementia: an evoked potential comparison

Auditory endogenous event-related potentials (ERPs) and flash visual evoked potentials (VEPs) were recorded in 26 elderly patients with idiopathic Parkinson's disease (PD), 14 with dementia and 12 non-demented, 16 elderly patients with Alzheimer dementia (AD) and 15 cognitively intact controls. ERP P3 and flash-VEP N2, P2 and delta (P2-P1) latency measures were significantly increased in the demented PD group compared with controls. The ERP P3 latency was also significantly delayed in the AD group compared with controls, but the differences in the flash-VEP measures from controls were not significant. No significant differences were noted between the PD groups, except for a significantly shorter flash-VEP N1 latency in the demented PD group; this was also the only significant evoked potential difference between the AD and PD dementia groups, which were otherwise electrophysiologically similar.     

Creutzfeldt-Jakob disease: neurophysiologic visual impairments

OBJECTIVE: The predictive value of electrophysiologic visual testing in Creutzfeldt-Jakob disease (CJD) was investigated, and the retinal pathologic findings in three cases are reported. BACKGROUND: The fatal prognosis of CJD, its transmissibility, and the lack of treatment make early diagnosis essential in averting human-to-human transmission. Electroretinogram and visual evoked potentials have been studied in few cases of CJD. METHODS: A visual electrophysiologic examination was performed in 41 consecutive patients referred with suspected CJD. The disease had been diagnosed in 24 patients (CJD group; 15 were confirmed neuropathologically and 9 by clinicolaboratory methods in accordance with diagnostic criteria). The remaining 17 patients were diagnosed with other neurologic disorders, and served as a control group. RESULTS: Flash electroretinogram revealed a significant decrease in the amplitude of the B1 wave (<60 microV) and the B/A ratio (<2) in the CJD group compared with those in the control group. Flash visual evoked potentials revealed no significant difference in latency, but amplitude was increased (>10 microV) in the CJD group, especially in patients with myoclonus. CONCLUSIONS: The visual electrophysiologic abnormalities provide an interesting noninvasive diagnostic tool in idiopathic CJD. The B1-wave decrease is closely correlated with the outer plexiform layer abnormalities observed on neuropathologic examination.     

Bisensory stimulation: inferring decision-related processes from P300 component

Three experiments were conducted to evaluate the P300 component of the human evoked response as an index of bisensory information processing. On different blocks of trials, subjects were presented with auditory stimuli alone, visual stimuli alone, or with audiovisual compounds. In each series there were two possible stimuli, one of which was presented less frequently than the other; the subjects' task was to count the infrequent stimuli. In the first two experiments the information in the two modalities was redundant, whereas in the third the modalities provided nonredundant information. With redundant information, the P300 latency indicated bisensory facilitation when the unimodal P300 latencies were similar; when the unimodal latencies were dissimilar, the bisensory P300 occurred at the latency of the earlier unimodal P300. Reaction times paralleled P300 latency. When the information in the two modalities was nonredundant, both P300 amplitude and reaction-time data indicated interference between the two modalities, regardless of which modality was task relevant. P300 latency and reaction time did not covary in this situation. These data suggest that P300 latency and amplitude do reflect bisensory interactions and that the P300 promises to be a valuable tool for assessing brain processes during complex decision making.     

Logarithmic distribution of amplitudes of compound muscle action potentials evoked by transcranial magnetic stimulation

Motor evoked potentials were recorded from the first dorsal interosseous muscle on the dominant side evoked by transcranial magnetic stimulation in 20 healthy volunteers. Amplitude data revealed skewness of distribution and variance heterogeneity. Natural logarithmic transformation of amplitude data results in normal distribution and ensures variance homogeneity. There was a negative first-order autocorrelation between consecutive recordings, which indicates that a stimulus-free interval of 5 s in consecutive stimulations is insufficient to ensure independent events. In a variability study, no systematic changes in latency and amplitude during day-to-day examinations or in consecutive examinations were found. There was a significant change in latency data (p = 0.02) during a gradual increase of constant elements in the stimulation procedure, whereas the amplitude data were unchanged. Estimation of random contributors to the total variability in the magnetic stimulation technique was performed. Intersubject differences were the major contributor to the variability of latency data but not to variability of logarithmic amplitude data. The variance estimates of different examiners' contribution to the variability was 0.02 for latency data and 0 for amplitude data. This indicates that staff members familiar with the principles in magnetic stimulation and following a thorough verbal and written instruction in the standardized examination procedure can perform the stimulation procedure without increasing the data variability.     

The effect of occlusion of the better seeing eye on the function of the visual system in children with unilateral amblyopia

Vision acuity and visual evoked potentials (VEP) to a homogeneous light field and chess field reversion were studied in children aged 5-6 years with unilateral amblyopia before and after 3-month direct total occlusion of the intact eye. Occlusion of the intact eye resulted in improvement of the vision acuity and VEP of the amblyopic eye, that correlated with the degree of amblyopia. At the same time examinations of the intact eyes revealed reduced amplitude of VEP to large and increased latency to small chess pattern cells but no changes of the vision acuity. The results evidence the necessity of monitoring the occlusion by VEP recording to prevent the detrimental effects of visual deprivation on the development of the system of vision in a child.     

The modulation of somatosensory evoked potentials during the foreperiod of a forewarned reaction time task

During the foreperiod of a forewarned reaction time (RT) task reflexes in the executing limb increase to a lesser extent than those in the contralateral limb. This is possibly due to input modulation. The present study investigates the possibility of cutaneous sensory modulation during motor preparation by studying the amplitudes of somatosensory evoked potentials (SEPs). Eighteen subjects performed a forewarned RT task with the same fingers as the ones which were electrically stimulated. SEPs evoked during the 4 sec preparatory period were compared to those evoked during movement execution and during the resting period after the motor response respectively. During response execution most SEP components showed smaller amplitudes, i.e., they were gated, which agrees with other studies. In the first part of the foreperiod no SEP modulation was observed. Towards the end of the foreperiod, 500 msec before the response stimulus (RS), the amplitude of the contralateral parietal N70-P100 was significantly decreased, while the P45-N70 showed a similar tendency. However, at the same time the P100-N140 was increased in amplitude. The decrease of the intermediate latency components towards the end of the foreperiod is discussed in terms of gating, while the increase in the long latency component is discussed with respect to a decrease in RT on trials where the fingers were stimulated just before the RS, pointing to the role of attentional mechanisms.