Postcovid Guillain-Barré syndrome with severe course - case series two patients including clinical evaluation of smell and examination of olfactory event-related potentials (OERPs).

INTRODUCTION: We report a case series two patients of Guillain-Barré syndrome (GBS) associated with previous COVID-19 that both patients survived. GBS is an immune-mediated disease that affects peripheral nerves and can cause life-threatening complications. CASE REPORTS: In both cases (53-year-old female and 59-year-old male) with severe GBS with complications, the smell of sense was investigated subjectively using Sniffin' sticks identification tests and objectively using objective olfactometry by the evaluation of olfactory event-related potentials (OERPs). Both patients had good results of the subjective Sniffin' sticks identification test without patholgical findings. Results of objective examination of OERPs: the P2-N1 wave complex was equipotent. No olfactory disturbance could be detected in either case, OERPs were plentiful in both cases. CONCLUSION: The presentation of a case series two patients of post-covid GBS are an example of one of the many complications of COVID-19 that can cause prolonged recovery. Despite the severe course of GBS and the long recovery time, both patients returned to normal life. An expanded prospective study is planned for the future to investigate post-covid olfactory impairment. The prevalence of GBS associated with COVID-19 is still unknown but it is evident that both mild and severe forms of GBS have been described in patients.

Impairment of central language processing in critically ill coronavirus disease 2019 patients with delirium.

Accumulating evidence indicates that coronavirus disease 2019 is a major cause of delirium. Given the global dimension of the current pandemic and the fact that delirium is a strong predictor of cognitive decline for critically ill patients, this raises concerns regarding the neurological cost of coronavirus disease 2019. Currently, there is a major knowledge gap related to the covert yet potentially incapacitating higher-order cognitive impairment underpinning coronavirus disease 2019 related delirium. The aim of the current study was to analyse the electrophysiological signatures of language processing in coronavirus disease 2019 patients with delirium by using a specifically designed multidimensional auditory event-related potential battery to probe hierarchical cognitive processes, including self-processing (P300) and semantic/lexical priming (N400). Clinical variables and electrophysiological data were prospectively collected in controls subjects (n = 14) and in critically ill coronavirus disease 2019 patients with (n = 19) and without (n = 22) delirium. The time from intensive care unit admission to first clinical sign of delirium was of 8 (3.5-20) days, and the delirium lasted for 7 (4.5-9.5) days. Overall, we have specifically identified in coronavirus disease 2019 patients with delirium, both a preservation of low-level central auditory processing (N100 and P200) and a coherent ensemble of covert higher-order cognitive dysfunctions encompassing self-related processing (P300) and sematic/lexical language priming (N400) (spatial-temporal clustering, P-cluster ≤ 0.05). We suggest that our results shed new light on the neuropsychological underpinnings of coronavirus disease 2019 related delirium, and may constitute a valuable method for patient's bedside diagnosis and monitoring in this clinically challenging setting.

The immediate effect of audiovisual entrainment on the P3 of the event-related potential

Non-invasive brain stimulation technologies are growing in popularity. This controlled small N study investigated the impact of a single exposure of Audio-Visual Entrainment (AVE) on Event-Related Potentials (ERPs). Literature review revealed that the effect of exposure to AVE on ERP had not been previously explored. We proposed that the effects of AVE exposure on sensory processing and cognitive performance, as measured by P3 amplitude and latency at Fz and Pz, would suggest changes in network recruitment. Thirty-five subjects were randomly assigned to a treatment or control group. The treatment group received one session of Mind Alive's "Brain Brightening" AVE protocol sandwiched between NeuroField's Go/NoGo continuous performance test (CPT). The 32-minute AVE program varied stimulation from 10-18 Hz. Eighteen healthy adults served as controls. Controls watched a peaceful nature video sandwiched between Go/NoGo CPTs. Traditional averaging extraction techniques were used to provide data for pre- and post-statistical analysis. Due to constraints imposed by COVID-19 restrictions, this study was under powered. However, the differences between groups in amplitude for Go trials at Fz nearly reached significance (t(33) = -1.648, CI[-1.248, 0.131], p(1-tail) = 0.054). The differences between groups in amplitude for NoGo trials at Pz did reach significance (t(33) = -2.464, CI[-1.426, -0.136], p(1-tail) = 0.009). None of the within subjects t-test comparisons of latency reached significance.The results of this study imply that the brain is immediately responsive to AVE stimulation, and that it may be possible for clinicians to utilize single session AVE in order to facilitate cognitive improvement either as a stand-alone therapy or in concert with other interventions. It is hoped that this study will lead other researchers to further investigate the effect of exposure to AVE on cognitive performance as measured by the ERP. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Neural markers of emotion regulation difficulties moderate effects of COVID-19 stressors on adolescent depression.

BACKGROUND: Stressful events, such as those imposed by the COVID-19 pandemic, are associated with depression risk, raising questions about processes that make some people more susceptible to the effects of stress on mental health than others. Emotion regulation may be a key process, but methods for objectively measuring emotion regulation abilities in youth are limited. We leveraged event-related potential (ERP) measures and a longitudinal study of adolescents oversampled for depression and depression risk to examine emotion regulation difficulties as prospective predictors of depressive symptoms in response to pandemic-related stress. METHODS: Before the pandemic, adolescents with (n = 28) and without (n = 34) clinical depression (N = 62 total) completed an explicit emotion regulation task while ERP data were recorded and measures of depressive symptoms. Adolescents were re-contacted during the pandemic to report on COVID-19 related stressful events and depressive symptoms (n = 48). RESULTS: Adolescents who had never experienced a depressive episode showed an increase in depressive symptoms during the pandemic, but adolescents who were clinically depressed before the pandemic did not exhibit significant changes in symptoms. Neural markers of emotion regulation abilities interacted with pandemic-related stressful events to predict depressive symptoms during the pandemic, such that stressors predicted increases in depressive symptoms only for adolescents with greater difficulty modulating responses to negative images before the pandemic. CONCLUSIONS: Results provide insight into adolescent mental health during the COVID-19 pandemic and highlight the role of emotion regulatory brain function in risk and resilience for depression.

Proposing a “Brain Health Checkup (BHC)” as a Global Potential “Standard of Care” to Overcome Reward Dysregulation in Primary Care Medicine: Coupling Genetic Risk Testing and Induction of “Dopamine Homeostasis”

In 2021, over 100,000 people died prematurely from opioid overdoses. Neuropsychiatric and cognitive impairments are underreported comorbidities of reward dysregulation due to genetic antecedents and epigenetic insults. Recent genome-wide association studies involving millions of subjects revealed frequent comorbidity with substance use disorder (SUD) in a sizeable meta-analysis of depression. It found significant associations with the expression of NEGR1 in the hypothalamus and DRD2 in the nucleus accumbens, among others. However, despite the rise in SUD and neuropsychiatric illness, there are currently no standard objective brain assessments being performed on a routine basis. The rationale for encouraging a standard objective Brain Health Check (BHC) is to have extensive data available to treat clinical syndromes in psychiatric patients. The BHC would consist of a group of reliable, accurate, cost-effective, objective assessments involving the following domains: Memory, Attention, Neuropsychiatry, and Neurological Imaging. Utilizing primarily PUBMED, over 36 years of virtually all the computerized and written-based assessments of Memory, Attention, Psychiatric, and Neurological imaging were reviewed, and the following assessments are recommended for use in the BHC: Central Nervous System Vital Signs (Memory), Test of Variables of Attention (Attention), Millon Clinical Multiaxial Inventory III (Neuropsychiatric), and Quantitative Electroencephalogram/P300/Evoked Potential (Neurological Imaging). Finally, we suggest continuing research into incorporating a new standard BHC coupled with qEEG/P300/Evoked Potentials and genetically guided precision induction of “dopamine homeostasis” to diagnose and treat reward dysregulation to prevent the consequences of dopamine dysregulation from being epigenetically passed on to generations of our children.

Effects of the COVID-19 Pandemic on Water Utility Operations and Vulnerability

The COVID-19 pandemic affected the operation of water utilities across the world. In the context of utilities, new protocols were needed to ensure that employees can work safely, and that water service is not interrupted. This study reports on how the operations of 27 water utilities worldwide were affected by the COVID-19 pandemic. Interviews were conducted between June and October 2020;respondents represent utilities that varied in population size, location, and customer composition (e.g., residential, industrial, commercial, institutional, and university customers). Survey questions focused on the effects of the pandemic on water system operation, demand, revenues, system vulnerabilities, and the use and development of emergency response plans (ERPs). Responses indicate that significant changes in water system operations were implemented to ensure that water utility employees could continue working while maintaining safe social distancing or alternatively working from home. A total of 23 of 27 utilities reported small changes in demand volumes and patterns, which can lead to some changes in water infrastructure operations and water quality. Utilities experienced a range of impacts on finances, where most utilities discussed small decreases in revenues, with a few reporting more drastic impacts. The pandemic revealed new system vulnerabilities, including supply chain management, capacity of staff to perform certain functions remotely, and finances. Some utilities applied existing guidance developed through ERPs with slight modifications, other utilities developed new ERPs to specifically address unique conditions induced by the pandemic, and a few utilities did not use or reference their existing ERPs to change operations. Many utilities suggested that lessons learned would be used in future ERPs, such as personnel training on pandemic risk management or annual mock exercises for preparing employees to better respond to emergencies.

Electrophysiological Measures of Swallowing Functions: A Systematic Review.

The purpose of this systematic review was to examine the application of event-related potentials (ERPs) to investigate neural processes of swallowing functions in adults with and without dysphagia. Computerized literature searches were performed from three search engines. Studies were screened using Covidence (Cochrane tool) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA-2009). A total of 759 studies were initially retrieved, of which 12 studies met inclusion criteria. Electrophysiological measures assessing swallowing functions were identified in two major ERP categories: (1) sensory potentials and (2) pre-motor potentials. Approximately 80% of eligible studies demonstrated strong methodological quality, although most employed a case series or case-control study design. Pharyngeal sensory-evoked potentials (PSEPs) were used to assess pharyngeal afferent cortical processing. The temporal sequence of the PSEP waveforms varied based on the sensory stimuli. PSEPs were delayed with localized scalp maps in patients with dysphagia as compared to healthy controls. The pre-motor ERPs assessed the cortical substrates involved in motor planning for swallowing, with the following major neural substrates identified: pre-motor cortex, supplementary motor area, and primary sensorimotor cortex. The pre-motor ERPs differed in amplitude for the swallow task (saliva versus liquid swallow), and the neural networks differed for cued versus non-cued task of swallowing suggesting differences in cognitive processes. This systematic review describes the application of electrophysiological measures to assess swallowing function and the promising application for furthering understanding of the neural substrates of swallowing. Standardization of protocols for use of electrophysiological measures to examine swallowing would allow for aggregation of study data to inform clinical practice for dysphagia rehabilitation.

Risk for youth anxiety during the COVID-19 pandemic: The interactive impact of financial stress and prepandemic electrocortical reactivity to negative self-referential stimuli.

Despite evidence that stress exposure increases risk for internalizing symptoms in youth, it remains unclear which youth are most vulnerable. This study examined whether youth's prepandemic late positive potential (LPP), an electrocortical marker of sustained attention to affective stimuli, exacerbated the impact of stress on prospective increases in depression and anxiety symptoms from before to during the COVID-19 pandemic. Participants were 29 youth (ages 9-16, 82.8% girls) who completed depression and anxiety symptom measures and an affective words task to assess LPP to positive and negative self-referential stimuli prepandemic onset. Postpandemic onset, approximately 16.03 months (SD = 8.86) after their baseline assessments, youth again completed symptom measures as well as the UCLA Life Stress Interview to assess ongoing social and financial chronic stress. Results indicated a significant interaction between youth LPP to negative words and financial stress. Greater exposure to financial stress during the pandemic predicted greater anxiety symptom increases specifically for youth who demonstrated enhanced prepandemic LPP to negative words. Results were specific to the prediction of anxiety, but not depression, symptoms. If replicated in larger studies, findings highlight enhanced LPP to negative stimuli as a promising target for intervention for youth exposed to greater financial stress.

Event-related potentials in insomnia reflect altered perception of sleep.

STUDY OBJECTIVES: Insomnia is defined by the subjective complaint of poor sleep as well as daytime impairments. Since polysomnography (PSG) typically shows only modest sleep impairment, some still unidentified property of sleep, not mirrored in PSG, may be modified in insomnia.One possible mechanistic hypothesis is that insomnia patients may be more sensitive to inevitably occurring internal or external stimuli during the night, causing brief sleep disruptions then perceived as wake time. METHODS: Auditory event-related potentials (ERP) to low intensity (50 dB SPL) synthesized guitar tones played continuously throughout two nights of polysomnographically registered sleep were obtained in fifty patients with insomnia disorder (ID, without comorbidities) and 50 age- and sex-matched good sleeper controls (GSC) for each sleep stage and NREM/REM cycle. Phasic and tonic REM were treated as separate stages. Latencies and amplitudes of components P1, N1 and P2 were measured and analyzed by multivariate repeated-measures ANCOVA including effects of group, night, cycle, and age. RESULTS: ID showed reduced P2 amplitudes relative to GSC specifically in phasic REM sleep. The same reduction also correlated with the amount of sleep misperception across groups. Independent component analysis showed a frontal negativity to contribute most to this group difference. CONCLUSIONS: The present finding can be interpreted as increased mismatch negativity (MMN) in ID, reflecting automated detection of change in the auditory system and a concomitant orienting response. Specifically phasic REM sleep appears to be vulnerable to sensory afferences in ID patients, possibly contributing to the perception of being awake. CLINICAL TRIAL INFORMATION: Short name "PERSLEEP 2," URL https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00008965, Registration DRKS00008965.

Relationship between Resting-State Alpha Coherence and Cognitive Control in Individuals with Internet Gaming Disorder: A Multimodal Approach Based on Resting-State Electroencephalography and Event-Related Potentials.

The human brain is constantly active, even at rest. Alpha coherence is an electroencephalography (EEG) rhythm that regulates functional connectivity between different brain regions. However, the relationships between resting-state alpha coherence and N2/P3 components associated with response inhibition and cognitive processes have not been investigated in addictive disorders. The present study investigated the relationships between alpha coherence during the resting state and N2/P3 components of event-related potentials during the Go/Nogo task in healthy controls (HCs) and patients with Internet gaming disorder (IGD). A total of 64 young adults (HC: n = 31; IGD: n = 33) participated in this study. Alpha coherence values at left fronto-central and bilateral centro-temporal electrode sites were significantly correlated with P3 latency in HCs, whereas inverse correlations were observed in patients with IGD. Furthermore, significant differences were observed in the correlation values between the groups. Our results suggest that patients with IGD lack dynamic interactions of functional connectivity between the fronto-centro-temporal regions during the resting state and the event-related potential (ERP) index during cognitive tasks. The findings of this study may have important implications for understanding the neurophysiological mechanisms linking resting-state EEG and task-related ERPs underlying IGD.

In the Face of Potential Harm: The Predictive Validity of Neural Correlates of Performance Monitoring for Perceived Risk, Stress, and Internalizing Psychopathology During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic is a major life stressor posing serious threats not only to physical but also to mental health. To better understand mechanisms of vulnerability and identify individuals at risk for psychopathological symptoms in response to stressors is critical for prevention and intervention. The error-related negativity (ERN) has been discussed as a neural risk marker for psychopathology, and this study examined its predictive validity for perceived risk, stress, and psychopathological symptoms during the COVID-19 pandemic. METHODS: A total of 113 individuals who had participated as healthy control participants in previous electroencephalography studies (2014-2019) completed a follow-up online survey during the first COVID-19 wave in Germany. Associations of pre-pandemic ERN and correct-response negativity (CRN) with perceived risk regarding COVID-19 infection, stress, and internalizing symptoms during the pandemic were examined using mediation models. RESULTS: Pre-pandemic ERN and CRN were associated with increased perceived risk regarding a COVID-19 infection. Via this perceived risk, the ERN and CRN were associated with increased stress during the pandemic. Furthermore, risk perception and stress mediated indirect effects of ERN and CRN on internalizing psychopathology, including anxiety, depression, and obsessive-compulsive symptoms, while controlling for the effects of pre-pandemic symptom levels. CONCLUSIONS: In summary, heightened pre-pandemic performance monitoring showed indirect associations with increases in psychopathological symptoms during the first COVID-19 wave via effects on perceived COVID-19 risk and stress. These results further strengthen the notion of performance monitoring event-related potentials as transdiagnostic neural risk markers and highlight the relevance of stress as a catalyst for symptom development.

Neurophysiological Responses to Interpersonal Emotional Images Prospectively Predict the Impact of COVID-19 Pandemic-Related Stress on Internalizing Symptoms.

BACKGROUND: Exposure to stressful events related to the COVID-19 coronavirus pandemic has been associated with increases in the prevalence of depression and anxiety, raising questions about vulnerabilities that make some individuals more susceptible to internalizing symptoms following stress exposure. METHODS: This prospective study examined the effects of neurophysiological reactivity to positive and threatening interpersonal stimuli, indexed by the late positive potential (LPP) event-related potential, in conjunction with exposure to interpersonal pandemic-related stressors in the prediction of internalizing symptom changes from before to during the pandemic. Emerging adults (n= 75) initially completed measures of internalizing symptoms and an interpersonal emotional images task while an electroencephalogram was recorded pre-pandemic and were recontacted during the COVID-19 pandemic in May 2020 to complete measures of exposure to pandemic-related stressful events and current internalizing symptoms. RESULTS: Results indicated that emerging adults experienced numerous stressful events associated with the pandemic, as well as overall increases in symptoms of depression and traumatic intrusions during the pandemic. Furthermore, significant interactions between LPP reactivity to positive and threatening interpersonal stimuli and interpersonal stress exposure emerged in the prediction of internalizing symptoms, controlling for baseline symptoms. Under high exposure to interpersonal stressors, reduced positive LPPs predicted increases in depressive symptoms while enhanced threatening LPPs predicted increases in traumatic intrusions. CONCLUSIONS: These findings highlight the mental health impacts of the COVID-19 pandemic on emerging adults, and the role of individual differences in neurophysiological reactivity to emotional stimuli in vulnerability for depression and traumatic intrusions following stress exposure.

Special Report on the Impact of the COVID-19 Pandemic on Clinical EEG and Research and Consensus Recommendations for the Safe Use of EEG.

INTRODUCTION: The global COVID-19 pandemic has affected the economy, daily life, and mental/physical health. The latter includes the use of electroencephalography (EEG) in clinical practice and research. We report a survey of the impact of COVID-19 on the use of clinical EEG in practice and research in several countries, and the recommendations of an international panel of experts for the safe application of EEG during and after this pandemic. METHODS: Fifteen clinicians from 8 different countries and 25 researchers from 13 different countries reported the impact of COVID-19 on their EEG activities, the procedures implemented in response to the COVID-19 pandemic, and precautions planned or already implemented during the reopening of EEG activities. RESULTS: Of the 15 clinical centers responding, 11 reported a total stoppage of all EEG activities, while 4 reduced the number of tests per day. In research settings, all 25 laboratories reported a complete stoppage of activity, with 7 laboratories reopening to some extent since initial closure. In both settings, recommended precautions for restarting or continuing EEG recording included strict hygienic rules, social distance, and assessment for infection symptoms among staff and patients/participants. CONCLUSIONS: The COVID-19 pandemic interfered with the use of EEG recordings in clinical practice and even more in clinical research. We suggest updated best practices to allow safe EEG recordings in both research and clinical settings. The continued use of EEG is important in those with psychiatric diseases, particularly in times of social alarm such as the COVID-19 pandemic.