Feasibility, Safety, and Performance of Full-Head Subscalp EEG Using Minimally Invasive Electrode Implantation.

BACKGROUND AND OBJECTIVES: Current practice in clinical neurophysiology is limited to short recordings with conventional EEG (days) that fail to capture a range of brain (dys)functions at longer timescales (months). The future ability to optimally manage chronic brain disorders, such as epilepsy, hinges upon finding methods to monitor electrical brain activity in daily life. We developed a device for full-head subscalp EEG (Epios) and tested here the feasibility to safely insert the electrode leads beneath the scalp by a minimally invasive technique (primary outcome). As secondary outcome, we verified the noninferiority of subscalp EEG in measuring physiologic brain oscillations and pathologic discharges compared with scalp EEG, the established standard of care. METHODS: Eight participants with pharmacoresistant epilepsy undergoing intracranial EEG received in the same surgery subscalp electrodes tunneled between the scalp and the skull with custom-made tools. Postoperative safety was monitored on an inpatient ward for up to 9 days. Sleep-wake, ictal, and interictal EEG signals from subscalp, scalp, and intracranial electrodes were compared quantitatively using windowed multitaper transforms and spectral coherence. Noninferiority was tested for pairs of neighboring subscalp and scalp electrodes with a Bland-Altman analysis for measurement bias and calculation of the interclass correlation coefficient (ICC). RESULTS: As primary outcome, up to 28 subscalp electrodes could be safely placed over the entire head through 1-cm scalp incisions in a ∼1-hour procedure. Five of 10 observed perioperative adverse events were linked to the investigational procedure, but none were serious, and all resolved. As a secondary outcome, subscalp electrodes advantageously recorded EEG percutaneously without requiring any maintenance and were noninferior to scalp electrodes for measuring (1) variably strong, stage-specific brain oscillations (alpha in wake, delta, sigma, and beta in sleep) and (2) interictal spikes peak-potentials and ictal signals coherent with seizure propagation in different brain regions (ICC >0.8 and absence of bias). DISCUSSION: Recording full-head subscalp EEG for localization and monitoring purposes is feasible up to 9 days in humans using minimally invasive techniques and noninferior to the current standard of care. A longer prospective ambulatory study of the full system will be necessary to establish the safety and utility of this innovative approach. TRIAL REGISTRATION INFORMATION: clinicaltrials.gov/study/NCT04796597.

Do we really measure what we think we are measuring?

Tests used in the empirical sciences are often (implicitly) assumed to be representative of a given research question in the sense that similar tests should lead to similar results. Here, we show that this assumption is not always valid. We illustrate our argument with the example of resting-state electroencephalogram (EEG). We used multiple analysis methods, contrary to typical EEG studies where one analysis method is used. We found, first, that many EEG features correlated significantly with cognitive tasks. However, these EEG features correlated weakly with each other. Similarly, in a second analysis, we found that many EEG features were significantly different in older compared to younger participants. When we compared these EEG features pairwise, we did not find strong correlations. In addition, EEG features predicted cognitive tasks poorly as shown by cross-validated regression analysis. We discuss several explanations of these results.

The EEG multiverse of schizophrenia.

Research on schizophrenia typically focuses on one paradigm for which clear-cut differences between patients and controls are established. Great efforts are made to understand the underlying genetical, neurophysiological, and cognitive mechanisms, which eventually may explain the clinical outcome. One tacit assumption of these "deep rooting" approaches is that paradigms tap into common and representative aspects of the disorder. Here, we analyzed the resting-state electroencephalogram (EEG) of 121 schizophrenia patients and 75 controls. Using multiple signal processing methods, we extracted 194 EEG features. Sixty-nine out of the 194 EEG features showed a significant difference between patients and controls, indicating that these features detect an important aspect of schizophrenia. Surprisingly, the correlations between these features were very low. We discuss several explanations to our results and propose that complementing "deep" with "shallow" rooting approaches might help in understanding the underlying mechanisms of the disorder.

Visual masking deficits in schizophrenia: a view into the genetics of the disease through an endophenotype.

Schizophrenia is a severe psychiatric disorder determined by a complex mixture of genetic and environmental factors. To better understand the contributions of human genetic variations to schizophrenia, we performed a genome-wide association study (GWAS) of a highly sensitive endophenotype. In this visual masking endophenotype, two vertical bars, slightly shifted in the horizontal direction, are briefly presented (vernier offset). Participants are asked to indicate the offset direction of the bars (either left or right). The bars are followed by a grating mask, which makes the task both spatially and temporally challenging. The inter-stimulus interval (ISI) between the vernier and the mask was determined in 206 patients with schizophrenia, 109 first-order relatives, and 143 controls. Usually, in GWAS studies, patients are compared to controls (i.e., a binary task) without considering the large differences in performance between patients and controls, as it occurs in many paradigms. The masking task allows for a particularly powerful analysis because the differences in ISI within the patient population are large. We genotyped all participants and searched for associations between human polymorphisms and the masking endophenotype using a linear mixed model. We did not identify any genome-wide significant associations (p < 5 × 10-8), indicating that common variants with strong effects are unlikely to contribute to the large inter-group differences in visual masking. However, we found significant differences in polygenetic risk scores (PRS) between patients and controls, and relatives and controls.

Temporal Dynamics of Intranasal Oxytocin in Human Brain Electrophysiology.

Oxytocin (OT) is a key modulator of human social cognition, popular in behavioral neuroscience. To adequately design and interpret intranasal OT (IN-OT) research, it is crucial to know for how long it affects human brain function once administered. However, this has been mostly deduced from peripheral body fluids studies, or uncommonly used dosages. We aimed to characterize IN-OT's effects on human brain function using resting-state EEG microstates across a typical experimental session duration. Nineteen healthy males participated in a double-blind, placebo-controlled, within-subject, cross-over design of 24 IU of IN-OT in 12-min windows 15 min-to-1 h 42min after administration. We observed IN-OT effects on all microstates, across the observation span. During eyes-closed, IN-OT increased duration and contribution of A and contribution and occurrence of D, decreased duration and contribution of B and C; and increased transition probability C-to-B and C-to-D. In eyes-open, it increased A-to-C and A-to-D. As microstates A and D have been related to phonological auditory and attentional networks, respectively, we posit IN-OT may tune the brain for reception of external stimuli, particularly of social nature-tentatively supporting current neurocognitive hypotheses of OT. Moreover, we contrast our overall results against a comprehensive literature review of IN-OT time-course effects in the brain, highlighting comparability issues.

Electrophysiological correlates of visual backward masking in patients with bipolar disorder.

In visual backward masking (VBM), a target is followed by a mask that decreases target discriminability. Schizophrenia patients (SZ) show strong and reproducible masking impairments, which are associated with reduced EEG amplitudes. Patients with bipolar disorder (BP) show masking deficits, too. Here, we investigated the neural EEG correlates of VBM in BP. 122 SZ, 94 unaffected controls, and 38 BP joined a standard VBM experiment. 123 SZ, 94 unaffected controls and 16 BP joined a corresponding EEG experiment, analyzed in terms of global field power. As in previous studies, SZ and BP show strong masking deficits. Importantly and similarly to SZ, BP show decreased global field power amplitudes at approximately 200 ms after the target onset, compared to controls. These results suggest that VBM deficits are not specific for schizophrenia but for a broader range of functional psychoses. Potentially, both SZ and BP show deficient target enhancement.

EEG microstates are a candidate endophenotype for schizophrenia.

Electroencephalogram microstates are recurrent scalp potential configurations that remain stable for around 90 ms. The dynamics of two of the four canonical classes of microstates, commonly labeled as C and D, have been suggested as a potential endophenotype for schizophrenia. For endophenotypes, unaffected relatives of patients must show abnormalities compared to controls. Here, we examined microstate dynamics in resting-state recordings of unaffected siblings of patients with schizophrenia, patients with schizophrenia, healthy controls, and patients with first episodes of psychosis (FEP). Patients with schizophrenia and their siblings showed increased presence of microstate class C and decreased presence of microstate class D compared to controls. No difference was found between FEP and chronic patients. Our findings suggest that the dynamics of microstate classes C and D are a candidate endophenotype for schizophrenia.

Neural Compensation Mechanisms of Siblings of Schizophrenia Patients as Revealed by High-Density EEG.

Visual backward masking (VBM) deficits are candidate endophenotypes of schizophrenia indexing genetic liability of the disorder. In VBM, a target is followed by a mask that deteriorates target perception. Schizophrenia patients and, to a lesser extent, their unaffected relatives show strong and reproducible VBM deficits. In patients, VBM deficits are associated with strongly decreased amplitudes in the evoked-related potentials (ERPs). Here, to unveil the neural mechanisms of VBM in schizophrenia, circumventing illness-specific confounds, we investigated the electroencephalogram correlates of VBM in unaffected siblings of schizophrenia patients. We tested 110 schizophrenia patients, 60 siblings, and 83 healthy controls. As in previous studies, patients showed strong behavioral deficits and decreased ERP amplitudes compared to controls. Surprisingly, the ERP amplitudes of siblings were even higher than the ones of controls, while their performances were similar. ERP amplitudes in siblings were found to correlate with performance. These results suggest that VBM is deteriorated in patients and siblings. However, siblings, unlike patients, can partially compensate for the deficits by over-activating a network of brain regions.

Electrophysiological correlates of visual backward masking in patients with major depressive disorder.

Depression and schizophrenia are two psychiatric diseases with high co-morbidity. For this reason, it is important to find sensitive endophenotypes, which may disentangle the two disorders. The Shine-Through paradigm, a visual backward masking task, is a potential endophenotype for schizophrenia. Masking is strongly deteriorated in schizophrenia patients, which is reflected in reduced EEG amplitudes. Here, we tested whether masking deficits and associated EEG changes are also found in patients with major depressive disorder. First, we replicated previous findings showing that depressive patients exhibit, at most, only weak masking deficits. Second, we found that the EEG amplitudes of depressive patients were reduced compared to controls and slightly increased compared to schizophrenia patients. As a secondary analysis, we compared the performance in the masking paradigm with three cognitive tasks, namely: the Wisconsin card sorting test, a verbal fluency test and a degraded continuous performance test. Performance in all but the verbal fluency test could discriminate schizophrenia from depression.

Electrophysiological correlates of visual backward masking in patients with first episode psychosis.

Visual backward masking is strongly impaired in patients with schizophrenia. Masking deficits have been proposed as potential endophenotypes of schizophrenia. Masking performance deficits manifest as strongly reduced amplitudes in the electroencephalogram (EEG). In order to fulfill the criteria of an endophenotype, masking deficits should not vary substantially across time and should be present at the first psychotic event. To verify whether these conditions are met for visual backward masking, we tested patients with first episode psychosis (n = 21) in a longitudinal study. Patients were tested with visual backward masking and EEG three times every six months over a period of one year. We found that the EEG amplitudes of patients with first episode psychosis were higher as compared to those of patients with schizophrenia but lower as compared to those of unaffected controls. More interestingly, we found that the EEG amplitudes of patients with first episode psychosis remained stable over the course of one year. Since chronic schizophrenia patients have strongly reduced amplitudes, we speculate that the neural correlates of masking deficits (EEG amplitudes) continue to decrease as the disease progresses.

Dominant men are faster in decision-making situations and exhibit a distinct neural signal for promptness.

Social dominance, the main organizing principle of social hierarchies, facilitates priority access to resources by dominant individuals. Throughout taxa, individuals are more likely to become dominant if they act first in social situations and acting fast may provide evolutionary advantage; yet whether fast decision-making is a behavioral predisposition of dominant persons outside of social contexts is not known. Following characterization of participants for social dominance motivation, we found that, indeed, men high in social dominance respond faster-without loss of accuracy-than those low in dominance across a variety of decision-making tasks. Both groups did not differ in a simple reaction task. Then, we selected a decision-making task and applied high-density electroencephalography (EEG) to assess temporal dynamics of brain activation through event related potentials. We found that promptness to respond in the choice task in dominant individuals is related to a strikingly amplified brain signal at approximately 240 ms post-stimulus presentation. Source imaging analyses identified higher activity in the left insula and in the cingulate, right inferior temporal and right angular gyri in high than in low dominance participants. Our findings suggest that promptness to respond in choice situations, regardless of social context, is a biomarker for social disposition.

An automatic pre-processing pipeline for EEG analysis (APP) based on robust statistics.

OBJECTIVE: With the advent of high-density EEG and studies of large numbers of participants, yielding increasingly greater amounts of data, supervised methods for artifact rejection have become excessively time consuming. Here, we propose a novel automatic pipeline (APP) for pre-processing and artifact rejection of EEG data, which innovates relative to existing methods by not only following state-of-the-art guidelines but also further employing robust statistics. METHODS: APP was tested on event-related potential (ERP) data from healthy participants and schizophrenia patients, and resting-state (RS) data from healthy participants. Its performance was compared with that of existing automatic methods (FASTER for ERP data, TAPEEG and Prep pipeline for RS data) and supervised pre-processing by experts. RESULTS: APP rejected fewer bad channels and bad epochs than the other methods. In the ERP study, it produced significantly higher amplitudes than FASTER, which were consistent with the supervised scheme. In the RS study, it produced spectral measures that correlated well with the automatic alternatives and the supervised scheme. CONCLUSION: APP effectively removed EEG artifacts, performing similarly to the supervised scheme and outperforming existing automatic alternatives. SIGNIFICANCE: The proposed automatic pipeline provides a reliable and efficient tool for pre-processing large datasets of both evoked and resting-state EEG.

Alpha neurofeedback training improves SSVEP-based BCI performance.

OBJECTIVE: Steady-state visual evoked potential (SSVEP)-based brain-computer interfaces (BCIs) can provide relatively easy, reliable and high speed communication. However, the performance is still not satisfactory, especially in some users who are not able to generate strong enough SSVEP signals. This work aims to strengthen a user's SSVEP by alpha down-regulating neurofeedback training (NFT) and consequently improve the performance of the user in using SSVEP-based BCIs. APPROACH: An experiment with two steps was designed and conducted. The first step was to investigate the relationship between the resting alpha activity and the SSVEP-based BCI performance, in order to determine the training parameter for the NFT. Then in the second step, half of the subjects with 'low' performance (i.e. BCI classification accuracy <80%) were randomly assigned to a NFT group to perform a real-time NFT, and the rest half to a non-NFT control group for comparison. MAIN RESULTS: The first step revealed a significant negative correlation between the BCI performance and the individual alpha band (IAB) amplitudes in the eyes-open resting condition in a total of 33 subjects. In the second step, it was found that during the IAB down-regulating NFT, on average the subjects were able to successfully decrease their IAB amplitude over training sessions. More importantly, the NFT group showed an average increase of 16.5% in the SSVEP signal SNR (signal-to-noise ratio) and an average increase of 20.3% in the BCI classification accuracy, which was significant compared to the non-NFT control group. SIGNIFICANCE: These findings indicate that the alpha down-regulating NFT can be used to improve the SSVEP signal quality and the subjects' performance in using SSVEP-based BCIs. It could be helpful to the SSVEP related studies and would contribute to more effective SSVEP-based BCI applications.

Objective evaluation of fatigue by EEG spectral analysis in steady-state visual evoked potential-based brain-computer interfaces.

BACKGROUND: The fatigue that users suffer when using steady-state visual evoked potential (SSVEP)-based brain-computer interfaces (BCIs) can cause a number of serious problems such as signal quality degradation and system performance deterioration, users' discomfort and even risk of photosensitive epileptic seizures, posing heavy restrictions on the applications of SSVEP-based BCIs. Towards alleviating the fatigue, a fundamental step is to measure and evaluate it but most existing works adopt self-reported questionnaire methods which are subjective, offline and memory dependent. This paper proposes an objective and real-time approach based on electroencephalography (EEG) spectral analysis to evaluate the fatigue in SSVEP-based BCIs. METHODS: How the EEG indices (amplitudes in δ, θ, α and ß frequency bands), the selected ratio indices (θ/α and (θ + α)/ß), and SSVEP properties (amplitude and signal-to-noise ratio (SNR)) changes with the increasing fatigue level are investigated through two elaborate SSVEP-based BCI experiments, one validates mainly the effectiveness and another considers more practical situations. Meanwhile, a self-reported fatigue questionnaire is used to provide a subjective reference. ANOVA is employed to test the significance of the difference between the alert state and the fatigue state for each index. RESULTS: Consistent results are obtained in two experiments: the significant increases in α and (θ + α)/ß, as well as the decrease in θ/α are found associated with the increasing fatigue level, indicating that EEG spectral analysis can provide robust objective evaluation of the fatigue in SSVEP-based BCIs. Moreover, the results show that the amplitude and SNR of the elicited SSVEP are significantly affected by users' fatigue. CONCLUSIONS: The experiment results demonstrate the feasibility and effectiveness of the proposed method as an objective and real-time evaluation of the fatigue in SSVEP-based BCIs. This method would be helpful in understanding the fatigue problem and optimizing the system design to alleviate the fatigue in SSVEP-based BCIs.