Motor Pathways Reorganization following Surgical Decompression for Degenerative Cervical Myelopathy: A Combined Navigated Transcranial Magnetic Stimulation and Clinical Outcome Study.

(1) Background: Degenerative cervical myelopathy is one of the main causes of disability in the elderly. The treatment of choice in patients with clear symptomatology and radiological correlation is surgical decompression. The application of navigated transcranial magnetic stimulation (nTMS) techniques has the potential to provide additional insights into the cortical and corticospinal behavior of the myelopathic cord and to better characterize the possible extent of clinical recovery. The objective of our study was to use nTMS to evaluate the effect of surgical decompression on neurophysiological properties at the cortical and corticospinal level and to better characterize the extent of possible clinical recovery. (2) Methods: We conducted a longitudinal study in which we assessed and compared nTMS neurophysiological indexes and clinical parameters (modified Japanese Orthopedic Association score and nine-hole pegboard test) before surgery, at 6 months, and at 12 months' follow-up in a population of 15 patients. (3) Results: We found a significant reduction in resting motor threshold (RMT; average 7%), cortical silent period (CSP; average 15%), and motor area (average 25%) at both 6 months and 12 months. A statistically significant linear correlation emerged between recruitment curve (RC) values obtained at follow-up appointments and at baseline (r = 0.95 at 6 months, r = 0.98 at 12 months). A concomitant improvement in the mJOA score and in the nine-hole pegboard task was observed after surgery. (4) Conclusions: Our results suggest that surgical decompression of the myelopathic spinal cord improves the neurophysiological balance at the cortical and corticospinal level, resulting in clinically significant recovery. Such findings contribute to the existing evidence characterizing the brain and the spinal cord as a dynamic system capable of functional and reversible plasticity and provide useful clinical insights to be used for patient counseling.

Age-related differences in the statistical learning of target selection and distractor suppression.

In recent years, the use of implicit mechanisms based on statistical learning (SL) has emerged as a strong factor in biasing visuospatial attention, so that target selection is improved at frequently attended locations and distractor filtering is facilitated at frequently suppressed locations. Although these mechanisms have been consistently described in younger adults, similar evidence in healthy aging is scarce. Therefore, we studied the learning and persistence of SL of target selection and distractor suppression in younger and older adults in visual search tasks where the frequency of target (Experiment 1) or distractor (Experiment 2) was biased across spatial locations. The results show that SL of target selection was preserved in the older adults so, similar to their younger counterparts, they showed a strong and persistent advantage in target selection at locations more frequently attended. However, unlike young adults, they did not benefit from implicit SL of distractor suppression, so that distractor interference was maintained throughout the experiment independently of the contingencies associated with distractor locations. Taken together, these results provide novel evidence of distinct developmental patterns for SL of task-relevant and task-irrelevant visual information, likely reflecting differences in the implementation of proactive suppression attentional mechanisms between younger and older adults. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Statistical learning of target selection and distractor suppression shape attentional priority according to different timeframes.

Recent findings suggest that attentional and oculomotor control is heavily affected by past experience, giving rise to selection and suppression history effects, so that target selection is facilitated if they appear at frequently attended locations, and distractor filtering is facilitated at frequently ignored locations. While selection history effects once instantiated seem to be long-lasting, whether suppression history is similarly durable is still debated. We assessed the permanence of these effects in a unique experimental setting investigating eye-movements, where the locations associated with statistical unbalances were exclusively linked with either target selection or distractor suppression. Experiment 1 and 2 explored the survival of suppression history in the long and in the short term, respectively, revealing that its lingering traces are relatively short lived. Experiment 3 showed that in the very same experimental context, selection history effects were long lasting. These results seem to suggest that different mechanisms support the learning-induced plasticity triggered by selection and suppression history. Specifically, while selection history may depend on lasting changes within stored representations of the visual space, suppression history effects hinge instead on a functional plasticity which is transient in nature, and involves spatial representations which are constantly updated and adaptively sustain ongoing oculomotor control.

Altering spatial priority maps via statistical learning of target selection and distractor filtering.

The cognitive system has the capacity to learn and make use of environmental regularities - known as statistical learning (SL), including for the implicit guidance of attention. For instance, it is known that attentional selection is biased according to the spatial probability of targets; similarly, changes in distractor filtering can be triggered by the unequal spatial distribution of distractors. Open questions remain regarding the cognitive/neuronal mechanisms underlying SL of target selection and distractor filtering. Crucially, it is unclear whether the two processes rely on shared neuronal machinery, with unavoidable cross-talk, or they are fully independent, an issue that we directly addressed here. In a series of visual search experiments, participants had to discriminate a target stimulus, while ignoring a task-irrelevant salient distractor (when present). We systematically manipulated spatial probabilities of either one or the other stimulus, or both. We then measured performance to evaluate the direct effects of the applied contingent probability distribution (e.g., effects on target selection of the spatial imbalance in target occurrence across locations) as well as its indirect or "transfer" effects (e.g., effects of the same spatial imbalance on distractor filtering across locations). By this approach, we confirmed that SL of both target and distractor location implicitly bias attention. Most importantly, we described substantial indirect effects, with the unequal spatial probability of the target affecting filtering efficiency and, vice versa, the unequal spatial probability of the distractor affecting target selection efficiency across locations. The observed cross-talk demonstrates that SL of target selection and distractor filtering are instantiated via (at least partly) shared neuronal machinery, as further corroborated by strong correlations between direct and indirect effects at the level of individual participants. Our findings are compatible with the notion that both kinds of SL adjust the priority of specific locations within attentional priority maps of space.

A low-cost, user-friendly electroencephalographic recording system for the assessment of hepatic encephalopathy.

UNLABELLED: Electroencephalography (EEG) is useful to objectively diagnose/grade hepatic encephalopathy (HE) across its spectrum of severity. However, it requires expensive equipment, and hepatogastroenterologists are generally unfamiliar with its acquisition/interpretation. Recent technological advances have led to the development of low-cost, user-friendly EEG systems, allowing EEG acquisition also in settings with limited neurophysiological experience. The aim of this study was to assess the relationship between EEG parameters obtained from a standard-EEG system and from a commercial, low-cost wireless headset (light-EEG) in patients with cirrhosis and varying degrees of HE. Seventy-two patients (58 males, 61 ± 9 years) underwent clinical evaluation, the Psychometric Hepatic Encephalopathy Score (PHES), and EEG recording with both systems. Automated EEG parameters were calculated on two derivations. Strong correlations were observed between automated parameters obtained from the two EEG systems. Bland and Altman analysis indicated that the two systems provided comparable automated parameters, and agreement between classifications (normal versus abnormal EEG) based on standard-EEG and light-EEG was good (0.6 < κ < 0.8). Automated parameters such as the mean dominant frequency obtained from the light-EEG correlated significantly with the Model for End-Stage Liver Disease score (r = -0.39, P < 0.05), fasting venous ammonia levels (r = -0.41, P < 0.01), and PHES (r = -0.49, P < 0.001). Finally, significant differences in light-EEG parameters were observed in patients with varying degrees of HE. CONCLUSION: Reliable EEG parameters for HE diagnosing/grading can be obtained from a cheap, commercial, wireless headset; this may lead to more widespread use of this patient-independent tool both in routine liver practice and in the research setting. (