- Email: [email protected]
104. Influence of valence and arousal on emotional prosody processing: ERP study
e44
Society Proceedings / Clinical Neurophysiology 120 (2009) e9–e88
as intrinsic alertness and sustained attention. Several studies have shown that the degree to which sustained attention is impaired is a strong predictor for the persistence of neglect. A postulated interaction between the anterior alerting and the posterior spatial attention network directly leads to the hypothesis that an alertness training may improve the spatial neglect in the right hemisphere stroke patients. Impact of alertness vs. OKS training on neglect: We examined the effect of the computerized alertness training AIXTENT in a group of 7 chronic neglect patients by means of fMRI (Thimm et al., 2006). Following the training, the group showed a significant improvement in the performance of a neglect test battery over and above any improvement during a four-week baseline phase. Improvements in the neglect tasks were accompanied by an increase of right hemisphere neural activity in frontal cortex, anterior cingulate cortex, precuneus, and angular gyrus, areas that are previously associated with the alertness and spatial attention. A similar pattern of the increased neural activity was found for the left hemisphere. Four weeks after the end of the training, the patients’ neglect test performance had mostly returned to baseline, while the increases in neural activity bilaterally in frontal areas, in the anterior cingulate cortex and in the left temporoparietal cortex remained. The data show that a three-week computerised alertness training can improve the performance in neglect tests and that these behavioural improvements are associated with functional reorganisation in the areas associated with alerting and visuospatial attention. In a similar approach, the impact of a three-week optokinetic stimulation training (OKS) on neglect was studied. Behaviourally, OKS caused both a short- and long-term (4 weeks) improvement of performance. This amelioration of neglect symptoms was associated with increases of neural activity during an fMRI spatial attention task bilaterally in the middle frontal gyrus and in the precuneus. Additional left hemisphere increases in the neural activity were observed in the cingulate gyrus, angular gyrus, middle temporal gyrus and occipital cortex. This pattern of activation represents a combination of areas normally involved in spatial attention plus a compensatory recruitment of the left hemisphere areas. These results were then compared with data from our alertness training study. After OKS training there was bilaterally more activation in the precuneus than after AIXTENT training (Fig. 1a). In contrast, after AIXTENT training there was more activation bilaterally in several frontal areas (Fig. 1b). Conclusion: The results show that the amelioration of neglect can be induced by both OKS and alertness training. The data furthermore suggest that the differential activation of frontal or parietal areas may reflect the specific impact of the two types of training either on an anterior system for the control of attention intensity (AIXTENT) or on the posterior system of spatial attention (OKS).
Fig. 1.
References Sturm W, Thimm M, Kust J, Karbe H, Fink GR. Alertness-training in neglect: behavioral and imaging results. Restor Neurol Neurosci 2006b;24:371–84. Thimm M, Fink GR, Kust J, Karbe H, Sturm W. Impact of alertness training on spatial neglect: a behavioural and fMRI study. Neuropsychologia 2006;44:1230–46. doi:10.1016/j.clinph.2008.07.101
103. Early brain death diagnosis by highend triplexsonography assistance—K.D.M. Resch, R. Schön (Klinikum Dessau, Neurochirurgie, Dessau, Germany) Objective: Early brain death determination is necessary if the organ transplantation is optional. Difficult cases of brain death diagnosis and decision making as well as aiming for early diagnosis need additional technical examinations. The goal was to examine the application in brain death determination and the possibility of early diagnosis by bedside examination. Methods: In 70 cases of brain death transcranial highend triplex sonography was applied and analyzed retrospectively. The ALOKA 5000 machine was used with a TCD probe (2.14–3.75 MHz). In addition to the frontobasal, temporal and suboccipital window, transorbital approach and craniotomy defects were used. Examinations were started routinely as early as possible, optional before clinical brain death. Results: We found no single diagnosis of brain death determination by cerebral circulation arrest in contradiction to the brain death protocol results, but several sonographic circulation presentations were seen. In such cases, after the second protocol of brain death diagnosis, different paradox circulation features were seen in the duplex mode which in most cases was a representation of pendel flow. However, in the doubtless cases and in the complex cases the ultrasound assisted in decreasing time needed for brain death determination. Main limitation is the users experience and a sufficient ultrasound window of the skull. Conclusions: Transcranial highend triplex sonography is a valuable tool in brain death determination and for early diagnosis. The actual ultrasound technique needs to be more examined for its capacity in reducing the diagnosis time of safe brain death determination. doi:10.1016/j.clinph.2008.07.102
104. Influence of valence and arousal on emotional prosody processing: ERP study—M. Arsic 1,2, J. Möbes 1, Z. Nikolova 1,2, M. Wittfoth 1, R. Dengler 1,2, C. Schröder 1 (1 Medizinische Hochschule Hannover, Neurologie, Hannover, Germany, 2 Zentrum für systemische Neurowissenschaften, Hannover, Germany) Accurate and fast perception of emotional prosody in the ongoing speech stream is cognitive function of high social and clinical importance. According to Russell (1980) each emotion can be defined in a 2-dimensional space in terms of valence (positive vs. negative) and arousal (low vs. high). In this study, we used event-related brain potentials (ERPs) to investigate how processing of emotional prosody depends upon the differences in valence and arousal of the presented stimuli. 24 healthy subjects (12 women) participated in our experiment. We presented two-syllable German words spoken by two professional speakers via headphones in an oddball paradigm. Pronounced words had semantically neutral content but differed with respect to emotional prosody (happy, relieved, angry, and sad tones of voice). Two different experimental conditions were considered namely ‘‘valence’’ and ‘‘arousal’’. In the former, a series of frequent standard
Society Proceedings / Clinical Neurophysiology 120 (2009) e9–e88
words spoken in negative prosody (e.g. sad) were violated by infrequent deviants of positive prosodic words (e.g. relieved). In the latter, instead of valence arousal was different for standards and deviants (e.g.: standard: sad; deviant: angry). The same word combinations were also presented in an opposite manner such that standard stimuli were used as deviant ones. The task was to evaluate the tone of each input according to either its valence (positive, negative or neutral) or arousal (calmed neutral or aroused) by pressing one of three available keyboard buttons. Statistically significant difference was observed between the ERP amplitudes of standard and deviant stimuli in 200–400 ms latency range at central electrode (p = 0.037; p < 0.05) for the happy/angry combination. Behavioral data also indicated that listeners rated more accurately on emotions presented in this combination. These results show that emotional prosody perception depends more on valence parameter, rather than on the arousal of auditory stimuli. doi:10.1016/j.clinph.2008.07.103
105. Intra- and peri-operative ultrasound in neurosurgery – Analysis of 1250 examinations—K.D.M. Resch, R. Schön, K.D.M. Resch (Klinikum Dessau, Neurochirurgie, Dessau, Germany) Objective: Neurosurgery has the privilege to benefit from long time experience and evolution of the techniques of many neighbour disciplines using ultrasound since several decades. The purpose of this study is to present our routine use of high-end ultrasound technique in neurosurgery. Methods: The ALOKA 5000 with four small probes offered a basis to improve minimally invasiveness in our discipline: TCD probe (2.14–3.75 MHz) was used in 770 cases mainly at ICU; the small part sector probe (3.8–7.5 MHz) was mainly applied intra-operatively in 220 cases and the burr hole probe (3.75–7.5 MHz) was also mainly used intra-operatively in 140 cases. The trans-endoscopic miniprobe (360°, 6F + 8F, 10–15–20 MHz) was used with strict indication in 78 cases. In the initial 31 intra-operative cases, an old b-mode machine was used. Results: The complete spectrum of the neurosurgical diagnoses presented applicable assistance for therapy in our experience. In 437 intra-operative applications ultrasound proved to be an excellent neuro - navigation system providing the surgeon with real-time imaging and targeting capabilities. Resection control in 255 tumor cases with targeting in 62 small lesions was very satisfying and in 11 cases craniotomy correction was possible before opening of dura mater. Compensation of computer-navigation failures was necessary in 20 cases preventing possible disasters. The 740 cases of application at the ICU showed a bedside use, resulting in the decrease of risky outdoor examination reduce stress for our patients and logistic efforts for the professionals. Investigations are running in innovative applications such as brain death diagnosis (70 cases), bedside-sono-CT (117 cases), aneurysm- monitoring (55 cases), bridging-vein monitoring (18 cases), sono-pupillometry (30 cases). Intra-operatively we examine sonoangiography in tumors and for clipping control of aneurysms (72 cases), control hematoma evacuation through key holes(2 23 cases) and we navigate endoscopes with our ‘‘brain-radar’’ (78 cases). Conclusion: We learned to use ultrasound routinely as an effective, ergonomic and economic tool in neurosurgery. We saw compensation for logistic economic and ergonomic pitfalls by high-end ultrasound. doi:10.1016/j.clinph.2008.07.104
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106. Functional properties of posterior hypothalamic neurones – Experience from microelectrode recordings in patients with cluster headache—T. Bartsch 1, F. Steigerwald 1, J. Herzog 1, M. Pinsker 2, T. Kinfe 3, M. Mehdorn 2, G. Deuschl 1, J. Krauss 3, J. Volkmann 1 (1 Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany, 2 Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany, 3 Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover, Germany) Introduction: Recently, deep brain stimulation (DBS) of the posterior hypothalamus has been shown to be effective in the treatment of drug-resistant chronic cluster headache. Objective: To study the functional properties of neurones of the posterior hypothalamus with regard to the nociceptive relay function and with regard to the pathophysiology of cluster headache. Methods: Patients fulfilled the published criteria for DBS in chronic cluster headaches. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to the published coordinates (2 mm lateral, 3 mm posterior, 5 mm inferior) referenced to the mid-AC-PC line (n = 6). In four patients microelectrode recordings were performed at ± 1 mm around the target. To assess the functional nature of the recorded neurons, in three patients sensory stimulation in the trigeminal and spinal dermatomes was performed. Further testing in two patients included motor stimulation (passive movement of elbow) and autonomic testing (counting backwards under stress, cold pack, and bladder filling). Affective stimulation was performed showing pictures with emotional content to the patients. Results: In the systematic microelectrode recordings form the level of the target only four neurones could be identified. Neurones showed a tonic firing pattern with no discernible rhythmic pattern. The average discharge rate of these four neurones was 17 Hz (range 13–35 Hz). Intraoperative testing using sensory, motor, autonomic and emotional stimulation (two patients each) did not reveal obvious neuronal responses that could be attributed to the modality-specific afferent stimulation. Discussion: Our microelectrode recording in the posterior hypothalamus correspond to the older literature as well as to the findings that neuronal activity in the posterior hypothalamus does not show a specific rhythmic pattern and only scarcely and inconsistently shows responses to sensory stimulation. The scarcity of neurones found may reflect the neuronal density within the posterior hypothalamus. The lack of neuronal responses to a modality-specific afferent stimulation probably reflects the functional anatomy of the posterior hypothalamus in terms of not being a primary afferent and nociceptive relay centre in contrast to the periaqueductal grey that is critically involved in stimulus-induced analgesia. doi:10.1016/j.clinph.2008.07.105
107. BOLD-signal changes in human visual cortex related to the fading of learned somatosensory-visual associations—M. Trenner 1, R. Schubert 2, H.R. Heekeren 3, M. Fahle 4 (1 Universität Leipzig, Psychiatrie, Leipzig, Germany, 2 Charité, Klinik und Poliklinik für Neurologie, Berlin, Germany, 3 Max-Planck-Institut für Bildungsforschung, Berlin, Germany, 4 Universität Bremen, Human-Neurobiologie, Bremen, Germany) Analogous to synchronisation phenomena in local neuronal assemblies (Singer, 1999), the integration of different sensory modalities might rely on a play of synchronisation and desynchronisation of neuronal activity across distributed cortical areas (Varela et al., 2001). In line with this hypothesis, Miltner et al. (1999)
Society Proceedings / Clinical Neurophysiology 120 (2009) e9–e88
as intrinsic alertness and sustained attention. Several studies have shown that the degree to which sustained attention is impaired is a strong predictor for the persistence of neglect. A postulated interaction between the anterior alerting and the posterior spatial attention network directly leads to the hypothesis that an alertness training may improve the spatial neglect in the right hemisphere stroke patients. Impact of alertness vs. OKS training on neglect: We examined the effect of the computerized alertness training AIXTENT in a group of 7 chronic neglect patients by means of fMRI (Thimm et al., 2006). Following the training, the group showed a significant improvement in the performance of a neglect test battery over and above any improvement during a four-week baseline phase. Improvements in the neglect tasks were accompanied by an increase of right hemisphere neural activity in frontal cortex, anterior cingulate cortex, precuneus, and angular gyrus, areas that are previously associated with the alertness and spatial attention. A similar pattern of the increased neural activity was found for the left hemisphere. Four weeks after the end of the training, the patients’ neglect test performance had mostly returned to baseline, while the increases in neural activity bilaterally in frontal areas, in the anterior cingulate cortex and in the left temporoparietal cortex remained. The data show that a three-week computerised alertness training can improve the performance in neglect tests and that these behavioural improvements are associated with functional reorganisation in the areas associated with alerting and visuospatial attention. In a similar approach, the impact of a three-week optokinetic stimulation training (OKS) on neglect was studied. Behaviourally, OKS caused both a short- and long-term (4 weeks) improvement of performance. This amelioration of neglect symptoms was associated with increases of neural activity during an fMRI spatial attention task bilaterally in the middle frontal gyrus and in the precuneus. Additional left hemisphere increases in the neural activity were observed in the cingulate gyrus, angular gyrus, middle temporal gyrus and occipital cortex. This pattern of activation represents a combination of areas normally involved in spatial attention plus a compensatory recruitment of the left hemisphere areas. These results were then compared with data from our alertness training study. After OKS training there was bilaterally more activation in the precuneus than after AIXTENT training (Fig. 1a). In contrast, after AIXTENT training there was more activation bilaterally in several frontal areas (Fig. 1b). Conclusion: The results show that the amelioration of neglect can be induced by both OKS and alertness training. The data furthermore suggest that the differential activation of frontal or parietal areas may reflect the specific impact of the two types of training either on an anterior system for the control of attention intensity (AIXTENT) or on the posterior system of spatial attention (OKS).
Fig. 1.
References Sturm W, Thimm M, Kust J, Karbe H, Fink GR. Alertness-training in neglect: behavioral and imaging results. Restor Neurol Neurosci 2006b;24:371–84. Thimm M, Fink GR, Kust J, Karbe H, Sturm W. Impact of alertness training on spatial neglect: a behavioural and fMRI study. Neuropsychologia 2006;44:1230–46. doi:10.1016/j.clinph.2008.07.101
103. Early brain death diagnosis by highend triplexsonography assistance—K.D.M. Resch, R. Schön (Klinikum Dessau, Neurochirurgie, Dessau, Germany) Objective: Early brain death determination is necessary if the organ transplantation is optional. Difficult cases of brain death diagnosis and decision making as well as aiming for early diagnosis need additional technical examinations. The goal was to examine the application in brain death determination and the possibility of early diagnosis by bedside examination. Methods: In 70 cases of brain death transcranial highend triplex sonography was applied and analyzed retrospectively. The ALOKA 5000 machine was used with a TCD probe (2.14–3.75 MHz). In addition to the frontobasal, temporal and suboccipital window, transorbital approach and craniotomy defects were used. Examinations were started routinely as early as possible, optional before clinical brain death. Results: We found no single diagnosis of brain death determination by cerebral circulation arrest in contradiction to the brain death protocol results, but several sonographic circulation presentations were seen. In such cases, after the second protocol of brain death diagnosis, different paradox circulation features were seen in the duplex mode which in most cases was a representation of pendel flow. However, in the doubtless cases and in the complex cases the ultrasound assisted in decreasing time needed for brain death determination. Main limitation is the users experience and a sufficient ultrasound window of the skull. Conclusions: Transcranial highend triplex sonography is a valuable tool in brain death determination and for early diagnosis. The actual ultrasound technique needs to be more examined for its capacity in reducing the diagnosis time of safe brain death determination. doi:10.1016/j.clinph.2008.07.102
104. Influence of valence and arousal on emotional prosody processing: ERP study—M. Arsic 1,2, J. Möbes 1, Z. Nikolova 1,2, M. Wittfoth 1, R. Dengler 1,2, C. Schröder 1 (1 Medizinische Hochschule Hannover, Neurologie, Hannover, Germany, 2 Zentrum für systemische Neurowissenschaften, Hannover, Germany) Accurate and fast perception of emotional prosody in the ongoing speech stream is cognitive function of high social and clinical importance. According to Russell (1980) each emotion can be defined in a 2-dimensional space in terms of valence (positive vs. negative) and arousal (low vs. high). In this study, we used event-related brain potentials (ERPs) to investigate how processing of emotional prosody depends upon the differences in valence and arousal of the presented stimuli. 24 healthy subjects (12 women) participated in our experiment. We presented two-syllable German words spoken by two professional speakers via headphones in an oddball paradigm. Pronounced words had semantically neutral content but differed with respect to emotional prosody (happy, relieved, angry, and sad tones of voice). Two different experimental conditions were considered namely ‘‘valence’’ and ‘‘arousal’’. In the former, a series of frequent standard
Society Proceedings / Clinical Neurophysiology 120 (2009) e9–e88
words spoken in negative prosody (e.g. sad) were violated by infrequent deviants of positive prosodic words (e.g. relieved). In the latter, instead of valence arousal was different for standards and deviants (e.g.: standard: sad; deviant: angry). The same word combinations were also presented in an opposite manner such that standard stimuli were used as deviant ones. The task was to evaluate the tone of each input according to either its valence (positive, negative or neutral) or arousal (calmed neutral or aroused) by pressing one of three available keyboard buttons. Statistically significant difference was observed between the ERP amplitudes of standard and deviant stimuli in 200–400 ms latency range at central electrode (p = 0.037; p < 0.05) for the happy/angry combination. Behavioral data also indicated that listeners rated more accurately on emotions presented in this combination. These results show that emotional prosody perception depends more on valence parameter, rather than on the arousal of auditory stimuli. doi:10.1016/j.clinph.2008.07.103
105. Intra- and peri-operative ultrasound in neurosurgery – Analysis of 1250 examinations—K.D.M. Resch, R. Schön, K.D.M. Resch (Klinikum Dessau, Neurochirurgie, Dessau, Germany) Objective: Neurosurgery has the privilege to benefit from long time experience and evolution of the techniques of many neighbour disciplines using ultrasound since several decades. The purpose of this study is to present our routine use of high-end ultrasound technique in neurosurgery. Methods: The ALOKA 5000 with four small probes offered a basis to improve minimally invasiveness in our discipline: TCD probe (2.14–3.75 MHz) was used in 770 cases mainly at ICU; the small part sector probe (3.8–7.5 MHz) was mainly applied intra-operatively in 220 cases and the burr hole probe (3.75–7.5 MHz) was also mainly used intra-operatively in 140 cases. The trans-endoscopic miniprobe (360°, 6F + 8F, 10–15–20 MHz) was used with strict indication in 78 cases. In the initial 31 intra-operative cases, an old b-mode machine was used. Results: The complete spectrum of the neurosurgical diagnoses presented applicable assistance for therapy in our experience. In 437 intra-operative applications ultrasound proved to be an excellent neuro - navigation system providing the surgeon with real-time imaging and targeting capabilities. Resection control in 255 tumor cases with targeting in 62 small lesions was very satisfying and in 11 cases craniotomy correction was possible before opening of dura mater. Compensation of computer-navigation failures was necessary in 20 cases preventing possible disasters. The 740 cases of application at the ICU showed a bedside use, resulting in the decrease of risky outdoor examination reduce stress for our patients and logistic efforts for the professionals. Investigations are running in innovative applications such as brain death diagnosis (70 cases), bedside-sono-CT (117 cases), aneurysm- monitoring (55 cases), bridging-vein monitoring (18 cases), sono-pupillometry (30 cases). Intra-operatively we examine sonoangiography in tumors and for clipping control of aneurysms (72 cases), control hematoma evacuation through key holes(2 23 cases) and we navigate endoscopes with our ‘‘brain-radar’’ (78 cases). Conclusion: We learned to use ultrasound routinely as an effective, ergonomic and economic tool in neurosurgery. We saw compensation for logistic economic and ergonomic pitfalls by high-end ultrasound. doi:10.1016/j.clinph.2008.07.104
e45
106. Functional properties of posterior hypothalamic neurones – Experience from microelectrode recordings in patients with cluster headache—T. Bartsch 1, F. Steigerwald 1, J. Herzog 1, M. Pinsker 2, T. Kinfe 3, M. Mehdorn 2, G. Deuschl 1, J. Krauss 3, J. Volkmann 1 (1 Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany, 2 Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany, 3 Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover, Germany) Introduction: Recently, deep brain stimulation (DBS) of the posterior hypothalamus has been shown to be effective in the treatment of drug-resistant chronic cluster headache. Objective: To study the functional properties of neurones of the posterior hypothalamus with regard to the nociceptive relay function and with regard to the pathophysiology of cluster headache. Methods: Patients fulfilled the published criteria for DBS in chronic cluster headaches. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to the published coordinates (2 mm lateral, 3 mm posterior, 5 mm inferior) referenced to the mid-AC-PC line (n = 6). In four patients microelectrode recordings were performed at ± 1 mm around the target. To assess the functional nature of the recorded neurons, in three patients sensory stimulation in the trigeminal and spinal dermatomes was performed. Further testing in two patients included motor stimulation (passive movement of elbow) and autonomic testing (counting backwards under stress, cold pack, and bladder filling). Affective stimulation was performed showing pictures with emotional content to the patients. Results: In the systematic microelectrode recordings form the level of the target only four neurones could be identified. Neurones showed a tonic firing pattern with no discernible rhythmic pattern. The average discharge rate of these four neurones was 17 Hz (range 13–35 Hz). Intraoperative testing using sensory, motor, autonomic and emotional stimulation (two patients each) did not reveal obvious neuronal responses that could be attributed to the modality-specific afferent stimulation. Discussion: Our microelectrode recording in the posterior hypothalamus correspond to the older literature as well as to the findings that neuronal activity in the posterior hypothalamus does not show a specific rhythmic pattern and only scarcely and inconsistently shows responses to sensory stimulation. The scarcity of neurones found may reflect the neuronal density within the posterior hypothalamus. The lack of neuronal responses to a modality-specific afferent stimulation probably reflects the functional anatomy of the posterior hypothalamus in terms of not being a primary afferent and nociceptive relay centre in contrast to the periaqueductal grey that is critically involved in stimulus-induced analgesia. doi:10.1016/j.clinph.2008.07.105
107. BOLD-signal changes in human visual cortex related to the fading of learned somatosensory-visual associations—M. Trenner 1, R. Schubert 2, H.R. Heekeren 3, M. Fahle 4 (1 Universität Leipzig, Psychiatrie, Leipzig, Germany, 2 Charité, Klinik und Poliklinik für Neurologie, Berlin, Germany, 3 Max-Planck-Institut für Bildungsforschung, Berlin, Germany, 4 Universität Bremen, Human-Neurobiologie, Bremen, Germany) Analogous to synchronisation phenomena in local neuronal assemblies (Singer, 1999), the integration of different sensory modalities might rely on a play of synchronisation and desynchronisation of neuronal activity across distributed cortical areas (Varela et al., 2001). In line with this hypothesis, Miltner et al. (1999)