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Patrick L Purdon,
Eric T Pierce,
Eran A Mukamel,
Michael J Prerau,
John L Walsh,
Kin Foon K Wong,
Andres F Salazar-Gomez,
Priscilla G Harrell,
Aaron L Sampson,
Aylin Cimenser,
Shinung Ching,
Nancy J Kopell,
Casie Tavares-Stoeckel,
Kathleen Habeeb,
Rebecca Merhar,
Emery N Brown
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ABSTRACT: Unconsciousness is a fundamental component of general anesthesia (GA), but anesthesiologists have no reliable ways to be certain that a patient is unconscious. To develop EEG signatures that track loss and recovery of consciousness under GA, we recorded high-density EEGs in humans during gradual induction of and emergence from unconsciousness with propofol. The subjects executed an auditory task at 4-s intervals consisting of interleaved verbal and click stimuli to identify loss and recovery of consciousness. During induction, subjects lost responsiveness to the less salient clicks before losing responsiveness to the more salient verbal stimuli; during emergence they recovered responsiveness to the verbal stimuli before recovering responsiveness to the clicks. The median frequency and bandwidth of the frontal EEG power tracked the probability of response to the verbal stimuli during the transitions in consciousness. Loss of consciousness was marked simultaneously by an increase in low-frequency EEG power (<1 Hz), the loss of spatially coherent occipital alpha oscillations (8-12 Hz), and the appearance of spatially coherent frontal alpha oscillations. These dynamics reversed with recovery of consciousness. The low-frequency phase modulated alpha amplitude in two distinct patterns. During profound unconsciousness, alpha amplitudes were maximal at low-frequency peaks, whereas during the transition into and out of unconsciousness, alpha amplitudes were maximal at low-frequency nadirs. This latter phase-amplitude relationship predicted recovery of consciousness. Our results provide insights into the mechanisms of propofol-induced unconsciousness, establish EEG signatures of this brain state that track transitions in consciousness precisely, and suggest strategies for monitoring the brain activity of patients receiving GA.
Proceedings of the National Academy of Sciences 03/2013; · 9.68 Impact Factor
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ABSTRACT: We present a novel methodology for instantaneous estimation of quantitative correlates of depth of Anesthesia from noninvasive electrocardiographic recordings. The analysis is based on a point process model of heartbeat dynamics that allows for continuous tracking of linear and nonlinear HRV indices, including a novel instantaneous assessment of the Lyapunov Spectrum by using a cubic autoregressive formulation. The effective estimation of the model parameters is ensured by the Laguerre expansion of the Wiener-Volterra kernels along with the maximum local log-likelihood procedure. We apply the proposed assessment to experimental recordings from healthy subjects during propofol anesthesia. The new assessment reveals novel time-varying complex heartbeat dynamics that underlie the quasi-periodic heartbeat fluctuations elicited by the sympatho-vagal balance. Results suggest that such quantification provides important information which is independent from the standard autonomic assessment and significantly correlated with loss of consciousness. Further investigation will focus on evolving our mathematical approach towards a promising monitoring tool for an accurate, noninvasive assessment of general anesthesia.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2012; 2012:3124-7.
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ABSTRACT: Burst suppression is an electroencepholagram (EEG) pattern in which high-voltage activity alternates with isoelectric quiescence. It is characteristic of an inactivated brain and is commonly observed at deep levels of general anesthesia, hypothermia, and in pathological conditions such as coma and early infantile encephalopathy. We propose a unifying mechanism for burst suppression that accounts for all of these conditions. By constructing a biophysical computational model, we show how the prevailing features of burst suppression may arise through the interaction between neuronal dynamics and brain metabolism. In each condition, the model suggests that a decrease in cerebral metabolic rate, coupled with the stabilizing properties of ATP-gated potassium channels, leads to the characteristic epochs of suppression. Consequently, the model makes a number of specific predictions of experimental and clinical relevance.
Proceedings of the National Academy of Sciences 02/2012; 109(8):3095-100. · 9.68 Impact Factor
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ABSTRACT: In recent years, time-varying inhomogeneous point process models have been introduced for assessment of instantaneous heartbeat dynamics as well as specific cardiovascular control mechanisms and hemodynamics. Assessment of the model's statistics is established through the Wiener-Volterra theory and a multivariate autoregressive (AR) structure. A variety of instantaneous cardiovascular metrics, such as heart rate (HR), heart rate variability (HRV), respiratory sinus arrhythmia (RSA), and baroreceptor-cardiac reflex (baroreflex) sensitivity (BRS), are derived within a parametric framework and instantaneously updated with adaptive and local maximum likelihood estimation algorithms. Inclusion of second-order non-linearities, with subsequent bispectral quantification in the frequency domain, further allows for definition of instantaneous metrics of non-linearity. We here present a comprehensive review of the devised methods as applied to experimental recordings from healthy subjects during propofol anesthesia. Collective results reveal interesting dynamic trends across the different pharmacological interventions operated within each anesthesia session, confirming the ability of the algorithm to track important changes in cardiorespiratory elicited interactions, and pointing at our mathematical approach as a promising monitoring tool for an accurate, non-invasive assessment in clinical practice. We also discuss the limitations and other alternative modeling strategies of our point process approach.
Frontiers in physiology. 01/2012; 3:4.
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ABSTRACT: MEG/EEG are non-invasive imaging techniques that record brain activity with high temporal resolution. However, estimation of brain source currents from surface recordings requires solving an ill-conditioned inverse problem. Converging lines of evidence in neuroscience, from neuronal network models to resting-state imaging and neurophysiology, suggest that cortical activation is a distributed spatiotemporal dynamic process, supported by both local and long-distance neuroanatomic connections. Because spatiotemporal dynamics of this kind are central to brain physiology, inverse solutions could be improved by incorporating models of these dynamics. In this article, we present a model for cortical activity based on nearest-neighbor autoregression that incorporates local spatiotemporal interactions between distributed sources in a manner consistent with neurophysiology and neuroanatomy. We develop a dynamic Maximum a Posteriori Expectation-Maximization (dMAP-EM) source localization algorithm for estimation of cortical sources and model parameters based on the Kalman Filter, the Fixed Interval Smoother, and the EM algorithms. We apply the dMAP-EM algorithm to simulated experiments as well as to human experimental data. Furthermore, we derive expressions to relate our dynamic estimation formulas to those of standard static models, and show how dynamic methods optimally assimilate past and future data. Our results establish the feasibility of spatiotemporal dynamic estimation in large-scale distributed source spaces with several thousand source locations and hundreds of sensors, with resulting inverse solutions that provide substantial performance improvements over static methods.
NeuroImage 11/2011; 63(2):894-909. · 5.89 Impact Factor
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Kin Foon Kevin Wong,
Anne C Smith,
Eric T Pierce,
P Grace Harrell,
John L Walsh,
Andrés Felipe Salazar,
Casie L Tavares,
Aylin Cimenser,
Michael J Prerau,
Eran A Mukamel,
Aaron Sampson, Patrick L Purdon,
Emery N Brown
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ABSTRACT: Accurate quantification of loss of response to external stimuli is essential for understanding the mechanisms of loss of consciousness under general anesthesia. We present a new approach for quantifying three possible outcomes that are encountered in behavioral experiments during general anesthesia: correct responses, incorrect responses and no response. We use a state-space model with two state variables representing a probability of response and a conditional probability of correct response. We show applications of this approach to an example of responses to auditory stimuli at varying levels of propofol anesthesia ranging from light sedation to deep anesthesia in human subjects. The posterior probability densities of model parameters and the response probability are computed within a Bayesian framework using Markov Chain Monte Carlo methods.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2011; 2011:4705-8.
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ABSTRACT: We present a comprehensive probabilistic point process framework to estimate and monitor the instantaneous heartbeat dynamics as related to specific cardiovascular control mechanisms and hemodynamics. Assessment of the model's statistics is established through the Wiener-Volterra theory and a multivariate autoregressive (AR) structure. A variety of instantaneous cardiovascular metrics, such as heart rate (HR), heart rate variability (HRV), respiratory sinus arrhythmia (RSA), and baroreceptor-cardiac reflex (BRS), can be rigorously derived within a parametric framework and instantaneously updated with an adaptive algorithm. Instantaneous metrics of nonlinearity, such as the bispectrum of heartbeat intervals, can also be derived. We have applied the proposed point process framework to experimental recordings from healthy subjects in order to monitor cardiovascular regulation under propofol anesthesia. Results reveal interesting dynamic trends across different pharmacological interventions, confirming the ability of the algorithm to track important changes in cardiorespiratory elicited interactions, and pointing at our mathematical approach as a promising monitoring tool for an accurate, noninvasive assessment of general anesthesia.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2011; 2011:8444-7.
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ABSTRACT: The state of general anesthesia (GA) is associated with an increase in spectral power in scalp electroencephalogram (EEG) at frequencies below 40 Hz, including spectral peaks in the slow oscillation (SO, 0.1-1 Hz) and α (8-14 Hz) bands. Because conventional power spectral analyses are insensitive to possible cross-frequency coupling, the relationships among the oscillations at different frequencies remain largely unexplored. Quantifying such coupling is essential for improving clinical monitoring of anesthesia and understanding the neuroscience of this brain state. We tested the usefulness of two measures of cross-frequency coupling: the bispectrum-derived SynchFastSlow, which is sensitive to phase-phase coupling in different frequency bands, and modulogram analysis of coupling between SO phase and α rhythm amplitude. SynchFastSlow, a metric that is used in clinical depth-of-anesthesia monitors, showed a robust correlation with the loss of consciousness at the induction of propofol GA, but this could be largely explained by power spectral changes without considering cross-frequency coupling. Modulogram analysis revealed two distinct modes of cross-frequency coupling under GA. The waking and two distinct states under GA could be discriminated by projecting in a two-dimensional phase space defined by the SynchFastSlow and the preferred SO phase of α activity. Our results show that a stereotyped pattern of phase-amplitude coupling accompanies multiple stages of anesthetic-induced unconsciousness. These findings suggest that modulogram analysis can improve EEG based monitoring of brain state under GA.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2011; 2011:1981-4.
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ABSTRACT: Determining the magnitude and location of neural sources within the brain that are responsible for generating magnetoencephalography (MEG) signals measured on the surface of the head is a challenging problem in functional neuroimaging. The number of potential sources within the brain exceeds by an order of magnitude the number of recording sites. As a consequence, the estimates for the magnitude and location of the neural sources will be ill-conditioned because of the underdetermined nature of the problem. One well-known technique designed to address this imbalance is the minimum norm estimator (MNE). This approach imposes an L(2) regularization constraint that serves to stabilize and condition the source parameter estimates. However, these classes of regularizer are static in time and do not consider the temporal constraints inherent to the biophysics of the MEG experiment. In this paper we propose a dynamic state-space model that accounts for both spatial and temporal correlations within and across candidate intra-cortical sources. In our model, the observation model is derived from the steady-state solution to Maxwell's equations while the latent model representing neural dynamics is given by a random walk process. We show that the Kalman filter (KF) and the Kalman smoother [also known as the fixed-interval smoother (FIS)] may be used to solve the ensuing high-dimensional state-estimation problem. Using a well-known relationship between Bayesian estimation and Kalman filtering, we show that the MNE estimates carry a significant zero bias. Calculating these high-dimensional state estimates is a computationally challenging task that requires High Performance Computing (HPC) resources. To this end, we employ the NSF Teragrid Supercomputing Network to compute the source estimates. We demonstrate improvement in performance of the state-space algorithm relative to MNE in analyses of simulated and actual somatosensory MEG experiments. Our findings establish the benefits of high-dimensional state-space modeling as an effective means to solve the MEG source localization problem.
The Annals of Applied Statistics 06/2011; 5(2B):1207-1228. · 1.58 Impact Factor
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ABSTRACT: Time and frequency domain analyses of scalp EEG recordings are widely used to track changes in brain states under general anesthesia. Although these analyses have suggested that different spatial patterns are associated with changes in the state of general anesthesia, the extent to which these patterns are spatially coordinated has not been systematically characterized. Global coherence, the ratio of the largest eigenvalue to the sum of the eigenvalues of the cross-spectral matrix at a given frequency and time, has been used to analyze the spatiotemporal dynamics of multivariate time-series. Using 64-lead EEG recorded from human subjects receiving computer-controlled infusions of the anesthetic propofol, we used surface Laplacian referencing combined with spectral and global coherence analyses to track the spatiotemporal dynamics of the brain's anesthetic state. During unconsciousness the spectrograms in the frontal leads showed increasing α (8-12 Hz) and δ power (0-4 Hz) and in the occipital leads δ power greater than α power. The global coherence detected strong coordinated α activity in the occipital leads in the awake state that shifted to the frontal leads during unconsciousness. It revealed a lack of coordinated δ activity during both the awake and unconscious states. Although strong frontal power during general anesthesia-induced unconsciousness--termed anteriorization--is well known, its possible association with strong α range global coherence suggests highly coordinated spatial activity. Our findings suggest that combined spectral and global coherence analyses may offer a new approach to tracking brain states under general anesthesia.
Proceedings of the National Academy of Sciences 05/2011; 108(21):8832-7. · 9.68 Impact Factor
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ABSTRACT: Coherence analysis characterizes frequency-dependent covariance between signals, and is useful for multivariate oscillatory data often encountered in neuroscience. The global coherence provides a summary of coherent behavior in high-dimensional multivariate data by quantifying the concentration of variance in the first mode of an eigenvalue decomposition of the cross-spectral matrix. Practical application of this useful method is sensitive to noise, and can confound coherent activity in disparate neural populations or spatial locations that have a similar frequency structure. In this paper we describe two methodological enhancements to the global coherence procedure that increase robustness of the technique to noise, and that allow characterization of how power within specific coherent modes change through time.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 01/2011; 2011:4725-8.
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ABSTRACT: Placing a patient in a state of general anesthesia is crucial for safely and humanely performing most surgical and many nonsurgical procedures. How anesthetic drugs create the state of general anesthesia is considered a major mystery of modern medicine. Unconsciousness, induced by altered arousal and/or cognition, is perhaps the most fascinating behavioral state of general anesthesia. We perform a systems neuroscience analysis of the altered arousal states induced by five classes of intravenous anesthetics by relating their behavioral and physiological features to the molecular targets and neural circuits at which these drugs are purported to act. The altered states of arousal are sedation-unconsciousness, sedation-analgesia, dissociative anesthesia, pharmacologic non-REM sleep, and neuroleptic anesthesia. Each altered arousal state results from the anesthetic drugs acting at multiple targets in the central nervous system. Our analysis shows that general anesthesia is less mysterious than currently believed.
Annual Review of Neuroscience 01/2011; 34:601-28. · 25.74 Impact Factor
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ABSTRACT: Recent data reveal that the general anesthetic propofol gives rise to a frontal α-rhythm at dose levels sufficient to induce loss of consciousness. In this work, a computational model is developed that suggests the network mechanisms responsible for such a rhythm. It is shown that propofol can alter the dynamics in thalamocortical loops, leading to persistent and synchronous α-activity. The synchrony that forms in the cortex by virtue of the involvement of the thalamus may impede responsiveness to external stimuli, thus providing a correlate for the unconscious state.
Proceedings of the National Academy of Sciences 12/2010; 107(52):22665-70. · 9.68 Impact Factor
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ABSTRACT: In this article, we present a point process method to assess dynamic baroreflex sensitivity (BRS) by estimating the baroreflex gain as focal component of a simplified closed-loop model of the cardiovascular system. Specifically, an inverse Gaussian probability distribution is used to model the heartbeat interval, whereas the instantaneous mean is identified by linear and bilinear bivariate regressions on both the previous R-R intervals (RR) and blood pressure (BP) beat-to-beat measures. The instantaneous baroreflex gain is estimated as the feedback branch of the loop with a point-process filter, while the RR-->BP feedforward transfer function representing heart contractility and vasculature effects is simultaneously estimated by a recursive least-squares filter. These two closed-loop gains provide a direct assessment of baroreflex control of heart rate (HR). In addition, the dynamic coherence, cross bispectrum, and their power ratio can also be estimated. All statistical indices provide a valuable quantitative assessment of the interaction between heartbeat dynamics and hemodynamics. To illustrate the application, we have applied the proposed point process model to experimental recordings from 11 healthy subjects in order to monitor cardiovascular regulation under propofol anesthesia. We present quantitative results during transient periods, as well as statistical analyses on steady-state epochs before and after propofol administration. Our findings validate the ability of the algorithm to provide a reliable and fast-tracking assessment of BRS, and show a clear overall reduction in baroreflex gain from the baseline period to the start of propofol anesthesia, confirming that instantaneous evaluation of arterial baroreflex control of HR may yield important implications in clinical practice, particularly during anesthesia and in postoperative care.
Annals of biomedical engineering 10/2010; 39(1):260-76. · 2.41 Impact Factor
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Proceedings of the IEEE International Conference on Acoustics, Speech, and Signal Processing, ICASSP 2010, 14-19 March 2010, Sheraton Dallas Hotel, Dallas, Texas, USA; 01/2010
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ABSTRACT: Modeling heartbeat variability remains a challenging signal-processing goal in the presence of highly non-stationary cardiovascular control dynamics. We propose a novel differential autoregressive modeling approach within a point process probability framework for analyzing R-R interval and blood pressure variations. We apply the proposed model to both synthetic and experimental heartbeat intervals observed in time-varying conditions. The model is found to be extremely effective in tracking non-stationary heartbeat dynamics, as evidenced by the excellent goodness-of-fit performance. Results further demonstrate the ability of the method to appropriately quantify the non-stationary evolution of baroreflex sensitivity in changing physiological and pharmacological conditions.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 01/2010; 2010:3567-70.
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Patrick L Purdon,
Eric T Pierce,
Giorgio Bonmassar,
John Walsh,
P Grace Harrell,
Jean Kwo,
Daniel Deschler,
Margaret Barlow,
Rebecca C Merhar,
Camilo Lamus,
Catherine M Mullaly,
Mary Sullivan,
Sharon Maginnis,
Debra Skoniecki,
Helen-Anne Higgins,
Emery N Brown
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ABSTRACT: It has been long appreciated that anesthetic drugs induce stereotyped changes in electroencephalogram (EEG), but the relationships between the EEG and underlying brain function remain poorly understood. Functional imaging methods including positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), have become important tools for studying how anesthetic drugs act in the human brain to induce the state of general anesthesia. To date, no investigation has combined functional MRI with EEG to study general anesthesia. We report here a paradigm for conducting combined fMRI and EEG studies of human subjects under general anesthesia. We discuss the several technical and safety problems that must be solved to undertake this type of multimodal functional imaging and show combined recordings from a human subject. Combined fMRI and EEG exploits simultaneously the high spatial resolution of fMRI and the high temporal resolution of EEG. In addition, combined fMRI and EEG offers a direct way to relate established EEG patterns induced by general anesthesia to changes in neural activity in specific brain regions as measured by changes in fMRI blood oxygen level dependent (BOLD) signals.
Annals of the New York Academy of Sciences 04/2009; 1157:61-70. · 3.15 Impact Factor
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Proceedings of the IEEE International Conference on Acoustics, Speech, and Signal Processing, ICASSP 2009, 19-24 April 2009, Taipei, Taiwan; 01/2009
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ABSTRACT: Quantitative evaluation of respiratory sinus arrhythmia (RSA) may provide important information in clinical practice of anesthesia and postoperative care. In this paper, we apply a point process method to assess dynamic RSA during propofol general anesthesia. Specifically, an inverse Gaussian probability distribution is used to model the heartbeat interval, whereas the instantaneous mean is identified by a linear or bilinear bivariate regression on the previous R-R intervals and respiratory measures. The estimated second-order bilinear interaction allows us to evaluate the nonlinear component of the RSA. The instantaneous RSA gain and phase can be estimated with an adaptive point process filter. The algorithm's ability to track non-stationary dynamics is demonstrated using one clinical recording. Our proposed statistical indices provide a valuable quantitative assessment of instantaneous cardiorespiratory control and heart rate variability (HRV) during general anesthesia.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 01/2009; 2009:5336-9.
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ABSTRACT: Simultaneous recording of electrophysiology and functional magnetic resonance imaging (fMRI) is a technique of growing importance in neuroscience. Rapidly evolving clinical and scientific requirements have created a need for hardware and software that can be customized for specific applications. Hardware may require customization to enable a variety of recording types (e.g., electroencephalogram, local field potentials, or multi-unit activity) while meeting the stringent and costly requirements of MRI safety and compatibility. Real-time signal processing tools are an enabling technology for studies of learning, attention, sleep, epilepsy, neurofeedback, and neuropharmacology, yet real-time signal processing tools are difficult to develop. We describe an open-source system for simultaneous electrophysiology and fMRI featuring low-noise (<0.6microV p-p input noise), electromagnetic compatibility for MRI (tested up to 7T), and user-programmable real-time signal processing. The hardware distribution provides the complete specifications required to build an MRI-compatible electrophysiological data acquisition system, including circuit schematics, print circuit board (PCB) layouts, Gerber files for PCB fabrication and robotic assembly, a bill of materials with part numbers, data sheets, and vendor information, and test procedures. The software facilitates rapid implementation of real-time signal processing algorithms. This system has been used in human EEG/fMRI studies at 3 and 7T examining the auditory system, visual system, sleep physiology, and anesthesia, as well as in intracranial electrophysiological studies of the non-human primate visual system during 3T fMRI, and in human hyperbaric physiology studies at depths of up to 300 feet below sea level.
Journal of Neuroscience Methods 09/2008; 175(2):165-86. · 1.98 Impact Factor
