Search

Purpose: The aim of this neurophysiological study was to retrospectively analyze visual evoked potentials (VEPs) acquired during an examination for diagnosing optic nerve involvement in patients with Lyme neuroborreliosis (LNB). Attention was focused on LNB patients with peripheral facial palsy (PFP) and optic nerve involvement., Methods: A total of 241 Czech patients were classified as having probable/definite LNB (193/48); of these, 57 were younger than 40 years, with a median age of 26.3 years, and 184 were older than 40 years, with a median age of 58.8 years. All patients underwent pattern-reversal (PVEP) and motion-onset (MVEP) VEP examinations., Results: Abnormal VEP results were observed in 150/241 patients and were noted more often in patients over 40 years (p = 0.008). Muscle/joint problems and paresthesia were observed to be significantly more common in patients older than 40 years (p = 0.002, p = 0.030), in contrast to headache and decreased visual acuity, which were seen more often in patients younger than 40 years (p = 0.001, p = 0.033). Peripheral facial palsy was diagnosed in 26/241 LNB patients. Among patients with PFP, VEP peak times above the laboratory limit was observed in 22 (84.6%) individuals. Monitoring of patients with PFP and pathological VEP showed that the adjustment of visual system function occurred in half of the patients in one to more years, in contrast to faster recovery from peripheral facial palsy within months in most patients., Conclusion: In LNB patients, VEP helps to increase sensitivity of an early diagnostic process., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: We developed a new portable device called "VEPpeak" for the examination of visual evoked potentials (VEPs) to extend VEP examination beyond specialized electrophysiological laboratories and to simplify the use of this objective, noninvasive, and low-cost method for diagnostics of visual and central nervous system dysfunctions., Methods: VEPpeak consists of a plastic headset with a total weight of 390 g containing four EEG amplifiers, an A/D converter, a control unit, and a visual LED stimulator built in the front, vertically adjustable peak. The device is powered and controlled via USB connection from a standard PC/notebook using custom software for visual stimuli generation and for VEP recording and processing. Up to four electrodes can be placed at any scalp location or in combination with two dry electrodes incorporated into the headset. External visual stimulators, such as a tablet, can be used with synchronization. Feasibility and validation studies were conducted with 86 healthy subjects and 76 neuro-ophthalmological patients including 67 who were during the same session also tested with a conventional VEP system., Results: VEPpeak recordings to standard (pattern-reversal) and non-standard (motion-onset, red-green alternation) were robust and repeatable and obtained also in immobilized patients. Good comparability of results was achieved between VEPpeak and standard examination. Some systematic differences in peak latencies and amplitudes are consistent with differences in stimulus characteristics of the two compared systems., Discussion: VEPpeak provides an inexpensive system for clinical use requiring portability. In addition to ISCEV standard VEP protocols, free choice of stimuli and bio-signal recordings make the device universal for many electrophysiological purposes., (© 2022. The Author(s).)

Background: For patients with age-related macular degeneration (AMD), a special intraocular lens implantation partially compensates for the loss in the central part of the visual field. For six months, we evaluated changes in neurophysiological parameters in patients implanted with a "Scharioth macula lens" (SML; a center near high add + 10 D and peripheral plano carrier bifocal lens designed to be located between the iris and an artificial lens)., Methods: Fourteen patients (5 M, 9 F, 63-87 years) with dry AMD were examined prior to and at 3 days after, as well as 1, 2, and 6 months after, implantation using pattern-reversal, motion-onset, and cognitive evoked potentials, psychophysical tests evaluating distant and near visual acuity, and contrast sensitivity., Results: Near visual acuity without an external aid was significantly better six months after implantation than before implantation (Jaeger table median (lower; upper quartile): 4 (1; 6) vs. 15 (13; 17)). Distant visual acuity was significantly altered between the pre- (0.7 (0.5; 0.8) logMAR) and last postimplantation visits (0.8 (0.7; 0.8) logMAR), which matched prolongation of the P100 peak time (147 (135; 151) ms vs. 161 (141; 166) ms) of 15 arc min pattern-reversal VEPs and N2 peak time (191.5 (186.5; 214.5) ms vs. 205 (187; 218) ms) of peripheral motion-onset VEPs., Conclusion: SML implantation significantly improved near vision. We also observed a slight but significant decrease in distant and peripheral vision. The most efficient electrophysiological approach to test patients with SML was the peripheral motion-onset stimulation, which evoked repeatable and readable VEPs.

Purpose: The aim of this neurophysiological study was to monitor changes in the visual and cognitive function of HIV-infected patients treated with combination antiretroviral therapy., Methods: Eleven adult Czech HIV+ patients, with a mean age of 35 years and CD4 cell count ≥ 230 × 10 6  cells/L of blood at the time of enrollment, underwent four to six examinations over the course of 2.5 years to evaluate pattern-reversal and motion-onset visual evoked potentials (P-VEPs and M-VEPs), visually driven oddball event-related potentials (ERPs) and Montreal Cognitive Assessments. In addition to evaluating the intraindividual change in the observed parameters, we also compared patient data to data from eleven age- and gender-matched controls., Results: We did not find any significant differences in P-VEPs between the patients and controls or in the paired comparison of the first and last visit. The only significant finding for P-VEPs was a linear trend in prolongation of the 20' P-VEP P100 peak time. In M-VEPs, we found a significant intergroup difference in the N160 peak time recorded during the first visit for peripheral M-VEPs only. During the last visit, all N160 peak times for patients differed significantly from those of the control group. The only intervisit difference close to the level of significance was for peripheral M-VEPs, which confirmed the trend analysis. No significant differences between patients and controls were found in the ERPs, but the P300 peak time showed a significant difference between the first and last visits, as confirmed by the trend. Patient reaction time was not significantly delayed at the first visit; however, it was prolonged with time, as confirmed by the trend., Conclusion: Our aim was to evaluate whether antiretroviral treatment in HIV+ patients is sufficient to preserve brain visual function. The optic nerve and primary visual cortex function tested by the P-VEPs seem to be preserved. The prolongation of the M-VEPs suggests an individually detectable decline in CNS function, but these changes did not show a progression during the follow-up. From a longitudinal perspective, the trends in peak time prolongation of the 20' P-VEP, peripheral M-VEP, ERP and reaction time suggest a faster decline than that caused by aging in healthy populations, as previously described in a cross-sectional study.

Purpose: The goal of the current study was to explore visual function in virally suppressed HIV patients undergoing combined antiretroviral therapy (cART) by using pattern-reversal and motion-onset visual evoked potentials (VEPs)., Methods: The pattern-reversal and motion-onset VEPs were recorded in 20 adult HIV+ patients with a mean age of 38 years and CD4 cell counts ≥230 × 10 6 cells/L of blood., Results: Nine out of 20 patients displayed VEP abnormalities. Pattern-reversal VEPs pathology was observed in 20% of subjects, and 45% HIV patients had impaired motion-onset VEPs. Five out of 16 neurologically asymptomatic HIV patients had prolonged motion-onset VEP latencies in both eyes. Four neurologically symptomatic patients displayed simultaneously abnormal motion-onset and pattern-reversal VEP latencies: monocular involvement was observed in two patients with Lyme and cytomegalovirus unilateral optic neuritis. Binocular involvement was noted in two patients with cognitive deficits. Correlation analysis between disease duration, CD4 cell count, HIV copies in plasma, MoCA and electrophysiological parameters did not show any significant relationships., Conclusions: The functional changes of the visual system in neurologically asymptomatic virally suppressed HIV patients displayed higher motion-onset VEP sensitivity than in standard pattern-reversal VEP examinations. This promising marker, however, has no significant association with clinical conditions. Further exploration is warranted.

Background: In adults, motion-onset visual evoked potentials (M-VEPs) with a dominant N2 peak represent a useful diagnostic tool. However, it is difficult to use this type of VEP in children because of the long maturation (up to 18 years) of M-VEPs, which is characterised by a gradual decrease in N2 peak latency and shape development. Moreover, in some children, M-VEPs are difficult to identify with standard stimuli., Methods: We tested features of M-VEPs in 30 children (7-12 years) with the following set of standard stimuli used in our lab for examining adults ( https://web.lfhk.cuni.cz/elf ): low-contrast translation motion (TM) and expansion/contraction motion (ExCoM) in full field and in periphery (with central 20° masked). In 16 children, a high-contrast TM was also tested., Results: With standard (low-contrast) stimuli, a common M-VEP to TM and to ExCoM was detected in 77 and 83 % of children, respectively. The M-VEPs to ExCoM in the periphery were detected in only 43 % of children. An abnormal dominant P1 peak was found in 9 % of VEPs to TM, 12 % of VEPs to full-field ExCoM and 14 % of VEPs to peripheral ExCoM. The M-VEPs to all low-contrast stimuli displayed large inter-individual latency variability (N2 peak latency differed for more than 100 ms). High contrast (more suitable for the non-mature magnocellular pathway) shortened M-VEP latencies and improved amplitudes., Conclusions: Our findings show that the maturation of motion perception in children is inter-individually variable, which limits the diagnostic use of M-VEPs.

Visual evoked potentials to motion-onset stimulation (M-VEPs) gradually attenuate in amplitude during examination. The observed decline in averaged responses can be caused by decreases in single response magnitudes and/or increased variability in a response delays, that is, latency jittering. To illuminate the origins of the suppression of M-VEPs during stimuli repetition, we used correlation technique to estimate an upper bound of possible latency jittering of single sweeps and we evaluated the effect of its correction on the amplitudes of three M-VEP dominant peaks P1, N2 and P3. During prolonged visual motion stimulation, the variability of corrective latency shifts in the occipital region increased (r = 0.35: 0.44) and the number of single responses corresponding to the average curve declined in occipital and parietal derivations (r = -0.48: -0.62). While the P1 peak amplitude did not exhibit any time-specific behaviour, the N2 amplitude exhibited a significant decay of 29.4% that was partially reduced to 16.6% in the central occipital derivation by the latency jitter and non-correspondence corrections. The strongest attenuation (32.7%) was observed in the P3 amplitude and was less sensitive to the corrections, dropping only to 27.9%. The main part of the response suppression to repeated motion stimulation was caused by amplitude drop and represents non-stationary process that likely correspond to a fatigue model. The rise of variability in latency jitter correction and the reduction in single responses correlated with the M-VEP were significant factors associated with prolonged motion stimulation. The relation of these parameters to a hypothetical veridical response is ambiguous and can be caused by a time shift of the response or by a change of signal-to-noise ratio. Using selective averaging and latency jitter correction, the effect of response suppression was partially removed.

The aim of our study was to verify reported visual dysfunctions of patients with Alzheimer disease with the use of several variants of VEPs and visual ERPs and to learn whether these methods can be useful in diagnostics of AD. We tested 15 patients (6 women and 9 men, aged from 58 to 87) with mild to moderate Alzheimer disease (12-23 points of Mini Mental State Examination) and 15 age, gender and education level matched controls. The examination consisted of VEPs to pattern-reversal and motion-onset stimulation (to translational and radial movement) and of visual ERPs recorded during an odd-ball test. The subjects were instructed to signalize target stimuli by pressing of a button, which enabled to evaluate also the reaction time. While pattern-reversal VEPs were comparable in patients and controls, there were significantly smaller N2 peak amplitudes of motion-onset VEPs in patients with AD (in particular in radial moving stimuli outside the central 20 deg of the visual field), which suggests a dysfunction of the motion-processing (magnocellular) system or the dorsal cortical stream. ERPs, having significantly longer latencies in patients than in controls, distinguished well both groups. However, the individual AD diagnostics based on ERPs seems to be limited by rather high inter-individual variability of the ERP latencies. The ERPs might, however, be useful in disease progress and therapy effect estimation. Electrophysiological parameters did not correlate with neuropsychological ADAS cog test (Alzheimer Disease Assessment Scale--cognitive part).

We explored the effect of repeated visual stimulation on motion-onset visual evoked potentials (M-VEPs) during 25 min recording sessions in 10 subjects. The aim of the experiment was to determine influence of global motion adaptation (without motion-aftereffect) on intra-individual variability of M-VEPs and to suggest an optimal recording design for clinical examination. In addition to well described middle-time sensory adaptation, we also observed a long-time effect on motion specific N2 peak (155 ms). The N2 peak exhibited a strong relationship between its latency and inter-peak amplitude to the duration of recording in occipito-parietal derivations. In addition to the middle-term adaptation, N2 peak latency was prolonged by 10 ms and amplitude was attenuated by 30% with respect to the start of the experiment. An exponential model was employed to describe the dependency. The model can be used to reduce intra-individual variability during examination. Observed resemblance between the measured electrophysiological values and already published metabolic changes (glucose and oxygen utilization) during brain processing of visual information is discussed.