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Background: We aimed to verify the usefulness of electroencephalographic (EEG) activity recording (that is mandatory according to the Italian law), in addition to two clinical evaluations spaced 6 h, among the procedures of brain death determination (BDD) in adult individuals. Methods: The study is a monocentric, retrospective analysis of all BDDs performed in the last 10 years at Policlinico Le Scotte in Siena (Italy). Results: Of the 428 cases revised (mean age 67.6 ± 15.03 years; range 24–92 years), 225 were males and 203 females. In total, 212 out of 428 patients (49.5%) were donors. None of the BDD procedures were interrupted due to the reappearance of EEG activity (neither for clinical reasons) at any sampling time, with the exception of one case that was considered a false negative at critical reinspection of the EEG. In 6/428 cases (1.4%), a cardiac arrest occurred during the 6 h between the first and second evaluation, thus missing the opportunity to take organs from these patients because the BDD procedure was not completed. Conclusions: Once the initial clinical examination before convening the BDD Commission has ascertained the absence of brainstem reflexes and of spontaneous breathing, and these clinical findings are supported by a flat EEG recording, the repetition of a 30-min EEG twice over a 6 h period seems not to add additional useful information to clinical findings. Current data, if confirmed in other centers and possibly in prospective studies, may help to promote a scientific and bioethical debate in Italy, as well as in other countries where the EEG is still mandatory, for eventually updating the procedures of BDD. [ABSTRACT FROM AUTHOR]

Abstract: This article is based on a consensus conference, which took place in Certosa di Pontignano, Siena (Italy) on March 7–9, 2008, intended to update the previous safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings. Over the past decade the scientific and medical community has had the opportunity to evaluate the safety record of research studies and clinical applications of TMS and repetitive TMS (rTMS). In these years the number of applications of conventional TMS has grown impressively, new paradigms of stimulation have been developed (e.g., patterned repetitive TMS) and technical advances have led to new device designs and to the real-time integration of TMS with electroencephalography (EEG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). Thousands of healthy subjects and patients with various neurological and psychiatric diseases have undergone TMS allowing a better assessment of relative risks. The occurrence of seizures (i.e., the most serious TMS-related acute adverse effect) has been extremely rare, with most of the few new cases receiving rTMS exceeding previous guidelines, often in patients under treatment with drugs which potentially lower the seizure threshold. The present updated guidelines review issues of risk and safety of conventional TMS protocols, address the undesired effects and risks of emerging TMS interventions, the applications of TMS in patients with implanted electrodes in the central nervous system, and safety aspects of TMS in neuroimaging environments. We cover recommended limits of stimulation parameters and other important precautions, monitoring of subjects, expertise of the rTMS team, and ethical issues. While all the recommendations here are expert based, they utilize published data to the extent possible. [Copyright &y& Elsevier]

Purpose: To assess the effectiveness of slow repetitive transcranial magnetic stimulation (rTMS) as an adjunctive treatment for drug-resistant epilepsy. Methods: Forty-three patients with drug-resistant epilepsy from eight Italian Centers underwent a randomized, double-blind, sham-controlled, crossover study on the clinical and EEG effects of slow rTMS. The stimulus frequency was 0.3 Hz. One thousand stimuli per day were given at the resting motor threshold intensity for 5 consecutive days, with a round coil at the vertex. Results:“Active” rTMS was no better than placebo for seizure reduction. However, it decreased interictal EEG epileptiform abnormalities significantly (p < 0.05) in one-third of the patients, which supports a detectable biologic effect. No correlation linked the rTMS effects on seizure frequency to syndrome or anatomic classification, seizure type, EEG changes, or resting motor threshold (an index of motor cortex excitability). Conclusions: Although the antiepileptic action was not significant (p > 0.05), the individual EEG reactivity to “active” rTMS may be encouraging for the development of more-powerful, noninvasive neuromodulatory strategies. [ABSTRACT FROM AUTHOR]

Event-related potentials (ERPs) are obtained from the electroencephalogram (EEG) or the magnetoencephalogram (MEG, event-related fields (ERF)), extracting the activity that is time-locked to an event. Despite the potential utility of ERP/ERF in cognitive domain, the clinical standardization of their use is presently undefined for most of procedures. The aim of the present review is to establish limits and reliability of ERP medical application, summarize main methodological issues, and present evidence of clinical application and future improvement. The present section of the review focuses on well-standardized ERP methods, including P300, Contingent Negative Variation (CNV), Mismatch Negativity (MMN), and N400, with a chapter dedicated to laser-evoked potentials (LEPs). One section is dedicated to proactive preparatory brain activity as the Bereitschaftspotential and the prefrontal negativity (BP and pN). The P300 and the MMN potentials have a limited but recognized role in the diagnosis of cognitive impairment and consciousness disorders. LEPs have a well-documented usefulness in the diagnosis of neuropathic pain, with low application in clinical assessment of psychophysiological basis of pain. The other ERP components mentioned here, though largely applied in normal and pathological cases and well standardized, are still confined to the research field. CNV, BP, and pN deserve to be largely tested in movement disorders, just to explain possible functional changes in motor preparation circuits subtending different clinical pictures and responses to treatments. [ABSTRACT FROM AUTHOR]

Cognitive control during conflict monitoring, error processing, and post‐error adjustment appear to be associated with the occurrence of midfrontal theta (MFϴ). While this association is supported by correlational EEG studies, much less is known about the possible causal link between MFϴ and error and conflict processing. In the present study, we aimed to explore the role of band‐specific effects in modulating the error system during a conflict resolution. In turn, we delivered transcranial alternating current stimulation (tACS) at different frequency bands (delta δ, theta θ, alpha α, beta β, gamma γ) and sham stimulation over the medial frontal cortex (MFC) in 36 healthy participants performing a modified version of the Flanker task. Task performance and reports about the sensations (e.g. visual flickering, cutaneous burning) induced by the different frequency bands, were also recorded. We found that online θ‐tACS increased the response speed to congruent stimuli after error execution with respect to sham stimulation. Importantly, the accuracy following the errors did not decrease because of speed‐accuracy trade off. Moreover, tACS evoked visual and somatosensory sensations were significantly stronger at α‐tACS and β‐tACS compared to other frequencies. Our findings suggest that theta activity plays a causative role in modulating behavioural adjustments during perceptual choices in a stimulus‐response conflict task. In the present study we aimed to explore the effects of transcranial Alternating Current Stimulation in modulating the error monitoring system during the Flanker task performance. We found that 6 Hz‐tACS applied over the medial frontal cortex increased the response speed to congruent stimuli after error execution with respect to sham stimulation. Our findings highlight the causative role of theta activity in modulating behavioural adjustments during conflicting perceptual choices. [ABSTRACT FROM AUTHOR]

Abstract: Noninvasive, objective quantitative techniques to gauge emotional states are fundamental for clinical psychology as they overcome subjective bias of currently used questionnaires. To this end, we investigated brain oscillatory EEG activity during caresslike, affective haptic elicitation conveyed on the forearm at two force (strength of the caress) and three velocity (velocity of the caress) levels. Thirty‐two healthy subjects (16 female) were asked to assess each haptic stimulus in terms of arousal (i.e., intensity of emotional perception) and valence (i.e., pleasantness/unpleasantness of emotional perception) scores, according to the circumplex model of affect. Changes in brain oscillations were quantified through spectral and functional connectivity analyses. EEG power spectra were estimated through the individual α frequency peak. Results, expressed in terms of p‐value topographic maps, revealed a suppression of α, β, and γ oscillations over the contralateral somatosensory cortex during unpleasant caresses performed with the lowest force (2 N) and the highest velocity (65 mm/s). Conversely, pleasant caresses at the highest force were associated with a significant decrease of EEG oscillatory activity over the midfrontal region, at frequency bands including α, β, and γ. A correlation analysis showed that EEG γ power from the somatosensory area was linked to caressing force. The more unpleasant the affective cutaneous stimuli, the more the brain dynamics decrease in activity all over the scalp, primarily showing a suppression of α power over the midfrontal cortex. These results also pave the way for the design of haptic systems eliciting a given emotional state. [ABSTRACT FROM AUTHOR]

Differential diagnoses between vegetative and minimally conscious states (VS and MCS, respectively) are frequently incorrect. Hence, further research is necessary to improve the diagnostic accuracy at the bedside. The main neuropathological feature of VS is the diffuse damage of cortical and subcortical connections. Starting with this premise, we used electroencephalography (EEG) recordings to evaluate the cortical reactivity and effective connectivity during transcranial magnetic stimulation (TMS) in chronic VS or MCS patients. Moreover, the TMS-EEG data were compared with the results from standard somatosensory-evoked potentials (SEPs) and event-related potentials (ERPs). Thirteen patients with chronic consciousness disorders were examined at their bedsides. A group of healthy volunteers served as the control group. The amplitudes (reactivity) and scalp distributions (connectivity) of the cortical potentials evoked by TMS (TEPs) of the primary motor cortex were measured. Short-latency median nerve SEPs and auditory ERPs were also recorded. Reproducible TEPs were present in all control subjects in both the ipsilateral and the contralateral hemispheres relative to the site of the TMS. The amplitudes of the ipsilateral and contralateral TEPs were reduced in four of the five MCS patients, and the TEPs were bilaterally absent in one MCS patient. Among the VS patients, five did not manifest ipsilateral or contralateral TEPs, and three of the patients exhibited only ipsilateral TEPs with reduced amplitudes. The SEPs were altered in five VS and two MCS patients but did not correlate with the clinical diagnosis. The ERPs were impaired in all patients and did not correlate with the clinical diagnosis. These TEP results suggest that cortical reactivity and connectivity are severely impaired in all VS patients, whereas in most MCS patients, the TEPs are preserved but with abnormal features. Therefore, TEPs may add valuable information to the current clinical and neurophysiological assessment of chronic consciousness disorders. [ABSTRACT FROM AUTHOR]

Abstract: Playing music in ensemble represents a unique human condition/performance where musicians should rely on empathic relationships. Recent theories attribute to frontal Brodmann areas (BAs) 44/45 and 10/11 a neural basis for “emotional” and “cognitive” empathy. We hypothesized that activity of these structures reflects empathy trait in professional musicians playing in ensemble. Simultaneous electroencephalographic (EEG) alpha rhythms (8–12Hz) were recorded in three saxophone quartets during music performance in ensemble (EXECUTION), video observation of their own performance (OBSERVATION), a control task (CONTROL), and resting state (RESTING). EEG source estimation was performed. Results showed that the higher the empathy quotient test score, the higher the alpha desynchronization in right BA 44/45 during the OBSERVATION referenced to RESTING condition. Empathy trait score and alpha desynchronization were not correlated in other control areas or in EXECUTION/CONTROL conditions. These results suggest that alpha rhythms in BA 44/45 reflect “emotional” empathy in musicians observing own performance. [Copyright &y& Elsevier]

Abstract: In this paper we present an off-line Kalman filter approach to remove transcranial magnetic stimulation (TMS)-induced artifacts from electroencephalographic (EEG) recordings. Two dynamic models describing EEG and TMS signals generation are identified from data and the Kalman filter is applied to the linear system arising from their combination. The keystone of the approach is the use of time-varying covariance matrices suitably tuned on the physical parameters of the problem that allow to model the nonstationary components of the EEG–TMS signal. This guarantees an efficient deletion of TMS-induced artifacts while preserving the integrity of EEG signals around TMS impulses. Experimental results show that the Kalman filter is more effective than stationary filters (Wiener filter) for the problem under investigation. [Copyright &y& Elsevier]

Abstract: Recent neuroimaging studies of long-term episodic memory have suggested that left prefrontal cortex predominates in encoding condition, whereas right prefrontal cortex predominates in retrieval condition (hemispheric encoding and retrieval asymmetry, HERA model). The present electroencephalographic (EEG) study investigated the functional coupling of fronto-parietal regions during long-term memorization of visuo-spatial contents (i.e. landscapes, interiors of apartments), to test the predictions of the HERA model. Global fronto-parietal coupling was estimated by spectral coherence, whereas the “direction” of the fronto-parietal information flow was estimated by directed transfer function (DTF). The EEG rhythms of interest were theta (4–7Hz), alpha (8–13Hz), beta (14–30Hz), and gamma (30–45Hz). Statistically significant coherence in line with the HERA model was obtained at the gamma band. Namely, the fronto-parietal gamma coherence prevailed in the left hemisphere during the encoding condition and in the right hemisphere during the retrieval condition. The DTF estimates of the gamma band showed a dominant parietal-to-frontal directional flow in the right hemisphere during the encoding condition and in the left hemisphere during the retrieval condition (i.e. hemisphere-condition combination not involved by the HERA model). In contrast, a balanced bidirectional flow of the fronto-parietal coupling was observed in the left hemisphere during the encoding condition and in the right hemisphere during the retrieval condition (i.e. hemisphere-condition combination involved by the HERA model). In conclusion, the present encoding-retrieval conditions induced maximal fronto-parietal gamma coupling with bidirectional information flow in the hemisphere-condition combination predicted by the HERA model. [Copyright &y& Elsevier]

Neuroimaging cognitive study of aging requires simple tasks ensuring a high rate of correct performances even in stressful neurophysiological settings. Here two simple delayed choice reaction time tasks were used to unveil event-related desynchronization (ERD) of theta (4–6 Hz) and alpha (6–12 Hz) electroencephalographic rhythms across normal aging. In the first condition, a cue stimulus (one bit) was memorized along a brief delay period (3.5–5.5 s). The explicit demand was visuo-spatial, but the retention could be also based on phonological and somatomotor coding. In the second condition, the cue stimulus remained available along the delay period. Correct performances were higher than 95% in both groups and tasks, although they were significantly better in young than elderly subjects (P<0.03). During the delay period, theta and alpha ERD accompanying correct responses were recognized in the two groups, the alpha ERD being stronger and prolonged during the memory than non-memory task. On the other hand, the fronto-parietal theta and parietal alpha ERD were stronger in young than elderly subjects during both tasks. Notably, the frontal alpha ERD was negligible in elderly subjects. In conclusion, the present simple tasks unveiled in elderly compared to young subjects (i) a weaker involvement of (para)hippocampal-cortical circuits as revealed by theta ERD and (ii) a weaker involvement of “executive” thalamo-cortical circuits as revealed by frontal alpha ERD. These effects might worsen behavioral performances to the simple cognitive tasks with age. The present protocol is promising for the neuroimaging study of pathological aging. [Copyright &y& Elsevier]

In this electroencephalographic study, the authors modeled the functional connectivity between frontal and parietal areas during short-term memory (STM) processes by spectral coherence analysis and the directed transfer function, that is, for the estimation of coherence "direction." A no-STM task was used as a reference. STM was characterized by an increased frontoparietal electroencephalograph coherence at high frequencies (beta and gamma, 14-45 Hz). In the control task, parietal-to-frontal flow prevailed at those frequencies. However, the STM task showed a bidirectional frontoparietal flow at the gamma band. In conclusion, frontoparietal connectivity would optimize "representational" memory during STM. In this context, the frontal areas would increase their influence on parietal areas for memory retention. [ABSTRACT FROM AUTHOR]

Many recent neuroimaging studies of episodic memory have indicated an asymmetry in prefrontal involvement, with the left prefrontal cortex more involved than the right in encoding, the right more than the left in retrieval (hemispheric encoding and retrieval asymmetry, or HERA model). In this electroencephalographic (EEG) high-resolution study, we studied brain rhythmicity during a visual episodic memory (recognition) task. The theta (4–6 Hz), alpha (6–12 Hz) and gamma (28–48 Hz) oscillations were investigated during a visuospatial long-term episodic memory task including an encoding (ENC) and retrieval (RET) phases. During the ENC phase, 25 figures representing interiors of buildings (“indoor”) were randomly intermingled with 25 figures representing landscapes (“landscapes”). Subject''s response was given at left (“indoor”) or right (“landscapes”) mouse button. During the RET phase (1 h later), 25 figures representing previously presented “indoor” pictures (“tests”) were randomly intermingled with 25 figures representing novel “indoor” (“distractors”). Again, a mouse response was required. Theta and alpha EEG results showed no change of frontal rhythmicity. In contrast, the HERA prediction of asymmetry was fitted only by EEG gamma responses, but only in the posterior parietal areas. The ENC phase was associated with gamma EEG oscillations over left parietal cortex. Afterward, the RET phase was associated with gamma EEG oscillations predominantly over right parietal cortex. The predicted HERA asymmetry was thus observed in an unexpected location. This discrepancy may be due to the differential sensitivity of neuroimaging methods to selected components of cognitive processing. The strict relation between gamma response and perception suggests that retrieval processes of long-term memory deeply impinged upon sensory representation of the stored material. [Copyright &y& Elsevier]

Objective: We investigated whether a very simple short-term memory (STM) demand induces a visible change of EEG rhythms over the two hemispheres.Methods: High-resolution EEG was obtained in young adults during two delayed choice reaction time tasks. In the STM condition, a simple cue stimulus (one bit) was memorized along a brief delay period (3.5–5.5 s). The task was visuo-spatial in nature.Results: In the control (NSTM) condition, the cue stimulus remained available along the delay period. Compared to the control condition, the theta power (4–6 Hz) decreased in left frontal and bilateral parietal areas (delay period). Furthermore, low alpha power (6–8 Hz) decreased in bilateral frontal and left parietal areas, while high alpha power (10–12 Hz) decreased in the left fronto-parietal areas.Conclusions: The decrease of the alpha power is as an expression of the efficient information transfer within thalamo-cortical pathways. The significance of the study stands in the fact that even a very simple STM task (only one bit to be memorized) revealed changes in fronto-parietal theta and alpha rhythms. [Copyright &y& Elsevier]