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An early disruption of neuronal excitation–inhibition (E–I) balance in preclinical animal models of Alzheimer’s disease (AD) has been frequently reported, but is difficult to measure directly and non-invasively in humans. Here, we examined known and novel neurophysiological measures sensitive to E–I in patients across the AD continuum. Resting-state magnetoencephalography (MEG) data of 86 amyloid-biomarker-confirmed subjects across the AD continuum (17 patients diagnosed with subjective cognitive decline, 18 with mild cognitive impairment (MCI) and 51 with dementia due to probable AD (AD dementia)), 46 healthy elderly and 20 young control subjects were reconstructed to source-space. E–I balance was investigated by detrended fluctuation analysis (DFA), a functional E/I (fE/I) algorithm, and the aperiodic exponent of the power spectrum. We found a disrupted E–I ratio in AD dementia patients specifically, by a lower DFA, and a shift towards higher excitation, by a higher fE/I and a lower aperiodic exponent. Healthy subjects showed lower fE/I ratios (fE/I results. Correlation analyses showed that a lower DFA (E–I imbalance) and a lower aperiodic exponent (more excitation) was associated with a worse cognitive score in AD dementia patients. In contrast, a higher DFA in the hippocampi of MCI patients was associated with a worse cognitive score. This MEG-study showed E–I imbalance, likely due to increased excitation, in AD dementia, but not in early stage AD patients. To accurately determine the direction of shift in E–I balance, validations of the currently used markers and additional in vivo markers of E–I are required.

Background: Insomnia is the transdiagnostically shared most common complaint in disorders of anxiety, stress and emotion regulation. Current cognitive behavioral therapies (CBT) for these disorders do not address sleep, while good sleep is essential for regulating emotions and learning new cognitions and behaviours: the core fundaments of CBT. This transdiagnostic randomized control trial (RCT) evaluates whether guided internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) (1) improves sleep, (2) affects the progression of emotional distress and (3) enhances the effectiveness of regular treatment of people with clinically relevant symptoms of emotional disorders across all mental health care (MHC) echelons. Methods: We aim for 576 completers with clinically relevant symptoms of insomnia as well as at least one of the dimensions of generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), posttraumatic stress disorder (PTSD) or borderline personality disorder (BPD). Participants are either pre-clinical, unattended, or referred to general- or specialized MHC. Using covariate-adaptive randomization, participants will be assigned to a 5 to 8-week iCBT-I (i-Sleep) or a control condition (sleep diary only) and assessed at baseline, and after two and eight months. The primary outcome is insomnia severity. Secondary outcomes address sleep, severity of mental health symptoms, daytime functioning, mental health protective lifestyles, well-being, and process evaluation measures. Analyses use linear mixed-effect regression models. Discussion: This study can reveal for whom, and at which stage of disease progression, better nights could mean substantially better days. Trial registration: International Clinical Trial Registry Platform (NL9776). Registered on 2021-10-07.

Objective Pituitary tumours that compress the optic chiasm are associated with long-term alterations in sleep–wake rhythm. This may result from damage to intrinsically photosensitive retinal ganglion cells (ipRGCs) projecting from the retina to the hypothalamic suprachiasmatic nucleus via the optic chiasm to ensure photoentrainment (i.e. synchronisation to the 24-h solar cycle through light). To test this hypothesis, we compared the post-illumination pupil response (PIPR), a direct indicator of ipRGC function, between hypopituitarism patients with and without a history of optic chiasm compression. Design Observational study, comparing two predefined groups. Methods We studied 49 patients with adequately substituted hypopituitarism: 25 patients with previous optic chiasm compression causing visual disturbances (CC+ group) and 24 patients without (CC– group). The PIPR was assessed by chromatic pupillometry and expressed as the relative change between baseline and post-blue-light stimulus pupil diameter. Objective and subjective sleep parameters were obtained using polysomnography, actigraphy, and questionnaires. Results Post-blue-light stimulus pupillary constriction was less sustained in CC+ patients compared with CC– patients, resulting in a significantly smaller extended PIPR (mean difference: 8.1%, 95% CI: 2.2–13.9%, P = 0.008, Cohen's d = 0.78). Sleep–wake timing was consistently later in CC+ patients, without differences in sleep duration, efficiency, or other rest–activity rhythm features. Subjective sleep did not differ between groups. Conclusion Previous optic chiasm compression due to a pituitary tumour in patients with hypopituitarism is associated with an attenuated PIPR and delayed sleep timing. Together, these data suggest that ipRGC function and consequently photoentrainment of the central biological clock is impaired in patients with a history of optic chiasm compression.

The “sleep to forget and sleep to remember hypothesis” proposes that sleep weakens the emotional tone of an experience while preserving or even enhancing its content. Prior experimental research however shows contradictory findings on how emotional reactivity changes after a period of sleep, likely explained by methodological variations. By addressing these inconsistencies, we investigated the mitigating effect of overnight sleep on emotional reactivity triggered by memory reactivation. Using a karaoke paradigm, we recorded participants’ singing of two songs, followed by exposing them to one of the recordings (rec1) to induce an embarrassing episode. After a 12-hr period of either day-time wakefulness (N = 20) or including nighttime sleep (N = 20), we assessed emotional reactivity to the previously exposed recording (rec1) and the newly exposed recording (rec2). Emotional reactivity was assessed with a physiological measure of facial blushing as the main outcome and subjective ratings of embarrassment and valence. Sleep and wake were monitored with diaries and actigraphy. The embarrassing episode was successfully induced as indicated by objective and subjective measures. After controlling for an order effect in stimulus presentation, we found a reduction in blushing response to the reactivated recording (rec1) from pre- to post-sleep compared to wakefulness. However, emotional reactivity to the reactivated recording (rec1) and the new recording (rec2) did not differ after sleep and wakefulness. This study shows that facial blushing was reduced following overnight sleep, while subjective ratings were unaffected. Whether the beneficial effect of sleep is due to changes in memory representation or rather emotion regulation remains elusive.

Background: Next generation sequencing studies have revealed an ever-increasing number of causes for genetic disorders of central nervous system white matter. A substantial number of disorders are identifiable from their specific pattern of biochemical and/or imaging findings for which single gene testing may be indicated. Beyond this group, the causes of genetic white matter disorders are unclear and a broader approach to genomic testing is recommended. Aim: This study aimed to identify the genetic causes for a group of individuals with unclassified white matter disorders with suspected genetic aetiology and highlight the investigations required when the initial testing is non-diagnostic. Methods: Twenty-six individuals from 22 families with unclassified white matter disorders underwent deep phenotyping and genome sequencing performed on trio, or larger, family groups. Functional studies and transcriptomics were used to resolve variants of uncertain significance with potential clinical relevance. Results: Causative or candidate variants were identified in 15/22 (68.2%) families. Six of the 15 implicated genes had been previously associated with white matter disease (COL4A1, NDUFV1, SLC17A5, TUBB4A, BOLA3, DARS2). Patients with variants in the latter two presented with an atypical phenotype. The other nine genes had not been specifically associated with white matter disease at the time of diagnosis and included genes associated with monogenic syndromes, developmental disorders, and developmental and epileptic encephalopathies (STAG2, LSS, FIG4, GLS, PMPCA, SPTBN1, AGO2, SCN2A, SCN8A). Consequently, only 46% of the diagnoses would have been made via a current leukodystrophy gene panel test. Discussion: These results confirm the importance of broad genomic testing for patients with white matter disorders. The high diagnostic yield reflects the integration of deep phenotyping, whole genome sequencing, trio analysis, functional studies, and transcriptomic analyses. Conclusions: Genetic white matter disorders are genetically and phenotypically heterogeneous. Deep phenotyping together with a range of genomic technologies underpin the identification of causes of unclassified white matter disease. A molecular diagnosis is essential for prognostication, appropriate management, and accurate reproductive counseling.

Loss of function of the astrocyte membrane protein MLC1 is the primary genetic cause of the rare white matter disease Megalencephalic Leukoencephalopathy with subcortical Cysts (MLC), which is characterized by disrupted brain ion and water homeostasis. MLC1 is prominently present around fluid barriers in the brain, such as in astrocyte endfeet contacting blood vessels and in processes contacting the meninges. Whether the protein plays a role in other astrocyte domains is unknown. Here, we show that MLC1 is present in distal astrocyte processes, also known as perisynaptic astrocyte processes (PAPs) or astrocyte leaflets, which closely interact with excitatory synapses in the CA1 region of the hippocampus. We find that the PAP tip extending toward excitatory synapses is shortened in Mlc1-null mice. This affects glutamatergic synaptic transmission, resulting in a reduced rate of spontaneous release events and slower glutamate re-uptake under challenging conditions. Moreover, while PAPs in wildtype mice retract from the synapse upon fear conditioning, we reveal that this structural plasticity is disturbed in Mlc1-null mice, where PAPs are already shorter. Finally, Mlc1-null mice show reduced contextual fear memory. In conclusion, our study uncovers an unexpected role for the astrocyte protein MLC1 in regulating the structure of PAPs. Loss of MLC1 alters excitatory synaptic transmission, prevents normal PAP remodeling induced by fear conditioning and disrupts contextual fear memory expression. Thus, MLC1 is a new player in the regulation of astrocyte-synapse interactions.

Tactile sensations can bias visual perception in the awake state while visual sensitivity is known to be facilitated by sleep. It remains unknown, however, whether the tactile sensation during sleep can bias the visual improvement after sleep. Here, we performed nap experiments in human participants (n = 56, 18 males, 38 females) to demonstrate that repetitive tactile motion stimulation on the fingertip during slow wave sleep selectively enhanced subsequent visual motion detection. The visual improvement was associated with slow wave activity. The high activation at the high beta frequency was found in the occipital electrodes after the tactile motion stimulation during sleep, indicating a visual-tactile cross-modal interaction during sleep. Furthermore, a second experiment (n = 14, 14 females) to examine whether a hand- or head-centered coordination is dominant for the interpretation of tactile motion direction showed that the biasing effect on visual improvement occurs according to the hand-centered coordination. These results suggest that tactile information can be interpreted during sleep, and can induce the selective improvement of post-sleep visual motion detection. SIGNIFICANCE STATEMENT Tactile sensations can bias our visual perception as a form of cross-modal interaction. However, it was reported only in the awake state. Here we show that repetitive directional tactile motion stimulation on the fingertip during slow wave sleep selectively enhanced subsequent visual motion perception. Moreover, the visual improvement was positively associated with sleep slow wave activity. The tactile motion stimulation during slow wave activity increased the activation at the high beta frequency over the occipital electrodes. The visual improvement occurred in agreement with a hand-centered reference frame. These results suggest that our sleeping brain can interpret tactile information based on a hand-centered reference frame, which can cause the sleep-dependent improvement of visual motion detection.

Insomnia is a heritable, highly prevalent sleep disorder for which no sufficient treatment currently exists. Previous genome-wide association studies with up to 1.3 million subjects identified over 200 associated loci. This extreme polygenicity suggested that many more loci remain to be discovered. The current study almost doubled the sample size to 593,724 cases and 1,771,286 controls, thereby increasing statistical power, and identified 554 risk loci (including 364 novel loci). To capitalize on this large number of loci, we propose a novel strategy to prioritize genes using external biological resources and functional interactions between genes across risk loci. Of all 3,898 genes naively implicated from the risk loci, we prioritize 289 and find brain-tissue expression specificity and enrichment in specific gene sets of synaptic signaling functions and neuronal differentiation. We show that this novel gene prioritization strategy yields specific hypotheses on underlying mechanisms of insomnia that would have been missed by traditional approaches.

Tissue-resident macrophages of the brain, including microglia, are implicated in the pathogenesis of various CNS disorders and are possible therapeutic targets by their chemical depletion or replenishment by hematopoietic stem cell therapy. Nevertheless, a comprehensive understanding of microglial function and the consequences of microglial depletion in the human brain is lacking. In human disease, heterozygous variants in CSF1R, encoding the Colony-stimulating factor 1 receptor, can lead to adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) possibly caused by microglial depletion. Here, we investigate the effects of ALSP-causing CSF1R variants on microglia and explore the consequences of microglial depletion in the brain. In intermediate- and late-stage ALSP post-mortem brain, we establish that there is an overall loss of homeostatic microglia and that this is predominantly seen in the white matter. By introducing ALSP-causing missense variants into the zebrafish genomic csf1ra locus, we show that these variants act dominant negatively on the number of microglia in vertebrate brain development. Transcriptomics and proteomics on relatively spared ALSP brain tissue validated a downregulation of microglia-associated genes and revealed elevated astrocytic proteins, possibly suggesting involvement of astrocytes in early pathogenesis. Indeed, neuropathological analysis and in vivo imaging of csf1r zebrafish models showed an astrocytic phenotype associated with enhanced, possibly compensatory, endocytosis. Together, our findings indicate that microglial depletion in zebrafish and human disease, likely as a consequence of dominant-acting pathogenic CSF1R variants, correlates with altered astrocytes. These findings underscore the unique opportunity CSF1R variants provide to gain insight into the roles of microglia in the human brain, and the need to further investigate how microglia, astrocytes, and their interactions contribute to white matter homeostasis.

The basilar pontine nuclei (bPN) are known to receive excitatory input from the entire neocortex and constitute the main source of mossy fibers to the cerebellum. Various potential inhibitory afferents have been described, but their origin, synaptic plasticity, and network function have remained elusive. Here we identify the mesodiencephalic junction (MDJ) as a prominent source of monosynaptic GABAergic inputs to the bPN. We found no evidence that these inputs converge with motor cortex (M1) inputs at the single neuron or at the local network level. Tracing the inputs to GABAergic MDJ neurons revealed inputs to these neurons from neocortical areas. Additionally, we observed little short-term synaptic facilitation or depression in afferents from the MDJ, enabling MDJ inputs to carry sign-inversed neocortical inputs. Thus, our results show a prominent source of GABAergic inhibition to the bPN that could enrich input to the cerebellar granule cell layer.

Synaptic transmission constitutes the primary mode of communication between neurons. It is extensively studied in rodent but not human neocortex. We characterized synaptic transmission between pyramidal neurons in layers 2 and 3 using neurosurgically resected human middle temporal gyrus (MTG, Brodmann area 21), which is part of the distributed language circuitry. We find that local connectivity is comparable with mouse layer 2/3 connections in the anatomical homologue (temporal association area), but synaptic connections in human are 3-fold stronger and more reliable (0% vs 25% failure rates, respectively). We developed a theoretical approach to quantify properties of spinous synapses showing that synaptic conductance and voltage change in human dendritic spines are 3–4-folds larger compared with mouse, leading to significant NMDA receptor activation in human unitary connections. This model prediction was validated experimentally by showing that NMDA receptor activation increases the amplitude and prolongs decay of unitary excitatory postsynaptic potentials in human but not in mouse connections. Since NMDA-dependent recurrent excitation facilitates persistent activity (supporting working memory), our data uncovers cortical microcircuit properties in human that may contribute to language processing in MTG.

In chapter 2, we recorded AP shapes and underlying Na+ and K+ currents in human cortical pyramidal neurons and compared them to rodents. We found that not only the AP shape, but also the underlying currents have remarkable stability, even when firing hundreds of consecutive APs at frequencies of 60 Hz. We then argued that biophysical adaptations in voltage-gated sodium and potassium channels must be responsible, and tested this by characterizing the voltage-dependent properties of the Na+ and K+ currents. We find that human Na+ and K+ currents had different biophysical features than their mouse counterparts. Then we used in silico models and found that indeed, the observed gating properties result in more stable APs. Furthermore, the models with human-like channel biophysics were able to reliably encode a larger range of inputs than models with rodent-like biophysics. Based on this we concluded that adaptations in the biophysical gating of Na+ and K+ channels contribute to the computational properties of human neurons. Fast Spiking interneurons (FSINs) are specialized in fast input-to-output conversion. The whole neuron is filled with adaptations that support this fast function. Therefore, this is the perfect neuron to study when interested in the speed limits of neural processing. In the human cortex, neurons are spaced further apart to make space for all the elaborate dendritic and axonal trees, which are much more interconnected than in rodents. This could potentially slow down neural signaling, as signals take time to travel and become weaker and slower over distance. Yet neural signaling seems not to be slow in human neurons. In this chapter, we investigated whether and how human FSINs can retain their fast function. We first characterized the dendritic morphology of these neurons and found that indeed, their dendritic paths are much longer. However, when we made paired recordings we did not find a slowdown of input and output, indicating that some compensatory mechanism must be at play. This could not be explained by sodium channel gating, as we find similar sodium current properties in human and mouse FSINs. Using biophysical modeling we find that a combination of enlarged synaptic inputs, reduced dendritic complexity and fast outputs in human FSINs are responsible for conserving a fast signaling speed even over large distances. In this chapter, we take the concept of cellular properties as important determinant for computational power of neurons and see how that relates to the function of the brain as a whole. Although we know that genetics and thickness of the cortex play an important role in IQ differences between individual humans, we do not know it’s structural and functional basis. In this first-of-its-kind study, we obtained IQ scores as well as cellular measurements from individuals. We find that high IQ score does not only go together with large cortical thickness of the temporal cortex, but also with increased dendritic complexity and fast AP shapes. This provided the first evidence that human intelligence is related to complexity and speed of information exchange between individual neurons. Strikingly, the increase in cortical thickness with IQ was found to be purely specific to layers 2 and 3 of the cortex. Apparently, these cortical layers, which serve as important computational layers between input and output layers, are pivotal for intelligence. We then confirmed that high IQ relates to lower cell density, larger cells, more complex dendrites and faster AP signaling all specifically to the pyramidal neurons in layers 2 and 3. Furthermore, we find that verbal intelligence correlates with all these microstructural and cellular features, but only on left, not right, temporal cortex.

Chapter 1 of this thesis introduces the question of why some individuals possess higher cognitive abilities than others. The chapter discusses traditional strategies employed to study the neurobiology of intelligence: brain imaging to investigate brain structure and function and genome-wide association studies to identify genes associated with intelligence. However, there is little information on how neuronal properties relate to intelligence. We propose that single-cell transcriptomics combined with functional and morphological analysis of neurons in the human neocortex may provide an opportunity to understand how genes of intelligence can act on cortical structure and function contributing to human cognitive ability. In chapter 2 we investigated the association between human intelligence and the structural and physiological properties of neurons. The study utilized electrophysiological recordings of neurosurgically resected temporal cortex in combination with presurgical IQ scores. The results demonstrate that high IQ scores associate with larger temporal cortical thickness and larger, more complex dendrites of pyramidal neurons. In silico analysis reveals that these dendritic trees allow pyramidal neurons to track activity of synaptic inputs with higher temporal precision, due to fast action potential kinetics. The study concludes that human intelligence is associated with neuronal complexity, action potential kinetics, and efficient information transfer from inputs to output within cortical neurons. Chapter 3 investigates whether cortical laminar architecture and cellular properties of the left temporal lobe relate to verbal intelligence by extending our previous findings with histological data and more detailed analysis. The findings indicate that individuals with higher general and verbal IQ scores have thicker left temporal cortex due to the selective increase in layer 2 and 3 thickness, accompanied by lower neuron densities and larger dendrites and cell body size of pyramidal neurons in these layers. These neurons also maintain faster action potential kinetics under pressure, which improves information processing. The study concludes that verbal mental ability associates with selective adaptations of supragranular layers and their cellular micro-architecture and function in the left, but not right, temporal cortex. Chapter 4 explores the genetic basis of human intelligence and how it relates to human brain evolution. The study investigates whether genes associated with human cognition and human accelerated regions (HARs) implicated in human brain evolution are expressed in adult human cortical neurons and brain areas of cognition and how their expression relates to neuronal function and structure. The findings reveal that these gene sets are preferentially expressed in layer 3 excitatory neurons in the middle temporal gyrus (MTG). The study also identifies a subset of genes associated with dendritic length, with predominantly synaptic functions and high abundance of HARs. The results suggest that the mechanisms underlying human brain evolution and interindividual differences in intelligence might share genetic origin and manifest in specific neuronal types. In conclusion, this thesis provides novel insights into the neurobiological basis of intelligence. By investigating the cellular and molecular mechanisms underlying differences in cognitive ability, we have identified specific adaptations in neuronal structure and function that associate with higher IQ scores and verbal mental ability. Our findings suggest that genes implicated in human brain evolution and cognitive function may act on the same biological processes, manifesting in specific neuronal types. This work highlights the potential of integrating single-cell transcriptomics, functional and morphological analysis of neurons, and brain imaging to better understand the complex neurobiology of higher brain functions.

Artificial Intelligence (AI) and machine learning have revolutionized society, impacting everything from search engines and media consumption to loan approval processes. These algorithms are powered by data and can solve problems that have been impossible for humans to solve. In the health sector, the use of AI has been growing exponentially, and investments in data collection and open data are crucial for its progress. The thesis discussed in the article uses ML models on open data sets to address various health-related questions. In chapter 1, the focus is on sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID) and the effect of maternal smoking during pregnancy. By using a glass-box model known as generalized additive models (GAMs), the authors found that SUID risk doubles with any maternal smoking during pregnancy, and each cigarette increases the odds by 0.07, with 22% of SUID deaths in the United States attributed to maternal smoking. In chapters 2 and 3, the authors differentiate between two distinct subpopulations of SUID deaths, depending on the age of the infant at the time of death. In chapter 3, the authors focus on sudden unexpected postnatal collapse (SUPC), a subcategory of SUID, and found that SUPC deaths differed statistically from SUID deaths occurring from 7-364 days of age, highlighting the need for adequate nurse staffing during the immediate recovery period and postpartum stay. Chapters 4 and 5 focus on COVID-19 and the use of open data to infer causality from observational data using synthetic controls and Bayesian structural time series. Chapter 4 analyzes the relationship between vaccination and reducing COVID-19 deaths in Washington state, finding a 27.1% decrease in deaths compared to the synthetic control. In chapter 5, the authors analyze the association between COVID-19 public health measures and the epidemiology of infectious conjunctivitis, finding a 34% decrease in search activity and a 37% decrease in emergency department encounters for infectious conjunctivitis after the adoption of COVID-19-associated public health measures. In conclusion, the use of AI and machine learning in health has immense potential, but investments in data collection and open data are essential. The thesis discussed in the article shows how machine learning can be used to address critical health-related questions and underscores the need for continued investment in this field. AI in health is still in its early stages, and we can expect further advancements in the future.

Evidence of criticality at various levels of neuronal organization has accumulated over the past 2 decades. However, little is known of how criticality affects brain function, whether the critical state is always optimal for information processing, and whether the brain can change its operating point with regards to criticality so as to accommodate varying information processing requirements. Therefore, the aim of this thesis is to elucidate mechanisms that regulate brain criticality and to understand their impact on local and global information processing. We empirically validated that the brain can control the level of criticality via neuromodulation, with implications on perception. Then, we relied on computational modeling to gain full control on the parameters that determine criticality, and tested the implications of the level of criticality on two theories of brain function. Last, since excitation/inhibition balance is known to be a crucial determinant of criticality, which can vary across individuals, but also within subjects across time with neuromodulation, we developed a method to non-invasively estimate the functional E/I ratio.

Primary sensory areas constitute crucial nodes during perceptual decision making. However, it remains unclear to what extent they mainly constitute a feedforward processing step, or rather are continuously involved in a recurrent network together with higher-order areas. We found that the temporal window in which primary visual cortex is required for the detection of identical visual stimuli was extended when task demands were increased via an additional sensory modality that had to be monitored. Late-onset optogenetic inactivation preserved bottom-up, early-onset responses which faithfully encoded stimulus features, and was effective in impairing detection only if it preceded a late, report-related phase of the cortical response. Increasing task demands were marked by longer reaction times and the effect of late optogenetic inactivation scaled with reaction time. Thus, independently of visual stimulus complexity, multisensory task demands determine the temporal requirement for ongoing sensory-related activity in V1, which overlaps with report-related activity.

Neuronal excitation-inhibition (E/I) imbalances are considered an important pathophysiological mechanism in neurodevelopmental disorders. Preclinical studies on tuberous sclerosis complex (TSC), suggest that altered chloride homeostasis may impair GABAergic inhibition and thereby E/I-balance regulation. Correction of chloride homeostasis may thus constitute a treatment target to alleviate behavioral symptoms. Recently, we showed that bumetanide—a chloride-regulating agent—improved behavioral symptoms in the open-label study Bumetanide to Ameliorate Tuberous Sclerosis Complex Hyperexcitable Behaviors trial (BATSCH trial; Eudra-CT: 2016-002408-13). Here, we present resting-state EEG as secondary analysis of BATSCH to investigate associations between EEG measures sensitive to network-level changes in E/I balance and clinical response to bumetanide. EEGs of 10 participants with TSC (aged 8–21 years) were available. Spectral power, long-range temporal correlations (LRTC), and functional E/I ratio (fE/I) in the alpha-frequency band were compared before and after 91 days of treatment. Pre-treatment measures were compared against 29 typically developing children (TDC). EEG measures were correlated with the Aberrant Behavioral Checklist-Irritability subscale (ABC-I), the Social Responsiveness Scale-2 (SRS-2), and the Repetitive Behavior Scale-Revised (RBS-R). At baseline, TSC showed lower alpha-band absolute power and fE/I than TDC. Absolute power increased through bumetanide treatment, which showed a moderate, albeit non-significant, correlation with improvement in RBS-R. Interestingly, correlations between baseline EEG measures and clinical outcomes suggest that most responsiveness might be expected in children with network characteristics around the E/I balance point. In sum, E/I imbalances pointing toward an inhibition-dominated network are present in TSC. We established neurophysiological effects of bumetanide although with an inconclusive relationship with clinical improvement. Nonetheless, our results further indicate that baseline network characteristics might influence treatment response. These findings highlight the possible utility of E/I-sensitive EEG measures to accompany new treatment interventions for TSC.Clinical Trial RegistrationEU Clinical Trial Register, EudraCT 2016-002408-13 (www.clinicaltrialsregister.eu/ctr-search/trial/2016-002408-13/NL). Registered 25 July 2016.

Pharmacological options for neurodevelopmental disorders are limited to symptom suppressing agents that do not target underlying pathophysiological mechanisms. Studies on specific genetic disorders causing neurodevelopmental disorders have elucidated pathophysiological mechanisms to develop more rational treatments. Here, we present our concerted multi-level strategy ‘BRAINMODEL’, focusing on excitation/inhibition ratio homeostasis across different levels of neuroscientific interrogation. The aim is to develop personalized treatment strategies by linking iPSC-based models and novel EEG measurements to patient report outcome measures in individual patients. We focus our strategy on chromatin- and SNAREopathies as examples of severe genetic neurodevelopmental disorders with an unmet need for rational interventions.

IntroductionA new line of insomnia research focuses on the developmental trajectories from early live stress to insomnia in adulthood. Adverse childhood experiences (ACE’s) might create a vulnerability for later maladaptive coping with distress, as seen in chronic hyperarousal or insomnia. In an functional magnetic resonance imaging (fMRI) study, failure to dissociate the neurobiological components of shame from autobiographical shameful memories in insomnia was reflected by continued activation of the dorsal anterior cingulate cortex (dACC), which may be a result of maladaptive coping in the wake of ACE’s. Following up on that study, the current pilot study explores the relation between ACE’s, shame coping-styles, adult insomnia, hyperarousal, and neurobiology of autobiographical memory.MethodsWe used existing data (N = 57) from individuals with insomnia (N = 27) and controls (N = 30), and asked these participants to complete the childhood trauma questionnaire (CTQ). Two structural equation models were used to test the hypotheses that shame-coping styles and insomnia symptom severity mediate the association between ACE’s and (1) self-rated hyperarousal symptoms and (2) dACC activation to recall of autobiographical memories.ResultsFor the association between ACE’s and hyperarousal, there was a significant mediation of shame-coping style (p < 0.05). This model also indicated worse shame coping with more ACE’s (p < 0.05) and worse insomnia symptoms with more ACES’s (p < 0.05), but no association between shame coping and insomnia symptoms (p = 0.154). In contrast, dACC activation to recall of autobiographical memories could only be explained by its direct association with ACE’s (p < 0.05), albeit that in this model more ACE’s were also associated with worse insomnia symptoms.DiscussionThese findings could have an implication for the approach of treatment for insomnia. It could be focused more on trauma and emotional processing instead of conventional sleep interventions. Future studies are recommended to investigate the relationship mechanism between childhood trauma and insomnia, with additional factors of attachment styles, personality, and temperament.

Sleep disturbances, such as insomnia and sleep apnea, are very common following acquired brain injury and have serious consequences. Poor sleep is associated with health problems, mood disturbances and work absenteeism. This thesis focuses specifically on insomnia following a traumatic brain injury or a stroke. For people with acquired brain injury, insomnia may exacerbate all other brain damage related problems, such as cognitive and emotional disturbance, leading to poorer quality of life. Treatment is needed, but to the best of our knowledge, there are no specific guidelines for the treatment of insomnia for people with acquired brain injury yet. In the general population, cognitive behavioral therapy for insomnia (CBT-I) is treatment of choice, and has demonstrated impressive efficacy in multiple randomized controlled trials. Online versions have been developed to reach a larger group of people with insomnia, with comparable efficacy to face-to-face CBT-I. If these findings will also hold for people with acquired brain injury, this could have major benefits.The central question of this thesis is whether cognitive behavioral can be effective for people with traumatic brain injury or a stroke, with a special interest in the efficacy of blended cognitive behavioral therapy, combining face-to-face with online sessions. Based on our systematic review of merely small group studies, we concluded that CBT-I seemed effective for people with insomnia following traumatic brain injury or a stroke. Next, we developed a blended CBT-I intervention (eCBT-I). This intervention was based on standard CBT-I and adjusted to acquired brain injury. The efficacy of the newly developed eCBT-I was evaluated in a pilot SCED study and multicenter RCT. Both experimental studies showed that eCBT-I is feasible and effective with regard to clinical remission and in reducing insomnia severity posttreatment, and positive results remain at follow up compared to baseline. No significant improvement was found on fatigue, emotional well-being, cognitive functioning and societal participation. A cross-sectional study was conducted for a better understanding of the role that sleep-related beliefs and behaviors play in insomnia following acquired brain injury. Results showed that also in people with acquired brain injury, some sleep-related beliefs and behaviors are associated with insomnia severity, especially the beliefs regarding a diminished perception of control and worry about sleep. However, clinicians noted that several sleep-related beliefs and behaviors may not be considered dysfunctional, and may reflect adequate coping with the consequences of the brain injury. Findings of this thesis strengthens the body of evidence of efficacy of CBT-I for people with insomnia following a traumatic brain injury, also when delivered in a blended format. To translate findings of this thesis into clinical practice, a standard screening of insomnia in patients with acquired brain injury is suggested, as is the implementation of CBT-I as treatment of choice. The CBT-I could be delivered face-to-face, completely online or in a blended format. The thesis ends with guidelines how large scale implementation could be facilitated and suggestions for future research.

The high prevalence and severe consequences of poor sleep following acquired brain injury emphasises the need for an effective treatment. However, treatment studies are scarce. The present study evaluates the efficacy of blended online cognitive behavioural therapy for insomnia (eCBT-I) developed specifically for people with acquired brain injury. In a multicentre prospective, open-label, blinded end-point randomised clinical trial, 52 participants with insomnia and a history of a stroke or traumatic brain injury were randomised to 6 weeks of guided eCBT-I or treatment as usual, with a 6-week follow-up. The primary outcome measure was the change in insomnia severity between baseline and after treatment, measured with the Insomnia Severity Index. Results showed that insomnia severity improved significantly more with eCBT-I than with treatment as usual compared to baseline, both at post-treatment (mean [SEM] 4.0 [1.3] insomnia severity index points stronger decrease, d = 0.96, p d = -0.78, p

Sleep bruxism (SB) is a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Sleep bruxism has been linked with insomnia symptoms. Moreover, it has been suggested that there is a positive association between distress and the occurrence of sleep bruxism. However, the occurrence of sleep bruxism and its association with distress have not been studied in patients with insomnia. Therefore, we hypothesised that: (1) the occurrence of sleep bruxism is higher in patients with insomnia than in healthy controls; and (2) the occurrence of sleep bruxism in insomnia patients with moderate to high distress (IMHD) is higher than that in insomnia patients with slight distress (ISD). A total of 44 controls (34 females, 10 males, mean ± SD age = 46.8 ± 14.4 years) and 42 participants with insomnia (35 females, 7 males, mean ± SD age = 51.3 ± 12.1 years) were enrolled in this study. Among 42 participants with insomnia, 20 participants were subtyped as IMHD, 17 participants as ISD. Another five participants were not subtyped due to insufficient information. Group differences in rhythmic masticatory muscle activity (RMMA), a biomarker of sleep bruxism, were evaluated with Mann–Whitney U tests. The medians and interquartile ranges of the RMMA indices were 0.8|1.8|3.3 in controls, 1.1|1.6|2.3 in IMHD and 1.2|1.9|2.9 in ISD. There was no significant difference in the RMMA index, neither between participants with insomnia and controls (P = 0.514) nor between IMHD versus ISD (P = 0.270). The occurrence of RMMA indicators of possible sleep bruxism is not significantly different between individuals with insomnia and controls, nor between IMHD versus ISD.

Visual perception is a creative process. An elaborate hierarchy of interconnected areas processes visual information, while incorporating predictions about the visual scene. How the brain creates the perceptually stable images, is a central question in the field of Neuroscience. This thesis was aimed at addressing fundamental questions on the organizational and computational principles of the visual cortex. We utilized a range of genetic tools, physiological recording techniques, computational procedures, and psychophysics methods to measure and manipulate neuronal activity in behaving mice. A long-standing argument questioning the transferability of research insights from the mouse to human vision has been that the mouse retina lacks a fovea. We demonstrated that the representation of space in mouse visual cortex resembles that in humans in a previously unforeseen manner. We measured cortex-wide population receptive-fields (pRFs) and discovered a region directly in front of, and slightly above the mouse with considerably smaller pRFs, called the ‘focea’. The decrease in pRF size in the focea was not caused by smaller receptive fields (RF) of individual neurons. Instead, a more orderly representation of space and an over-representation of binocular regions cause reduced pRF sizes in the focea. Using behavioral paradigms, we showed that mice have improved visual resolution in the focea and that mice make compensatory eye movements to stabilize this region. These experiments advance our knowledge about organizational principles of the mouse visual system and have important implications for the translatability of research on mouse vision. After examining organizational principles of the visual system, we explored functional properties of the visual cortex, investigating the neural circuits underlying perceptual organization. Perceptual organization describes the grouping of image elements that belong to the same object and segregating these from the (irrelevant) background. It has been shown that the activity of neurons is elevated when their RF lies on a perceptually interesting area, a figure. This phenomenon is known as figure-ground modulation and has been extensively studied in primates. We adapted the paradigm for mice and performed causal tests to probe whether the figural response enhancement in V1 was necessary for perception. We demonstrated that the delayed processing phase, which is dominated by feedback, is crucial for figure-ground perception. We showed that figures elicit stronger activity than the background in multiple higher visual areas, and that this extra activity is fed back to enhance the V1 figure representation. Within V1, figures increased the activity of pyramidal neurons, PV- and VIP-neurons, but decreased the activity of SST-interneurons. This suggests that feedback drives VIP-neurons, which in turn inhibit SST-neurons to disinhibit the cortical column, resulting in an enhanced V1 figure representation. We confirmed the involvement of this disinhibitory microcircuit through optogenetic manipulation of VIP-neuron activity. These results elucidate the neuronal mechanisms for figure-ground modulation and demonstrate how it contributes to perception. In another study, we showed that V1 neurons were robustly activated by stimuli that did not impinge on the classical RF. This purely contextual activation was delayed relative to onset latencies when the RF was stimulated, and the response was strongest in the feedback recipient layers of V1. The three main classes of interneurons were differentially activated, with particularly strong drive of VIP-neurons and weak activation of SST-neurons. Using optogenetics, we identified a VIP-mediated disinhibitory circuit to be involved in generating contextual signals. Finally, we established a relation between contextual drive and the perceptual interpretation of the visual scene. These results provided new insights in the mechanisms for contextual activation in V1. In summary, the experiments described in this thesis examined organizational and functional principles of sensory processing and emphasize the fundamental role of feedback processing in constructing visual experiences.

Neurons in the primary visual cortex (V1) respond to stimuli in their receptive field (RF), which is defined by the feedforward input from the retina. However, V1 neurons are also sensitive to contextual information outside their RF, even if the RF itself is unstimulated. Here, we examined the cortical circuits for V1 contextual responses to gray disks superimposed on different backgrounds. Contextual responses began late and were strongest in the feedback-recipient layers of V1. They differed between the three main classes of inhibitory neurons, with particularly strong contextual drive of VIP neurons, indicating a contribution of disinhibitory circuits to contextual drive. Contextual drive was strongest when the gray disk was perceived as figure, occluding its background, rather than a hole. Our results link contextual drive in V1 to perceptual organization and provide previously unknown insight into how recurrent processing shapes the response of sensory neurons to facilitate figure perception.

Machine learning techniques such as deep learning have been increasingly used to assist EEG annotation, by automating artifact recognition, sleep staging, and seizure detection. In lack of automation, the annotation process is prone to bias, even for trained annotators. On the other hand, completely automated processes do not offer the users the opportunity to inspect the models’ output and re-evaluate potential false predictions. As a first step towards addressing these challenges, we developed Robin’s Viewer (RV), a Python-based EEG viewer for annotating time-series EEG data. The key feature distinguishing RV from existing EEG viewers is the visualization of output predictions of deep-learning models trained to recognize patterns in EEG data. RV was developed on top of the plotting library Plotly, the app-building framework Dash, and the popular M/EEG analysis toolbox MNE. It is an open-source, platform-independent, interactive web application, which supports common EEG-file formats to facilitate easy integration with other EEG toolboxes. RV includes common features of other EEG viewers, e.g., a view-slider, tools for marking bad channels and transient artifacts, and customizable preprocessing. Altogether, RV is an EEG viewer that combines the predictive power of deep-learning models and the knowledge of scientists and clinicians to optimize EEG annotation. With the training of new deep-learning models, RV could be developed to detect clinical patterns other than artifacts, for example sleep stages and EEG abnormalities.

From the very beginning of evolution on, virtually all life forms have developed in an environment where light intensity and temperature cycled at a rate of about 24h. It is therefore not surprising that rhythms of about 24h, i.e., circadian, are integrated in all processes of life, including gene expression, the biochemical processes in a cell, the complex physiology of an organism, its behavior and cognition. A complex system comprising central autonomous oscillators and peripheral slaved damped oscillators is responsible for this circadian modulation of our bodily functions, and is described in detail in other parts of this Encyclopedia. Sleep is one of the states that is under control of the body clock system; sleep is most likely to occur within a specified phase range of the circadian cycle. Homeostasis is the second important factor involved in sleep regulation; the need for sleep increases with the duration of wakefulness. The circadian and homeostatic regulatory systems interact to concertedly regulate the timing of sleep and wakefulness. With increasing age, cracks may start to appear in the functionality of this complex interacting system. For human sleep, this can result in a decreased ability to maintain uninterrupted sleep during the night and an increased probability for napping during the day. Sleep complaints indeed increase with age and are among the most disturbing subjectively judged consequences of getting older. At present, satisfactory pharmacological interventions to improve the sleep–wake rhythm on a daily basis are lacking. The present paper addresses the question whether the human sleep-wake rhythm is still sensitive to its evolutionary oldest environmental modulators or “Zeitgebers”: light and temperature. The focus moreover is on their capacity to support the sleep–wake rhythm of elderly people on a daily basis.

Insomnia disorder has been associated with poor executive functioning. Functional imaging studies of executive functioning in insomnia are scarce and inconclusive. Because the Attentional Network Test relies on well-defined cortical networks and sensitively distinguishes different aspects of executive function, it might reveal brain functional alterations in relatively small samples of patients. The current pilot study assessed functional connectivity during the Attentional Network Test performed using magnetic resonance imaging in 12 participants with insomnia and 13 self-defined good sleepers. ANCOVAs were used to evaluate group differences in performance and functional connectivity in the regions of interest representing the attentional networks (i.e. alerting, orienting and executive control) at p < 0.05, uncorrected. During the orienting part, participants with insomnia showed weaker connectivity of the precentral gyrus with the superior parietal lobe (false discovery rate-corrected), while they showed stronger connectivity between premotor and visual regions. Individual differences in connectivity between premotor and visual regions correlated inversely with reaction time. Reaction times suggested more efficient executive control in participants with insomnia compared with good sleepers. During the executive control part, participants with insomnia showed stronger connectivity of thalamic parts of the arousal circuit with the middle frontal and the occipital gyri. Conversely, connectivity between the inferior and superior frontal gyri was weaker. Participants with insomnia seem to recruit more cortical resources in visuo-motor regions to orient attention than good sleepers do, and seem to have enhanced executive control that relates to stronger connectivity of arousal-related thalamic areas. This latter result should be treated with caution and requires confirmation.

Background: The highest risk of depression is conveyed by insomnia. This risk can be mitigated by sleep interventions. Understanding brain mechanisms underlying increased emotional stability following insomnia treatment could provide insight relevant to the prevention of depression. Here, we investigated how different sleep interventions alter emotion-related brain activity in people with insomnia at high risk of developing depression. Methods: Functional magnetic resonance imaging was used to assess how the amygdala response to emotional stimuli (negative facial expression) in 122 people with insomnia disorder differed from 36 control subjects and how the amygdala response changed after 6 weeks of either no treatment or internet-based circadian rhythm support (CRS), cognitive behavioral therapy for insomnia (CBT-I), or their combination (CBT-I+CRS). Effects on depression, insomnia and anxiety severity were followed up for 1 year. Results: Only combined treatment (CBT-I+CRS) significantly increased the amygdala response, compared with no treatment, CBT-I, and CRS. Individual differences in the degree of response enhancement were associated with improvement of insomnia symptoms directly after treatment (r = −0.41, p = .021). Moreover, exclusively CBT-I+CRS enhanced responsiveness of the left insula, which occurred in proportion to the reduction in depressive symptom severity (r = −0.37, p = .042). Conclusions: This functional magnetic resonance imaging study on insomnia treatment, the largest to date, shows that a combined cognitive, behavioral, and circadian intervention enhances emotional brain responsiveness and might improve resilience in patients with insomnia who are at high risk of developing depression.

In the past decades, actigraphy has emerged as a promising, cost-effective, and easy-to-use tool for ambulatory sleep recording. Polysomnography (PSG) validation studies showed that actigraphic sleep estimates fare relatively well in healthy sleepers. Additionally, round-the-clock actigraphy recording has been used to study circadian rhythms in various populations. To this date, however, there is little evidence that the diagnosis, monitoring, or treatment of insomnia can significantly benefit from actigraphy recordings. Using a case–control design, we therefore critically examined whether mean or within-subject variability of actigraphy sleep estimates or circadian patterns add to the understanding of sleep complaints in insomnia. We acquired actigraphy recordings and sleep diaries of 37 controls and 167 patients with varying degrees of insomnia severity for up to 9 consecutive days in their home environment. Additionally, the participants spent one night in the laboratory, where actigraphy was recorded alongside PSG to check whether sleep, in principle, is well estimated. Despite moderate to strong agreement between actigraphy and PSG sleep scoring in the laboratory, ambulatory actigraphic estimates of average sleep and circadian rhythm variables failed to successfully differentiate patients with insomnia from controls in the home environment. Only total sleep time differed between the groups. Additionally, within-subject variability of sleep efficiency and wake after sleep onset was higher in patients. Insomnia research may therefore benefit from shifting attention from average sleep variables to day-to-day variability or from the development of non-motor home-assessed indicators of sleep quality.

Objectives: Metachromatic leukodystrophy (MLD) has characteristic white matter (WM) changes on brain MRI, which often trigger biochemical and genetic confirmation of the diagnosis. In early or pre-symptomatic disease stages, these typical MRI changes might be absent, hampering early diagnosis. This study aims to describe the characteristics of MRI WM abnormalities at diagnosis, related to clinical presentation. Methods: We retrospectively reviewed brain MRIs of MLD patients followed in 2 centers at the time of diagnosis regarding MLD MRI score and presence of tigroid pattern. In addition, MLD subtype, symptom status, CNS/PNS phenotype, motor/cognitive/mixed phenotype, and the presence of CNS symptoms were evaluated. Results: We included 104 brain MRIs from patients with late-infantile (n = 43), early-juvenile (n = 24), late-juvenile (n = 20) and adult (n = 17) onset. Involvement of the corpus callosum was a characteristic early MRI sign and was present in 71% of the symptomatic late-infantile patients, 94% of the symptomatic early-juvenile patients and 100% of the symptomatic late-juvenile and adult patients. Symptomatic early-juvenile, late-juvenile and adult patients generally had WM abnormalities on MRI suggestive of MLD. By contrast, 47% of the early-symptomatic late-infantile patients had no or only mild WM abnormalities on MRI, even in the presence of CNS symptoms including pyramidal signs. Interpretation: Patients with late-infantile MLD may have no or only mild, nonspecific abnormalities at brain MRI, partly suggestive of ‘delayed myelination’, even with clear clinical symptoms. This may lead to significant diagnostic delay. Knowledge of these early MRI signs (or their absence) is important for fast diagnosis.

The neocortex is disproportionately expanded in human compared with mouse1,2, both in its total volume relative to subcortical structures and in the proportion occupied by supragranular layers composed of neurons that selectively make connections within the neocortex and with other telencephalic structures. Single-cell transcriptomic analyses of human and mouse neocortex show an increased diversity of glutamatergic neuron types in supragranular layers in human neocortex and pronounced gradients as a function of cortical depth3. Here, to probe the functional and anatomical correlates of this transcriptomic diversity, we developed a robust platform combining patch clamp recording, biocytin staining and single-cell RNA-sequencing (Patch-seq) to examine neurosurgically resected human tissues. We demonstrate a strong correspondence between morphological, physiological and transcriptomic phenotypes of five human glutamatergic supragranular neuron types. These were enriched in but not restricted to layers, with one type varying continuously in all phenotypes across layers 2 and 3. The deep portion of layer 3 contained highly distinctive cell types, two of which express a neurofilament protein that labels long-range projection neurons in primates that are selectively depleted in Alzheimer’s disease4,5. Together, these results demonstrate the explanatory power of transcriptomic cell-type classification, provide a structural underpinning for increased complexity of cortical function in humans, and implicate discrete transcriptomic neuron types as selectively vulnerable in disease., Combined patch clamp recording, biocytin staining and single-cell RNA-sequencing of human neurocortical neurons shows an expansion of glutamatergic neuron types relative to mouse that characterizes the greater complexity of the human neocortex.

Objective Insulin resistance (IR), a marker of metabolic dysregulation and pro-inflammatory state, moderates the antidepressant treatment effect in patients with type 2 diabetes (T2D) and is therefore a potential marker for personalized treatment. Based on data from a light therapy trial (NTR4942), we aimed to evaluate whether 1) depression symptoms differ according to the level of IR, and 2) improvement of specific depression symptoms drive the positive effects of light therapy in those with higher IR. Methods This secondary analysis in 59 individuals with depression and T2D explored differences in depressive symptom profile (30-item Inventory of Depressive Symptomatology (IDS)) at baseline and in response to light therapy (versus placebo), between lower and higher IR individuals, using Likelihood Ratio tests and Linear-by-linear association. IR was measured using the gold standard, a hyperinsulinemic-euglycaemic clamp. Results At baseline, higher IR individuals reported more symptoms of irritability (p=0.024) anhedonia (no interest in people and activities: p=0.011; absence of pleasure and enjoyment: p=0.021), fatigue (fatigue: p=0.036; physical fatigue: p=0.035) and hypersomnia (p=0.029) relative to persons with lower IR, who reported more insomnia (nightly awakening: p=0.041; early morning awakening: p=0.012). Light therapy led to an improvement across IDS symptoms in higher IR individuals, while in lower IR individuals, light therapy improved early morning awakening (p=0.005) and interest in people and activities (p=0.015), but worsened mood (feeling sad: p=0.001; feeling irritable: p=0.002; interpersonal sensitivity: p=0.014). Conclusions Results add to the hypothesis of an immune-metabolic subtype of depression, and suggest that IR might be a promising focus for precision medicine.

Adaptive control is the online adjustment of behavior to guide and optimize responses after errors or conflict. The neural circuits involved in monitoring and adapting behavioral performance following error are poorly understood. The prefrontal cortex (PFC) plays a critical role in this form of control. However, these brain areas are densely connected with many other regions, and it is unknown which projections are critical for adaptive behavior. Here, we tested the involvement of four distinct dorsal and ventral prefrontal cortical projections to striatal and thalamic target areas in adaptive control. We re-analyzed data from published experiments, using trial-by-trial analyses of behavior in an operant task for attention and impulsivity. We find that male rats slow their responses and perform worse following errors. Moreover, by combining retrograde labeling and chemogenetic silencing, we find that dorsomedial prefrontal pyramidal neurons that project to the lateral nucleus of the mediodorsal thalamus (MDL) are involved in posterror performance and timing of responses, specifically with unpredictable delays until stimulus presentation. Together, these data show that dorsal medial PFC (mPFC) projection neurons targeting the lateral MDT regulate adaptive control to flexibly optimize behavioral responses in goal-directed behavior.

Vanishing white matter (VWM) is classified as a leukodystrophy with astrocytes as primary drivers in its pathogenesis. Magnetic resonance imaging has documented the progressive thinning of cortices in long-surviving patients. Routine histopathological analyses, however, have not yet pointed to cortical involvement in VWM. Here, we provide a comprehensive analysis of the VWM cortex. We employed high-resolution-mass-spectrometry-based proteomics and immunohistochemistry to gain insight into possible molecular disease mechanisms in the cortices of VWM patients. The proteome analysis revealed 268 differentially expressed proteins in the VWM cortices compared to the controls. A majority of these proteins formed a major protein interaction network. A subsequent gene ontology analysis identified enrichment for terms such as cellular metabolism, particularly mitochondrial activity. Importantly, some of the proteins with the most prominent changes in expression were found in astrocytes, indicating cortical astrocytic involvement. Indeed, we confirmed that VWM cortical astrocytes exhibit morphological changes and are less complex in structure than control cells. Our findings also suggest that these astrocytes are immature and not reactive. Taken together, we provide insights into cortical involvement in VWM, which has to be taken into account when developing therapeutic strategies.

The development of validated algorithms for automated handling of artifacts is essential for reliable and fast processing of EEG signals. Recently, there have been methodological advances in designing machine-learning algorithms to improve artifact detection of trained professionals who usually meticulously inspect and manually annotate EEG signals. However, validation of these methods is hindered by the lack of a gold standard as data are mostly private and data annotation is time consuming and error prone. In the effort to circumvent these issues, we propose an iterative learning model to speed up and reduce errors of manual annotation of EEG. We use a convolutional neural network (CNN) to train on expert-annotated eyes-open and eyes-closed resting-state EEG data from typically developing children (n= 30) and children with neurodevelopmental disorders (n= 141). To overcome the circular reasoning of aiming to develop a new algorithm and benchmarking to a manually-annotated gold standard, we instead aim to improve the gold standard by revising the portion of the data that was incorrectly learned by the network. When blindly presented with the selected signals for re-assessment (23% of the data), the two independent expert-annotators changed the annotation in 25% of the cases. Subsequently, the network was trained on the expert-revised gold standard, which resulted in improved separation between artifacts and nonartifacts as well as an increase in balanced accuracy from 74% to 80% and precision from 59% to 76%. These results show that CNNs are promising to enhance manual annotation of EEG artifacts and can be improved further with better gold-standard data.

BACKGROUND: The formation and retrieval of fear memories depends on orchestrated synaptic activity of neuronal ensembles within the hippocampus, and it is becoming increasingly evident that astrocytes residing in the environment of these synapses play a central role in shaping cellular memory representations. Astrocyte distal processes, known as leaflets, fine-tune synaptic activity by clearing neurotransmitters and limiting glutamate diffusion. However, how astroglial synaptic coverage contributes to mnemonic processing of fearful experiences remains largely unknown.METHODS: We used electron microscopy to observe changes in astroglial coverage of hippocampal synapses during consolidation of fear memory in mice. To manipulate astroglial synaptic coverage, we depleted ezrin, an integral leaflet-structural protein, from hippocampal astrocytes using CRISPR (clustered regularly interspaced short palindromic repeats)/Cas9 gene editing. Next, a combination of Föster resonance energy transfer analysis, genetically encoded glutamate sensors, and whole-cell patch-clamp recordings was used to determine whether the proximity of astrocyte leaflets to the synapse is critical for synaptic integrity and function.RESULTS: We found that consolidation of a recent fear memory is accompanied by a transient retraction of astrocyte leaflets from hippocampal synapses and increased activation of NMDA receptors. Accordingly, astrocyte-specific depletion of ezrin resulted in shorter astrocyte leaflets and reduced astrocyte contact with the synaptic cleft, which consequently boosted extrasynaptic glutamate diffusion and NMDA receptor activation. Importantly, after fear conditioning, these cellular phenotypes translated to increased retrieval-evoked activation of CA1 pyramidal neurons and enhanced fear memory expression.CONCLUSIONS: Together, our data show that withdrawal of astrocyte leaflets from the synaptic cleft is an experience-induced, temporally regulated process that gates the strength of fear memories.

Borderline personality disorder (BPD) is a highly disabling psychiatric disorder with emotion dysregulation at its core, resulting in affective instability, impulsivity and sometimes self-harming or suicidal behavior. Sleep is increasingly recognized to play a crucial role in emotion regulation. BPD patients often suffer from (severe) insomnia, potentially aggravating symptoms and preventing recovery from BPD. Yet, the effects of insomnia treatments have not been investigated in context of BPD. Guided internet-based cognitive behavioral therapy for insomnia (iCBT-I; i-Sleep) has been proven effective in improving both insomnia and affective symptoms. In this randomized controlled trial among 96 patients with a DSM-5 diagnosis of BPD (or other personality disorder with ≥4 BPD traits) and insomnia symptoms, we will test the effectiveness of iCBT-I before regular BPD treatment starts, during the waitlist period, on BPD symptoms. Patients in the control group monitor their sleep through a sleep diary during the waitlist period and also receive standard BPD treatment after that. Using linear mixed models we will test the hypothesis that the iCBT-I group improves more than the control group on BPD symptoms (primary outcome), insomnia severity, additional subjective and objective sleep variables, emotion regulation, comorbid anxiety and depression complaints, and quality of life. These effects are thought to arise from a direct effect of improved sleep on emotion regulation and a synergistic effect on the consolidation and internalization of the BPD treatment effect. To our knowledge, this is the first trial assessing effectiveness of CBT-I in patients with BPD (traits). The accessibility of the studied intervention greatly facilitates clinical implication in case of positive results.

Introduction: Vanishing white matter (VWM) is a leukodystrophy that leads to neurological dysfunction and early death. Astrocytes are indicated as therapeutic target, because of their central role in VWM pathology. Previous cell replacement therapy using primary mouse glial precursors phenotypically improved VWM mice. Aims: The aim of this study was to determine the translational potential of human stem cell-derived glial cell replacement therapy for VWM. We generated various glial cell types from human pluripotent stem cells in order to identify a human cell population that successfully ameliorates disease hallmarks of a VWM mouse model. The effects of cell grafts on motor skills and VWM brain pathology were assessed. Results: Transplantation of human glial precursor populations improved the VWM phenotype. The intrinsic properties of these cells were partially reflected by cell fate post-transplantation, but were also affected by the host microenvironment. Strikingly, the spread of transplanted cells into the white matter versus the gray matter was different when grafted into the VWM brain as compared to a healthy brain. Conclusions: Transplantation of human glial cell populations can have therapeutic effects for VWM. For further translation to the clinic, the microenvironment in the VWM patient brain should be considered as an important moderator of cell replacement therapy.

Background: Evidence-based interventions to improve the sleep–wake rhythm, mood and behaviour in older adults with intellectual disabilities (ID) are limited. Increasing light exposure has been shown to be effective in improving the sleep–wake rhythm, mood, and behaviour in other populations. The current study investigates the effect of installing environmental dynamic lighting in common living rooms of care facilities on sleep–wake rhythm, mood, and behaviour in older adults with ID. Methods: A non-randomised, non-concurrent, multiple baseline study was performed from October 2017 to May 2018. Fifty-four participants [mean (SD) age of 63.42 (8.6) years, 65% female] in six care facilities were included. All participants had three baseline measurements (Weeks 1, 5 and 9). Dynamic lighting was installed in Week 10, after which three intervention measurements took place (Weeks 12, 17 and 24). Sleep characteristics and the sleep–wake rhythm were assessed using actigraphy (GENEActiv). Mood was measured with the Anxiety, Depression and Mood Scale (ADAMS) and behaviour with the Aberrant Behaviour Checklist (ABC). Results: Mixed-effect regression analysis showed a worsening of the primary outcome interdaily stability (P = 0.001). This could be attributed to one care facility, whereas interdaily stability did not change in the other care facilities (P = 0.74). Dynamic lighting led to earlier mid-sleep (P = 0.003) and sleep onset (P P P = 0.004) subscales. The prevalence of screening above cut-off for depression decreased from 23 to 9.8% (OR =.16, P = 0.003). For behaviour, a decrease was seen in hyperactivity (−0.43 SD, P P = 0.008) and irritability (−0.33 SD, P

Proteostasis is essential for cellular survival and particularly important for highly specialised post-mitotic cells such as neurons. Transient reduction in protein synthesis by protein kinase R-like endoplasmic reticulum (ER) kinase (PERK)-mediated phosphorylation of eukaryotic translation initiation factor 2α (p-eIF2α) is a major proteostatic survival response during ER stress. Paradoxically, neurons are remarkably tolerant to PERK dysfunction, which suggests the existence of cell type-specific mechanisms that secure proteostatic stress resilience. Here, we demonstrate that PERK-deficient neurons, unlike other cell types, fully retain the capacity to control translation during ER stress. We observe rescaling of the ATF4 response, while the reduction in protein synthesis is fully retained. We identify two molecular pathways that jointly drive translational control in PERK-deficient neurons. Haem-regulated inhibitor (HRI) mediates p-eIF2α and the ATF4 response and is complemented by the tRNA cleaving RNase angiogenin (ANG) to reduce protein synthesis. Overall, our study elucidates an intricate back-up mechanism to ascertain translational control during ER stress in neurons that provides a mechanistic explanation for the thus far unresolved observation of neuronal resilience to proteostatic stress.

Objective: Vanishing white matter (VWM) is a leukodystrophy, characterized by stress-sensitive neurological deterioration and premature death. It is currently without curative treatment. It is caused by bi-allelic pathogenic variants in the genes encoding eukaryotic initiation factor 2B (eIF2B). eIF2B is essential for the regulation of the integrated stress response (ISR), a physiological response to cellular stress. Preclinical studies on VWM mouse models revealed that deregulated ISR is key in the pathophysiology of VWM and an effective treatment target. Guanabenz, an α2-adrenergic agonist, attenuates the ISR and has beneficial effects on VWM neuropathology. The current study aimed at elucidating guanabenz's disease-modifying potential and mechanism of action in VWM mice. Sephin1, an ISR-modulating guanabenz analog without α2-adrenergic agonistic properties, was included to separate effects on the ISR from α2-adrenergic effects. Methods: Wild-type and VWM mice were subjected to placebo, guanabenz or sephin1 treatments. Effects on clinical signs, neuropathology, and ISR deregulation were determined. Guanabenz's and sephin1's ISR-modifying effects were tested in cultured cells that expressed or lacked the α2-adrenergic receptor. Results: Guanabenz improved clinical signs, neuropathological hallmarks, and ISR regulation in VWM mice, but sephin1 did not. Guanabenz's effects on the ISR in VWM mice were not replicated in cell cultures and the contribution of α2-adrenergic effects on the deregulated ISR could therefore not be assessed. Interpretation: Guanabenz proved itself as a viable treatment option for VWM. The exact mechanism through which guanabenz exerts its ameliorating impact on VWM requires further studies. Sephin1 is not simply a guanabenz replacement without α2-adrenergic effects.

Background Bumetanide is a selective NKCC1 chloride importer antagonist which is being repurposed as a mechanism-based treatment for neurodevelopmental disorders (NDDs). Due to their specific actions, these kinds of interventions will only be effective in particular subsets of patients. To anticipate stratified application, we recently completed three bumetanide trials each focusing on different stratification strategies with the additional objective of deriving the most optimal endpoints. Here we publish the protocol of the post-trial access combined cohort study to confirm previous effects and stratification strategies in the trial cohorts and in new participants. Method/design Participants of the three previous cohorts and a new cohort will be subjected to 6 months bumetanide treatment using multiple baseline Single Case Experimental Designs. The primary outcome is the change, relative to baseline, in a set of patient reported outcome measures focused on direct and indirect effects of sensory processing difficulties. Secondary outcome measures include the conventional questionnaires ‘social responsiveness scale’, ‘repetitive behavior scale’, ‘sensory profile’ and ‘aberrant behavior scale’. Resting-state EEG measurements will be performed at several time-points including at Tmax after the first administration. Assessment of cognitive endpoints will be conducted using the novel Emma Tool box, an in-house designed battery of computerized tests to measure neurocognitive functions in children. Discussion This study aims to replicate previously shown effects of bumetanide in NDD subpopulations, validate a recently proposed treatment prediction effect methodology and refine endpoint measurements. Trial registration EudraCT: 2020–002196-35, registered 16 November 2020, https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-002196-35/NL

BACKGROUND: Cocaine-associated environments (i.e., contexts) evoke persistent memories of cocaine reward and thereby contribute to the maintenance of addictive behavior in cocaine users. From a therapeutic perspective, enhancing inhibitory control over cocaine-conditioned responses is of pivotal importance but requires a more detailed understanding of the neural circuitry that can suppress context-evoked cocaine memories, e.g., through extinction learning. The ventral medial prefrontal cortex (vmPFC) and dorsal medial prefrontal cortex (dmPFC) are thought to bidirectionally regulate responding to cocaine cues through their projections to other brain regions. However, whether these mPFC subregions interact to enable adaptive responding to cocaine-associated contextual stimuli has remained elusive.METHODS: We used antero- and retrograde tracing combined with chemogenetic intervention to examine the role of vmPFC-to-dmPFC projections in extinction of cocaine-induced place preference in mice. In addition, electrophysiological recordings and optogenetics were used to determine whether parvalbumin-expressing inhibitory interneurons and pyramidal neurons in the dmPFC are innervated by vmPFC projections.RESULTS: We found that vmPFC-to-dmPFC projecting neurons are activated during unreinforced re-exposure to a cocaine-associated context, and selective suppression of these cells impairs extinction learning. Parvalbumin-expressing inhibitory interneurons in the dmPFC receive stronger monosynaptic excitatory input from vmPFC projections than local dmPFC pyramidal neurons, consequently resulting in disynaptic inhibition of pyramidal neurons. In line with this, we show that chemogenetic suppression of dmPFC parvalbumin-expressing inhibitory interneurons impairs extinction learning.CONCLUSIONS: Our data reveal that vmPFC projections mediate extinction of a cocaine-associated contextual memory through recruitment of feed-forward inhibition in the dmPFC, thereby providing a novel neuronal substrate that promotes extinction-induced inhibitory control.

Vanishing white matter (VWM) is a leukodystrophy caused by recessive variants in subunits of eIF2B. At present, no curative treatment is available and patients often die at young age. Due to its monogenic nature, VWM is a promising candidate for the development of CRISPR/Cas9-mediated gene therapy. Here we tested a dual-AAV approach in VWM mice encoding CRISPR/Cas9 and a DNA donor template to correct a pathogenic variant in Eif2b5. We performed sequencing analysis to assess gene correction rates and examined effects on the VWM phenotype, including motor behavior. Sequence analysis demonstrated that over 90% of CRISPR/Cas9-induced edits at the targeted locus are insertion or deletion (indel) mutations, rather than precise corrections from the DNA donor template by homology-directed repair. Around half of the CRISPR/Cas9-treated animals died prematurely. VWM mice showed no improvement in motor skills, weight, or neurological scores at 7 months of age, and CRISPR/Cas9-treated controls displayed an induced VWM phenotype. In conclusion, CRISPR/Cas9-induced DNA double-strand breaks (DSBs) at the Eif2b5 locus did not lead to sufficient correction of the VWM variant. Moreover, indel formation in Eif2b5 induced an exacerbated VWM phenotype. Therefore, DSB-independent strategies like base- or prime editing might better suited for VWM correction., Molecular Therapy - Methods & Clinical Development, 25, ISSN:2329-0501

The left temporal lobe is an integral part of the language system and its cortical structure and function associate with general intelligence. However, whether cortical laminar architecture and cellular properties of this brain area relate to verbal intelligence is unknown. Here, we addressed this using histological analysis and cellular recordings of neurosurgically resected temporal cortex in combination with presurgical IQ scores. We find that subjects with higher general and verbal IQ scores have thicker left (but not right) temporal cortex (Brodmann area 21, BA21). The increased thickness is due to the selective increase in layers 2 and 3 thickness, accompanied by lower neuron densities, and larger dendrites and cell body size of pyramidal neurons in these layers. Furthermore, these neurons sustain faster action potential kinetics, which improves information processing. Our results indicate that verbal mental ability associates with selective adaptations of supragranular layers and their cellular micro-architecture and function in left, but not right temporal cortex.

Temporal lobe epilepsy (TLE) patients are at risk of memory deficits, which have been linked to functional network disturbances, particularly of integration of the default mode network (DMN). However, the cellular substrates of functional network integration are unknown. We leverage a unique cross-scale dataset of drug-resistant TLE patients (n = 31), who underwent pseudo resting-state functional magnetic resonance imaging (fMRI), resting-state magnetoencephalography (MEG) and/or neuropsychological testing before neurosurgery. fMRI and MEG underwent atlas-based connectivity analyses. Functional network centrality of the lateral middle temporal gyrus, part of the DMN, was used as a measure of local network integration. Subsequently, non-pathological cortical tissue from this region was used for single cell morphological and electrophysiological patch-clamp analysis, assessing integration in terms of total dendritic length and action potential rise speed. As could be hypothesized, greater network centrality related to better memory performance. Moreover, greater network centrality correlated with more integrative properties at the cellular level across patients. We conclude that individual differences in cognitively relevant functional network integration of a DMN region are mirrored by differences in cellular integrative properties of this region in TLE patients. These findings connect previously separate scales of investigation, increasing translational insight into focal pathology and large-scale network disturbances in TLE.