Michael J. Prerau

Electroencephalogram signatures of loss and recovery of consciousness from propofol

Significance Anesthesiologists reversibly manipulate the brain function of nearly 60,000 patients each day, but brain-state monitoring is not an accepted practice in anesthesia care because markers that reliably track changes in level of consciousness under general anesthesia have yet to be identified. We found specific behavioral and electrophysiological changes that mark the transition between consciousness and unconsciousness induced by propofol, one of the most commonly used anesthetic drugs. Our results provide insights into the mechanisms of propofol-induced unconsciousness and establish EEG signatures of this brain state that could be used to monitor the brain activity of patients receiving general anesthesia. Unconsciousness is a fundamental component of general anesthesia (GA), but anesthesiologists have no reliable ways to be certain that a patient is unconscious. To develop EEG signatures that track loss and recovery of consciousness under GA, we recorded high-density EEGs in humans during gradual induction of and emergence from unconsciousness with propofol. The subjects executed an auditory task at 4-s intervals consisting of interleaved verbal and click stimuli to identify loss and recovery of consciousness. During induction, subjects lost responsiveness to the less salient clicks before losing responsiveness to the more salient verbal stimuli; during emergence they recovered responsiveness to the verbal stimuli before recovering responsiveness to the clicks. The median frequency and bandwidth of the frontal EEG power tracked the probability of response to the verbal stimuli during the transitions in consciousness. Loss of consciousness was marked simultaneously by an increase in low-frequency EEG power (<1 Hz), the loss of spatially coherent occipital alpha oscillations (8–12 Hz), and the appearance of spatially coherent frontal alpha oscillations. These dynamics reversed with recovery of consciousness. The low-frequency phase modulated alpha amplitude in two distinct patterns. During profound unconsciousness, alpha amplitudes were maximal at low-frequency peaks, whereas during the transition into and out of unconsciousness, alpha amplitudes were maximal at low-frequency nadirs. This latter phase–amplitude relationship predicted recovery of consciousness. Our results provide insights into the mechanisms of propofol-induced unconsciousness, establish EEG signatures of this brain state that track transitions in consciousness precisely, and suggest strategies for monitoring the brain activity of patients receiving GA.

A comparison of propofol- and dexmedetomidine-induced electroencephalogram dynamics using spectral and coherence analysis.

Background:Electroencephalogram patterns observed during sedation with dexmedetomidine appear similar to those observed during general anesthesia with propofol. This is evident with the occurrence of slow (0.1 to 1 Hz), delta (1 to 4 Hz), propofol-induced alpha (8 to 12 Hz), and dexmedetomidine-induced spindle (12 to 16 Hz) oscillations. However, these drugs have different molecular mechanisms and behavioral properties and are likely accompanied by distinguishing neural circuit dynamics. Methods:The authors measured 64-channel electroencephalogram under dexmedetomidine (n = 9) and propofol (n = 8) in healthy volunteers, 18 to 36 yr of age. The authors administered dexmedetomidine with a 1-µg/kg loading bolus over 10 min, followed by a 0.7 µg kg−1 h−1 infusion. For propofol, the authors used a computer-controlled infusion to target the effect-site concentration gradually from 0 to 5 &mgr;g/ml. Volunteers listened to auditory stimuli and responded by button press to determine unconsciousness. The authors analyzed the electroencephalogram using multitaper spectral and coherence analysis. Results:Dexmedetomidine was characterized by spindles with maximum power and coherence at approximately 13 Hz (mean ± SD; power, −10.8 ± 3.6 dB; coherence, 0.8 ± 0.08), whereas propofol was characterized with frontal alpha oscillations with peak frequency at approximately 11 Hz (power, 1.1 ± 4.5 dB; coherence, 0.9 ± 0.05). Notably, slow oscillation power during a general anesthetic state under propofol (power, 13.2 ± 2.4 dB) was much larger than during sedative states under both propofol (power, −2.5 ± 3.5 dB) and dexmedetomidine (power, −0.4 ± 3.1 dB). Conclusion:The results indicate that dexmedetomidine and propofol place patients into different brain states and suggest that propofol enables a deeper state of unconsciousness by inducing large-amplitude slow oscillations that produce prolonged states of neuronal silence.

Characterizing learning by simultaneous analysis of continuous and binary measures of performance

Continuous observations, such as reaction and run times, and binary observations, such as correct/incorrect responses, are recorded routinely in behavioral learning experiments. Although both types of performance measures are often recorded simultaneously, the two have not been used in combination to evaluate learning. We present a state-space model of learning in which the observation process has simultaneously recorded continuous and binary measures of performance. We use these performance measures simultaneously to estimate the model parameters and the unobserved cognitive state process by maximum likelihood using an approximate expectation maximization (EM) algorithm. We introduce the concept of a reaction-time curve and reformulate our previous definitions of the learning curve, the ideal observer curve, the learning trial and between-trial comparisons of performance in terms of the new model. We illustrate the properties of the new model in an analysis of a simulated learning experiment. In the simulated data analysis, simultaneous use of the two measures of performance provided more credible and accurate estimates of the learning than either measure analyzed separately. We also analyze two actual learning experiments in which the performance of rats and of monkeys was tracked across trials by simultaneously recorded reaction and run times and the correct and incorrect responses. In the analysis of the actual experiments, our algorithm gave a straightforward, efficient way to characterize learning by combining continuous and binary measures of performance. This analysis paradigm has implications for characterizing learning and for the more general problem of combining different data types to characterize the properties of a neural system.

A mixed filter algorithm for cognitive state estimation from simultaneously recorded continuous and binary measures of performance

Continuous (reaction times) and binary (correct/ incorrect responses) measures of performance are routinely recorded to track the dynamics of a subject’s cognitive state during a learning experiment. Current analyses of experimental data from learning studies do not consider the two performance measures together and do not use the concept of the cognitive state formally to design statistical methods. We develop a mixed filter algorithm to estimate the cognitive state modeled as a linear stochastic dynamical system from simultaneously recorded continuous and binary measures of performance. The mixed filter algorithm has the Kalman filter and the more recently developed recursive filtering algorithm for binary processes as special cases. In the analysis of a simulated learning experiment the mixed filter algorithm provided a more accurate and precise estimate of the cognitive state process than either the Kalman or binary filter alone. In the analysis of an actual learning experiment in which a monkey’s performance was tracked by its series of reaction times, and correct and incorrect responses, the mixed filter gave a more complete description of the learning process than either the Kalman or binary filter. These results establish the feasibility of estimating cognitive state from simultaneously recorded continuous and binary performance measures and suggest a way to make practical use of concepts from learning theory in the design of statistical methods for the analysis of data from learning experiments.

Phase-based measures of cross-frequency coupling in brain electrical dynamics under general anesthesia

The state of general anesthesia (GA) is associated with an increase in spectral power in scalp electroencephalogram (EEG) at frequencies below 40 Hz, including spectral peaks in the slow oscillation (SO, 0.1–1 Hz) and α (8–14 Hz) bands. Because conventional power spectral analyses are insensitive to possible cross-frequency coupling, the relationships among the oscillations at different frequencies remain largely unexplored. Quantifying such coupling is essential for improving clinical monitoring of anesthesia and understanding the neuroscience of this brain state. We tested the usefulness of two measures of cross-frequency coupling: the bispectrum-derived SynchFastSlow, which is sensitive to phase-phase coupling in different frequency bands, and modulogram analysis of coupling between SO phase and α rhythm amplitude. SynchFastSlow, a metric that is used in clinical depth-of-anesthesia monitors, showed a robust correlation with the loss of consciousness at the induction of propofol GA, but this could be largely explained by power spectral changes without considering cross-frequency coupling. Modulogram analysis revealed two distinct modes of cross-frequency coupling under GA. The waking and two distinct states under GA could be discriminated by projecting in a two-dimensional phase space defined by the SynchFastSlow and the preferred SO phase of α activity. Our results show that a stereotyped pattern of phase-amplitude coupling accompanies multiple stages of anesthetic-induced unconsciousness. These findings suggest that modulogram analysis can improve EEG based monitoring of brain state under GA.

Tracking the sleep onset process: an empirical model of behavioral and physiological dynamics.

The sleep onset process (SOP) is a dynamic process correlated with a multitude of behavioral and physiological markers. A principled analysis of the SOP can serve as a foundation for answering questions of fundamental importance in basic neuroscience and sleep medicine. Unfortunately, current methods for analyzing the SOP fail to account for the overwhelming evidence that the wake/sleep transition is governed by continuous, dynamic physiological processes. Instead, current practices coarsely discretize sleep both in terms of state, where it is viewed as a binary (wake or sleep) process, and in time, where it is viewed as a single time point derived from subjectively scored stages in 30-second epochs, effectively eliminating SOP dynamics from the analysis. These methods also fail to integrate information from both behavioral and physiological data. It is thus imperative to resolve the mismatch between the physiological evidence and analysis methodologies. In this paper, we develop a statistically and physiologically principled dynamic framework and empirical SOP model, combining simultaneously-recorded physiological measurements with behavioral data from a novel breathing task requiring no arousing external sensory stimuli. We fit the model using data from healthy subjects, and estimate the instantaneous probability that a subject is awake during the SOP. The model successfully tracked physiological and behavioral dynamics for individual nights, and significantly outperformed the instantaneous transition models implicit in clinical definitions of sleep onset. Our framework also provides a principled means for cross-subject data alignment as a function of wake probability, allowing us to characterize and compare SOP dynamics across different populations. This analysis enabled us to quantitatively compare the EEG of subjects showing reduced alpha power with the remaining subjects at identical response probabilities. Thus, by incorporating both physiological and behavioral dynamics into our model framework, the dynamics of our analyses can finally match those observed during the SOP.

A general likelihood framework for characterizing the time course of neural activity

We develop a general likelihood-based framework for use in the estimation of neural firing rates, which is designed to choose the temporal smoothing parameters that maximize the likelihood of missing data. This general framework is algorithm-independent and thus can be applied to a multitude of established methods for firing rate or conditional intensity estimation. As a simple example of the use of the general framework, we apply it to the peristimulus time histogram and kernel smoother, the methods most widely used for firing rate estimation in the electrophysiological literature and practice. In doing so, we illustrate how the use of the framework can employ the general point process likelihood as a principled cost function and can provide substantial improvements in estimation accuracy for even the most basic of rate estimation algorithms. In particular, the resultant kernel smoother is simple to implement, efficient to compute, and can accurately determine the bandwidth of a given rate process from individual spike trains. We perform a simulation study to illustrate how the likelihood framework enables the kernel smoother to pick the bandwidth parameter that best predicts missing data, and we show applications to real experimental spike train data. Additionally, we discuss how the general likelihood framework may be used in conjunction with more sophisticated methods for firing rate and conditional intensity estimation and suggest possible applications.

Characterizing context-dependent differential firing activity in the hippocampus and entorhinal cortex.

The rat hippocampus and entorhinal cortex have been shown to possess neurons with place fields that modulate their firing properties under different behavioral contexts. Such context‐dependent changes in neural activity are commonly studied through electrophysiological experiments in which a rat performs a continuous spatial alternation task on a T‐maze. Previous research has analyzed context‐based differential firing during this task by describing differences in the mean firing activity between left‐turn and right‐turn experimental trials. In this article, we develop qualitative and quantitative methods to characterize and compare changes in trial‐to‐trial firing rate variability for sets of experimental contexts. We apply these methods to cells in the CA1 region of hippocampus and in the dorsocaudal medial entorhinal cortex (dcMEC), characterizing the context‐dependent differences in spiking activity during spatial alternation. We identify a subset of cells with context‐dependent changes in firing rate variability. Additionally, we show that dcMEC populations encode turn direction uniformly throughout the T‐maze stem, whereas CA1 populations encode context at major waypoints in the spatial trajectory. Our results suggest scenarios in which individual cells that sparsely provide information on turn direction might combine in the aggregate to produce a robust population encoding.

Beamforming approach to phase-amplitude modulation analysis of multi-channel EEG

Phase-amplitude modulation is a form of cross frequency coupling where the phase of one frequency influences the amplitude of another higher frequency. It has been observed in neurophysiological recordings during sensory, motor, and cognitive tasks, as well as during general anesthesia. In this paper, we describe a novel beamforming procedure to improve estimation of phase-amplitude modulation. We apply this method to 64-channel EEG data recorded during propofol general anesthesia. The method improves the sensitivity of phase-amplitude analyses, and can be applied to a variety of multi-channel neuroscience data where phase-amplitude modulation is present.

A probabilistic framework for time-frequency detection of burst suppression

General anesthesia is a drug-induced, reversible condition comprised of hypnosis, amnesia, analgesia, akinesia, and autonomic stability. During the deepest levels of anesthesia, burst suppression is observed in the EEG, which consists of alternating periods of bursting and isoelectric activity. By accurately tracking anesthesia-induced burst suppression, it may be possible to provide a higher level of care for patients receiving general anesthesia. We develop a probabilistic framework for detecting burst suppression events. The algorithm uses multinomial regression to estimate the probability of burst, suppression, and artifact states at each time given EEG frequency-domain data. We test the efficacy of this method on clinical EEG acquired during operating room surgery with GA under propofol.