Clinical correlates of brain-stem auditory evoked potential variables in multiple sclerosis. Relation to click polarity

The correlations between clinical signs and BAEP latency, amplitude and dispersion variables were investigated in 98 multiple sclerosis patients. A new dispersion variable, the wave IV–V “shape ratio” (SR IV–V), correlated most strongly with brain-stem signs (i.e., nystagmus). Severely reduced wave IV–V amplitude was frequently found in patients with vertical nystagmus or internuclear ophthalmoplegia, and interpeak latency (IPL) III–V correlated most strongly with cerebellar dysfunction (i.e., ataxia). The results may reflect different localizing ability among the various BAEP variables.The association between ataxia and increased IPL III–V was significantly stronger for BAEP to C clicks than to R clicks. Patients with abnormal BAEPs to one polarity (C or R) but not to the other, had significantly more clinical dysfunction than patients with normal BAEPs to both C and R clicks. Hence, C vs. R discordance may be interpreted to indicate possible brain-stem dysfunction.     

The interaction between sex and click polarity in brain-stem auditory potentials evoked from control subjects of Oriental and Caucasian origin

Brain-stem auditory evoked potentials (BAEPs) were performed on 30 male and 30 female young normal Oriental subjects, using both condensation and rarefaction stimulation. The effects of sex and click polarity on the BAEP latencies and amplitudes were studied. Females had shorter absolute and interpeak latencies and higher absolute amplitudes than the males. These sex-related BAEP differences were independent of the click polarity. Rarefaction clicks produced shorter wave I latency and longer I–III interpeak latency, but the differences were significant in the female only. The polarity-related BAEP amplitude differences were essentially independent of the sex. BAEPs performed on 60 sex- and age-matched young Caucasian subjects produced similar results. The importance of establishing control BAEP values according to the sex and click polarity is emphasised.     

Methods for determining auditory evoked brain-stem response thresholds in human newborns

Previous investigators have reported that newborn auditory evoked brain-stem responses (ABRs) are 20–30 dB higher than adult psychophysical thresholds to the same stimuli. These investigators reduced the intensity of the stimulus until they no longer reported an ABR to the stimulus. We adapted 2 widely used psychophysical methods, the up-down-transformed response (UDTR) method and the method of constant stimuli, for ABR threshold determination of human newborns. Response judgments were made blindly. ABR thresholds of healthy normal newborns by both procedures were no more than 10–15 dB higher than adult psychophysical thresholds. The differences between the newborn ABR thresholds we reported and those in the literature were probably explained by different procedures including the method used to estimate adult psychophysical thresholds. The correlations between ABR thresholds and suprathreshold ABR latencies and amplitudes and latency and amplitude/intensity functions were modest at best. In normal newborns suprathreshold ABR measurements are of little value in predicting ABR thresholds.     

Age-dependent amplitude variation of brain-stem auditory evoked potentials

Normative amplitude values of brain-stem auditory evoked potential (BAEP) components are given for normally hearing subjects at 1, 10, 30, 50 and 70 years of age, with an intragroup age variation of only ±6 months. Under these circumstances amplitude standard deviations decreased to less than 20% of the mean values. In contrast with the reduced evolution of latency with age, BAEP amplitude (for components I–V) undergoes a greater oscillation during ontogeny. With the exception of component I, it increased markedly from 1 year to 10 years of age and decreased thereafter constantly up to 50 years, with a mean rate of 10 nV yearly. The decrease slowed down between 50 and 70 years. The amplitude differences between the subgroups are highly significant statistically (P < 0.01). Possible reasons for these changes are discussed.     

Diagnostic role of brain-stem auditory evoked potentials in neurobrucellosis

Evoked potential audiometry and brain-stem auditory evoked potentials were evaluated in 15 patients with systemic brucellosis in whom brucella meningitis was suspected clinically. In 8 patients cerebrospinal fluid (CSF) was abnormal with high brucella titre, and evoked potentials were abnormal in all of them. In 7 patients the CSF was normal and evoked potentials were also normal. Brain-stem auditory evoked potential abnormalities were categorised into 4 types: (1) abnormal wave I, (2) abnormal wave V, both irreversible, (3) prolonged I–III interpeak latencies, and (4) prolonged I–V interpeak latencies, both reversible. These findings are of important diagnostic value and correlate well with the clinical features, aetiopathogenesis and final outcome.     

Classification of brain-stem auditory evoked potentials by syntactic methods

A syntactic pattern recognition procedure for classification of brain-stem auditory evoked potential (BSAEP) is presented. A pre-processing stage of zero-phase bandpass filtering enhances the peaks and suppresses the noise. A finite-state grammar was designed to identify the peaks. Attributes of the peaks (latencies and amplitudes) that are identified are checked for their acceptability. A training run in 70 subjects of known diagnosis was perfomed finr-tune the system and build up necessary acceptance criteria. Peak latency differences are used for the classification rather than absolute peak latencies. Acceptance criteria for peak latency differences were empirically optimized. A data base of normal BSAEPs, created during the training run, was updated and used during the test run. Test of the classifier using 60 subjects yielded a classification accuracy of 83%. The classifier has acceptable accuracy and can be modified for other evoked potentials such as visual and somatosensory by establishing relevant attribute tables.     

Chronic effects of phenytoin on brain-stem auditory evoked potentials in man

The effects of phenytoin (PHT) on brain-stem auditory evoked potentials (BAEPs) were studied in 65 epileptic patients who received long-term PHT monotherapy at therapeutic and supra-therapeutic levels with no clinical evidence of brain-stem toxicity. Abnormal BAEPs were found in 7.5% and 33.3% of patients with therapeutic and supra-therapeutic PHT levels respectively. Serum PHT levels had a trend towards a positive relationship with the I–V interpeak latency (IPL), and a significant negative relationship with the amplitudes of waves I and V. at supra-therapeutic levels, both I–V and I–III IPLs were significantly prolonged while at therapeutic evels onl I–III IPLs were prolonged. The absolute latency of wave I was prolonged in both the therapeutic and the supra-therapeutic groups. These results suggest that PHT acts both peripherally on either the auditory nerve or the cochlea, and centrally on brain-stem conduction.     

Contributions from the auditory nerve to the brain-stem auditory evoked potentials (BAEPs): results of intracranial recording in man

Intraoperative recordings obtained from electrodes placed on the scalp (vertex and earlobe or ear canal) in response to click stimulation were compared with recordings made directly from the auditory nerve in patients undergoing microvascular decompression (MVD) operations to relieve hemifacial spasm (HFS) and disabling positional vertigo (DPV). The results support earlier findings that show that the auditory nerve is the generator of both peak I and peak II in man, and that it is the intracranial portion of the auditory nerve that generates peak II. The results indicate that the second negative peak in the potentials recorded from the earlobe is generated by the auditory nerve where it passes through the porus acusticus into the skull cavity, and that the proximal portion of the intracranial portion of the auditory nerve generates a positive peak in the potentials that are recorded from the vertex. This peak appears with a latency that is slightly longer than that of the second negative peak in the potentials recorded from the earlobe (or ear canal). The second negative peak in the recording from the ear canal and the positive peak in the vertex recording contribute to peak II in the differentially recorded BAEP. Since our results indicate that the difference in the latency of the second negative peak in the recording from the earlobe and that of the positive peak in the vertex recording represents the neural travel time in the intracranial portion of the auditory nerve, this measure may be valuable in the differential diagnosis of eighth nerve disorders such as vascular compression syndrome.     

Differential impact of hypothermia and pentobarbital on brain-stem auditory evoked responses

Two experiments were conducted to determine the effects of hypothermia and pentobarbital anesthesia, alone and in combination, on the brain-stem auditory evoked responses (BAERs) of rats. In experiment I, unanesthetized rats were cooled to colonic temperatures 0.5 and 1.0°C below normal. In experiment II, 2 groups of rats were cooled and tested at 37.5, 36.0, 34.5 and 31.5°C. One group was anesthetized during testing and the other group was awake. The rat BAER was sensitive to cooling of 1°C or less. Peak latencies were prolonged and peak-to-peak amplitudes were increased by hypothermia alone. The effect on amplitude may be related to the time course of temperature change or to stimulus level. Pentobarbital significantly affected both latencies and amplitudes over and above the effects of cooling. The specific effects of pentobarbital differed by BAER peak and by temperature. The findings point up the importance of the potential confound of anesthetic drugs in most of the evoked potential literature on hypothermia and, for the first time, quantify the complex interactions between pentobarbital and temperature which affect the BAER wave form.     

Effects of cocaine on the brain-stem auditory evoked potential in the Long-Evans rat

The present study examined the effects of an acute psychoactive dose of cocaine hydrochloride (HCl) in the rat, using the brain-stem auditory potential (BAEP) as an objective, quantitative measure of this substance's effects on brain and auditory electrophysiology. The animals were 8 adult Long-Evans rats (4 female, 4 male). BAEPs were recorded from skull screw electrodes during a baseline period as well as 30–90 min after cocaine HCl treatment (10 mg/kg, i.p.). Normothermia was maintained to control for possible temperature-related effects. Cocaine's effects on the BAEP were examined over a broad range of stimulus intensities (intensity profiles) and repetition rates (rate profiles). Cocaine prolonged latencies of several BAEP components at low stimulus intensities and shortened these latencies at high stimulus intensities. The average BAEP threshold was alos increased by cocaine treatment. These results were not strong, but were suggestive of a recruitment type change in auditory function. Cocaine treatment had no convincing effects on the BAEP as a function of stimulus repetition rate.     

The effect of click rate on latency and interpeak interval of the brain-stem auditory evoked potentials in children from birth to 6 years

Latency and interpeak interval of the brain-stem auditory evoked potentials at different click rates were measured in 80 healthy children from birth to 6 years, and 21 adults. Clicks were presented at 10, 30, 50, 70 and 90/sec, and 70, 40 and 20 db HL. At high stimulus intensity (70 dB SL), all latencies of waves I, III and V and the I–V, I–III and III–V intervals showed a progressive prolongation with increasing repetition rate. The latency- and the interval-rate functions were similar for all age groups but their slopes were slightly steeper in younger than in older. As click rate increased from 10/sec to 90/sec, the latencies of waves I, III and V at different age groups were prolonged by 4–10%, 9–13% and 12–15% respectively, and the intervals of I–V, I–III and III–V were prolonged by 15–16%, 8–16% and 14–24% respectively. The mean increments of wave V latency and I–V interval in different age groups were 0.404–0.575 and 0.332–0.526 msec respectively with increasing click rate from 10 to 50/sec, and 0.697–1.009 and 0.629–0.776 msec respectively with increasing click rate from 10 to 90/sec. The younger the age the larger the absolute increments for all these BAEP parameters, but the increasing rates for a BAEP measure were similar among different age groups, exhibiting no age-dependent differences. The III–V/I–III interval ration in most age groups was increased by 3–10% with increasing click rate from 10 to 90/sec, suggesting that the III–V interval was affected by stimulus rate slightly more than I–III interval.At moderate (40 dB HL) and low (20 dB SL) intensity, all waves and intervals showed similar latency- and interval-rate functions to those at high intensity. This demonstrates that the shifting latencies and interpeak intervals with increasing click rate appeared to be independent of the stimulus intensities.     

Evaluation of brain-stem auditory evoked potentials using dynamic time warping

Dynamic time warping is a procedure whereby portions of a temporal sequence of values are stretched or shrunk to make it similar to another sequence. This procedure can be used to align the brain-stem auditory evoked potentials recorded from different subjects prior to averaging. The resultant warp-average more closely resembles the wave form of a typical subject than the conventional average. Dynamic time warping can also be used to compare one brain-stem auditory evoked potential to another. This comparison can show the differences that result from changes in a stimulus parameter such as intensity or repetition rate. When a patient's wave form is compared to a normal template, warping can identify the peaks in the patient's wave form that correspond most closely to the peaks in the normal template. Compared to an experienced human interpreter, warping is very accurate in identifying the waves of normal brain-stem auditory evoked potentials (error rate between 0 and 4%) and reasonably accurate in identifying the peaks in abnormal wave forms (error rate between 3 and 18%).     

Neuroanatomic correlations with the late waves of the brain-stem auditory evoked potential

The goal of this study was to investigate the neuroanatomic correlations of the late waves (VI–VIII) of the BAEP. Patients (N = 55) with clinical evidence of a CVA were compared to a normal control group (N = 85). Latencies of > 3 S.D. from the means of the normal group were considered abnormal. CT and MRI scans provided evidence of the lesions. For the 14 patients who had normal BAEPs, the sizes of lesions were significantly smaller than for those with abnormal tests. Evidence shows that an abnormal wave VI was related to an ipsilateral cortical lesion and an abnormal wave VIII was related to a lesion in the internal capsule-corpus striatum.     

A dipole localization method in analyzing the auditory brain-stem evoked potential]

The localization of generators of brainstem auditory evoked response (BAER) has been studied in one patient using the method of dipole localization based on the spatial distribution of BAER over the surface of the head. It has been found that in formation of all BAER waves the activity of several generators overlaps. It is especially marked for the peaks I', II', III and III'--their potential distribution can not be described by single-dipole model, thus preventing the defining of their generation site. Distribution of potential for other peaks corresponds to the single-dipole model. The coordinates of the equivalent sources of these peaks are in the vicinity of the auditory structures: I--near the distal part of the auditory nerve, II--near the auditory nerve in the place of its entering the brainstem, V--near contralateral auditory pontine structures, V--near lateral lemniscus while V', VI and VI'--near mesencephalic auditory structures.     

The origin of the human auditory brain-stem response wave II

Auditory brain-stem responses (ABRs) were recorded from human subjects undergoing neurosurgical procedures which exposed the auditory nerve. Scalp recordings indicated that the latency of the negativity between waves (I_n) and II (I_n) and the latency of positive peak II (II_p) were shorter when the nerve was suspended in air than when the nerve was submerged in cerebrospinal fluid or saline, while earlier and later waves remained unaffected. These results could not be attributed to changes in stimulus or recording parameters or conduction velocity. Computational and somatosensory experimental evidence of stationary potentials generated by physical properties of the volume conductor, including changes in conductivity or geometry, are presented to develop a model of wave II_p generation. The results of this study suggest that wave II_p (and probably I_n) are manifestations of current flux asymmetries across conductivity boundaries created by the temporal bone-cerebrospinal fluid intradural space-brain-stem interfaces. The current flux asymmetries are generated as the propagating auditory nerve action potential crosses the conductivity boundaries. These results also indicate that the physical characteristics of the volume conductor and neural pathways must be considered when interpreting surface recorded evoked potentials.     

High-rate sequential sampling of auditory brain-stem and somatosensory evoked responses in hypoxia

We developed a high-rate sequential recording technique that allowed simultaneous measurements of both auditory brain-stem response (ABR) and somatosensory evoked potential (SEP) every 10 sec. Using this method, a transient increase in amplitude of all the ABR and SEP components in response to hypoxia in dogs could be detected. The increase in amplitude preceded the prolongation of latency. Our study showed that there were succesive changes of evoked potentials in response to hypoxia. A transient increase in amplitude is the first to occur, followed by a latency prolongation and an amplitude decrease for both ABRs and SEPs.     

Three-channel Lissajous' trajectory of the binaural interaction components in human auditory brain-stem evoked potentials

The 3-channel Lissajous' trajectory (3-CLT) of the binaural interaction components (BI) in auditory brain-stem evoked potentials (ABEPs) was derived from 17 normally hearing adults by subtracting the response to binaural clicks (B) from the algebraic sum of monaural responses (L + R). ABEPs were recorded in response to 65 dB nHL, alternating polarity clicks, presented at a rate of 11/sec. A normative set of BI 3-CLT measures was calculated and compared with the corresponding measures of simultaneously recorded, single-channel vertex-left mastoid and vertex-neck derivations of BI and of ABEP L+R and B. 3-CLT measures included: apex latency, amplitude and orientation, as well as planar segment duration and orientation.The results showed 3 apices and associated planar segments (“Bd_II,” “Be” and “Bf”) in the 3-CLT of BI which corresponded in latency to the vertex-mastoid and vertex-neck peaks IIIn, V and VI of ABEP L + R and B. These apices corresponded in latency and orientation to apices of the 3-CLT of ABEP L + R and ABEP B. This correspondence suggests generators of the BI components between the trapezoid body and the inferior colliculus output. Durations of BI planar segments were approximately 1.0 msec. Apex amplitudes of BI 3-CLT were larger than the respective peak amplitudes of the vertex-mastoid and vertex-neck recorded BI, while their intersubject variabilities were comparable.