Scalp-recorded oscillatory potentials evoked by transient pattern-reversal visual stimulation in man

Replicable oscillatory potentials, time-locked to pattern stimuli (9.0° central; counterphase reversal at 2.13 Hz) were dissociated from conventional, broad-band VEPs recorded in healthy volunteers at occipital scalp locations by high-pass digital filtering at 17.0–20.0 Hz. Nine consecutive wavelets were identified with a 56.4 ± 8.4 msec mean latency of the first replicable wavelet and mean peak-to-peak amplitude varying between 0.9 and 2.0 μV. The first 2 wavelets had significantly shorter latencies than wave N70 of unfiltered VEP, whereas the last 2 wavelets had longer latencies than N145. Latency and amplitude values varied as a function of contrast and spatial frequency of the stimulus, with shorter latencies and larger amplitudes at 60–90% contrast level and tuning of amplitude at 5.0 c/deg. All wavelets were correlated with wave P100 of unfiltered VEP, while a correlation with N70 of VEP was observed only for those wavelets with latencies in the range of wave P100. Two patients with documented brain lesions involving the visual system are described as examples of oscillatory responses occurring irrespective of filter bandpass and instead of the expected conventional VEP when the generation of these is interfered with by brain pathology. A substantial cortical contribution to the origin of the oscillatory response is conceivable. It is suggested that the oscillatory response to pattern-reversal stimulation reflects events in the visual system that are parallel to, and partly independent of, the conventional VEP, with potential application in research or for clinical purposes.     

The phases of visual cortex and hippocampal evoked potentials in rabbit reflect the orienting reaction in case of visual stimuli intensity changes

The oddball paradigm was applied in experiments with waking rabbits using rare (deviant) and frequent (standard) stimuli, which were similar in color but different in intensity, deviant ones being of lower intensity. In addition, the VEPs to the single deviants were averaged. Such single deviants (without standard stimuli) were given at the beginning and at the end of the stimulation. The positivity of cortical and hippocampal visual evoked potentials to deviant stimuli increased in comparison to responses to standards and single deviants. The VEP-peaks P1 and P2 in the visual cortex and the VEP P1, N1 and P2 peaks in hippocampus increased. The most prominent significant changes were demonstrated for cortical VEP P2 (P130) peak. It is suggested that the increase of positivity to oddball deviants is due to the orienting reflex arising in response to rare stimuli. The increase of P2-peak can be connected with the transfer of information signaling changes of light intensity. It was demonstrated that the most clear and contrast differences in the VEPs to deviants and standards took place for the case of minimal distinction in their intensities. This fact may reflect the orienting reactionto threshold stimuli.     

Subclinical VEP abnormalities in patients on chronic deferoxamine therapy: longitudinal studies

As deferoxamine (DFO) appeared to have certain toxic effects on the sensory pathways in some of our patients on nightly subcutaneous deferoxamine (DFO) for transfusion-dependent anemia, treatment was stopped in all of these patients to obtain a comprehensive baseline assessment of sensory function. Visual evoked potentials (VEPs) were studied in all patients; the 77 described in this report all had normal ophthalmological examinations. Abnormally prolonged VEP lantecies were found in 21%. The patients remained off DFO for 2–6 months, and most of those with abnormal VEPs who were retested showed improvement in their VEPs over this period with the VEPs returning to within normal range in half the cases; two showed no change. Since restarting DFO, VEP latencies in 10 of these patients have increased again beyond normal limits, as have the VEPs in 7 who had previously normal VEPs. Although most of the 77 patients have VEPs that are currently normal and stable while on DFO, a significant sub-group have abnormal VEPs that appear sensitive to the administration of DFO and may reflect a vulnerability to DFO neurotoxicity. These data suggest that the VEPs can detect subclinical toxic effects of DFO on the visual system and should be considered as a monitor for patients receiving chronic DFO therapy.     

Multichannel visual evoked potentials in migraine

Multichannel recordings of visual evoked potentials (VEPs) have proved to be useful in the evaluation of visual field defects. We studied the topographic distribution of transient VEPs in 15 migraine patients (8 with visual aura and 7 without) and 15 age-matched controls during the migraine-free interval. All the subjects included in the study had normal visual fields. VEPs were recorded from 9 electrodes placed on the posterior scalp. Stimuli were full-field and hemifield reversing square wave grating patterns of medium spatial frequency (4 c/deg). The groups did not show significant differences in latencies and amplitudes of the major components (N70, P100) recorded from the midline. However, migraine patients with visual hemianopic aura showed definite asymmetries in the VEP amplitude distribution. Significantly reduced, absent or polarity-invered VEP responses were recorded ipsilateral to the side of the prodromic visual symptoms. Direct comparison of affected and unaffected hemispheres by partial field stimulation confirmed these findings. According to the VEP cortical generator theory, these abnormalities suggest a functional anomaly consistent with the clinical syndrome and detectable also in the migraine-free interval. None of the migraine patients without aura or the controls showed VEP amplitude asymmetries. We conclude that multichannel VEP recordings may discriminate between different subtypes of migraine and contribute important physiopathological information to the study of this disease.     

Effects of chlorpromazine on pattern and flash ERGs and VEPs compared to oxazepam and to placebo in normal subjects

Antidopaminergic drugs delay the pattern-reversal VEP (P-VEP) and the flash VEP (F-VEP) and, in separate studies, reductions in the amplitude and increases in the latencies of scotopic ERGs have been reported. This study investigated the effects of chlorpromazine (CPZ) on the pattern ERG (P-ERG), P-VEP, flash ERGs and VEPs and oscillatory potentials (OPs). Normal volunteers (N = 15) were administered a placebo, or a single dose of CPZ 100 mg or oxazepam (OZP) 15 mg at weekly intervals, in a double-blind crossover design. A gold foil-ipsilateral ear derivation and an Oz′-Fz derivation were used for the ERG and VEP recordings, respectively. The latencies of ‘mixed’ and cone ERGs were significantly prolonged after CPZ compared to both placebo and to OZP. Amplitudes of rod- and cone-dominated ERGs were reduced following CPZ administration. All components of the OPs were significantly delayed after CPZ administration. No significant intertreatment differences were found in the F-VEP results. The P-ERG P50 peak and the P-VEP N70 and P100 peaks were significantly delayed after CPZ in the case of 28′ checks but not 55′ checks. Retinocortical times and P-ERG and P-VEP amplitudes were not significantly affected. In contrast to CPZ, the administration of OZP had virtually no significant effects compared to placebo. These findings suggest that the antidopaminergic CPZ has a primary effect on retinal electrophysiology. Similar findings have been reported in Parkinson's disease and in animal models.     

Clinical Utility and Limitations of Intraoperative Monitoring of Visual Evoked Potentials

Objectives

During surgeries that put the visual pathway at risk of injury, continuous monitoring of the visual function is desirable. However, the intraoperative monitoring of the visual evoked potential (VEP) is not yet widely used. We evaluate here the clinical utility of intraoperative VEP monitoring.

Methods

We analyzed retrospectively 46 consecutive surgeries in 2011-2013. High luminance stimulating devices delivered flash stimuli on the closed eyelid during intravenous anesthesia. We monitored VEP features N75 and P100 and took patients'' preoperative and postoperative visual function from patient charts. Postoperative ophthalmologic workup was performed in 25 (54%) patients and preoperatively in 28 (61%) patients.

Results

VEP recordings were feasible in 62 of 85 eyes (73%) in 46 patients. All 23 eyes without VEP had impaired vision. During surgery, VEPs remained stable throughout surgery in 50 eyes. In 44 of these, visual function did not deteriorate and three patients (6 eyes) developed hemianopia. VEP decreased transiently in 10 eyes and visual function of all was preserved. VEPs were lost permanently in 2 eyes in two patients without new postoperative visual impairment.

Conclusions

Satisfactory intraoperative VEP monitoring was feasible in all patients except in those with severe visual impairment. Preservation of VEPs predicted preserved visual function. During resection of lesions in the visual cortex, VEP monitoring could not detect new major visual field defects due to injury in the posterior visual pathway. Intraoperative VEPs were sensitive enough to detect vascular damage during aneurysm clipping and mechanical manipulation of the anterior visual pathway in an early reversible stage. Intraoperative VEP monitoring influenced surgical decisions in selected patients and proved to be a useful supplement to the toolbox of intraoperative neurophysiological monitoring.     

Visual evoked potential in guinea pigs

The present study was designed to establish visual evoked potential (VEP) as one of clinical tests for veterinary medicine. Experiments were carried out on eight adult male guinea pigs weighed 350 to 750 g. We investigated influences of click sound, luminous intensity and habituation on VEP patterns. The VEP of the guinea pig was composed of primary (P 10, N 20, P 30, N 40) and secondary (P 55, N 75, P 100, N 140) components, followed by a rhythmic after-discharge. Click sound with flash produced some unclear peaks in VEP, while click sound without flash elicited clear six peaks. These different components of the response to stimulation suggested that the acoustically evoked potential induced some peaks in VEP. With the intensity used in the present study, changes in luminous intensity resulted in unrecognizable difference among the VEPs. Early components of VEP were not clearly influenced by the habituation to stimulation. As the stimulation was repeated, rhythmic after-discharge seemed to be suppressed in the half of experiments.     

Utility of visual evoked potentials using hemifield stimulation and several check sizes in the evaluation of suspected multiple sclerosis

One hundred and eleven patients with suspected multiple sclerosis (64 possible, 47 probable) and 16 with a definite diagnosis of MS were evaluated with pattern-reversal visual evoked potentials (VEPs), employing monocular full-field checks subtending 7′, 14′ and 28′ of visual angle, and right and left hemifield 28′ checks. Thirty-seven patients (29%) had a completely normal study. Sixty-six patients (52%) had abnormal responses to full-field 28′ checks, and in 13 (10%) of these, additional abnormalities were found in one or more of the other test conditions, which indicated the presence of an additional site of dysfunction in the visual pathway. Twenty-four patients (19%) with ‘normal’ full-field 28′ response had abnormalities in one or more of the other test conditions; these included prolonged latency to small size (7′ and 14′) full-field checks, abnormal responses in homonymous hemifields, and abnormal responses limited to a hemifield of one eye. Thus, the use of several check sizes and hemifield stimulation not only increases the sensitivity of VEPs in the evaluation of patients with suspected demyelinating disease, but enhances the capability of the VEP to demonstrate more than one area of visual system impairment.     

Chromatic and achromatic visual evoked potentials in Parkinson's disease

Chromatic and achromatic visual evoked potentials (VEP) were evaluated in 39 patients with idiopathic Parkinson's disease (PD) (age 64.0 ± 8.6 years) and 43 healthy controls (age 62.8 ± 8.7 years). The following pattern-reversal checkerboard stimuli were performed: (1) achromatic with luminance contrast 86% (achr.hk.); (2) achromatic with luminance contrast 20% (achr.lk.); (3) chromatic isoluminant blue-yellow (by.); (4) chromatic isoluminant red-green (rg.). The mean latencies N70, P100, and N135 of chromatic and achromatic VEP were significantly delayed in patients with PD as compared to controls. The highest rate (41.0%) of pathological findings could be demonstrated by achromatic stimulation (luminance contrast 86%). Isolated abnormalities of chromatic VEP (in combination with normal achromatic VEP) were found in 5 (12.8%) patients. The delay of VEP-latencies was significantly correlated with the severity of motor symptoms in PD patients. We conclude that VEP are valuable tools to demonstrate a dysfunction of the visual system in PD. Although chromatic VEP are less sensitive than achromatic VEP, the combination of both will increase the diagnostic yield. Therefore, there seems to exist a variety of individual characters of visual impairment in PD.     

Mapped distribution of pattern reversal VEPs to central field and lateral half-field stimuli of different spatial frequencies

Visual evoked potentials (VEPs) to pattern reversal vertical bar stimuli of 3 different sizes (1, 2, 4 c/deg) were recorded from 19 scalp derivations in 50 controls. The stimuli were presented on a full-field (FF) screen of 24° visual angle, and on left and right half-fields (HF) of 12° radius. In 15 controls partial HF stimuli were presented on the central 3 and 6° and as hemiannular stimuli of 12° with occlusion of the central 3 and 6°.An antero-posterior polarity reversal of the N1-P1-N2 sequence was observed for FF VEPs. A tangential polarity reversal was observed for HF VEPs. Also with central or hemiannular stimuli polarity reversals of all VEP components were observed within the scalp.Variants of VEP distribution, absence of prominence of some of the ipsi- or contralateral VEP components were observed in 8–40% of controls.The FF and HF VEP distribution, and the variant VEP asymmetries were partly dependent on the pattern spatial frequency.     

Delayed visual evoked potentials are independent of pattern orientation in macular disease

Visual evoked potentials (VEPs) and contrast sensitivity (CS) were studied in patients affected by maculopathy. VEP delays and CS reduction were demonstrated in each affected eye. In distinction to patients affected by multiple sclerosis (MS), in maculopathy patients VEP latency is independent of the orientation of the grating stimulus. It is proposed that stimulating with more than one pattern orientation is useful in the differential diagnostic use of VEPs.     

A neurophysiologically-based mathematical model of flash visual evoked potentials

Evidence is presented that a neurophysiologically-inspired mathematical model, originally developed for the generation of spontaneous EEG (electroencephalogram) activity, can produce VEP (visual evoked potential)-like waveforms when pulse-like signals serve as input. It was found that the simulated VEP activity was mainly due to intracortical excitatory connections rather than direct thalamic input. Also, the model-generated VEPs exhibited similar relationships between prestimulus EEG characteristics and subsequent VEP morphology, as seen in human data. Specifically, the large correlation between the N1 amplitude and the prestimulus alpha phase angle, and the insensitivity of P2 to the latter feature, as observed in actual VEPs to low intensity flashes, was also found in the model-generated data. These findings provide support for the hypothesis that the spontaneous EEG and the VEP are generated by some of the same neural structures and that the VEP is due to distributed activity, rather than dipolar sources.     

Effects of age and sex on pattern electroretinograms and visual evoked potentials

Pattern-electroretinograms (P-ERGs) and visual evoked potentials (VEPs) were simulataneously recorded in 112 normal individuals aged 20–75. Two sized checks subtending 15′ and 31′ were used as stimuli. A weighted regression analysis was used to determine which of the variables, sex or age, was significant. The latency of the a and b wave of the P-ERGs showed a progressive increase with age but no difference between sexes. The effect was statistically significant for both 15′ and 31′ checks. There was no statistically significant aging effects for VEPs elicited by 31′ checks. Aging, however, affected N70, P100, and the interpeak interval between b wave to N70 and b wave to P100 for responses to 15′ checks. Shorter VEP latencies were noted in females for both 15′ and 31′ checks.The simultaneous recording of P-ERGs and VEPs has demonstrated that aging is a major variable at the retinal level. The effects on the a and b waves are mostly due to optic changes with aging and only partially to aging changes in the neuronal retinal circuitry. The effect of aging on VEPs is different for different size stimuli. The cause is a random neuronal cell loss in the visual pathways from the optic nerve to the visual cortex as the individual ages.The difference in VEP data between sexes may be related to anatomical size and hormonal influences.     

Three-dimensional human pattern visual evoked potentials. II. Multiple sclerosis patients

Pattern visual evoked potentials were obtained from 46 patients with definite relapsing/remitting multiple sclerosis, using both a conventional 5-channel occipital array and a 3-D recording technique consisting of three bipolar derivations approximating the three dimensions of space. These three orthogonal wave forms were displayed as a 3-D Lissajous trajectory for each subject. Two of the 15 patients with completely normal conventional pattern VEPs had abnormalities of the orientation of the B-C curvilinear segment of the 3-D pattern VEPs. Delays in the first major occipital positive component (P100) were evident using both techniques; the correlation between P100 latency and the latency of the corresponding trajectory apex was r = 0.99 (P < 0.01). Post-chiasmal MRI abnormalities were associated with 3-D VEP orientation abnormalities. Three-dimensional pattern VEPs are moderately more sensitive than conventional pattern VEPs at detecting dysfunction posterior to the optic chiasm in demyelinating disease and do not require the use of eccentric fixation to do so.     

Changes in visual evoked potentials after phosphene electrostimulation in children suffering from myopia

We recorded visual evoked potentials (VEPs) in children suffering from medium and high myopia (3.0 to 6.0 and more than 6.0 D; 28 and 21 patients, respectively); a light flash was used as the stimulus. The VEPs were recorded before and after a curative course of phosphene electrostimulation (PhES; frequency 15 sec⁻¹, 10 to 15 10-min-long everyday sessions). The above course resulted in clear trends toward decreases in the peak latencies of the P60 and P100 VEP components; changes in the latencies of other components were expressed to a lesser extent. In children with medium myopia, the latency of the P60 component decreased, on average, by more than 21% (P < 0.05); in patients with high myopia, the respective decrease was about 12% (P > 0.05). These shifts were accompanied by increases in the mean amplitudes of the P60 and, to a lesser degree, P100 (more expressed in medium myopia). The data obtained allow us to suppose that the PhES course provides increases in the transmission velocity through relay structures of the visual analyzer and in neuronal networks of the visual cortex and also in the number of neuronal units whose activity is reflected in generation of VEPs. Application of the PhES technique is much more effective in relatively moderate myopia. Neirofiziologiya/Neurophysiology, Vol. 40, No. 3, pp. 228–235, May–June, 2008.     

Effects of chronic high serum levels of phenobarbital on evoked potentials in epileptic children

We studied VEP and BAEP in 8 epileptic children with chronic high serum levels of phenobarbital. Records were obtained when the drug serum level was more than 40 mg/l and repeated when serum concentrations was within the normal range. During the periods of high levels, P2 latency of the VEP was abnormally increased in all cases but one. The mean P2 latency decreased according to the reduction of the serum level of phenobarbital (139.6 msec vs. 110.1 msec, P = 0.002), and a significant regression coefficient (r = 0.546, P = 0.0271) w also noted between P2 latency and drug serum concentration. BAEPs were normal in all cases but one, who had a coexisting high level of phenytoin.All these findings suggest that the pharmacological effect of phenobarbital may be detected by VEPs and may result in delay of the P2 component.     

Prognostic value of visual evoked potentials in occipital blindness following basilar artery occlusion.

Three patients suffering from sudden occipital blindness following basilar artery occlusion underwent electroretinography and visual evoked potential (VEP) examinations. The VEPs performed early in those blind patients and repeated later seem to be of prognostic value. Responses of normal shape and amplitude after monocular and binocular stimulation were followed by complete recovery of vision. Unequal and subnormal VEPs obtained following monocular stimulation, and even smaller responses reached after binocular stimulation, accompanied permanent unilateral occipital damage resulting in homonymous hemianopsia. Lack of VEP was proved to be a preceding sign of permanent blindness.     

Visual evoked potentials in the vicinity of the optic tract during stereotactic pallidotomy

We recorded visual evoked responses in eight patients with Parkinson's disease, using a depth electrode either at or below the stereotactic target in the ventral part of the globus pallidus internus (GPi), which is located immediately dorsal to the optic tract. Simultaneously, scalp visual evoked potentials (VEPs) were also recorded from a mid-occipital electrode with a mid-frontal reference electrode. A black-and-white checkerboard pattern was phase reversed at 1 Hz; check size was 50 min of arc. Pallidal VEPs to full field stimulation showed an initial positive deflection, with a latency of about 50 ms (P50), followed by a negativity with a mean latency of 80 ms (N80). The mean onset latency of P50 was about 30 ms. P50 and N80 were limited to the ventralmost of the GPi and the ansa lenticularis. Left half field stimulation evoked responses in the right ansa lenticularis region while right half field stimulation did not, and vice versa. These potentials thus seemed to originate posterior to the optic chiasm. The scalp VEPs showed typical triphasic wave forms consisting of N75, P100 and N145. The location of the recording electrode in the ansa lenticularis region did not modify the scalp VEP. These results suggest that P50 and N80 are near-field potentials reflecting the compound action potentials from the optic tract. Therefore, N75 of the scalp VEPs may represent an initial response of the striate cortex but not of the lateral geniculate nucleus.     

Visual evoked potentials in response to dichoptic presentation of sinusoidal grating and noise background

Dichoptic stimulation was used in comparison of visual evoked potentials (VEPs) with those obtained with monocular stimulation (recordings made from the occipital area). 16 subjects viewed sinusoidal gratings with the right eye while a visual noise was added via a mirror for the left eye. In presence of the noise, amplitude of the early VEP components' N1, P1b, and the late component P2 decreased, P1a is not changed in presence of the noise, and the late negative wave N2 increased for all spatial frequencies. The effect of noise on the amplitude of VEPs obtained for monocular and dichoptic stimulation was similar. The data suggest that external noise is filtered by the V1 cortical neurons--matched filters for the gratings.     

Age-related changes in pattern visual evoked potentials: differential effects of luminance,contrast and check size

We recorded visual evoked potentials (VEPs) to checkerboard pattern-reversal stimulation in 109 normal subjects (51 males and 59 females; aged 19–84 years) in order to study the aging effect on the multiple channels of the visual system in humans. Transient VEPs to 3 check sizes (15′, 30′ and 50′) were obtained by monocular stimulation. Two test conditions were employed: (1) a high luminance (180 cd/m²) and a low luminance (11 cd/m²) both with a fixed contrast (90%), and (2) a high contrast (85%) and a low contrast (10%) both at a fixed luminance (57 cd/m²). The major features of our results included: (1) the presence of a curvilinear relationship between P100 latency and age for all conditions, while the P100 amplitude did not show any such aging effect, (2) the age-latency function was similar between the two luminance conditions, while it was different between the two contrast conditions, and (3) the differential age effect on the P100 latency caused by changes in contrast depended on the check size. These results suggest that age-related changes in the human visual system are not uniform, but rather are different in the specific functional subdivisions. It is thus hypothesized that aging may differentially influence the separate channels of the human visual system.