2009, Number 6
Cambios del EEG por habituación y condicionamiento en niños de tres a 15 años que acuden al Instituto Nacional de Rehabilitación (INR)
Brust-Carmona H, Ramírez-Aboytes F, Sánchez A, Martínez J, Rodríguez MÁ, Flores-Ávalos B, Yáñez-Suárez O
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Language: Spanish
References: 26
Page: 459-467
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ABSTRACT
During waking, stimuli activate the sensory pathways giving rise to sensation and the response to such stimulation. The electrobiochemical changes and modifications in EEG rhythms eventrelated synchronization or event-related desynchronization, ERD or ERS) propagated in the specific and unspecific cortex are added to the changes elicited by the responses and to the new signals originated by those same responses, bringing about perception. Diverse factors can alter these glialneuronal circuits, producing alterations in attention processes (ADD) and in the integration with their meaning. The inability to identify signals and integrate correct coordinated responses leads to deficiencies in responding to the environment and to associated morbidities that are added to ADD. ADD and its associated morbidities cause high social and economic impacts and, even more so, because of their persistence into adolescence and adulthood. Therefore, highly accurate diagnostic procedures are needed for these diseases. According to the CIE-10, in the clinical setting symptoms are analyzed without studying the neuro-developmental and neurodegenerative signs that identify alterations in neuronal circuits. As is known, behavior (including motivation, memory, thoughts) results from the Central Nervous System (CNS) activity, and the EEG records the electrical activity of neurons and synapses of the cerebral cortex, where cognitive processes are most likely to take place.To establish more accurate diagnostic procedures for ADD, we are integrating an electronic database, considering the intensity and cerebral distribution of theta (θ), alpha (α), and beta (β) rhythms. We propose that the ERD of α and β reflects a cortical activation that gives rise to sensory-motor coordination processes. The first stimulations induce ERD, and their repetitions produce its decrement (ERS): ERD habituation. In addition, this ERD to ERS change might be reversed when giving meaning to the stimulation. We present herein the changes in θ, α, and β rhythms induced by repeated photostimulation (RPS), with the same characteristics, that, when presented, requires the subject to press a knob.
Hundred-twenty-four children were studied at the Instituto Nacional de Rehabilitación (INR, for its initials in Spanish) in Mexico City. Children were of either gender and aged from 3 to 15 years, separated in four groups of 3-year intervals. During clinical exploration, we searched for possible delays in physical-emotionalintellectual development, epilepsy, and medical or psychological treatments during the last six months, which were considered exclusion factors. Parents were briefed on the study, explaining them that the procedure had a low-risk nature and allowed for the analyzis of the electrical activity of the brain. Once having understood and accepted the procedure, they signed the informed consent form prepared by the institution. Children were explained «how the batteries of the brain» work and that the procedure caused no pain at all. They were asked to close their eyelids during the recordings, and to remain as motionless as possible. The exclusion factors left a sample of 94 children for the habituation analysis and of 47 for the simple conditioning procedures. The EEG was recorded in dorsal decubitus position, with a digital 24-channel electroencephalograph, according to the 10/20 international system. In addition, we recorded eye movements and the EKG. After 5-min recordings with closed eyelids, photo-stimulation was started at 5 flashes per second during 2s, repeated 20 times (RPS), at 21 to 25 sec. intervals. After finishing the series, 5 min rest were provided, and then a round device with a knob was placed in the children’s hands, telling them to press the knob at the start of the RPS and to release it at the end. Analyses were performed with 1.6 to 40 Hz bandwidth filters. From the bipolar leads, samples recorded 2 sec. before, during, and after the 1st, 5th, 10th, 20th associations (PS-knob pressing) were manually chosen. For conditioning analyses, we also measured the response latency. The Fourier’s FT was applied to the samples and the absolute potency (AP) was calculated for θ (4.0 to 7.5 Hz), α (8.0 to 12.5 Hz), and β (13 to 20 Hz). The average of these frequencies was obtained for each hemisphere (Right, RH; Left, LH) and for both (BH). Wilcoxon’s test for related samples was used with α › 0.05 as significant.
Analyses of the AP of the three frequencies in all children revealed a background activity below 10 µV2. The first RPS produced a decrease in the AP of θ and α, with an increase in β in BH. At the 5th RPS, θ and α continued to decrease along with an increase in β. At the 10th RPS, θ and α decreased less but the increase in β persisted.
At the 15th RPS, θ continued to decrease but α increased in the LH and decreased somewhat in the RH, whereas β continued its increase in BH. At the 20th RPS, the AP of θ and α decreased in BH, but the difference was smaller than that recorded during the previous RPS. The AP of β continued to increase in BH. The most relevant aspects are: a) in G-1 (children aged 3 to 6 years), the AP of the three frequencies is higher, predominating θ, which is twice the magnitude of that of the whole group; b) the 1st PS produced an increase in the AP of all three frequencies, which was not recorded in the other groups (children aged 6.5 to 15 years); c) in G-4 (children 12.5 to 15 years of age), the 1st and 5th PS produced a clear diminution in the AP of θ and α (ERD), which was smaller at the 10th RPS and reversed at the 15th and 20th RPS (ERS). After indicating to the children that with each RPS they would have to press a knob, the background activity increased to 12 µV2. During the 1st association (assoc), the AP of θ and α decreased with a slight decrease in β; the response latency was 930 ms. At the 5th assoc, θ decreased together with a small increase in α and β, and the response latency decreased to 750 ms. On the 10th and 15th assoc, the three frequencies increased and the latency decreased to 650 and 640 ms, respectively. On the 20th assoc, the AP increase of each rhythm was smaller, and the latency increased to 750 ms.
The EEG analysis per group revealed a higher AP for θ in the smaller children that decreased along increasing age together with a relative increase in α, which reached its maximal value in G-4. In the four groups, the RPS induced an undulating tendency towards a decrease in the EEG desynchronization that represents habituation, being more noticeable in G-4. Although the reached synchronization level did not reflect a better inhibition, as described in adults, it suggested that, in these children, the inhibitory activity on sensory control has not yet developed completely. Another important finding is that in G-1, the 1st RPS induced and increase in θ and α that was not observed in the other groups. This suggests that a facilitation of the circuits predominates in this age group. Children of G-4 depict the best habituation curve; however, because of the reduced number of children in this group, some data did not reach statistical significance, their clinical relevance is a strong indicator of the need to enlarge the sample size for more in-depth analyses. The knobpressing response improved in correlation with the chronological age, coinciding with the decrease in θ and the increase of α. Surprisingly, according to our hypothesis, conditioning at the cortical level would be reflected in an increase of the β rhythm (DRE), which we did not register. However, we did find an inverse correlation between the decrease or increase in θ and α rhythms, as well as a better motor response with interhemispheric differences, manifested more intensely in the RH, which for most of the studied population represents the «non-dominant» hemisphere. The modification of θ and α may be explained as resulting from the functional integration of the specific and unspecific central-encephalic-thalamic-cortical sensorial circuits that may be related, in turn, to alpha rhythm generation and the limbic circuits, related to the theta rhythm, which participate in the integration of memory.
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