Cognitive evoked potentials to anticipated oesophageal stimulus in humans: quantitative assessment of the cognitive aspects of visceral perception

Hollerbach,; Fitzpatrick,; Shine,; Kamath,; Upton,; Tougas,

doi:10.1046/j.1365-2982.1999.00132.x

Cited by 12 publications

(6 citation statements)

References 37 publications

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“…The application of CEP methodologies to study gastrointestinal afferent sensory function provides an objective and quantifiable approach to examine the contribution of different sensory pathways in health, as well as under pathological conditions 27 . 29 , 33 , 40 –50 However, only one previous study investigated the yield of CEP responses in patients with NCCP 51 . Smout et al .…”

Section: Discussionmentioning

confidence: 99%

Abnormal cerebral processing of oesophageal stimuli in patients with noncardiac chest pain (NCCP)

Hollerbach¹,

Bulat²,

May³

et al. 2000

Neurogastroenterology Motil

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In noncardiac chest pain (NCCP), altered visceral perception may result from abnormal cerebral processing of sensory input rather than abnormalities of afferent pathways. However, the interactions between symptoms, autonomic function and oesophageal stimuli are poorly studied. Oesophageal stimulation elicits reproducible cortical evoked potentials [CEP] and modulates heart rate variability via vagal pathways, as visible on power spectrum analysis of heart rate variability [PS-HRV]. These methods are increasingly used to study the function of visceral afferent neural pathways in human. The aim of this study was to compare EP and PS-HRV during oesophageal stimuli in NCCP and controls. Twelve healthy volunteers (one female, 11 male; aged 24-51 years; mean 32 +/- 8 years), and eight NCCP patients (three female, five male; age range 26-58, mean 40.5 +/- 10 years) were studied. Electrical oesophageal stimulation (EOS; 200 microseconds, 0.2 Hz, 25 stimuli) was applied to the oesophageal wall 5 cm above the lower oesophageal sphincter (LOS), and perception thresholds (measured in mA) determined. EP responses were recorded using 22 standard electroencephalogram scalp electrodes. Autonomic activity was assessed using PS-HRV, before, during, and after oesophageal stimulation. Measured PS-HRV indices included high frequency (HF; 0. 15-0.5 Hz) and low frequency (LF; 0.06-0.15 Hz) power, respectively, assessing vagal and sympathetic activity, and the LF/HF ratio. EOS perception occurred at lower thresholds in NCCP than in controls (3. 6 +/- 1 vs. 7.8 +/- 2 mA, P < 0.05). EP amplitude was greater (13 +/- 2 vs. 6 +/- 1 microV, P < 0.0001), and latency longer in controls vs. NCCP (191 +/- 7 ms vs. 219 +/- 6 ms, P < 0.001). In NCCP, EOS decreased sympathetic outflow (low frequency peak on PS-HRV) and increased cardiovagal activity (high frequency peak, P < 0.02) to a significantly higher degree in comparison with controls. During EOS, heart rate decreased in NCCP from 68 vs. 62 beats min-1 (P < 0.003) but not in controls. In NCCP patients, EOS was perceived at lower intensities and was associated with a greater cardiovagal reflex response. EP responses associated with EOS were smaller in NCCP than in controls, suggesting that an increased perception of oesophageal stimuli results from an enhanced cerebral processing of visceral sensory input in NCCP, rather than from hyperalgesic responses in visceral afferent pathways.

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Section: Discussionmentioning

confidence: 99%

Abnormal cerebral processing of oesophageal stimuli in patients with noncardiac chest pain (NCCP)

Hollerbach¹,

Bulat²,

May³

et al. 2000

Neurogastroenterology Motil

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“…Findings in imaging studies may be biased as they reflect a combination of early pain-specific and later nonpain-specific neural activity [27,28]. On the other hand, Hollerbach et al [34] have shown that evoked potentials to anticipated oesophageal stimuli produce endogenous but not exogenous responses, whereas responses to actual oesophageal stimuli contain both. Being able to differentiate between endogenous and exogenous activity is an advantage as new analgesics in drug development aim at modulating the exogenous pain-specific responses [35].…”

Section: Advantages Of the Current Methodmentioning

confidence: 99%

Is Electrical Brain Activity a Reliable Biomarker for Opioid Analgesia in the Gut?

Staahl

Krarup

Olesen

et al. 2011

Basic &Amp; Clinical Pharmacology &Amp; Toxicology

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The effects of morphine on brain potentials after experimental gut pain have never been investigated. This study explored whether multi-channel-evoked brain potentials (EP) and corresponding dipole sources in the brain would reflect the effects of morphine on experimental oesophageal pain. In a crossover study, the effects of oral morphine (30 mg) or corresponding placebo on pain from electrical oesophageal stimulation were tested in 12 healthy male volunteers. The electroen-cephalographic (EEG) activity was monitored with 64 surface recordings. Pain was assessed by subjective scores on a visual analogue scale, amplitude and latency of the vertex-EP as well as on multi-channel recordings of EPs. Finally, electrical brain sources after pain stimuli were modelled from the EEG data. Morphine attenuated subjective pain scores (p = 0.008). The amplitude of the P2 peak (230 msec. post-stimulus) in the vertex EPs was unaltered after treatment with morphine, whereas after placebo treatment, it decreased (p = 0.03). However, the overall topography changed and the source of P1 (100 msec. post-stimulus), possibly originating from areas near the cingulate gyrus, changed localization in an upward, posterior direction (p = 0.04). The length of the vector describing this shift correlated inversely with the magnitude of the subjective pain relief (r =)0.7; p = 0.02). With the potential of becoming a useful biomarker in analgesic trials, the localization of the dipole sources reflected the analgesic action of morphine after pain stimuli of the gut. Even though further evaluation of the method is necessary, it has the potential to be a valid objective biomarker for opioid analgesia. For several years, only few drugs with new modes of action have been successful in entering the market. Trials of new analgesics often fail, and part of the solution to this could be the development of biomarkers that could give objective measures of analgesia in both healthy volunteers and patients [1]. Amplitudes and latencies of evoked brain potentials (EP) have been used in both patients and healthy volunteers to reflect pain intensity and the change herein after the administration of analgesics. However, results have been contradic-tive, and this may be related to the methods, as previous studies have mainly been based on single-electrode recordings from the vertex electrodes (Cz) [2-5]. Although this is relatively easy, it only reflects a minor part of the underlying brain activity, and to explore the different centres active in the pain network, more detailed recording of the electroen-cephalographic (EEG) activity is needed. Opioids are potent analgesics and have major impact on the cerebral modulation of pain [6,7]. Hence, opioids are good candidates for showing the sensitivity of new biomar-kers in pain research. The pain experience is multi-dimensional and traditionally divided into sensory-discriminative and affective-motivational components. In the brain, the sensory components of pain are mainly mediated by the 'lateral pain system' [8]....

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“…[1][2][3][4] In IBS, for example, a number of findings favour a psychological rather than a biological basis for increased pain sensitivity. First, IBS patients often rate even sham distensions as painful.…”

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confidence: 99%

Cognitive modulation of the cerebral processing of human oesophageal sensation using functional magnetic resonance imaging

Gregory

Yágüez²,

Williams

et al. 2003

Gut

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Background: While cortical processing of visceral sensation has been described, the role that cognitive factors play in modulating this processing remains unclear. Aim: To investigate how selective and divided attention modulate the cerebral processing of oesophageal sensation. Methods: In seven healthy volunteers (six males, mean age 33 years; ranging from 24 to 41 years old) from the general community, phasic visual and oesophageal (non-painful balloon distension) stimuli were presented simultaneously. During the selective attention task, subjects were instructed to press a button either to a change in frequency of oesophageal or visual stimuli. During a divided attention task, subjects received simultaneous visual and oesophageal stimuli and were instructed to press a button in response to a change in frequency of both stimuli. Results: Selectively focussing attention on oesophageal stimuli activated the visceral sensory and cognitive neural networks (primary and secondary sensory cortices and anterior cingulate cortex respectively) while selective attention to visual stimuli primarily activated the visual cortex. When attention was divided between the two sensory modalities, more brain regions in the sensory and cognitive domains were utilised to process oesophageal stimuli in comparison to those employed to process visual stimuli (p = 0.003). Conclusion: Selective and divided attention to visceral stimuli recruits more neural resources in both the sensory and cognitive domains than attention to visual stimuli. We provide neurobiological evidence that demonstrates the biological importance placed on visceral sensations and demonstrate the influence of cognitive factors such as attention on the cerebral processing of visceral sensation.

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Cognitive evoked potentials to anticipated oesophageal stimulus in humans: quantitative assessment of the cognitive aspects of visceral perception

Cited by 12 publications

References 37 publications

Abnormal cerebral processing of oesophageal stimuli in patients with noncardiac chest pain (NCCP)

Abnormal cerebral processing of oesophageal stimuli in patients with noncardiac chest pain (NCCP)

Is Electrical Brain Activity a Reliable Biomarker for Opioid Analgesia in the Gut?

Cognitive modulation of the cerebral processing of human oesophageal sensation using functional magnetic resonance imaging

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