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Biomedical subjects

A M Halliday

Publications and source records attributed to A M Halliday.

At least 55 records · Page 3Linked to original sources

Evoked potentials following unilateral ECT. II. The flash evoked potential.

The flash evoked potential (VEP) was recorded in 16 depressed patients before, during and for 0.5 h following administration of unilateral ECT. In 14 the recordings were made following right ECT and in 3 following left ECT. One patient was recorded after right- and left-sided treatments administered on separate occasions. While the patients were conscious, responses were averaged with eyes open and eyes closed. During anaesthesia, ictus and post-ictal coma the response to repetitive stimulation through closed eyes was recorded continuously in sequential runs. Consistent latency differences between VEPs with eyes open and closed were established in the runs prior to treatment. In postictal coma there was a marked asymmetry in the response from the two sides. Component P140, in particular, was significantly smaller and later over the side which received ECT. On average, these asymmetries lasted less than 15 min following the treatment. A significant latency increase, common to both hemispheres, was found at the end of the recording session.

Adult↗

Pattern evoked potentials in human albinism. Evidence of two different topographical asymmetries reflecting abnormal retino-cortical projections.

In fifteen subjects with oculo-cutaneous or ocular albinism pattern-reversal visual evoked potentials (VEP) were recorded to monocular whole-field (16 degrees radius) and right and left vertical half-field (16 degrees radius) stimulation from an array of occipital electrodes. In all 15 subjects the VEP was of low amplitude and the monocular response to whole-field stimulation showed abnormal asymmetry in scalp topography. This asymmetry was similar to that produced by stimulation of the temporal half-field in the same eye. Two distinct types of VEP asymmetry were readily identified in different subjects. In 5 the major positivity of the response (P100) was distributed in the channels ipsilateral to the stimulated eye or temporal half-field, being similar in distribution to the P100 from the temporal hemifield or normal individuals. In 9 other subjects the converse occurred; the P100 was distributed contralaterally. The remaining subject was unique in that the responses from each eye had a distribution that resembled one of the two main groups. The nasal half-field responses also differentiated the two groups. On stimulation of the nasal field in the first group the P100 was usually absent or attenuated and when present it had the same topography as the temporal half-field P100. In contrast the nasal half-field P100 from the second group was always present and, although almost invariably smaller than the temporal half-field P100, it had an identical distribution. There was no correlation between these two patterns of VEP asymmetry and clinical or known genetic features. The findings confirm that in human albinos each hemisphere receives a predominantly monocular input from the contralateral eye; i.e. in addition to the temporal, half-field, approximately 20 degrees of the nasal half-field is projected to the hemisphere contralateral to each eye and not, as in normal subjects, to the ipsilateral hemisphere. Furthermore, the findings of two distinct and in some respects opposite types of VEP topographical asymmetry raises the possibility of two variants of the geniculo-cortical projection patterns existing in human albinos similar to those described in the Siamese cat.

Adolescent↗

The incidence and nature of visual pathway involvement in Friedreich's ataxia. A clinical and visual evoked potential study of 22 patients.

Pattern-reversal visual evoked potentials (VEP) were recorded from 22 patients (mean age 33.7 years) with Friedreich's ataxia, 15 of whom also had a detailed neuro-ophthalmological assessment prior to the VEP examination. None had noted symptomatic visual impairment. Eleven of the 15 (73 per cent) examined clinically had one or more neuro-ophthalmic abnormality and 14/22 (64 per cent) had an abnormal VEP study which was always binocular and comprised absent responses, or most commonly, increased P100 component latencies. The maximum P100 latency was 143 ms and the group mean was 118 ms. The P100 amplitude was also generally reduced particularly in those patients with latencies less than 115 ms (upper limit of normal), while in those with latencies above the normal range there was a significant inverse correlation between the P100 amplitude and latency. The waveform, temporal dispersion and interocular differences were normal in almost all patients with identifiable responses, including those with prolonged VEP latencies. Electroretinograms recorded from three selected patients were either normal or minimally abnormal and suggested secondary rather than primary retinal involvement. The only VEP parameter to correlate with either the duration of the generalized disease or the visual acuity was the P100 amplitude. A good correlation was found between the VEP and the clinical neuro-ophthalmic findings. Temporal pallor of the optic disc was most often associated with an abnormal VEP result and impaired visual acuity or colour vision were uncommon in the absence of VEP abnormalities. The VEP changes and those obtained from 24 age- and acuity-matched cases of demyelinating optic neuritis are contrasted and the probable pathophysiology is discussed. Two main conclusions emerge from this study. First, there is a high incidence of asymptomatic visual pathway involvement in Friedreich's ataxia which can be demonstrated by both clinical and VEP examination. Secondly, the VEP changes in Friedreich's ataxia differ from those found in typical demyelinating optic neuropathy and are consistent with progressive nerve fibre loss and associated slowing of conduction, indicating that the visual pathway is affected by the same widespread process of axonal degeneration found throughout the nervous system.

Adult↗

Peripheral and central somatosensory nerve conduction defects in Friedreich's ataxia.

Somatosensory evoked potentials were recorded over the clavicle, cervical spine, mastoid processes and the hand area of the contralateral somatosensory cortex to median nerve stimulation in 22 cases of Friedreich's ataxia. There was a marked attenuation of the clavicular potential, but little evidence of delay of this or the major cervical component. A dispersed and delayed cortical response was therefore suggestive of slowed conduction in central pathways. The cortical response was shown to be mediated by peripheral fibres with normal conduction velocity between stimulation sites at the wrist and the elbow.

Adolescent↗

Hemisphere contributions to the composition of the pattern-evoked potential waveform.

The transverse distribution of scalp-recorded potentials evoked by pattern reversal stimulation was studied in 50 healthy subjects. In most individuals the full-field responses were symmetrical over the occipital scalp, but important variations in distribution, symmetry and waveform were recorded in some cases. Asymmetrical responses were similar for each eye (i.e., they were "uncrossed" or homonymous asymmetries). Full-field peak latencies and amplitudes in the lateral channels were more variable than those at midline electrodes. Half-field responses were markedly asymmetric with well-lateralised components widespread over occipital-parietal scalp. In contrast to the full-field responses, component values measured near the midline were less consistent than those from lateral channels due to waveform distortions in this area ("transitional zone"). Upper field stimulation is particularly likely to produce such midline waveform distortions. Activity recorded from the scalp contralateral to the half-field stimulated shows more inter-individual and inter-hemispheric variation than that recorded from ipsilateral electrodes. Variants in the full-field waveform can be accounted for by relative differences in amplitude and distribution of the ipsilateral and contralateral components from each half field. The algebraic sum of these half-field components does not differ significantly from the components of the separately recorded full-field response. Furthermore, responses from the surviving half-field in patients after total hemispherectomy contain all the ipsilateral and contralateral half-field components seen in healthy subjects.

Dominance, Cerebral↗

The effect of experimental 'scotomata' on the ipsilateral and contralateral responses to pattern-reversal in one half-field.

The averaged cortical responses to a reversing checkerboard pattern presented monocularly in either left or right visual half-fields have been recorded from the occipital scalp using a transverse chain of widely spaced electrodes referred to a common mid-frontal electrode. The half-field responses showed a consistent asymmetry, the dominant feature of which was a positive wave (P100) that was widespread on the ipsilateral scalp and maximally recorded from the midline and ipsilateral electrodes. This formed part of the triphasic negative-positive-negative complex, the other two components being an N75 and an N145. On the contralateral scalp it was generally possible to record a triphasic complex of opposite polarity, but this was usually of smaller amplitude and its components (P75, N105, P135) showed greater variation in latency and morphology than the ipsilateral components. With progressive occlusion of the pattern stimulus from the central regions of the visual half-field, the ipsilateral positive wave (P100) was increasingly attenuated, while components of the contralateral complex were relatively unaffected, or, in some cases, enhanced. By contrast, reducing the radius of the stimulated area had relatively little effect on the ipsilateral P100, while the contralaterally recorded response was attenuated. These differential effects on the half-field response components are discussed in relation to the anatomy of the central and paracentral cortical representation of the visual field. The implications for the interpretation of evoked potential recordings in patients with field defects are considered.

Adolescent↗

EEG immediately after unilateral ECT.

EEG was continuously recorded in 15 patients for a period extending from just before to 1/2 hour after unilateral ECT. Fourier analysis was performed on the EEG following 15 right-sided treatments and five left-sided treatments. During the induced seizure, epileptic slow-wave activity had significantly greater power on the treated side. Immediately after the seizure, there was significantly more delta activity and less alpha and beta activity on the treated side. This asymmetry, though becoming less marked, was usually still present at the end of the recording period. Analysis of other variables associated with the treatment showed that there was a significant correlation between the time to eye-opening after ECT and both the duration of the seizure and the amount of anaesthetic administered. The similarity between these induced unilateral seizures and unilateral seizures occurring spontaneously in some epileptics is discussed.

Adolescent↗

Neurological asymmetries immediately after unilateral ECT.

Twenty-nine right handed patients were examined neurologically before and immediately after each of 62 unilateral ECTs to the dominant and non-dominant hemispheres. Most convulsions were followed by signs of transitory neurological dysfunction referable to the treated hemisphere. These signs included deep tendon reflex asymmetry, hemiparesis, tactile and visual inattention, and homonymous hemianopia. After treatment to the right hemisphere some patients had left visuospatial neglect, while all patients who had dominant hemisphere ECT were transiently dysphasic. All neurological abnormalities tested resolved within 20 minutes of treatment.

Aphasia↗

New developments in the clinical application of evoked potentials.

The introduction of the pattern-evoked response and of far field recording of the auditory and somatosensory short latency responses has provided to major advances in the clinical application of evoked potentials. The sensitivity of the pattern response in the detection of minimal lesions of the visual pathways is now well established, and makes the test of particular value in the diagnosis of demyelinating disease and in the early detection of compressive lesions. The short latency auditory and somatosensory responses also show a high incidence of abnormalities in demyelinating disease. The technique will not compete directly with such well established methods as audiometry and perimetry, but it can provide valuable additional information, not accessible to these methods, particularly where the lesions are clinically silent or inconspicuous.

Auditory Cortex↗

The asymmetrical visual evoked potential to pattern reversal in one half field and its significance for the analysis of visual field defects.

The consistency of the major positive component (P100) of the full-field pattern-reversal response provides a clinically valuable and objective means of detecting visual field defects. Its normally symmetrical distribution about the midline of the occipital scalp results from the summation of two highly asymmetric half-field responses, each of which shows the positive component well lateralised with a widespread distribution on the ipsilateral side. Stimulation of each eye in patients with bitemporal and homonymous hemianopias results in two characteristic patterns of asymmetry, named 'crossed' and 'uncrossed' respectively, in which the major positivity is consistently recorded on the side ipsilateral to the preserved half field. Recordings from a patient after occipital lobectomy confirm the authors' previous suggestion that although the major positive component is recorded from the ipsilateral scalp the typical asymmetric half-field response is generated in the contralateral hemisphere.

Action Potentials↗

The pattern-evoked potential in compression of the anterior visual pathways.

Pattern evoked responses have been recorded in 19 patients with compression of the optic nerve, chiasm or tract, verified at operation. These included 4 patients with orbital tumours, 5 with intracranial meningiomas, 2 with craniopharyngiomas and 8 with pituitary tumours. The evoked response was abnormal in all except one of these patients. The pattern of abnormalities in the response, however, differed from that in the earlier series of patients with primary demyelinating disease. The incidence of delayed responses was much lower, and the magnitude of the delays was smaller. Absent responses were particularly characteristic of patients with intracranial meningiomas. Tumours arising in the region of the sella turcica were associated with a high incidence of abnormalities of the waveform of the response, and asymmetry of the field of the occipital evoked potential was especially characteristic of this group. Most, but not all, asymmetric cases were associated with field defects.

Adult↗