Middle Latency Auditory Potential (MAEP) & Long Latency Auditory Evoked Potential (LAEP)

KUNNAMPALLIL GEJO JOHN, BASLP,MASLP AUDIOLOGIST

KUNNAMPALLIL GEJO JOHN

GENERAL OVERVIEW
Evoked Potential (EP)
electrical changes
Peripheral & Central nervous system

related to the sensory pathways

stimulation of the sensory end organs

SENSORY EVOKED POTENTIAL

AEP

KUNNAMPALLIL GEJO JOHN

VEP

SSEP

Contd AUDITORY EVOKED POTENTIAL

occur in response to changes in dimensions of the stimulus Affected by internal events viz cognition or perception

EXOGENOUS BAEP MAEP LAEP (90-200ms)

ENDOGENOUS

EVENT RELATED POTENTIALS (200-600ms)

KUNNAMPALLIL GEJO JOHN

MAEP
BACKGROUND:
Described by Dan Geisler (1958) Extensively studied by Robert Goldstein et al in 1960s. Labeling of the components by Goldstein et al (1967)

WAVEFORM:
Occurs within the interval of 15-50ms post stimulus presentation. Peaks are labeled N (negative voltage) and P (positive voltage) Major sequential peaks are Na, Pa, Nb and Pb. Major peak is the Pa component which occurs at ~25ms.
KUNNAMPALLIL GEJO JOHN

Contd..

KUNNAMPALLIL GEJO JOHN

Contd
ANATOMIC GENERATORS:
Posterior temporal lobe i.e. Primary Auditory cortex - Pa and Thalamus (medial geniculate body) contribute to Na component. Reticular formation and lemniscal auditory pathways also probable contributors to the response.

KUNNAMPALLIL GEJO JOHN

Contd

RECORDING:
Stimulus Parameters:
1. Transducer : Supra aural/ER-3A 2. Stimulus type: Click (Neurodiagnosis) Tone Burst (Threshold estimation) 3. Duration : 0.1ms (clicks) 4. Rise/Fall time: 2 cycles 5. Plateau: 1 cycle 0r 0 msec 6. Rate: 7.1/sec (slower if indicated by age/pathology) 7. Polarity : Alternating 8. Intensity: ~ 70dBHL (neurodiagnosis) Variable (for Threshold estimation) 9. Number of stimuli: 1000 (variable, signal-noise ratio is vital) 10. Ear(s) : Monaural
KUNNAMPALLIL GEJO JOHN

Contd Acquisition Parameters:

1. 2. 3. 4. 5. 6. 7. Amplification: 75,000 Sensitivity: 50uVolts Analysis time: 100msecs. Prestimulus time: 10% Data points: 512 Sweeps: 1000 Filter : Band pass 10 -1500Hz or 10- 200Hz Notch Filter None 8. Electrodes: C3/C5-Mi/Mc
Hemispheric electrode (neurodiagnosis)

C4/C6-Mi/Mc Fz-Mi/Mc Ground: Fpz / Cz

Estimation of thresholds

KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

Contd CLINICAL APPLICATIONS: 1. Neurodiagnosis: a. Supra brainstem auditory sites not reached by ABR
b. c. d. e. Can be recorded in young children Is not suppressed by sedatives or coma Relative site specificity Information about auditory regions vital to auditory language functioning. f. Can be recorded with ER system used for ABR recording

KUNNAMPALLIL GEJO JOHN

Contd 2. Frequency specific hearing assessment:

a. No behavioral response/participation

b. c. d. e.

Best evoked by frequency specific tone burst stimuli Not affected by sedatives or coma Not seriously affected by mild conductive hearing loss Differential diagnosis of Cochlear Vs Retro cochlear auditory dysfunction in severe-profound high frequency hearing loss

KUNNAMPALLIL GEJO JOHN

BACKGROUND:

LAEP

Auditory component in EEG noted as early as 1939 by Pauline Davis. Systematic effect of measurement parameters on the response : Hallowell Davis et al (1960s-1970s). Topographic mapping response studied by Vaughan & Ritter (1970) Recent interest in clinical application of the response with Computer evoked Potential Topography.

WAVEFORM:
Major components occur within 75-200msecs post stimulus. Sequential peaks labelled by N or P Sequential peaks are labeled as P1, N1, P2 and N2 recorded with the vertex electrode.
KUNNAMPALLIL GEJO JOHN

ANATOMIC GENERATORS:
N1 and P2 components arise from the auditory cortex However overlapping generators are reported i.e. Posterior portion of the temporal plane, lateral temporal lobe, adjacent parietal lobe. Response reflects dendritic neural activity (vs. action potential)

KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

 Stimulus Parameters:
1. Transducer : Supra aural/ER-3A 2. Stimulus type: Tone Burst 3. Rise/Fall time: 10msec 4. Plateau: 30 msec 5. Rate: 1.1/sec 6. Intensity: ~ 70dBHL 7. Number of stimuli: 250 8. Ear(s) : Monaural 9. Mode: Air conduction 10. Frequency: 1000Hz
KUNNAMPALLIL GEJO JOHN

Contd

Acquisition Parameters:
1. 2. 3. 4. 5. 6. Amplification: 50,000 Sensitivity: 100uVolts Analysis time: 600msecs. Prestimulus time: 10% Data points: 512 Filter : Band pass 1-30Hz Notch Filter None 7. Electrodes: Fz-Mi or Fz-Mc Ground: Fpz / Cz
KUNNAMPALLIL GEJO JOHN

CLINICAL APPLICATIONS: Electro physiologic assessment of higher level auditory CNS functioning. Was used to assess frequency specific estimation of hearing sensitivity in cooperative children and adults.

KUNNAMPALLIL GEJO JOHN

EVENT RELATED POTENTIALS

Auditory P300 response BACKGROUND:
Described by Hallowell Davis in 1964, Samuel Sutton et al 1965 Test paradigm influences on P300 and other endogenous potential during the 1960s Substantial research on clinical value of P300 in electro physiologic assessment of higher level auditory processing

WAVEFORM:
Major peak occurs approx at 300msecs after a rare auditory stimulus. P3 label used as it is the 3rd positive going wave in the late response time frame. Endogenous is often used to describe the P300 response.
KUNNAMPALLIL GEJO JOHN

ANATOMIC GENERATORS
Candidates found in: bilaterally in the anterior superior temporal gyrus inferior and middle frontal gyrus inferior and superior parietal lobules anterior and posterior cingulate Thalamus Caudate Amygdala/hippocampal complex Insula Among others!
KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

Contd

Stimulus Parameters:
1. Transducer : Supra aural/ER-3A 2. Stimulus type: Tone Burst 3. Rise/Fall time: 10msec 4. Plateau: 30 msec 5. Rate: 1.1/sec 6. Polarity : Alternating 7. Intensity: ~ 70dBHL 8. Number of stimuli: 250 9. Ear(s) : Monaural 10. Mode: Air conduction 11. Frequency: Frequent 1000Hz Infrequent 2000Hz
KUNNAMPALLIL GEJO JOHN

Contd

Acquisition Parameters:
1. 2. 3. 4. 5. 6. Amplification: 50,000 Sensitivity: 100uVolts Analysis time: 600msecs. Prestimulus time: 10% Data points: 512 Filter : Band pass 1-30Hz Notch Filter None 7. Electrodes: Fz-Mi or Fz-Mc Ground: Fpz / Cz
KUNNAMPALLIL GEJO JOHN

How Many P3s?

The Classic P3/P300
Parietal Central Maximum Largest when stimuli rare and task-relevant

The P3a (Squires et al., 1975) or

Novelty P3 (Courchesne et al., 1975)
More anterior scalp distribution Slightly earlier latency Responsive to rare, unexpected, unattended stimuli
KUNNAMPALLIL GEJO JOHN

Clinical applications
Electrophysiologic assessment of high level auditory function.

KUNNAMPALLIL GEJO JOHN

Factors affecting P300

Attention to the oddball paradigm, but not the frequent. Altered by subjects state of arousal, by sleep stage and drugs Instruction for the listening task Age

KUNNAMPALLIL GEJO JOHN

MISMATCH NEGATIVITY (MMN)

BACKGROUND :
Reported by Risto Naatanen (1979) Outgrowth of experiments conducted on P300. It is generated by a change-discrimination process that mainly occurs in auditory cortex. Hence is a specially attractive tool for auditory research and clinical practice.

WAVEFORM:
Obtained by Oddball Paradigm similar to P300. It is a difference waveform (standard- deviant) A negative potential peaking at 100-200ms after stimulus onset.
KUNNAMPALLIL GEJO JOHN

Contd ANALYSIS:
a. b. c. d. Latency of onset of MMN Absolute amplitude of MMN MMN duration Area under MMN wave

ANATOMIC GENERATORS:
Supra Temporal plane of the Primary Auditory Cortex/Heschls gyrus Frontal cortex Thalamus and hippocampus have also been suggested
KUNNAMPALLIL GEJO JOHN

Contd

ELICITING MISMATCH NEGATIVITY RESPONSE:

Frequency Differences (smaller differences are better) Intensity differences Duration differences Location of the sound source in space Interstimulus Interval Phonetic differences and cues VOT Formant transition duration contrasts Formant frequency contrasts Acoustic differences
KUNNAMPALLIL GEJO JOHN

Contd

KUNNAMPALLIL GEJO JOHN

CLINICAL APPLICATIONS:
Assessment of higher level auditory functioning in infants Description of cortical auditory organization Confirmation of neural dysfunction in clinical populations Parkinsons disease, Dementia/Alzheimers disease Stroke, schizophrenia, dysphagia, CI users, HA users, Central auditory processing disorders. Studying learning Studying speech perception Fine acoustic differences Plasticity of speech discrimination CAPD Neuroanatomy of speech perception.
KUNNAMPALLIL GEJO JOHN

Difference between P300 and MMN P300 MMN

Attention required Reflects conscious discrimination Large stimulus differences produce largest response Attention not required Automatic discrimination Small differences produce largest response

KUNNAMPALLIL GEJO JOHN

N400-P500
BACKGROUND:
First described by Kutas and Hillyard (1980). Present during presentation of semantic material.

WAVEFORM
N400 is a negative potential that occurs at about 400 msecs. P500 occurs in contrast to this, a positive potential at 500msecs Amplitude of ~ 23-28uV N400- Semantic priming (ambigous constructs) P500- Literal word difference in a sentence( not of context)

KUNNAMPALLIL GEJO JOHN

Contd..

Stimulus Parameters:
1. Transducer : Supra aural/ER-3A 2. Stimulus type: speech i.e. sentences 3. Rate: 1.0/sec 4. Intensity: ~60-70dBHL 3. Number of stimuli: 100 9. Ear(s) : Monaural/Binaural 10.Mode: Air conduction
KUNNAMPALLIL GEJO JOHN

Contd

Acquisition Parameters:
1. 2. 3. 4. 5. Amplification: 50,000 Sensitivity: 100uVolts Analysis time: 1000msecs. Data points: 512 Filter : Band pass 0.05-50Hz Notch Filter None 7. Electrodes: Fz,Cz,Pz-Mi/Mc and T3 or T4 Ground: Fpz

KUNNAMPALLIL GEJO JOHN

Clinical applications
Assesses semantic processing and higher level decisions

Factors Affecting
Attention Semantic content

KUNNAMPALLIL GEJO JOHN

Contingent Negative Variation (CNV)

BACKGROUND:
CNV or Expectancy wave (E-wave) first described by Walter et al (1964). Related to the readiness of the subject to make a response

WAVEFORM:
Occurs at ~ 400 ms following stimulus onset Onset of the response at ~ 450-470ms Characterised by a negative offset to the baseline ~ 30-50uV Appears between a warning stimulus and an imperative stimulus. Amplitude of the CNV varies with psychological states related to meaning and motivation
KUNNAMPALLIL GEJO JOHN

KUNNAMPALLIL GEJO JOHN

ANATOMIC GENERATORS Overlapping generators thought to have its origin in Specific, non specific and association areas of Thalamus. Midbrain reticular formation Pre frontal cortex

KUNNAMPALLIL GEJO JOHN

 Stimulus Parameters:
1. Transducer : Supra aural/ER-3A 2. Stimulus type: Tone burst Speech Non Speech 3. Rate: 0.5/sec 4. Intensity: ~60-70dBHL 3. Number of stimuli: 20 9. Ear(s) : Monaural/Binaural 10.Mode: Air conduction
KUNNAMPALLIL GEJO JOHN

Contd

Acquisition Parameters:
1. 2. 3. 4. 5. Amplification: 50,000 Sensitivity: 100uVolts Analysis time: 3000msecs. Data points: 512 Filter : Band pass DC-30Hz Notch Filter None 7. Electrodes: Fz,Cz,Pz-Mi/Mc and T3 or T4 Ground: Fpz

KUNNAMPALLIL GEJO JOHN

CLINICAL APPLICATIONS Evaluation of attention and expectancy

KUNNAMPALLIL GEJO JOHN