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INTRODUCTION In the early 2000s, a subcommittee of the American Clinical Neurophysiology Society (ACNS) set out to “standardize terminology of periodic and rhythmic EEG patterns in the critically ill to aid in future research involving such patterns.” The initial proposed terminology was published in 2005.1 This was presented at many meetings on several continents, subjected to multiple rounds of testing of interrater reliability, underwent many revisions, and was then published as an ACNS guideline in 2013.2 Interrater agreement of the 2012 version (published in early 2013) was very good, with almost perfect agreement for seizures, main terms 1 and 2, the +S modifier, sharpness, absolute amplitude, frequency, and number of phases.3 Agreement was substantial for the +F and +R modifiers (66% and 67%) but was only moderate for triphasic morphology (58%) and fair for evolution (21%, likely at least partly because of the short EEG samples provided).3 The authors concluded that interrater agreement for most terms in the ACNS critical care EEG terminology was high and that these terms were suitable for multicenter research on the clinical significance of these critical care EEG patterns. With the help of infrastructure funding from the American Epilepsy Society and administrative and website support from the ACNS, a database that incorporated the ACNS terminology was developed for clinical and research purposes, tested during routine clinical care in multiple centers,4 and made available at no cost on the ACNS website (https://www.acns.org/research/critical-care-eeg-monitoring-research-consortium-ccemrc/ccemrc-public-database). This greatly enhanced the ability to complete multicenter investigations. After the establishment of the standardized terminology and free access to a database incorporating these terms, there have been many investigations into the clinical significance of rhythmic and periodic patterns (RPPs) in critically ill patients. Patterns such as lateralized rhythmic delta activity (LRDA) were found to be highly associated with acute seizures,5,6 equivalent to the association found with lateralized periodic discharges (LPDs) in one study.5 The association of all the main patterns in the nomenclature with seizures was defined in a multicenter cohort of almost 5,000 patients, with seizure rates highest for LPDs, intermediate for LRDA and generalized periodic discharges (GPDs), and lowest for generalized rhythmic delta activity (GRDA).6 This and other studies have shown that several of the modifiers within the nomenclature do indeed have clinically relevant meaning. For example, studies have shown that higher frequency (especially >1.5 Hz), higher prevalence, longer duration, and having a “plus” modifier are all associated with a higher chance of acute seizures.6,7 On the other hand, whether a pattern was spontaneous or “stimulus-induced” did not seem to have a significant effect on its association with seizures.6 In other investigations, the “triphasic morphology” modifier was investigated blindly with multiple expert reviewers, calling into question its relationship with metabolic encephalopathy and its lack of a relationship with seizures.8,9 For patients with refractory status epilepticus treated with anesthetic-induced coma, the presence of “highly epileptiform” bursts suggested that an attempted wean off of anesthetics at that time was much more likely to lead to seizure recurrence than if the bursts were not highly epileptiform.10 Even long-term outcome seemed to be associated with some modifiers, with a higher risk of later epilepsy found if LPDs were more prevalent, had longer duration, or had a “plus” modifier.7 CHANGES IN THE 2021 VERSION OF THE TERMINOLOGY Although the previous version of the terminology was easy to use, reliable, and valuable for both research and clinical care, new terms and concepts have emerged. In this version, we incorporate recent research findings, add definitions of several new terms, and clarify a few definitions of old terms. Most of the old terms remain unchanged, but there have been some important clarifications and corrections (such as the calculation of the number of phases) and multiple additions. All changes have been summarized in Table 1. One new main term 1 was added (Unilateral Independent), and main term 2 “Lateralized” was updated to include “bilateral asynchronous” patterns. Electrographic seizures (ESz), electrographic status epilepticus (ESE), electroclinical seizures (ECSz), and electroclinical status epilepticus (ECSE) have now been defined, largely based on the “Salzburg criteria.”11,12 Brief potentially ictal rhythmic discharges (BIRDs) have been added based on recent publications13,14, and a consensus definition of the ictal-interictal continuum (IIC) has been proposed. We also added definitions of identical bursts,15 state changes, cyclic alternating pattern of encephalopathy (CAPE), and extreme delta brush (EDB).16 To facilitate daily use, we are also providing the “ACNS Standardized Critical Care EEG Terminology 2021: Condensed Version” (see Supplemental Digital Content, http://links.lww.com/JCNP/A149) and the “ACNS Standardized Critical Care EEG Terminology 2021: Reference Chart” (see Supplemental Digital Content, http://links.lww.com/JCNP/A150). Finally, for educational purposes and conceptual clarity, we provided extensive schematic diagrams (Figures 1–42) of most patterns to quickly demonstrate the core features and principles. Supplemental figures include EEG examples from 30 cases and are available as Supplemental Digital Content at http://links.lww.com/JCNP/A134. TABLE 1. - ACNS Standardized Critical Care EEG Terminology: Major and Minor Changes Between the 2012 and 2021 Versions Major changes EEG background • “Variability” and and now • of • bursts and Patterns and • 1 • • Patterns that in one and to the other now be as a lateralized • • For and only be to if or have a frequency and are these as electrographic seizures and be to as such than as or • in this terminology have a frequency of if a pattern and for or an electrographic seizure (see definitions this not as but as a • • of an now to patterns that are with evolution as a (see with evolution of an electrographic seizure and be as • • Electrographic and • Electrographic seizure • Electrographic status epilepticus • seizure • status epilepticus (ECSE) • electroclinical status epilepticus Brief (BIRDs) (IIC) Minor changes EEG background • background frequency • has now been added than only or • • from to • from to • from to of the • • now also be the of term 1 • • if multiple discharges are within the of bursts and at an of or if a potentially pattern at or within the of • if 2 or more discharges or are within the of bursts and at an of 1 or within a as the of the of discharges within a if a potentially pattern at or within the of • • or all activity has now been added as a and periodic patterns • • from to the definition of status epilepticus with the • from to • • from to • from to • from modifier to modifier All the definitions are based on extensive not only the authors of this but also many both and and was not complete consensus on some to the of for the was for most of these We changes from previous or from the such as the for electrographic seizures but because no consensus was was to a this was not 2021 ACNS EEG TERMINOLOGY EEG (RPPs) (BIRDs) (IIC) This terminology to be at all some terms not be for For the version of the This terminology for in the critically be in other as with the of terms most clinical Although on EEG be or such as an or and this a very important in some such as epilepsy all of these are within the terms or in this the pattern and are be provided and also be to several modifiers and This was into the available Critical Care EEG database that incorporated the previous version of this nomenclature new database with this 2021 nomenclature In this and the the term to to an EEG pattern during an whether clinical or as the term in EEG as an for for all of periodic or rhythmic to All in this are based on to to in a for an The term or to of of discharges in a periodic of of a rhythmic or of the for a background EEG 1. in on an of or in frequency of to 1 or frequency in in in and of the features are be for Most or After or frequency are be to with to frequency to frequency to the but with of the of or of of are but of the higher of are for to the of the that or this in are this to as or This as with other from the ACNS pattern of alternating with higher with to of the of or pattern of alternating with higher with to of the of (see EEG Supplemental Digital Content or (see EEG 2, Supplemental Digital Content The term with and have at least at least for definition of number of if or be defined main term 2, within or to 30 an the on one of the (see and and or the of the that or This from to or but not or For example, a with 2 bursts alternating with of be with a of or the of the that or This from to or but not For example, a with 2 bursts alternating with of as shown be with a of patterns also the of be the terms in 1 that to rhythmic and periodic generalized with or of bursts and of a the defined The presence or of if or more discharges or are within most bursts and at an of 1 or within a as the of the of discharges within a (see EEG Supplemental Digital Content frequency and or as defined in if a potentially pattern within most frequency and if this The presence or of if the or longer of or of of 2 or more bursts in all in most bursts (see EEG Supplemental Digital Content or of the of as defined or activity but not as whether or of based on at on the and on the but the This be an of generalized with based on than be of on the and other the bursts on the with a on the This an of are not bursts because there a relationship the activity the patterns are not longer of longer of The or longer of are in all only 1 in most in a The or longer of of 2 or more bursts in a are in all only 1 in most in EEG activity to This include in or frequency, of of be and a of testing with multiple of activity or not as as the suggested that if an EEG one of a of standardized be to the and be with the in and the on or we this important in the the only or discharges This or (see multiple testing have not been there was much to the or there was a of a in activity but not was not tested or was the EEG Changes if there are at least 2 of background EEG to the of or at least to as a be to the from the to more changes also The more pattern the EEG pattern for the state changes as the with and but with • both and as the and but frequency, but least 2 of background 1. The background activity to of or to as a be to the from the to more The more state the changes also The presence of state changes the presence of the presence of not the presence of state changes because the of to changes in background patterns include at least and alternating the 2 patterns in a for at least to to the of time the both whether in the more state or state if pattern and of if this pattern with of other such as and of Changes in EEG background pattern 1 and pattern 2, 1. pattern at least the patterns in a For at least pattern of this as the presence of state be with and at least one of the for a to have and no state most or all activity in with from to most or all activity in with from to but not as all activity the background or EEG background to the higher at in the there a and least 1 to of and such that are in and higher are in defined but with a to of and but effect to EEG activity or a and of activity of higher and sharpness, of with the of the with the on the of the This to and and as defined in the of terms most clinical defined as from background with at a time and from to with at the EEG defined but with a of to or or with a than but be the and a or associated with some other of the to 2 or more in a with no and as if alternating with or a highly within The of discharges and be as but not be to the and number of discharges are but than 1 but than (RPPs) All terms of main terms, with modifiers added as term 1 to the of the pattern and main term 2 the of 1. or and pattern (see and Supplemental Digital Content if has a and periodic In this the pattern pattern that with based on amplitude, higher on and based on on the and but not of the lateralized to one be With one the time suggested that a more term be “bilateral but this was for several 1. many lateralized patterns are also (see definition of this more to and the has been to to seizures, and that are not in this has also been in many studies in the to critical care EEG and in the previous version of this was not for in at least than that in on a or (see EEG Supplemental Digital Content in at least than in on a or in at least than in on a or not in all and not as one of the but and higher in one (see EEG Supplemental Digital Content but with a from the This and patterns. lateralized patterns with one in with both patterns (see EEG Supplemental Digital Content patterns at the time in than the other discharges only in one this discharges but and of the higher one this discharges but and of the on one this are not because the are not In lateralized patterns in and at there are lateralized patterns at on the for an and then later in the on the for an these be LPDs from the and LPDs from the but not because are not The in because for its periodic (see EEG Supplemental Digital Content or rhythmic patterns (see EEG Supplemental Digital Content in the with both patterns patterns at the time in than the other In periodic discharges in with both within a this there are lateralized patterns at in the for an and then later in the the for an these be of LPDs on the but not periodic discharges because are not patterns be in the as an pattern in the or For example, at 1 in the with at as periodic at least lateralized with at least one in with all or more patterns (see EEG Supplemental Digital Content In periodic discharges in with at least one in all within a this remain for and if whether or in only one be but and higher in one to as For example, and but on the be to as LPDs, (see EEG Supplemental Digital Content but and with a from the to as For example, LPDs that are on the the time lateralized pattern be both “bilateral and “bilateral the most or if more not For the be for pattern for and in both or with no Patterns that are and be or and more on one Patterns that are and but more on one be or or most in both or if more not or • of a with morphology and with a and recurrence of the at defined as having a from one to the in most • of number of or with no more than This as to defined as and having at least and bursts out from the background • of a with morphology and and an The of one the of the rhythmic pattern from the of the for most to as of a rhythmic pattern be a there are other a pattern be at the the of the and be rhythmic no longer be or delta not be as • activity to or or a in a and alternating pattern with a relationship the or and the for at least and with no one and the (see EEG Supplemental Digital Content there an this as a 1. of a with morphology and duration, with a and recurrence of the at having a from one to the in the of pattern as rhythmic or periodic if and only if for at least 1 for or for 2 1. of a with morphology and and an The of one the of the rhythmic pattern from the of the for the of to as pattern as rhythmic or periodic if and only if for at least 1 for or for 2 or or or a in a and alternating pattern with a relationship the or and the for at least and with no one and the there an this as a pattern as rhythmic or periodic if and only if for at least 1 for or for 2 a pattern as both and be as than (see “plus” modifier of the be to EEG of or that the This be based on the of an that or within the The time as of the pattern For example, for 1 prevalence, and for 1 also or terms, the for clinical terms are as or more patterns are the presence and of one and of to of to of to of of of pattern if not or terms, the for the to 1 to to and for all patterns LPDs with frequency of 1 and of and frequency the 2, and and if very and For and only be to if or have a frequency and are these as electrographic seizures and be to as such than as or in this terminology have a frequency of if an and the for or electrographic seizure (see definitions this not as but as a of 1 number of of the as in and in the in most that of the that on one of or the The and do not as to and the or of the This not to as 2, or for both the with and the if For both the only to and the of not as of that at the EEG of that to for that have a morphology to one of the or at but are in to as a having or or not background in in in the in the pattern most For this to the highest For this to the be from to to for as as to to For only absolute and of of the highest of the to the of the background in the and as absolute as or or as or an with or clinical a in an pattern also be at other to spontaneous or (see EEG Supplemental Digital Content Even if most of the pattern are as if be an or an with or clinical a in an pattern also at other Even if most of the pattern or as if be or an or or The of of 1 number of of the In this there are a of 2 the number of 1 2 the of the or the In this 1 2 and of care and other or or The term to or discharges and a term that all patterns or In one to the pattern than the term for a or terms to changes in frequency, or least changes in frequency, or defined as in frequency defined as at least changes in the at least from 2 to to or from to 2 to in morphology defined as at least changes to a morphology in defined as into or out of at least The changes be in the morphology or to • To as evolution in frequency, a frequency for at least 1 for or for 1 the pattern as for then 2 for then for (see EEG Supplemental Digital Content • To as evolution in morphology or morphology its at least the for then for then for • To as evolution in the pattern into or out of and the of be for at least LPDs only at to include for then and for • The for evolution be the or for or more the pattern not as for 1 then 2 for then for 2 • in not as and not as a of least 2 changes in defined as at least 2 changes in the at least To as a frequency for at least The for evolution be the for or more of least 2 changes to a morphology or morphology its at least of as into or out of at least To as a for at least of an now to patterns that are with evolution as (see with evolution of an electrographic seizure and be as changes, not more than 1 in frequency at least morphology or at least 1 but not as (see EEG 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Digital Content The or to at least but not as of an pattern activity as +F if the activity of the or pattern and not of the background activity with the periodic activity a pattern as or has associated or this and be as +F if the activity not in the background activity the or not activity with the rhythmic delta and having a relationship to the delta at the time as but association with the as rhythmic delta activity with associated in one only on one and +S on the as to have for or for The within periodic discharges not a pattern as because the of the the periodic at the time as but association with the as a pattern as both and with be as than a pattern and as on one but not on the the main term include the one not a For example, periodic discharges with activity in one only on one and on the for (see EEG Supplemental Digital Content generalized rhythmic delta activity with associated in one only on one and on the for activity with activity in one only on one and +F on the for a pattern as or has associated or this and be as +F if the activity not in the background activity the or not In other as +F if the activity of the or pattern and not of the background activity and to the activity be as the activity was not the were not or with in a of of +F TABLE - and or if only the are delta of to of activity relationship to delta activity relationship to delta or but • of or in the activity has a relationship to the delta on the or of the and This a of with or or if the are delta the activity has a relationship to delta delta brush of that for and with an that not as the activity of the background this pattern not as of the are delta that for and not as the +F not on the delta not delta not +F as the activity of the not be in of a delta with and in the activity has a relationship to the delta periodic delta (see EEG Supplemental Digital Content and or only or than or the activity a relationship to the delta activity during into this and a of as +F for to also be as with activity in the background and not associated with the pattern not as +F and as The only periodic pattern that for periodic delta other periodic pattern with activity with the in periodic delta also not as This because the activity not associated with the not periodic delta be in as other of or generalized lateralized or also as if the or and as if the or also as if the or and as if the or also as if the or and as if the or are multiple other features that a pattern more such as sharpness, higher and but these are for in the other Minor of the be to EEG defined as from to within with longer than the and the of highest (see EEG Supplemental Digital Content or the but with the of to be background a in that a be as this The triphasic morphology” be added to the term this modifier This modifier to and but not also be to or if there a of from the most to the most in or (see EEG Supplemental Digital Content in from to to in both a and a with an This to or the of for the with the be in a the only to and the of not as 1. 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CONTEXT: Despite recent studies that failed to show catastrophic effects of prenatal cocaine exposure, popular attitudes and public policies still reflect the belief that cocaine is a uniquely dangerous teratogen. OBJECTIVE: To critically review outcomes in early childhood after prenatal cocaine exposure in 5 domains: physical growth; cognition; language skills; motor skills; and behavior, attention, affect, and neurophysiology. DATA SOURCES: Search of MEDLINE and Psychological Abstracts from 1984 to October 2000. STUDY SELECTION: Studies selected for detailed review (1) were published in a peer-reviewed English-language journal; (2) included a comparison group; (3) recruited samples prospectively in the perinatal period; (4) used masked assessment; and (5) did not include a substantial proportion of subjects exposed in utero to opiates, amphetamines, phencyclidine, or maternal human immunodeficiency virus infection. DATA EXTRACTION: Thirty-six of 74 articles met criteria and were reviewed by 3 authors. Disagreements were resolved by consensus. DATA SYNTHESIS: After controlling for confounders, there was no consistent negative association between prenatal cocaine exposure and physical growth, developmental test scores, or receptive or expressive language. Less optimal motor scores have been found up to age 7 months but not thereafter, and may reflect heavy tobacco exposure. No independent cocaine effects have been shown on standardized parent and teacher reports of child behavior scored by accepted criteria. Experimental paradigms and novel statistical manipulations of standard instruments suggest an association between prenatal cocaine exposure and decreased attentiveness and emotional expressivity, as well as differences on neurophysiologic and attentional/affective findings. CONCLUSIONS: Among children aged 6 years or younger, there is no convincing evidence that prenatal cocaine exposure is associated with developmental toxic effects that are different in severity, scope, or kind from the sequelae of multiple other risk factors. Many findings once thought to be specific effects of in utero cocaine exposure are correlated with other factors, including prenatal exposure to tobacco, marijuana, or alcohol, and the quality of the child's environment. Further replication is required of preliminary neurologic findings.

No AccessAmerican Journal of Speech-Language PathologyViewpoint1 Sep 1994Evaluation and Treatment of Swallowing Disorders Jeri A. LogemannPhD Jeri A. Logemann Department of Communication Sciences and Disorders, Otolaryngology - Head and Neck Surgery and Neurology, Northwestern University, 2299 North Campus Drive, Evanston, IL 60208 Google Scholar https://doi.org/10.1044/1058-0360.0303.41 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationTrack Citations ShareFacebookTwitterLinked In References Connelly, A., & Goldacker, F. (1992). Dysphagia management: Are training programs meeting the needs of students? Unpublished survey. Google Scholar Fujiu, M., Toleikis, J. R., Logemann, J. A., & Larson, C. R. (in press). Glossopharyngeal evoked potentials in normal subjects following mechanical stimulation of the anterior faucial pillar.Electroencephalography and Clinical Neurophysiology. Google Scholar Horner, J., Massey, E., Riski, J., Lathrop, M., & Chase, K. (1988). Aspiration following stroke: Clinical correlates and outcomes.Neurology, 38, 1359–1362. Google Scholar Johnson, E. R., McKenzie, S. W., & Sievers, A. (1993). Aspiration pneumonia in stroke.Archives of Physical Medicine and Rehabilitation, 74, 973–976. Google Scholar Kahrilas, P. J., Logemann, J. A., Krugler, C., & Flanagan, E. (1991). Volitional augmentation of upper esophageal sphincter opening during swallowing.American Journal of Physiology, 260 (Gastrointestinal Physiology, 23), G450–456. MedlineGoogle Scholar Kahrilas, P. J., Logemann, J. A., & Gibbons, P. (1992). Food intake by maneuver: An extreme compensation for impaired swallowing.Dysphagia, 7, 155–159. Google Scholar Lazarus, C., Logemann, J. A., & Gibbons, P. (1993). Effects of maneuvers on swallowing function in a dysphagic oral cancer patient.Head and Neck, 15, 419–424. Google Scholar Lazarus, C., Logemann, J. A., Rademaker, A. W., Kahrilas, P. J., Pajak, T., Lazar, R., & Halper, A. (1993). Effects of bolus volume, viscosity and repeated swallows in nonstroke subjects and stroke patients.Archives of Physical Medicine and Rehabilitation, 74, 1066–1070. Google Scholar Logemann, J. A. (1990). Dysphagia.Seminars in Speech and Language, 11(3), 157–164. Google Scholar Logemann, J. A. (1993a). The dysphagia diagnostic procedure as a treatment efficacy trial.Clinics in Communication Disorders, 3(4), 1–10. Google Scholar Logemann, J. A. (1993b). A manual for videofluoroscopic evaluation of swallowing (2nd ed.). Austin, TX: Pro-Ed. Google Scholar Logemann, J. A. (1993c). Noninvasive approaches to deglutitive aspiration.Dysphagia, 8, 331–333. Google Scholar Logemann, J. A., Rademaker, A. W., Pauloski, B. R., & Kahrilas, P. J. (1994). Effects of postural change on aspiration in head and neck surgical patients.Otolaryngology–Head and Neck Surgery, 110(2), 222–227. Google Scholar Martin, B. J. W., Logemann, J. A., Shaker, R., & Dodds, W. J. (1993). Normal laryngeal valving patterns during three breath-hold maneuvers: A pilot investigation.Dysphagia, 8, 11–20. Google Scholar Martin, B. J., Corlew, M., Wood, H., Olson, D., Golopol, L., Wingo, M., & Kirmani, N. (1994). The association of swallowing dysfunction and aspiration pneumonia.Dysphagia, 9, 1–6. Google Scholar Rademaker, A. W., Pauloski, B. R., Logemann, J. A., & Shanahan, T. K. (in press). Oropharyngeal swallow efficiency as a representative measure of swallowing function.Journal of Speech and Hearing Research. Google Scholar Rasley, A., Logemann, J. A., Kahrilas, P. J., Rademaker, A. W., Pauloski, B. R., & Dodds, W. J. (1993). Prevention of barium aspiration during videofluoroscopic swallowing studies: Value of change in posture.American Journal of Roentgenology, 160, 1005–1009. CrossrefMedlineGoogle Scholar Schmidt, J., Holas, M., Halvorson, K., & Reding, M. (1994). Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke.Dysphagia, 9, 7–11. Google Scholar Shanahan, T. K., Logemann, J. A., Rademaker, A. W., Pauloski, B. R., & Kahrilas, P. J. (1993). Chin down posture effects on aspiration in dysphagic patients.Archives of Physical Medicine and Rehabilitation, 74, 736–739. Google Scholar Welch, M. W., Logemann, J. A., Rademaker, A. W., & Kahrilas, P. J. (1993). Changes in pharyngeal dimensions effected by chin tuck.Archives of Physical Medicine and Rehabilitation, 74, 178–181. MedlineGoogle Scholar Additional Resources FiguresReferencesRelatedDetailsCited ByAmerican Journal of Speech-Language Pathology8:2 (109-117)1 May 1999Ethical Issues Involved in Patients' Rights to Refuse Artificially Administered Nutrition and Hydration and Implications for the Speech-Language PathologistTracy L. LandesAmerican Journal of Speech-Language Pathology5:1 (15-22)1 Feb 1996Ethical Decision-Making in Dysphagia ManagementHelen M. Sharp and Leigh B. Genesen Volume 3Issue 3September 1994Pages: 41-44 Get Permissions Add to your Mendeley library History Published in issue: Sep 1, 1994 Metrics Downloaded 657 times Topicsasha-topicsleader-topicsasha-article-typesKeywordsdysphagicvideofluoroscopyevaluationtreatmentswallowingCopyright & PermissionsCopyright © 1994 American Speech-Language-Hearing AssociationPDF DownloadLoading ...

There is converging evidence that high doses of hallucinogenic drugs can produce significant alterations of self-experience, described as the dissolution of the sense of self and the loss of boundaries between self and world. This article discusses the relevance of this phenomenon, known as "drug-induced ego dissolution (DIED)", for cognitive neuroscience, psychology and philosophy of mind. Data from self-report questionnaires suggest that three neuropharmacological classes of drugs can induce ego dissolution: classical psychedelics, dissociative anesthetics and agonists of the kappa opioid receptor (KOR). While these substances act on different neurotransmitter receptors, they all produce strong subjective effects that can be compared to the symptoms of acute psychosis, including ego dissolution. It has been suggested that neuroimaging of DIED can indirectly shed light on the neural correlates of the self. While this line of inquiry is promising, its results must be interpreted with caution. First, neural correlates of ego dissolution might reveal the necessary neurophysiological conditions for the maintenance of the sense of self, but it is more doubtful that this method can reveal its minimally sufficient conditions. Second, it is necessary to define the relevant notion of self at play in the phenomenon of DIED. This article suggests that DIED consists in the disruption of subpersonal processes underlying the "minimal" or "embodied" self, i.e., the basic experience of being a self rooted in multimodal integration of self-related stimuli. This hypothesis is consistent with Bayesian models of phenomenal selfhood, according to which the subjective structure of conscious experience ultimately results from the optimization of predictions in perception and action. Finally, it is argued that DIED is also of particular interest for philosophy of mind. On the one hand, it challenges theories according to which consciousness always involves self-awareness. On the other hand, it suggests that ordinary conscious experience might involve a minimal kind of self-awareness rooted in multisensory processing, which is what appears to fade away during DIED.

In 1999, the International Federation of Clinical Neurophysiology (IFCN) published "IFCN Guidelines for topographic and frequency analysis of EEGs and EPs" (Nuwer et al., 1999). Here a Workgroup of IFCN experts presents unanimous recommendations on the following procedures relevant for the topographic and frequency analysis of resting state EEGs (rsEEGs) in clinical research defined as neurophysiological experimental studies carried out in neurological and psychiatric patients: (1) recording of rsEEGs (environmental conditions and instructions to participants; montage of the EEG electrodes; recording settings); (2) digital storage of rsEEG and control data; (3) computerized visualization of rsEEGs and control data (identification of artifacts and neuropathological rsEEG waveforms); (4) extraction of "synchronization" features based on frequency analysis (band-pass filtering and computation of rsEEG amplitude/power density spectrum); (5) extraction of "connectivity" features based on frequency analysis (linear and nonlinear measures); (6) extraction of "topographic" features (topographic mapping; cortical source mapping; estimation of scalp current density and dura surface potential; cortical connectivity mapping), and (7) statistical analysis and neurophysiological interpretation of those rsEEG features. As core outcomes, the IFCN Workgroup endorsed the use of the most promising "synchronization" and "connectivity" features for clinical research, carefully considering the limitations discussed in this paper. The Workgroup also encourages more experimental (i.e. simulation studies) and clinical research within international initiatives (i.e., shared software platforms and databases) facing the open controversies about electrode montages and linear vs. nonlinear and electrode vs. source levels of those analyses.

Do principles of language processing in the brain affect the way grammar evolves over time or is language change just a matter of socio-historical contingency? While the balance of evidence has been ambiguous and controversial, we identify here a neurophysiological constraint on the processing of language that has a systematic effect on the evolution of how noun phrases are marked by case (i.e. by such contrasts as between the English base form she and the object form her). In neurophysiological experiments across diverse languages we found that during processing, participants initially interpret the first base-form noun phrase they hear (e.g. she…) as an agent (which would fit a continuation like … greeted him), even when the sentence later requires the interpretation of a patient role (as in … was greeted). We show that this processing principle is also operative in Hindi, a language where initial base-form noun phrases most commonly denote patients because many agents receive a special case marker ("ergative") and are often left out in discourse. This finding suggests that the principle is species-wide and independent of the structural affordances of specific languages. As such, the principle favors the development and maintenance of case-marking systems that equate base-form cases with agents rather than with patients. We confirm this evolutionary bias by statistical analyses of phylogenetic signals in over 600 languages worldwide, controlling for confounding effects from language contact. Our findings suggest that at least one core property of grammar systematically adapts in its evolution to the neurophysiological conditions of the brain, independently of socio-historical factors. This opens up new avenues for understanding how specific properties of grammar have developed in tight interaction with the biological evolution of our species.

Mathematical models and computer simulations have the great potential to substantially increase our understanding of the biophysical behavior of the neuromuscular system. This, however, requires detailed multiscale, and multiphysics models. Once validated, such models allow systematic in silico investigations that are not necessarily feasible within experiments and, therefore, have the ability to provide valuable insights into the complex interrelations within the healthy system and for pathological conditions. Most of the existing models focus on individual parts of the neuromuscular system and do not consider the neuromuscular system as an integrated physiological system. Hence, the aim of this advanced review is to facilitate the prospective development of detailed biophysical models of the entire neuromuscular system. For this purpose, this review is subdivided into three parts. The first part introduces the key anatomical and physiological aspects of the healthy neuromuscular system necessary for modeling the neuromuscular system. The second part provides an overview on state-of-the-art modeling approaches representing all major components of the neuromuscular system on different time and length scales. Within the last part, a specific multiscale neuromuscular system model is introduced. The integrated system model combines existing models of the motor neuron pool, of the sensory system and of a multiscale model describing the mechanical behavior of skeletal muscles. Since many sub-models are based on strictly biophysical modeling approaches, it closely represents the underlying physiological system and thus could be employed as starting point for further improvements and future developments. This article is categorized under: Physiology > Mammalian Physiology in Health and Disease Analytical and Computational Methods > Computational Methods Models of Systems Properties and Processes > Organ, Tissue, and Physiological Models.

Almost half a century ago, a series of remarkable therapeutic developments occurred and were soon recognised as milestones in the history of medicine. The introduction of lithium, chlorpromazine, imipramine and the monoamine oxidase inhibitors, within a few years of each other, radically altered the prospects for treating serious psychiatric disorders. Until then, electroconvulsive therapy had been the only definitive treatment available. Research on pharmacological agents that alleviate disturbances of mood, cognition and behaviour, was given an impetus that led to quantum expansion in the ensuing years. It has become customary to recount the history of neuropsychopharmacology from that time. Although this is an understandable bias, it ignores much fundamental research in neurophysiology, neurochemistry and pharmacology and clinical experimentation with psychoactive agents that laid the foundations for what was to follow. Nevertheless, neuropsychopharmacology is still a very young discipline. This manifests not only in chronology but in the ferment, rapid shifts in priorities and fluidity of fundamental concepts that are hallmarks of youth. The critical observer cannot but concede the likelihood that tenets held basic to contemporary neuropsychopharmacology could turn out to be substantially overemphasised, unacceptably simplistic or even incorrect, in the relatively near future. Perusal of major papers in the field, published no more than one or two decades ago, confirms this impression. Rather than detracting from the discipline, these attributes are what give neuropsychopharmacology its remarkable allure. There is the distinct feeling that much of what can be known has yet to be discovered. Steps equal to or greater in impact than those of half a century ago, wait to be taken.

Backward masking can potentially provide evidence of the time needed for visual processing, a fundamental constraint that must be incorporated into computational models of vision. Although backward masking has been extensively used psychophysically, there is little direct evidence for the effects of visual masking on neuronal responses. To investigate the effects of a backward masking paradigm on the responses of neurons in the temporal visual cortex, we have shown that the response of the neurons is interrupted by the mask. Under conditions when humans can just identify the stimulus, with stimulus onset asynchronies (SOA) of 20 msec, neurons in macaques respond to their best stimulus for approximately 30 msec. We now quantify the information that is available from the responses of single neurons under backward masking conditions when two to six faces were shown. We show that the information available is greatly decreased as the mask is brought closer to the stimulus. The decrease is more marked than the decrease in firing rate because it is the selective part of the firing that is especially attenuated by the mask, not the spontaneous firing, and also because the neuronal response is more variable at short SOAs. However, even at the shortest SOA of 20 msec, the information available is on average 0.1 bits. This compares to 0.3 bits with only the 16-msec target stimulus shown and a typical value for such neurons of 0.4 to 0.5 bits with a 500-msec stimulus. The results thus show that considerable information is available from neuronal responses even under backward masking conditions that allow the neurons to have their main response in 30 msec. This provides evidence for how rapid the processing of visual information is in a cortical area and provides a fundamental constraint for understanding how cortical information processing operates.

Numerous previous neuroimaging studies suggest an involvement of cortical motor areas not only in action execution but also in action recognition and understanding. Motor areas of the human brain have also been found to activate during the processing of written and spoken action-related words and sentences. Even more strikingly, stimuli referring to different bodily effectors produced specific somatotopic activation patterns in the motor areas. However, metabolic neuroimaging results can be ambiguous with respect to the processing stage they reflect. This is a serious limitation when hypotheses concerning linguistic processes are tested, since in this case it is usually crucial to distinguish early lexico-semantic processing from strategic effects or mental imagery that may follow lexico-semantic information access. Timing information is therefore pivotal to determine the functional significance of motor areas in action recognition and action-word comprehension. Here, we review attempts to reveal the time course of these processes using neurophysiological methods (EEG, MEG and TMS), in visual and auditory domains. We will highlight the importance of the choice of appropriate paradigms in combination with the corresponding method for the extraction of timing information. The findings will be discussed in the general context of putative brain mechanisms of word and object recognition.

With the advent of non-invasive brain stimulation (NIBS), a new decade in the study of language has started. NIBS allows for testing the functional relevance of language-related brain activation and enables the researcher to investigate how neural activation changes in response to focal perturbations. This review focuses on the application of NIBS in the healthy brain. First, some basic mechanisms will be introduced and the prerequisites for carrying out NIBS studies of language are addressed. The next section outlines how NIBS can be used to characterize the contribution of the stimulated area to a task. In this context, novel approaches such as multifocal transcranial magnetic stimulation and the condition-and-perturb approach are discussed. The third part addresses the combination of NIBS and neuroimaging in the study of plasticity. These approaches are particularly suited to investigate short-term reorganization in the healthy brain and may inform models of language recovery in post-stroke aphasia.

ness includes an expansion of concepts dealing with psychoacoustics, neurophysiology, genetics, diagnostic audiology, and the education of deaf children. The chapters on conservation of hearing, audiometry, special auditory tests, standards for hearing, and medicolegal rules now include technical statements and guidelines assembled from a variety of journals into a single book source. There are those who might complain about the chapter sequence of material presenta¬ tion since some of the more technical chap¬ ters are presented early in the text, but the authors point out that their chosen sequence is arbitrary. The authors point out in their foreword an often overlooked fact . . . hear¬ ing is within the province of psychology, and all the variables that influence behavior must also be considered in any discussion of the hearing process. So important is their concept, the authors state that the permea¬ tion of the text with the psychological as¬ pects of hearing, give the book unity and a common theme. The editors chose to leave a few chapters relatively in their third edition, as memorial to authors who are now de¬ ceased, and because principles have re¬ mained unchanged since 1947. These chap¬ ters, dealing primarily with the rehabilita¬ tion of hearing impaired persons, are now the weakest portion of the book and de¬ served to be updated to match the outstanding quality of the rest of the text. The success of this textbook may be at¬ tributed to the broadness of topics present¬ ed. With such a wide scope of topics, how¬

To date, non-reproducibility of neurophysiological research is a matter of intense discussion in the scientific community. A crucial component to enhance reproducibility is to comprehensively collect and store metadata, that is, all information about the experiment, the data, and the applied preprocessing steps on the data, such that they can be accessed and shared in a consistent and simple manner. However, the complexity of experiments, the highly specialized analysis workflows and a lack of knowledge on how to make use of supporting software tools often overburden researchers to perform such a detailed documentation. For this reason, the collected metadata are often incomplete, incomprehensible for outsiders or ambiguous. Based on our research experience in dealing with diverse datasets, we here provide conceptual and technical guidance to overcome the challenges associated with the collection, organization, and storage of metadata in a neurophysiology laboratory. Through the concrete example of managing the metadata of a complex experiment that yields multi-channel recordings from monkeys performing a behavioral motor task, we practically demonstrate the implementation of these approaches and solutions with the intention that they may be generalized to other projects. Moreover, we detail five use cases that demonstrate the resulting benefits of constructing a well-organized metadata collection when processing or analyzing the recorded data, in particular when these are shared between laboratories in a modern scientific collaboration. Finally, we suggest an adaptable workflow to accumulate, structure and store metadata from different sources using, by way of example, the odML metadata framework.

A significant body of work has investigated the effects of acute exercise, defined as a single bout of physical activity, on mood and cognitive functions in humans. Several excellent recent reviews have summarized these findings; however, the neurobiological basis of these results has received less attention. In this review, we will first briefly summarize the cognitive and behavioral changes that occur with acute exercise in humans. We will then review the results from both human and animal model studies documenting the wide range of neurophysiological and neurochemical alterations that occur after a single bout of exercise. Finally, we will discuss the strengths, weaknesses, and missing elements in the current literature, as well as offer an acute exercise standardization protocol and provide possible goals for future research.

The premise of this study is that current models of speech perception, which are driven by acoustic features alone, are incomplete, and that the role of decoding time during memory access must be incorporated to account for the patterns of observed recognition phenomena. It is postulated that decoding time is governed by a cascade of neuronal oscillators, which guide template-matching operations at a hierarchy of temporal scales. Cascaded cortical oscillations in the theta, beta, and gamma frequency bands are argued to be crucial for speech intelligibility. Intelligibility is high so long as these oscillations remain phase locked to the auditory input rhythm. A model (Tempo) is presented which is capable of emulating recent psychophysical data on the intelligibility of speech sentences as a function of "packaging" rate (Ghitza and Greenberg, 2009). The data show that intelligibility of speech that is time-compressed by a factor of 3 (i.e., a high syllabic rate) is poor (above 50% word error rate), but is substantially restored when the information stream is re-packaged by the insertion of silent gaps in between successive compressed-signal intervals - a counterintuitive finding, difficult to explain using classical models of speech perception, but emerging naturally from the Tempo architecture.

Cough is due to activation of sensory receptors in the larynx and lower respiratory tract, sending impulses to the brainstem. The central organization of cough is poorly understood. The afferent pathways for cough are from receptors in and under the epithelium of the airways. These receptors are rapidly adapting, with thin myelinated fibres in the vagus nerves, which can be directly stimulated by tussive agents. Activation of C-fibre receptors in the airway releases sensory neuropeptides. These cause neurogenic inflammation and may activate rapidly adapting receptors to cause cough. The central connections of the C-fibre receptors inhibit cough. Thus, the sensitivity of the cough reflex and its pattern of response is due to a complex interaction between C-fibre receptors and rapidly adapting receptors, with peripheral and central nervous interactions. How these mechanisms apply to clinical cough in patients is at present poorly understood, but is beginning to be clarified.