Name: electrophysiological measurement of noxious-evoked brain activity in neonates using a flat-tip probe coupled to electroencephalography
Uploaded: 2017-11-29T15:00:00
Description: Watch this Scientific Journal Video about Electrophysiological Measurement of Noxious-evoked Brain Activity in Neonates Using a Flat-tip Probe Coupled to Electroencephalography at JoVE.com

The authors would like to acknowledge Caroline Hartley and Rebeccah Slater (Department of Paediatrics, University of Oxford, UK) for critical reviewing our paper and Walter Magerl (Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim (CBTM), University of Heidelberg, Germany) for supporting us with technical equipment and knowledge.

The study was approved by the Competent Ethics Committee of Northwestern Switzerland (EKNZ 2015-079) and informed written parental consent for the participant was obtained before the measurement.
1. Preparation
<ol>
	<li>Make sure the baby is settled. It should be quiet and settled, without sucking motions during the recording because of movement artefacts. The baby can be asleep9.</li>
	<li>Measure the neonate&#39;s head circumference with a measuring tape to define ...

<ol>
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The approach presented here shows how noxious-evoked brain activity in neonates can be measured in an objective way using EEG recording and flat-tip probe stimulators to apply experimental noxious stimuli. This technique can be used in various clinical settings to detect nociception, e.g. in non-verbal persons such as neonates. The complete study can be done within 15 min, including placing the baby, identifying, preparing and mounting the electrodes, and finally applying and recording the 50 noxious stimuli. Th...

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage1. The inability to communicate verbally does not negate the possibility that an individual is experiencing pain but makes it very challenging to assess pain-relieving treatment, for example in newborn infants2. Several behavioral and physiological indicators are used to assess pain in non-verbal patients. Different scales have been developed over the years, the choice depends on the type of stimulus, gestational age and the environment in which the neonates are embeded3,4,5. These pain assessment tools either rely on the rater&#39;s interpretation or they demand secondary physiological indicators.
In this video, we present a method to assess nociception with electrophysiological recordings optimized for use in newborn infants. Nociception is defined as the neural process of encoding noxious stimuli. Thus, quantitating nociception is an elegant and objective method to determine the neural input in a non-verbal person. Moreover, cortical activity detected by electroencephalography (EEG) is correlated with the intensity of noxious events5,6.
The method presented here combines EEG recording with noxious stimuli produced by a mechanical stimulation with a flat-tip probe, also called a pinprick7, which is not skin-breaking and does not cause behavioral distress6. It has been shown, that nociception following punctuate stimulation is predominantly mediated by A&#948;-fibers, does not need a skin breaking lesion8 and the magnitude of the nociceptive-specific potential is not dependent on sleep state9. The probe is well accepted also by parents when applying this method in a study setting with neonates. The probe is electronically linked to the EEG recording system enabling the EEG recording to be precisely tagged when the probe contacts the skin. This greatly simplifies the process of time locking and is the premise for all subsequent EEG analyses. In order to minimize preparation time of the infant EEG recording we used a modified international 10/20 electrode placement system where we reduced the number of electrodes to the minimum requirement of three electrodes (Figure 1). The central vertex Cz electrode, where the noxious-evoked brain activity is maximal9,10,11, was used together with one reference and one ground electrode.

<table>
	<tbody>
		<tr>
			<td>Easycap</td>
			<td>EASYCAP GmbH</td>
			<td>AC-32-C</td>
			<td>EEG caps for infants sizes 34 and 36</td>
		</tr>
		<tr>
			<td>actiCAP</td>
			<td>Brain Products GmbH</td>
			<td>BP-04243-SIG</td>
			<td>active electrodes</td>
		</tr>
		<tr>
			<td>ImpBox</td>
			<td>Brain Products GmbH</td>
			<td></td>
			<td>impedance measurement</td>
		</tr>
		<tr>
			<td>V-Amp</td>
			<td>Brain Products GmbH</td>
			<td></td>
			<td>EEG recording device</td>
		</tr>
		<tr>
			<td>Contact trigger for pinprick stimulation</td>
			<td>MRC Systems GmbH</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>PinPrick stimulator set</td>
			<td>MRC Systems GmbH</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>EEG prepping paste</td>
			<td>USB Pharmacy</td>
			<td></td>
			<td>contains sodium chloride, pumice stone, propylene glycol</td>
		</tr>
		<tr>
			<td>SuperVisc</td>
			<td>EASYCAP GmbH</td>
			<td></td>
			<td>Electrolyte-Gel for active electrodes</td>
		</tr>
		<tr>
			<td>Brain Vision Recorder</td>
			<td>Brain Products GmbH</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Brain Vision Analyzer</td>
			<td>Brain Products GmbH</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>MATLAB using EEGLAB
			
			
			
			
			
			</td>
			<td>Swartz Center for Computational Neuroscience, University of California San Diego</td>
			<td></td>
			<td>For EEG processing, including averaging of all EEG epochs
			
			
			
			</td>
		</tr>
	</tbody>
</table>

electrophysiological measurement of noxious-evoked brain activity in neonates using a flat-tip probe coupled to electroencephalography

Pain is an unpleasant sensory and emotional experience. In non-verbal patients, it is very difficult to measure pain, even with pain assessment tools. Those tools are subjective or determine secondary physiological indicators which also have certain limitations particularly when exploring the effectiveness of analgesia. As cortical processing is essential for pain perception, brain activity measures may provide a useful approach to assess pain in infants. Here we present a method to assess nociception with electrophysiological brain activity recordings optimized for the use in newborn infants. To produce highly standardized and reproducible noxious stimuli we applied mechanical stimulation with a flat-tip probe, e.g., PinPrick, which is not skin-breaking and does not cause behavioral distress. The noxious-evoked potential allows the objective measurement of nociception in non-verbal patients. This method can be used in newborn infants as early as 34 weeks of gestational age. Moreover, it could be applied in different situations such as measuring the efficacy of analgesic or anesthetic drugs.

Figure 1 is the diagrammatic representation of the electrode positioning using the modified international 10/20 electrode placement system. Figure 2 shows the EEG activity recorded shortly before and after application of one single noxious stimulus using a flat-tip probe with 32 mN force, stimulation occurred as described in the protocol to the neonate&#39;s right hand (Figure 2A). The noxious-evoked...

Watch this Scientific Journal Video about Electrophysiological Measurement of Noxious-evoked Brain Activity in Neonates Using a Flat-tip Probe Coupled to Electroencephalography at JoVE.com

Electrophysiological Measurement of Noxious-evoked Brain Activity in Neonates Using a Flat-tip Probe Coupled to Electroencephalography

Measuring pain in non-verbal patients is a challenge. In this study we combine EEG recording with stimulation using a flat-tip probe to detect noxious-evoked brain activity in an objective manner.

Pain is an unpleasant sensory and emotional experience. In non-verbal patients, it is very difficult to measure pain, even with pain assessment tools. ...

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