Thesis Reference - Archive ouverte UNIGE
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Thesis Reference - Archive ouverte UNIGE
Thesis Influence of sleep-wake states on human memory and underlying neural plasticity: insights from EEG recordings and parasomnia CONSTANTINESCU, Irina Oana Abstract L'objectif de cette thèse est d'intégrer plusieurs niveaux d’observation (comportement, réseaux neuronaux, potentiels neuraux locaux) de la plasticité du cerveau humain lie à l’apprentissage et a la formation de la mémoire. Nous avons évalué la réorganisation des représentations neuronales post-apprentissage au cours du sommeil et de l'éveil. Nous apportons la preuve, pour la première fois, d’une réactivation comportementale pendant le sommeil chez les humains, en étudiant des patients présentant des épisodes d’activité motrice pendant le sommeil. Nous avons aussi montré chez l'homme, qu'une stimulation faible et répétée de balancement, modifie l'architecture du sommeil et rends le sommeil plus stable. Les résultats de cette thèse de doctorat ouvre de nouvelles perspectives de recherches pluridisciplinaires sur le sommeil et la mémoire. Reference CONSTANTINESCU, Irina Oana. Influence of sleep-wake states on human memory and underlying neural plasticity: insights from EEG recordings and parasomnia. Thèse de doctorat : Univ. Genève et Lausanne, 2011, no. Neur. 60 URN : urn:nbn:ch:unige-161683 Available at: http://archive-ouverte.unige.ch/unige:16168 Disclaimer: layout of this document may differ from the published version. [ Downloaded 15/10/2016 at 06:52:48 ] DOCTORAT EN NEUROSCIENCES des Universités de Genève et de Lausanne UNIVERSITÉ DE GENÈVE FACULTÉ DE MÉDECINE Docteure Sophie Schwartz, directrice de thèse Professeure Margitta Seeck, co-directrice de thèse TITRE DE LA THÈSE INFLUENCE OF SLEEP-WAKE STATES ON HUMAN MEMORY AND UNDERLYING NEURAL PLASTICITY: INSIGHTS FROM EEG RECORDINGS AND PARASOMNIA. THÈSE Présentée à la Faculté de Médecine de l‟Université de Genève pour obtenir le grade de Docteure en Neurosciences par Irina CONSTANTINESCU de Roumanie Thèse N° 60 Genève Editeur ou imprimeur : Université de Genève 2011 To my family, my friends and my mentors Eu nu strivesc corola de minuni a lumii şi nu ucid cu mintea tainele, ce le-ntâlnesc în calea mea în flori, în ochi, pe buze ori morminte. I do not crush the aura of world's wonders and do not obliterate within my mind the unrevealed crossed along my path, be it on flowers, eyes, lips, or graves. *Lucian Blaga (1895 – 1961)* Romanian philosopher, poet, playwright, translator, journalist, university professor and diplomat. Impressive and multidimensional personality of the European culture, Blaga also approached the philosophical problematic of science. * 2 The dream (1937) by Salvador Dali 3 Remerciements Mes remerciements vont tout d‟abord a Sophie Schwartz, de m‟avoir accueillie il y a 5 ans dans son groupe en m‟offrant le privilège de découvrir l‟univers passionnant de la recherche sur le sommeil. Un grand merci pour l‟inépuisable enthousiasme, générateur des idées innovatrices, pour son support permanent et sa confiance en moi et en nos projets, pour la grande ouverture d‟esprit, pour la créativité, l‟humanisme, pour l‟écoute et les conseils précieux qui m‟ont aide a évolué pas seulement dans le plan scientifique, mais aussi personnel. Un grand merci pour tout, Sophie ! Et merci la petite Elsa pour son doux sourire. Je tiens à remercier vivement Margitta Seeck, qui m‟a offert la possibilité d‟accueillir des précieuses données des patients épileptiques implantes dans l‟unité d‟évaluation prechirurgicale de l‟épilepsie, et qui a accepte d‟être co-conductrice de cette thèse. Je remercie chaleureusement Isabelle Arnulf, qui dirige le laboratoire du sommeil, à l‟hôpital Pitié-Salpêtrière à Paris, qui m‟a offert l‟occasion de m‟impliquer dans un projet passionnant sur les patients parasomniaques. Merci pour l‟enthousiasme communicatif et pour son support. Merci aussi a Delphine Oudiette, pour les discussions très constructives sur le sommeil et la cognition, et pas seulement, mais également pour sa bonne humeur et sa promptitude. Mes remerciements s‟adressent en particulier à Marzia De Lucia pour son aide précieuse sur les données intracrâniennes, sa rigueur scientifique et sa grande patience avec moi. Je remercie également Laurence Bayer pour sa collaboration fructueuse sur le projet « hamac », son calme, son écoute, et sa confiance dans notre projet. Merci a Virginie Sterpenich pour son écoute, sa désarmante perspicacité et ses conseils éclairés sur la dernière ligne droite de la thèse. Merci a Gilles Pourtois, pour sa vivacité, son enthousiasme contagieux, et ses conseils avisés sur les données EEG. Je tiens à remercier Michel Mühlethaler pour ses conseils et son soutien. 4 Un grand merci a Patrik Vuilleumier, pour son son accueil parmi les « Labnics », son support constant, ses conseils précieux a travers ces années. Mes remerciements s‟adressent à Stephen Perrig pour son enthousiasme, et les échanges constructifs sur le sommeil pendant la durée de la thèse. Je tiens également à remercier chaleureusement Philippe Peigneux et Dimitri Van De Ville d‟avoir accepte d‟être rapporteurs de cette thèse et suis heureuse de pouvoir soumettre ce travail a leur critique. Je remercie également Pierre Maquet pour ses conseils avisés. Mes remerciements vont aussi vers Laurent Spinelli et Denis Brunet pour leur aide précieux concernant les données EEG. Je remercie vivement mes collègues, Karsten, Stéphanie, Amal, Camille, Karim, Hamdi, Wiebke, Agustina, Tonia, Julie pour leur support, leur gentillesse et la bonne humeur a travers ces années. Je n‟oublie pas l‟équipe du laboratoire du sommeil de Belle-Idée pour leur support et leur accueil. Je tiens à remercier le Professeur Landis pour son grand support et pour ses encouragements a poursuivre les travaux de neurosciences. Je remercie Martine Collart pour son soutien avisé. Je remercie également le Professeur Lücking, Université de Freiburg, Allemagne, pour son soutien et sa confiance en moi à travers mes années d‟étude. Merci a mes mentors de l‟Université de Iasi en Roumanie pour leur chaleureux support et l‟ouverture d‟esprit. Un grand merci a mes amis qui ont su m‟écouter et me soutenir pendant ces années, qui ont été près de moi et ont eu confiance en moi. Je tiens enfin à adresser toute ma reconnaissance et mon affection à ma chère famille et a Xavier pour leur énorme soutien inconditionné, leur attention, leur patience et leur confiance en mes rêves. 5 Resumé L'objectif du présent travail est d'étudier l'influence des états de veille-sommeil sur la mémoire humaine et les mécanismes sous-jacents de la plasticité neuronale en utilisant des enregistrements electro-encephalographiques (EEG) et des modèles neurologiques comme la parasomnie. Mieux comprendre comment les états du sommeil et de l'éveil interfèrent avec des processus de la mémoire pourrait également révéler des indices nouveaux et fondamentaux sur le fonctionnement du cerveau humain. Malgré un grand nombre d'études, il ya encore des questions ouvertes sur ce sujet, qui a motivé le présent travail. Nous avons observé des processus physiologiques et cognitifs liés à la consolidation des connaissances récemment acquises dans différents états de vigilance, en appliquant un schéma convergente des études expérimentales. L'objectif était d'intégrer plusieurs niveaux d‟observation (comportement, réseaux neuronaux, potentiels neuraux locaux) de la plasticité du cerveau humain. Nous avons utilisé le concept de réactivations neuronales liées à l‟expérience récemment acquise pour étudier la dynamique du cerveau sous-tendant la mémoire. Nous avons évalué la réorganisation des représentations neuronales au cours du sommeil post-formation et de l'éveil, qu‟elle soit produite spontanément ou induite par la présentation des stimuli externes, associes. Plus précisément, nous avons étudié la dynamique neuronale liées à l'expérience acquise chez des patients épileptiques pharmaco-résistants, pendant la procédure d'apprentissage des séquences de mouvements. Nous avons également étudié la réactivation induite et la réorganisation des traces mnésiques pendant l'éveil post-apprentissage en utilisant des enregistrements EEG du scalp, de haute densité chez l'homme. La réactivation au niveau du comportement des événements récemment acquis a été évaluée pendant le sommeil post-apprentissage chez des patients parasomniaques, présentant des épisodes d‟activité motrice pendant le sommeil. Nous apportons la preuve, pour la première fois à notre connaissance, d‟une réactivation comportementale pendant le sommeil chez l‟homme. Sur le plan méthodologique, la présente thèse combine de manière innovante les différentes techniques EEG 6 (enregistrements intracrâniennes, des enregistrements de haute densité au niveau du scalp, des enregistrements des rythmes de sommeil) qui fournissent une fenêtre unique, directe et précise, sur le fonctionnement cérébral de l'homme. En outre, nous avons donné à des techniques déjà existantes de traitement du signal de nouvelles applications; parmi les techniques appliquées, la présente thèse met en évidence la valeur unique de l'EEG intracrânien pour la cartographie du cerveau humain. Une des façons les plus courantes et archaïques pour faciliter le sommeil est le balancement : nous nous endormons irrésistiblement dans une balançoire et, depuis des temps immémoriaux, le bercement aide l‟endormissement des bébés. Pourtant, aucune explication claire physiologique à cet effet n‟a pas encore été fournie. Dans notre étude, nous avons montré chez l'homme, en utilisant un lit-balançoire pendant les siestes l'après-midi, qu'une stimulation faible et répétée de balancement, modifie l'architecture du sommeil et a un effet bénéfique sur le sommeil en rendant le sommeil plus stable. Notre travail montre que le sommeil peut être amélioré d‟une manière instrumentale et motive le développement de nouveaux dispositifs pour aider à dormir. Les résultats de cette thèse de doctorat contribuent à une meilleure compréhension des réorganisations de l'activité cérébrale liés à l'apprentissage et ouvre de nouvelles perspectives de recherches pluridisciplinaires sur le sommeil et la mémoire. 7 Abstract The aim of the present work was to study the influence of sleep-wake states on human memory and underlying neural plasticity by using EEG recordings and neurological models as parasomnia. Understanding how sleep and wakefulness states impact memory processes may reveal new and fundamental cues on human brain functioning. Despite a large number of studies, there are still opened questions on this topic, which motivated the present work. We observed physiological and cognitive processes related to the consolidation of recently acquired knowledge across different vigilance states, by applying a convergent diagram of studies. The aim was to integrate multilevel (behavior, brain networks, local field potentials) views of plasticity in the human brain. We used the concept of experience-related neural reactivations to study brain dynamics subtending memory. We assessed re-shaping of neural representations during post-training sleep and wakefulness, either produced spontaneously or induced by presentation of learning-related external cues. More precisely, we studied experience-related neural dynamics in pharmaco-resistant epileptic patients while procedurally learning sequences of movements. We also studied induced reactivation and reorganization of neural traces during post-training wakefulness at scalp level by using high-density recordings in humans. Experience-related behavioral re-enactment during posttraining sleep was assessed in parasomnia patients. We bring evidence, for the first time to our knowledge, of a learning-related behavioral replay in humans. Methodologically, the present thesis combines in an innovative manner different EEG techniques (intracranial recordings, high-density scalp recordings, sleep rythms recordings) which provide a particularly direct and accurate window onto human brain function (Michel 2009). Furthermore, we conferred to already existent signal processing techniques new applications: in project 1, a multivariate decoding algorithm captured learning-dependent changes in intracranial EEG signal at the single trial level. Among the techniques applied, the present thesis highlights the unique value of the intracranial EEG for human brain mapping. 8 One of the most common and archaic way to facilitate sleep is rocking: we irresistibly fall asleep in a rocking-chair and, since immemorial times, we cradle our babies to sleep. Yet, no clear physiological explanation has been provided to this observed effect. In our study, we showed by using using a swinging-bed during afternoon naps that a low and repeated stimulation mimicking rocking modifies sleep architecture in humans and has a beneficial effect on sleep by rendering sleep more stable. Our work shows that sleep may be improved instrumentally and motivates the development of new devices to help sleep. The present results may contribute at further understanding of learning-related reorganization of brain activity and opens new perspectives of multidisciplinary research. 9 INDEX 1. INTRODUCTION ........................................................................ 8 2. LEARNING AND MEMORY SYSTEMS ........................................... 9 2.1. Memory systems: theoretical and experimental approaches ..... 10 2.2. Perceptual and motor skill learning ........................................... 14 Perceptual learning ................................................................................. 14 Motor learning ......................................................................................... 15 Attentional influences on learning ........................................................... 16 2.3. The temporal dynamics of perceptual and motor skill learning.. 17 3. ANATOMO-FUNCTIONAL CORRELATES OF MEMORY ................ 19 3.1. Memory and brain plasticity ...................................................... 19 3.2. Brain systems for memory processes ........................................ 21 Hippocampus and related structures ....................................................... 21 Implications of the hippocampus in memory functions ........................... 22 Amygdala and emotional memory ........................................................... 24 Diencephalon and declarative memory deficits ....................................... 24 Motor areas, basal ganglia, cerebellum and memory for motor skills ...... 24 Prefrontal cortex and memory consolidation ........................................... 25 3.3. Distinct steps in memory consolidation ..................................... 25 4. THE INFLUENCE OF SLEEP-WAKE STATES ON MEMORY PROCESSES ....................................................... 28 4.1. Sleep functions: a beneficial role for memory consolidation? .... 28 Aspects of sleep physiology..................................................................... 28 Sleep functions ........................................................................................ 30 Napping in humans ................................................................................. 31 4.2. Sleep and wakefulness: recent hypotheses on memory consolidation ............................. 32 4.2.1. Neural reactivations during sleep .................................................. 32 Reactivations at the cellular and neuronal networks levels ..................... 32 Reactivations at the brain areas level ..................................................... 36 4.2.2. Neural reactivations during wakefulness....................................... 38 4.3. Sleep homeostasis hypothesis ................................................... 39 5. RATIONALE OF THE PRESENT WORK: MAIN QUESTION AND METHODOLOGICAL APPROACHES .................................... 40 Experimental part OVERVIEW .................................................................................. 42 THESIS EXPERIMENTAL DESIGN ................................................. 42 Experiment 1 Neurophysiological evidence from human intracranial recordingsof sequenced knowledge consolidation CONTEXT .................................................................................... 43 METHODOLOGICAL HIGHLIGHTS ................................................ 43 SUMMARY OF RESULTS ............................................................... 44 CONCLUSION .............................................................................. 44 10 Article submitted to NeuroImage ............................................... 45 ABSTRACT ........................................................................................ 46 1. INTRODUCTION ............................................................................ 46 2. MATERIAL AND METHODS............................................................. 48 2.1. Patients ..................................................................................... 48 2.2. Behavioral task and experimental procedure ............................ 49 2.3. Intracranial EEG recording ........................................................ 50 2.4. Data analysis ............................................................................. 51 2.4.1. Multivariate decoding approach to iEEG ........................................ 51 Hidden Markov Model of single-trial iEEG ................................................ 52 2.4.2. Accuracy estimation ...................................................................... 54 2.4.3. Estimating contacts with higher classification power .................... 55 2.4.4. Event-related potentials ................................................................ 55 3. RESULTS ....................................................................................... 55 3.1. Behavioral results...................................................................... 57 3.2. Results from the multivariate decoding approach to single-trial iEEG...................................................... 57 3.2.1. Accuracy estimation ...................................................................... 57 3.2.2. Estimating contacts with higher classification power .................... 58 3.3.3. Relation between classification accuracy and spatio-temporal pattern of single-trial events ......................... 59 3.3. Intracranial event-related potentials......................................... 60 4. DISCUSSION................................................................................. 61 4.1. Learning-related changes in the stability of momentary neural states ....................................................... 62 4.2. Role of the hippocampus in sequence learning .......................... 63 4.3. Multivariate decoding approach to single-trial iEEG data ........... 64 5. CONCLUSIONS .............................................................................. 66 Acknowledgments ............................................................................ 66 Reference list ................................................................................... 66 Figures ............................................................................................. 71 Experiment 2 Evidence of overt replay of a recently learned motor sequence during human sleep CONTEXT .................................................................................... 75 METHODOLOGICAL HIGHLIGHTS ................................................ 75 SUMMARY OF RESULTS ............................................................... 75 CONCLUSION .............................................................................. 75 Article submitted to PLoS Biology ............................................... 76 ABSTRACT ........................................................................................ 76 INTRODUCTION ................................................................................ 77 METHODS ......................................................................................... 78 Ethic Statement ................................................................................ 78 Subjects ........................................................................................... 78 Behavioral task and experimental procedure ................................... 79 Sleep and nocturnal behavior monitoring ......................................... 81 Statistical analyses of motor performance ....................................... 81 Assessment of sequence replay during sleep ................................... 82 RESULTS ........................................................................................... 82 Sleep and cognitive performances .................................................... 82 11 Dreams content after the post-training night of sleep ...................... 83 Behaviors exhibited during post-training sleep ................................ 83 RBD patients ........................................................................................... 83 Sleepwalkers .................................................................................... 84 Evidence for behavioral replay during sleep ..................................... 84 DISCUSSION..................................................................................... 85 Acknowledgements .......................................................................... 87 References ....................................................................................... 87 Figures ............................................................................................. 89 SUPPLEMENTAL DATA ....................................................................... 92 Questions to judges .......................................................................... 92 Experiment 3 Experience-dependent induced reactivations during post-training wakefulness CONTEXT .................................................................................... 94 METHODOLOGICAL HIGHLIGHTS ................................................ 94 SUMMARY OF RESULTS ............................................................... 94 CONCLUSIONS ............................................................................ 95 Article in preparation.................................................................. 95 INTRODUCTION ................................................................................ 95 EXPERIMENTAL PROCEDURE ............................................................ 96 Subjects ........................................................................................... 96 Stimuli and task ............................................................................... 97 Behavioral task and experimental procedure ................................... 97 Electrophysiological data acquisition.............................................. 100 Event-related potential analysis ..................................................... 101 Segmentation analyses .................................................................. 101 RESULTS ......................................................................................... 102 Behavioral results .......................................................................... 102 ELECTROPHYSIOLOGICAL RESULTS ................................................ 103 ERPs ............................................................................................... 103 Perception condition....................................................................... 103 Mental imagery condition ............................................................... 104 Scalp topography analysis .............................................................. 105 DISCUSSION................................................................................... 108 SUPPLEMENTARY DATA .................................................................. 109 Instructions .................................................................................... 109 Eyes Opened ................................................................................... 110 Eyes Closed .................................................................................... 111 References ..................................................................................... 112 Experiment 4 Instrumental modulation of electrophysiological features of sleep CONTEXT .................................................................................. 114 METHODOLOGICAL HIGHLIGHTS .............................................. 114 SUMMARY OF RESULTS ............................................................. 114 CONCLUSION ............................................................................ 115 12 Article submitted in Current Biology ......................................... 116 SUPPLEMENTAL DATA ..................................................................... 120 SUPPLEMENTAL EXPERIMENTAL PROCEDURES ............................... 120 Participants .................................................................................... 120 Protocol .......................................................................................... 121 EEG data analyses .......................................................................... 121 References and Notes ..................................................................... 122 Supplemental References ............................................................... 123 DISCUSSION ............................................................................. 124 MULTIMODAL APPROACH TO MEMORY CONSOLIDATION.......... 124 NOVELTY OF THE TECHNIQUES ................................................. 126 CONCLUSIONS AND PERSPECTIVES .......................................... 127 BIBLIOGRAPHY ........................................................................ 129 13 1. INTRODUCTION The aim of this preamble is to provide a rationale for the present research work. It offers an overview of the cognitive and neural processes underlying learning and memory, as well as the influence of sleep on these processes. This introduction therefore highlights a selection of key issues which support the theoretical questions and the methodological approaches of the thesis. Neuroscience has provided lately some astonishing breakthroughs in our understanding of sleep and memory (Kandel 2009), from noninvasive large-scale imaging of the human brain during sleep to revealing the molecular machinery of complex processes like cerebral plasticity. This evolving knowledge about brain functioning together with the recent development of investigation techniques foster translations between distinct levels of description, such as the molecular/cellular level, the macroscopic systems level, and the behavioral level. The main motivation for the present work comes from these new possibilities to study the interaction between sleep and memory both at the neural and behavioral levels. The introduction begins with a conceptual framework for learning and memory. In the second part, some key aspects of memory consolidation and supporting plasticity mechanisms are introduced, with a special emphasis on interacting neural circuits. In the third part of the introduction, recent contributions on the role of sleep and wakefulness in memory formation are reviewed. Some aspects concerning local brain activity and regulatory processes during sleep are also detailed, as well as their possible functional links with memory and plasticity processes. To conclude the introduction, the research questions and hypotheses investigated in this thesis are briefly presented. After the introduction, the experimental part reports in detail each of the four projects conducted in the context of this thesis: the hypotheses tested, the methodological approaches used, the main findings and their interpretation. A general discussion concludes the thesis by providing an integrated overview of all the results and opening some new perspectives for further research. 14 2. LEARNING AND MEMORY SYSTEMS Learning is the process of acquiring new information, while memory refers to the persistence of learning in a state that can be revealed at a later time. Memory is the usual consequence of learning. Squire, Memory and Brain, 1987, p.3 Almost every aspect of our thinking and behavior depends on the acquisition and retention of new knowledge: our sense of identity, how we perceive the world, how we react to various stimuli, perform simple or complex activities, such as eat or drive, organize our daily agenda. Thus, learning and memory play a fundamental role in cognitive functioning and behavioral adjustment. Learning most often refers to the gradual acquisition of the information, while memory refers more to specific processes manipulating the established information, which may impact further behavior. Remembering – the direct effect of memoryenables one to compare the newly learned information with the already existent memory content and decide the relevance of the information for the system (thus maintaining the system‟s efficiency). Therefore, although memory holds information about the past, its main function is to allow predictions and adaptive responses to events yet to come (Schacter and Addis 2007; Schacter, Addis et al. 2008). La mémoire du passé n'est pas faite pour se souvenir du passé, elle est faite pour prévenir le futur. La mémoire est un instrument de prédiction. Alain Berthoz, www.automatesintelligents.com/interviews/2003/octobre/berthoz.html Because many elements in the future are produced according to probabilistic laws, the machinery that encodes memories in the brain has to operate fast and recurrent updating of the stored information. This built-in capacity to anticipate change is reflected at multiple brain levels (Addis, Wong et al. 2007; Bar 2009). As stated by Bar et al (2009), memory-related brain dynamics actually reflect ongoing generation of predictions, which relies on acquired experience and aim at providing permanent and adequate adjustment to our interaction with the changing environment. 15 2.1. Memory systems: theoretical and experimental approaches The topic of memory is broad and accumulating. Much theoretical and experimental effort has been allocated in the last years in the attempt to clearly define and characterize the neural systems that are recruited during the acquisition of different tasks and subsequent memory processes (Squire 2004). Theoretically, memory is not currently viewed and studied as a unitary process. The concept of memory system was first promoted by Tulving et al. (1985), who defined it as “a set of correlated processes, more closely related to one another than they are to processes outside the system” (p.386). More precisely, memory systems can be characterized according to the kind of processed information and to the contributing brain mechanisms (Schacter and Tulving, 1994). According to these aspects, early work on memory postulated two distinct systems. On one hand, a system that deals with explicitly acquired information, generically termed declarative memory. Declarative memory, usually defined as the memory for facts and events (“know what”), can be further divided into episodic memory, reflecting autobiographical events, and semantic memory, dealing with general knowledge about the world. The other classically accepted memory system operates with implicitly acquired information, in the absence of conscious awareness and is termed procedural memory (Eustache and Desgranges 2008). Procedural memory (“know how”) is mainly based on the acquisition of perceptual and motor skills. Another way to look at memory processes is by considering the time axis. Therefore, R. Atkinson and R. Shiffrin proposed in the late 60ies a “multi-store” model, which assumed that human memory is formed through three consequent stages: sensory memory, short-term memory and long-term memory (Atkinson 1968). According to the authors, sensory memory corresponds approximately to the initial 200-500 milliseconds after a stimulus is perceived. Short-term memory refers to memory for information currently “held” in mind and has limited capacity. It allows recall for a period of several seconds to a minute without rehearsal, allowing the temporarily saving of a limited quantity of information. Long-term memory refers to information that is stored for an extended period of time. It has a potentially unlimited duration and capacity. In the present thesis we do not deal with short-term memory, 16 but with long-term memory aspects, which implies changes in widely distributed neural connections throughout the brain. Among all areas, the hippocampus seems particularly important for the transformation of information from short-term to longterm memory. In humans, studies in neurological patients with focal brain damage remain critical in the attempt to define which brain regions are contributing to certain memory processes. Furthermore, as lesion studies address disruption instead of engagement of memory systems, they can reveal structures that are indispensably required for a certain function. Maybe the first influential observation which turned into a landmark for the development of the neuroscience of memory systems, was the case of the patient H.M. (Squire 2009). In 1953, an experimental brain surgery intended to control severe seizure disorder, left patient H.M. unable to form new memories. A finger-sized piece of the temporal lobes on both sides of the brain, including most of the hippocampus, amygdala, and nearby parahippocampal gyrus, was removed. Patient H.M. could remember facts he had learned and names of people he had met before the surgery, but virtually nothing after it. For half a century, the findings from testing the patient H.M. highlighted memory as a distinct cerebral function, accessible for evaluation, independently from other perceptual and cognitive capacities. Since the case of patient H.M., several theories suggested that memory involves several successive steps leading to stable memory. In particular, it was proposed that new memories formed by the hippocampus are later transferred in the cerebral cortex for long-term storage (Scoville 1957; Scoville 2000). A large body of studies deals with long-term memory in the attempt to understand the basis of information storage and use over time. Studies in amnestic patients showed that damage limited to the hippocampal structure results in selective deficits in recollection and relational memory. Among the techniques used to approach cognitive and neurophysiological aspects of memory, EEG studies represent a prominent neuroimaging tool. Different effects related to memory processes, such as explicit/implicit, old/new, recognition/familiarity, have been addressed by analyzing modulations in the electrical activity of the brain, time-locked to an event (such as a stimulus to be encoded). Event-related brain potentials (ERPs) have been employed in memory research to identify neural activity associated with both encoding of information and the later retrieval of stored information. Different correlates between amplitudes and/or latencies of event-related 17 brain potentials and cognitive tasks are quantified depending on the memory paradigm applied (Voss 2008; Friedman 2000; Wieser 2003). For example, it has been shown in terms of ERP activity, that implicit and explicit learning of event sequences yield different neural representations in the brain (Russeler 2000). In this EEG study, event-related brain potentials of 21 subjects were recorded while they performed a choice reaction time task. In this task, a repetitive sequence of eight successive stimuli (e.g. a sequence of letters) was presented on a computer screen and subjects had to react as quickly and accurately as possible when a stimulus appeared on the screen, by pressing a button, either with the index or middle finger, of either left or right hand, according to the stimulus position on the screen. There were therefore four finger press possibilities and eight “standard” stimuli, which meant that the same finger coded for two stimuli. The regularity of the sequence was unknown to the subjects. Within the regular event sequence, a “perceptual” or a “motor” deviant stimulus replaced sometimes an expected stimulus: a “perceptual” deviant was a different letter from the expected one in the sequence, but which required the same motor response, while a “motor” deviant was a letter from those requiring a response with the opposite hand. Post-experimental free recall and recognition test, assigned subjects to either an explicit or implicit group, according to the either explicit or implicit knowledge of the sequence regularity. The ERPs showed different brain potential modulation for different types of stimuli (perceptual and motor deviants as compared to expected stimuli) between the two groups. In the group of explicit learners, a larger N200 component (negative component peaking at 200 ms post-stimulus) was evoked by both types of deviants (perceptual and motor) as compared to standard stimuli; a larger P300 (positive component peaking at 300 ms post-stimulus) was evoked by “motor” deviants only as compared to “perceptual” and “standard” stimuli. In the group of implicit learners, the N200 and P300 components remained unaffected. In both groups of subjects the lateralized readiness potential (LRP) which accompanied “motor” deviants revealed a different modulation as compared “standard” and “perceptual” stimuli. This meant that in both groups, the preparation for the next motor response dependent on the previous one, therefore on response-response association. These results suggest that while implicit learners acquire knowledge about response dependencies only, explicit learners acquire knowledge about both response and stimulus dependencies. 18 Moreover, the study of EEG microstates of temporal stability in the brain electrical activity opens promising perspectives concerning the further understanding of the memory architecture (Lehmann 2010; Pascual-Marqui 1995; Van de Ville 2010). Functional microstates (Michel et al. 1992; Lehman 1987) refer to time segments of stable potential map configuration supposed to reflect different steps of information processing. According to the microstate model, the brain activity can be seen as a sequence of non-overlapping microstates of variable duration and strength. A growing number of studies evaluate functional microstates in the spontaneous EEG and their influence by specific mental conditions, such as memory impairment in Alzheimer disease. Dierks et al (1997) studied alterations of EEG microstates in Alzheimer disease patients compared to healthy controls. The main findings were shorter segment duration and increased number of segments in patients with memory impairment compared to healthy controls. Another complementary neurophysiological approach to memory related dynamics is represented by the study of synchronous brain oscillations such as theta or gamma activity during subsequent stages of memory formation (Axmacher 2006; Kirk 2003). While EEG provides a high temporal resolution of recordings, it does not allow the unequivocal location of the neural generators responsible for the scalp-recorded potentials. One option is to integrate the ERP findings with the results of functional neuroimaging studies and thus to identify the intracerebral generators of the memory effects. Direct intracranial recordings in animals or humans (in the context of presurgical investigation), which provides a combination of precise spatial and temporal information (Guo 2005; Fell 2008). For example, one intracranial study on seven epileptic pharmaco-resistant patients (Seeck 1997), required precise discrimination between repeated and non-repeated faces. The patients failed to show explicit knowledge of previously seen faces, as measured by the accuracy of motor responses. However, all subjects showed a differential modulation of the intracranial potential to repeated versus non-repeated faces, thus suggesting implicit discrimination between the two types of stimuli. Some considerations need to be taken into account when testing pharmaco-resistant epileptic patients. Although the intracranial recordings performed in these patients provide unique opportunities to observe cognitive processes at a very high spatial and temporal resolution, the neural responses collected may be subject to considerable individual differences (Halgren 19 1978). Epileptic patients represent a heterogenous population and the presence, the severity and the localization of the epileptic disturbances may influence the interpretation of the cognitive testing; maybe the most contributive variable for the memory research in these patients is the extent to which the implanted tissue (most frequently the temporal lobe) is affected. Also, convulsivant medication may have significant effects on memory functions in these patients. The left and right-sided focus of epileptic discharges has also been related to the presence of more or less important verbal /non verbal memory deficits (Kapur 1994). The important advances in signal processing methods allow a more and more accurate distinction between pathological and physiological data from testing these patients. 2.2. Perceptual and motor skill learning Skill learning represents “a more or less permanent change in behavior which occurs as a result of practice” (Kimble 1961, p.6). Experimentally, perceptual skill learning is defined as improvement in sensory discrimination after practice (Karni and Sagi 1991); motor skill learning is generally evaluated by improved efficiency and speed of task execution (Poldrack 2005; Doyon and Benali 2005). Perceptual learning Perceptual learning essentially implies detecting discriminatory issues between initially very similar stimuli (Mitchell 2009). The behavioral improvement is underlined by stable learning-related changes at the neural level, which persist after the active stimulation. A broad literature in the perceptual field deals with visual tasks and practice-induced improvement in visual performance (Ahissar and Hochstein 2004). This involves training-related increased expertise to detect and extract the taskrelevant information from a mixture of input signals. A simple example is provided by the experimented radiologists who can readily identify abnormalities in highly complex images, whereas this task is rather impossible for an untrained person (Skrandies and Fahle 1994; Sasaki, Nanez et al. 2010). Experimentally, it has been shown that experience-dependent changes in neural patterns may happen at the earliest cortical stage of visual processing, i.e., in primary visual cortex (Karni and Sagi 1991; Schwartz, Maquet et al. 2002; Furmanski, Schluppeck et al. 2004; Li, 20 Piech et al. 2004; Pourtois, Rauss et al. 2008). This has been shown by using cell recordings in animals (monkeys) and brain imaging in humans. These data suggest that perceptual learning is highly localized as it essentially depends on selective local changes, specifically driven by the task performance (Seitz and Watanabe 2005). However, these findings do not rule out the involvement of a broader spectrum of areas, as the strength of neural connections between low-level visual areas and higher integrative areas might also undergo task-specific modulations (Schwartz, Maquet et al. 2002; Ahissar and Hochstein 2004). This in agreement with general learning theories, which state that the interactions between bottom-up sensory inputs and topdown goal-directed influences are critical for consolidating memory traces and therefore lead to a better performance (Gilbert, Sigman et al. 2001). In the above studies dealing with visual tasks, it has been proposed that perceptual learning recruits a rather highly localized network. Motor learning Motor learning generally refers to the gradual process by which more or less complex motor behaviors come to be performed without effort through repeated practice and/or interactions with the environment (Willingham 1998). Motor skill may refer to either simple, repetitive movements (such as when playing the „„ball and cup” (Milner, Fogel et al. 2006), or to more complex sequences of movements (such as when playing the piano) (Krings, Topper et al. 2000). The learning of sequences of movements and the underlying neural dynamics across vigilance states represents one of the research topics addressed in this thesis. Motor sequences can be explicitly known or not, but even in the latter case, the regularity of the motor sequence can still be learned, even though it remains implicit. The multitude of tasks used to experimentally investigate motor skill learning evaluate either the incremental acquisition of movements that subjects have to execute as quickly and accurately as possible such as finger tapping tasks (Walker 2005; Karni, Meyer et al. 1995; Maquet, Laureys et al. 2000; Maquet, Laureys et al. 2003; Hotermans, Peigneux et al. 2006), or the ability to compensate for environmental changes such as motor adaptation tasks consisting in adapting the motor reaction to externally manipulated conditions (Shadmehr and Holcomb 1997; Huber, Ghilardi et al. 2004). 21 At the brain level, different anatomical structures are involved in motor learning: the motor cortex, the cerebellum and the basal ganglia seem to play a key role in skill learning, whether it is about sequential motor learning or about motor adaptation tasks. Depending on the stage of learning, the primary motor cortex, supplementary motor cortex, the cerebellum and the putamen are mainly activated at an early stage, while the supplementary motor area, precuneus and prefrontal cortex are rather active at a more advanced stage of learning. The task demands (e.g. motor or more cognitive demands) (Doyon, Song et al. 2002; Doyon, Penhune et al. 2003) also modulate the anatomo-functional contributions, with the cortico-striatal pathways classically known to mediate learning of implicit motor behaviors (Doyon, Bellec et al. 2009), while the cortico-cerebellar loop is rather important for motor adaptation. Recent reports suggest that both implicit and explicit learning of a sequence of movements requires the contribution of the hippocampus and its associated medio-temporal limbic areas (Schendan, Searl et al. 2003; Albouy, Sterpenich et al. 2008). Therefore, this type of motor acquisition would require not only the cortico-striatal and cortico-cerebellar systems, but also hippocampal regions. It seems that these differently contributing brain areas interact to create new memories coding for the acquired behavior. Attentional influences on learning Attention contributes to the improved performance after perceptual learning by enhancing the selection of task-relevant features of the stimulus. It has been proposed that attention modulates early stages of perceptual processing in a task-relevant manner (Schwartz, Vuilleumier et al. 2005; Klemen, Buchel et al. 2009). It is equally accepted, in the visual domain at least, that attentional processes may be engaged in a top-down control of early stages of sensory information processing (Lamme and Roelfsema 2000). However, attention may not be mandatory for learning as demonstrated by recent studies showing performance improvements outside the focus of attention (task-irrelevant learning) (Watanabe, Nanez et al. 2001; Watanabe, Nanez et al. 2002; Seitz and Watanabe 2005). 22 2.3. The temporal dynamics of perceptual and motor skill learning In any type of learning, be it perceptual or motor, the factor time represents a critical dimension, because during learning the brain learns new routines gradually, through practice and interactions with the environment. At the behavioral level, the gradual increase in accuracy and speed level does not only benefit from the intrapractice sessions, but also from the inter-practice periods, with no additional training (Karni and Sagi 1991; Karni, Meyer et al. 1995; Karni, Meyer et al. 1998; Doyon, Penhune et al. 2003; Press, Casement et al. 2005; Halsband and Lange 2006). At the brain level, the neural representations of the newly acquired skill, whether referring to perceptual or to motor behaviors, undergo time-dependent re-shaping, leading to better performance. The time-course of skill learning can be divided into several distinct stages. A well-studied, „typical” example is that of a visuo-motor learning task, namely the serial reaction time task. Subjects are facing a computer screen where visual cues could appear successively at four different spatial locations, arranged horizontally. Each of the four possible positions of the visual cue on the screen corresponds to one of four response buttons on a response pad. When a visual cue appears on one of the position, the subjects are instructed to react as quickly and accurately as possible by pressing the spatially corresponding response button. The succession of the visual cues appearance follows a sequential order, pre-defined or probabilistically established. Firstly, considerable improvement occurs within one session of intense training; this is an initial, “fast” stage, where the performance is under sensory (e.g. visual) control. A second, intermediate, “slow” stage follows, where there is gradual learning of the sensori-motor (e.g. visual-keypress response) associations across repetitive training. A third “consolidation” stage following after a certain time interval without training (Ungerleider, Doyon et al. 2002) leads to further performance increases in the absence of additional training. A following, “automatic” stage is proposed, where the task is correctly executed with minimal effort (Doyon and Benali 2005; Halsband and Lange 2006). Thus, it takes time for long-lasting plastic brain changes necessary for consolidating the motor routine to occur. 23 The individual contribution of the brain regions involved in motor skill learning varies across different stages of the acquisition: the cerebellum seems more involved in the early stages of acquisition, while the basal ganglia is important for later stages of learning (Doyon and Benali 2005). Plasticity-related changes during motor skill learning occur at both intra- and inter-system levels. Besides, it has been shown, by using functional brain imaging, that motor representations may shift from the associative cortex to the striatum during the explicit learning of a motor sequence (Hikosaka, Nakamura et al. 2002). A transfer of activity from the cerebellar cortex to the dentate nucleus may accompany the implicit acquisition of a known sequence of movements (Jueptner, Frith et al. 1997). Perceptual learning, much like motor skill learning, is accompanied by timedependent changes across distinct cortical areas, over shorter or longer time scales. Yotsumoto et al. (2008) trained subjects during few weeks on a visual task and have showed an increase in both execution performance and brain activity in early vision regions corresponding to the trained visual quadrant. Once performance reached an optimal level and remained constant, the brain activation in the corresponding areas decreased. These results suggest that distinct temporal phases characterize perceptual learning. Mukai et al. (2007) showed in participants who were trained on a visual learning task, that once a certain level of performance is reached, the activation in early visual areas as well as in higher-level regions associated with attentional processes decreased. It has been shown that stimulus specificities found in perceptual learning were maintained across time (Parkosadze, Otto et al. 2008). For instance improvement for vertical bisection stimuli (a central element bisecting an interval) did not transfer to horizontal bisection. So, the time-related improvement for this perceptual task is specific for the stimulus type. Similarly, it has been shown in the motor domain, by studying intermanual transfer of a visuo-motor sequence, that what is acquired is the specific regularity of the motor sequence and not a spatial pattern, and intermanual transfer of implicit learning was found only in a mirror image of the originally trained sequence (Wachs 1994). 24 3. ANATOMO-FUNCTIONAL CORRELATES OF MEMORY 3.1. Memory and brain plasticity It is known that activity-dependent modulation of synaptic efficiency (e.g. synaptic strengthening) and also structural changes (e.g. changes in cell dimensions and number and in axonal length) represent the neurobiological bases of memory formation. The activity-driven molecular and cellular changes support consequent remodeling of functional neural circuits at larger scales in the brain (Bruel-Jungerman, Davis et al. 2007). While neural plasticity is most evident during development, experience can reshape neural networks throughout all life span. The plasticity mechanisms which contribute conjointly to the formation of longterm memory are represented by long-term potentiation (LTP, rapid and enduring synaptic strengthening), long-term depression (LTD, weakening of synaptic strength), synaptogenesis (growth of new synapses) and neurogenesis (formation and growth of new neurons) (Bruel-Jungerman, Davis et al. 2007). One of the most extensively investigated forms of synaptic change related to learning and memory is the LTP. For example, it has been shown in rats that the synaptic strengthening (LTP) implying a modulation of amygdaloidal synaptic transmission is critical for fear conditioning (Shaban, Humeau et al. 2006). Further demonstration of the LTP as a necessary condition for the maintenance of memory is brought by studies where suppression of LTP after learning, disrupts a previously established memory trace (Pastalkova, Serrano et al. 2006). The LTD mechanism based on the rule of “use it or lose it”, by weakening unused connections, may promote the consolidation of patterns of intensely used specific neural connections, which could contribute to the memory storage. Synaptogenesis, i.e. the actual formation of new viable synapses, has been a subject of debate: does this process reflect a true synaptic growth or just morphological changes at the existent synaptic level? For instance, exposure to a “rich” environment or certain learning paradigms have been shown to determine an increase in synapses number (Markham and Greenough 2004). Several studies promote the idea that hippocampal neurogenesis may be triggered by learning of specific tasks and furthermore, that the formation of new neurons is related to the task difficulty and 25 hippocampal involvement in the learning process (Leuner, Mendolia-Loffredo et al. 2004). Moreover, it has been shown that a blockage of neurogenesis in the adult hippocampus specifically disrupts the eye-blink conditioning, which is a form of learning depending on the hippocampus (Shors, Miesegaes et al. 2001). Plasticity mechanisms engaged in learning and memory processes are also associated with rapid gene regulation in different brain areas, depending on the type of the informational input. For example, the expression of a class of immediate early genes (IEGs) seems particularly important for triggering transcriptional control mechanisms subserving the stabilization of different types of memory, especially fear related memories, olfactory and spatial memories (Davis, Bozon et al. 2003; Bailey, Wade et al. 2009; Loebrich and Nedivi 2009). All in all, the plasticity mechanisms highlighted above contribute to memory related functional and structural changes across different brain areas. As an example, the primary visual cortex (V1) of the adult mammalian brain has provided one of the clearest evidence of the experience-dependent plasticity processes at cortical circuits level, which could be modeled according to a variety of manipulations, such as perceptual learning and visual deprivation (Schwartz, Maquet et al. 2002; Karmarkar and Dan 2006). The concept of learning as “organized knowledge which grows and becomes better organized” (McDermott 1985) also suggests that learning mechanisms may operate at some relatively abstract levels, which would imply accumulating, organizing and re-organizing information, leading to improved processing efficiency and thus changes in behavior. At the brain level, learning can be viewed as “experience-dependent lasting modification in neural representations” (Dudai 1989). This definition highlights two key principles: first, the changes in brain activity are “experience-dependent” (therefore, the changes are caused by experience) and secondly, this definition promotes the notion of “neural representation”, in the sense of an acquired “code” or “trace” of the learned knowledge (for example, newly encountered stimuli, or the forming of new associations between already learned stimuli). Furthermore, the formed neural representations are of dynamic nature in the sense of flexible processing rather than fixed encoding of information. Thus, learning and memory involve cognitive and neural reorganization at multiple levels of integration (which is a key notion for the experimental part of the thesis). 26 3.2. Brain systems for memory processes In the following sections, I will briefly overview same anatomical and functional characteristics of different brain regions involved in memory, with a special emphasis on the hippocampus as a key contributor to memory formation. As shown above, there are distinct memory systems. Until recently, it was considered that these distinct memory systems also involve selective brain systems: procedural memory would involve cortical regions (motor or sensory cortices), the striatum, and the cerebellum among others (Grafton, Mazziotta et al. 1992; Doyon, Gaudreau et al. 1997; Ungerleider, Doyon et al. 2002; Doyon, Penhune et al. 2003; Monchi, Petrides et al. 2006), whereas declarative memory would involve the medial temporal lobes, in particular the hippocampus (Squire and Zola-Morgan 1991; Squire 1992; Reber and Squire 1994; Squire and Zola 1996; Squire 2004; Squire, Stark et al. 2004). However, recent studies challenge the above schema. For instance, there is evidence for a hippocampus role in the learning of a sequence of movements (Albouy, Sterpenich et al. 2008) (Schendan, Searl et al. 2003), which is classically considered as a procedural task (see also below). Hippocampus and related structures Together with adjacent perirhinal, entorhinal and parahippocampal cortices, the hippocampus is often referred to as the medial temporal lobe (MTL) memory system (Squire and Zola-Morgan 1991). The organization of the MTL system involves bidirectional pathways between the cerebral cortex and the hippocampus, and these pathways are largely conserved across mammalian species (Manns and Eichenbaum 2006). Neurons within the hippocampus form a network different from that found anywhere else in the nervous system (Andersen, Morris et al. 2007). Firstly, the relatively simplified two- or three-layered architecture, with its strict layering of synapses in the dendritic arborisation is a characteristic proper to the hippocampus. Therefore, the hippocampal neuroanatomy sustains a unique internal network organization, taking into account the large unidirectional information flow through hippocampal circuits and the highly distributed organization of within hippocampus associative connections. This high degree of neuronal interconnectivity within the 27 hippocampus allows the consequent integration and comparison of the information (Amaral, Ishizuka et al. 1990). These anatomical properties may help to understand why the hippocampus is one of the only few brain regions that receive highly processed, multimodal information from different neocortical regions. Across species, the cortical association areas do not target directly the hippocampus, but instead connect to a sum of related areas within the parahippocampus region. Therefore, the flow of information from cerebral cortex is first directed to the parahippocampal region, whose outputs converge to the hippocampus; the outputs of hippocampal processing are directed back to the parahippocampus, which, in turn, send its outputs to the same original cortical areas: therefore, the cerebral cortex, the parahippocampal region and the hippocampus can be viewed as a hierarchy of connectivity (Lavenex and Amaral 2000; Eichenbaum and Lipton 2008). Small neuronal ensembles in the hippocampus form local circuits which may generate spatiotemporal patterns of spiking activity, therefore converting relatively unstructured inputs into specific patterns of activation (Takahashi and Sakurai 2009). In other words, the local connectivity within the hippocampus may provide the mechanism by which any initial input can “organize” the response to any subsequent input. Implications of the hippocampus in memory functions It is known that the hippocampal structure plays a key role in the episodic memory formation (Alvarez and Squire 1994; Eichenbaum 2004; Ergorul and Eichenbaum 2004; Squire 2004), as part of the explicit declarative memory system. However, recent neuroimagery results provide a new perspective upon hippocampusrelated memory processes, by demonstrating the direct hippocampal involvement in the processing of non-declarative memory (Schendan, Searl et al. 2003; Albouy, Sterpenich et al. 2008). In a functional magnetic resonance study, Albouy and colleagues showed by training subjects on an implicit oculomotor sequence learning task and testing them at different time intervals, that both the hippocampus and striatum interact and are involved in the consolidation of motor sequence memory, thus bringing support for the hippocampal involvement in long-term formation of procedural memory. These results confirm the cell-level evidence for the hippocampal capacity to associate temporally fragmented, but structured information to form integrative, coherent memory representations (Burgess, Maguire et al. 2002). 28 Moreover, recent theoretical approaches suggest a potential role of hippocampal circuitry in representing sequences of events, based on its anatomical and functional capacity to mediate three prominent cognitive features: associative representation, sequential organization and relational networking (Wallenstein, Eichenbaum et al. 1998; Eichenbaum 2004). Rich experimental animal data supports this perspective (Agster, Fortin et al. 2002; Fortin, Agster et al. 2002; Lee and Wilson 2002; Ergorul and Eichenbaum 2004) and provides further evidence for firing patterns in the hippocampus time-locked to individual sequential events (Louie and Wilson 2001; Foster and Wilson 2006). Navigation studies in rodents report specialized neural networks co-mapping visual and spatial features into flexible representations (Ekstrom, Kahana et al. 2003), thus confirming the hippocampus relevance for navigation, path integration and cognitive mapping (McNaughton, Battaglia et al. 2006). Furthermore, while initial studies showed the role of hippocampal neurons in signaling relative to the position of the animal in the environment (“place cells”), thus forming a spatial cognitive map of the environment (O'Keefe and Dostrovsky 1971), the idea also emerged that spatial information encoded in the “place cells” actually reflects a more general category of relational information, which depends on the hippocampus (Eichenbaum 2001). It has been therefore proposed that the hippocampus has the capacity to build and store “configural” associations between separate events. Studies on associative memory provided further insights concerning the hippocampus capacity to form flexible new associations between different stimuli irrespective of modality (Henke 2010). Chadwick et al (2010) presented three distinct short videoclips of every day life episodes to healthy human subjects and than asked them during an fMRI scanning session to recall as much details as possible of each episode a number of times. The authors have than directly examined neural computations within hippocampus related to the three episodic representations and were able to indentify from the pattern of fMRI hemodynamic response whioch specific episode of memory has been recalled. They therefore showed that neural traces of recently encoded episodic memories are detectable from the BOLD patterns of fMRI. The role of hippocampus in relational memory is a central research question addressed in the personal part of the thesis. 29 Amygdala and emotional memory Since the demonstration in monkeys by Mishkin et al. (1978) that conjoint lesions of amygdala and hippocampus resulted in greater impairments on declarative memory tests than did individual lesions of each structure, the contribution of amygdala to memory either as a proper storage area or as a modulator of mnemonic processes has become an important topic of research. Fear conditioning, a special form of procedural memory based on emotional learning and on Pavovlian conditioning, has been the initial paradigm use to study amygdala function in memory (LeDoux 2003). Recent long-term memory consolidation theories implying amygdalohippocampal connections, demonstrate that amygdala also plays an enhancing role in the encoding and long-term recall of emotional stimuli (McGaugh 2004; Sterpenich, Albouy et al. 2009). Diencephalon and declarative memory deficits Damage to diencephalic regions (e.g. the thalamus, the hypothalamus) is currently believed to impact memory not by actually disrupting memory processing per se, but rather by altering communication between the medial temporal lobe and other regions, responsible for memory processes. For instance, the mammillothalamic and the amygdalofugal tracts are two pathways through which structures of the medial temporal lobe are connected to memory structures. This explains the presence of amnesic elements in patients with Korsakoff's syndrome, who do not show significant damage of medial temporal lobe structures, but rather present damage to diencephalic structures, including mammillary bodies and the dorsomedial nucleus of the thalamus (Hampstead and Koffler 2009). Motor areas, basal ganglia, cerebellum and memory for motor skills There is extensive evidence for the involvement of motor brain regions such as supplementary motor area, primary motor and premotor cortices in the memory for motor behaviors (Doyon, Penhune et al. 2003). Moreover, it has also been suggested that areas previously acknowledged to subserve pure motor executive and control functions (e.g. the basal ganglia), are also mediating the memory formation of learned 30 sensory-motor associations (White 2009). The other aspects related to motor skill learning and contributing areas has already been tackled in previous sections, and will be further discussed in the main experimental part. Prefrontal cortex and memory consolidation The dorsolateral prefrontal cortex may play a critical role in memory consolidation processes, particularly for hippocampal-dependent spatial and contextual information (Frankland and Bontempi 2005). Because of its dense interactions with both MTL structures and the basal ganglia, the prefrontal cortex may support hippocampal-prefrontal interactions in memory processes. Namely, it may participate to the extraction of regularities based on internal representations, so as to improve behavioral control (Robertson 2007; Shima, Isoda et al. 2007). In line with this idea, the next section will detail memory consolidation models, based on reactivation of hippocampal-prefrontal neural patterns across different vigilance states to allow stabilization of the acquired knowledge and subsequent performance improvement (Peyrache, Khamassi et al. 2009). 3.3. Distinct steps in memory consolidation The term “consolidation” was first associated with memory processes by the German researchers Müller and A. Pilzecker, in their work, Experimentelle Beiträge zur Lehre vom Gedächtnis [Experimental contributions to the science of memory]. Zeitschrift für Psychologie Ergänzungsband, 1, 1–300 (1900). The authors noticed that learning new stimuli immediately after training on series of non-sense syllables interfered with the recall of the items learned first. They postulated therefore that it takes time for the memory trace to become stable and resistant to interferences. Memory consolidation defines a continuum of experience-driven processes, both at synaptic and systemic level, that render an initially fragile memory trace resistant to interferences through stabilization. In other words, it operates a spatial and temporal reorganization of recently acquired information into a stable representation (Dudai 2004; Buzsaki and Chrobak 2005). At the synaptic level, memory consolidation involves a cascade of molecular events, implying the restructuring of existing synapses (Dudai 2004) and the formation of new connections (Malenka and Nicoll 31 1999), within the first few hours after learning. The changes at the synaptic level determine modulations in gene expression and consequent synthesis of new proteins contributing to structural changes (Bozon, Davis et al. 2003). System-level consolidation is a slower process that involves the gradual reorganization of neural representation of new memories over extended periods of time (Frankland and Bontempi 2005). One prevalent view of such memory consolidation process is that the hippocampus would act as a temporary store for newly acquired information, which is then gradually transferred, for permanent storage, on a distributed cortical network (McClelland, McNaughton et al. 1995; Squire and Alvarez 1995; Frankland and Bontempi 2005). Figure 1 is adapted from and illustrates distinct steps in memory consolidation: first, the hippocampus integrates newly acquired information from different cortical modules (Figure 1 A); successive reactivations take place within the hippocampal-cortical network, with time (Figure 1 B); the gradual strengthening of cortico-cortical connections renders the newly formed memories independent of the hippocampus (Figure 1 C). Figure 1. Time-dependent memory consolidation model (A,B,C explained in the text) Thus, the initial encoding of the sensory, cognitive and motor information takes place in different primary cortical (visual, auditory, olfactive and somatosensory) and associative areas. The hippocampus integrates the different inputs coming from cortical modules and maps them into coherent representations. Then, successive reactivations of hippocampal-cortical networks allow the reinforcement of the 32 network intraconnections, either by strengthening the pre-existent links or by creating new ones (Frankland and Bontempi 2005). The progressive enrichment of the corticocortical connections by synchronous reactivations renders the new traces gradually independent of the hippocampus and facilitates their integration into the pre-existent cortical memory representations. Thus, the changes in the connectivity between the hippocampus and the neocortex happen first, then changes in connectivity among the different cortical regions can occur (Dudai and Eisenberg 2004; Frankland and Bontempi 2005). Recently, a third step in the process of memory consolidation has been identified: memory reconsolidation. It has been postulated that, once stabilized, a memory trace is maintained in a “latent state” and has the capacity to return to an “active state”, whenever the recall of the original information is needed. When reactivated, the memory re-enters a dynamic and fragile state, requiring further active processes of stabilization (additional consolidation) via synaptic changes and protein synthesis (Nader, Schafe et al. 2000; Alberini 2005). Another complementary view on memory consolidation processes is provided by the Multiple Trace Model (MTM). MTM is principally based on the distinction between semantic memory and episodic memory, arguing that while the hippocampus is necessary for the retention and retrieval of episodic memories, semantic memories are created by multiple traces organized in the neocortex through the process of consolidation and do not specifically depend on the hippocampus. According to this model, acquired information is saved in a distributed network, including the hippocampus and cortical regions (Nadel and Moscovitch 1997). The MTM is supported by three main arguments: (1) episodic memory is completely abolished if the medial temporal lobe (containing the hippocampus) is damaged (development of retrograde amnesia); (2) the hippocampus is active when recalling episodic, autobiographic events (Gilboa, Winocur et al. 2004); (3) the forgetting rate in amnesia is proportional with the volume of hippocampal lesion (Cipolotti, Shallice et al. 2001). Taken together, these observations point out the hippocampus critical involvement in the formation of long-term memory. 33 4. THE INFLUENCE OF SLEEP-WAKE STATES ON MEMORY PROCESSES Although the functions of sleep remain largely unknown, one of the most exciting hypothesis is that sleep contributes importantly to processes of memory and brain plasticity. Walker and Stickgold, Sleep, memory, and plasticity, Annu Rev Psychol, 2006 If the mechanisms underlying the formation of new memories are quite well understood, the precise timing of the gradual transformation of hippocampusdependent recent memories into cortex-dependent remote memories, are still a matter of debate. One prevalent hypothesis is that memory consolidation involves the reactivation of neural traces acquired during wakefulness, and that sleep may offer a permissive condition for such reactivation to occur (Ribeiro, Mello et al. 2002; Walker 2005; Dang-Vu, Desseilles et al. 2006; Peigneux, Orban et al. 2006; Karlsson and Frank 2009). Therefore, memory consolidation cannot be fully understood without considering both wake and sleep brain states. . 4.1. Sleep: a beneficial role for memory consolidation? Aspects of sleep physiology Human sleep consists of cyclic succession of distinct stages, characterized depending on the EEG patterns, eye movement and mucle tonus: non rapid eye movement sleep (NREM sleep with stages 1, 2, 3, 4), generally characterized by high amplitude and low frequency EEG activity, slow eye movements and relatively diminshed muscle tonus and rapid eye movement sleep (REM sleep) which is characterized by low amplitude and high frequency EEG activity, rapid eye movements and abolition of muscle tonus. Sleep is not a uniform state, as distinct neurobiological processes cyclically alternate throughout a night of sleep according to an ultradian rythm of 90-100 minutes. Nocturnal sleep in humans can be divided into an early sleep (in which SWS predominates) and late sleep, in the second part of the night (in which REM sleep predominates). Each sleep phase, namely NREM and REM sleep, is characterized by dramatic changes both at electrophysiological and anatomo-functional level (Walker 2008). The NREM sleep presents some specifical 34 EEG oscilations: spindles, delta waves and slow wave activity. Sleep spindles reflect brain oscillations within 11-15 Hz (sigma band) and of less than 0.5 ms duration. Delta waves are high amplitude oscillations, with a frequency between 1 and 4; the slow waves are characterized by a frequency less than 1Hz. Stage 2 of sleep, named light slow wave sleep, contains sleep spindles and some specific phasic graphoelements named K complexes; stages 3 and 4 of NREM sleep are characterized by the predominance of slow wave sleep (named SWS). At cellular level, the different sleep oscillations ae sustained by different brain structures: sleep spindles are generated by thalamo-reticular neurons (Steriade 2005). The slow waves are initiated by the neorcortex. Sleep duration and intensity are regulated by two physiological processes: homeostatic process and circadian rythm. The circadian rythms generate a close to 24h biological rythm, entrained via the suprachiasmatic nucleus, brain structure which plays the role of an internal clock. External stimuli such as light, food intake and social constraints train the internal clock to regulate with high precision the circadian rythm of sleep. The homeostatic control reflects the growing sleep pressure accumulated with time spent awake. The homeostatic pressure may be quantified by measuring the slow wave activity (Borbely and Achermann 2005). Sleep is therefore a highly controlled process, through the complex and permanent interaction of circadian and homeostatic mechanisms (Borbely 1982; Franken and Dijk 2009). Perturbations in sleep architecture and physiology generate sleep disorders, such as parasomnias (sleepwalking, nightmares, REM sleep behavior disorder, etc), in which wake and sleep elements co-exist, and thus provoke undesirable physical or verbal overt behaviors during sleep, probably by inappropriate activation of systems or programs normally differently modulated during sleep, such as autonomic nervous system, or programs, such as cognitive, behavioral, or motor program stimulation (Guilleminault 1994). 35 Figure 2. Sleep architecture A. Sleep stages in a young adult. B. Different stages of sleep and wakefulness (EEG: electroencephalogram, EOG: electroculogram, EMG: electromyogram) Sleep functions From Thomas Edison‟s view of sleep as “a waste of time” (he believed long sleep is a sign of laziness), to Francis Crick, suggesting that sleep allowed the brain to “take out the trash” by removing non relevant information not needed for long term storage, several hypotheses proposed a role of sleep in memory consolidation. Therefore, beside the extended number of documented implications of sleep in metabolic recovery (Spiegel, Leproult et al. 1999), cellular energy conservation (Benington and Heller 1995), thermoregulation (McGinty, Alam et al. 2001), brain detoxification (Inoue, Honda et al. 1995), tissue restoration (Everson, Laatsch et al. 2005), hormonal balance (Van Cauter, Spiegel et al. 2008) and genetic reprogramming (Jouvet 1998), a potentially critical contribution of sleep to plasticity mechanisms and memory stabilization processes have gained increasing scientific interest (Maquet 2001; Peigneux, Laureys et al. 2004; Stickgold 2005; Diekelmann, Wilhelm et al. 2009). It has been therefore suggested that sleep is required both for brain maturation at earlier stages in life and for consolidating memory traces throughout the life span of an individual (Maquet 2001). 36 Maybe the first systematic study on sleep and impact on memory was conducted by Jenkins and Dallenbach (1924), who trained two subjects on lists of nonsense syllables at different times during the day. When tested at various time intervals after learning, recall was much better after a period of sleep than a comparable period of wake, showing that retention is much higher after period of sleep than after period of wakefulness. The result was interpreted in the context of the interference theory, based on the assumption that sleep is a passive state, lacking sensory interference and therefore, preventing any external disruption of the ongoing memory processes. Some researchers argue that these specific changes impact differently the memory traces, depending on the sleep phase where they occur: this view is reflected by “the dual-process” theory (Plihal and Born 1999) which stands for a contribution of NREM sleep on more declarative aspects, while REM sleep is considered to play a more prominent role on procedural tasks (although this strict rule is challenged by studies which show that sleep stage 2 also contributes to learning of some procedural tasks (Fogel, Smith et al. 2007) and that REM sleep plays a role in the consolidation of emotional declarative memory (Wagner, Gais et al. 2001)). Another view is the “double step” hypothesis (Giuditta, Ambrosini et al. 1995), which posits that both sleep stages are required for memory consolidation, regardless of the memory system involved. According to this theory, the alternation itself of the two different sleep phases may favor memory processes (Stickgold, Whidbee et al. 2000). Napping in humans Beside the night sleep, humans also may perform naps, which are usually defined as short periods of sleep during day time. It is not yet clear if the same molecular and physiological processes that occur during night sleep also occur during napping. Yet, the behavioral and cognitive benefits of a nap are already welldocumented. Usually, naps have been used as a countermeasure for sleepiness and fatigue, as they improve arousal and alterness. Napping has been also shown to increase memory performance, even in the absence of fatigue and sleepiness. Studies on the benefit of napping on performance have demonstrated that short day time sleep episodes have selective enhacement on various forms of memory (Mednick 2003; Schmidt 2006; Backhaus 2006). Furthermore, these studies have showed that the nap related performance improvement is related to the specific stages of sleep within the 37 nap. Mednick et al (2002) applied a visual perception task to show that a 60 minute midday nap, rich in SWS, reverses deterioration of a perceptual task. Naps including both SWS and REM leed to an improvement in performance similar to that of a full night of sleep (Mednick 2003). The area of research in napping is still young. Future research concerning the functions of nappig needs to address physiological and medical benefits of day time naps that have been studied for nocturnal sleep (Stickgold and Walker 2009). 4.2. Sleep and wakefulness: recent hypotheses on memory consolidation 4.2.1. Neural reactivations during sleep Sleep might provide a permissive condition for neurophysiological mechanisms underlying brain plasticity to occur. This observation emerge from different studies in animals and in humans, assessing memory processe at different brain levels: cellular, neuronal assemblies, brain areas, behavioral (Agster, Fortin et al. 2002; Hobson and Pace-Schott 2002; Ribeiro, Mello et al. 2002; Massimini, Huber et al. 2004; Aton, Seibt et al. 2009). Reactivations at the cellular and neuronal networks levels At cellular level, much light has been brought by studies of individual hippocampal “place” neurons in rats. These cells exhibit elevated rates of firing whenever the animal is in a specific location in environment, therefore coding for the space map. It has been initially shown that the same firing patterns expressed during waking behavior are spontaneously reactivated during the following period of sleep. Practically, the same cells involved in a spatial task were specifically reactivated during subsequent sleep (Pavlides and Winson 1989). In another seminal paper, the hippocampal place cells presenting highly correlated activity during spatial exploration in a labyrinth showed high firing correlation during the deep NREM sleep represented by slow wave sleep (SWS), following the training period (Wilson and McNaughton 1994). Importantly, the temporal order of firing during post-training sleep was similar to the firing order during previous wake experience. The temporally ordered sequence of neuronal bursts was replayed within the CA1 region of the 38 hippocampus during SWS periods, in a “compressed” manner of approximately 20fold the initial neuronal discharge rate (Skaggs and McNaughton 1996; Lee and Wilson 2002). The temporally structured replay of a recently learned behavior is not only appearing during SWS, but also during REM sleep, as reflected by long temporal sequences of synchronized firing patterns in the hippocampus cells during this sleep phase (Louie and Wilson 2001). Therefore, one can conclude that both NREM and REM sleep contribute in a non-exclusive manner to memory consolidation processes. It has been proposed that SWS may promote mainly post-acquisition neuronal reverberations, while REM sleep is a favoring transcriptional features intervening in long-term memory storage (Ribeiro and Nicolelis 2004). The reinstatement of specific patterns of activity during sleep, consistent with wake behavior patterns, was also in songbirds, especially during song-recognition behavior (Dave and Margoliash 2000; Gentner and Margoliash 2003; Shank and Margoliash 2009). By using the birdsong and the comparison during sleep between vocal production (imprinted in premotor areas and spontaneously replayed during sleep) and stored auditory feedback, as “off-line” models for learning, the authors showed that bursts of activity during sleep induced adaptive changes in premotor networks as part of song learning. The replayed patterns of activity in the hippocampus reflect specific oscillations: on one hand, gamma oscillations (40-100 Hz) and theta rhythm (4-7 Hz), which characterize the hippocampus activity during exploratory behavior and REM sleep. On the other hand, the resting periods and SWS are characterized by irregular bursts of spike-like activity calles “sharp waves” and very fast oscillations, termed “ripples” (140-200 Hz) which represent pattern reinstatement at CA1 hippocampal level (Kudrimoti, Barnes et al. 1999). The sleep – memory consolidation assumes an interaction between neocortex and hippocampus during sleep. More specifically, during learning at wakefulness, the information si encoded simultaneously into neocortical networks and in a temporary fashion in the hippocampus. During subsequent SWS, neuronal activity related to recently acquired information is grouped by the slow oscillations (frequency less than 1 Hz) into up-states (neuronal activity) and down-states (neuronal diminished activity). This grouping mechanism generates within the thalamo-cortical network spindle activity and in the hippocampus it generates sharp-wave ripples, which contribute to the transfer of information from the 39 hippocampus to the neocortex. This transfer is initially associated with an increase in thalamo-cortical spindle activity. The synchronization orchestrated by the cortical slow oscillations between spindles within thalamocortical network and hippocampal sharp-wave ripples seems to be important for the memory long-term storage within neocortex (Born 2010). Figure 2. Model of the consolidation of declarative memory| as an interaction between the neocortex and the hippocampus (after Born 2010) Taking into consideration these different types of oscillations and their specific “windows” of appearance, Lorincz et al. (2000) elaborated a computational model based on two complementary phases, aimed at explaining the information trafficking within the hippocampal-neocortical axis and consequent long-term memory stabilization. The model advocates that during gamma and theta oscillations, the neocortex sends its inputs to the hippocampus through the enthorinal region. The opposite phenomena (i.e. the hippocampus sends information to the neocortex via the enthorinal cortex) coincide with the ripples and sharp waves activity. In its most general form, the model proposes that memories are stored within the hippocampus during wake experience and transferred to the neocortex during sleep, where sharp waves and ripples are suggested to drive Hebbian synaptic changes (increase in synaptic efficacy induced by repetitive and persistent stimulation of the post synaptic cell by the presynaptic cell) in the neocortical target areas. From a computational perspective, the averaged firing rates of neurons reflecting several hundred milliseconds of behavior provide a “rate” code of the recorded inputs. The influential Hebbian laws of learning and synaptic plasticity require a precise temporal code of 40 spikes sequence over very short timescales (generally less than several milliseconds). It has been established for the hippocampal pyramidal neurons that their rate of spiking and temporal codes are highly correlated, which can be critical for understanding the fast synaptic stabilization of temporally ordered sequences of events occurring at large behavioral scales (Mehta, Lee et al. 2002). Neuronal reactivations occur equally in other brain areas besides the hippocampus. Siapas et al. (Siapas and Wilson 1998) have provided a clear demonstration of temporal correlations between the hippocampal fast ripples and spindle (7-14 Hz) oscillations present in the prefrontal cortex during NREM sleep. The authors proposed that the correlated activity of hippocampal and neocortical regions may be important for the gradual transfer of memory traces from the hippocampus to neocortex within the dynamics of memory consolidation. Post exposure brain reactivations have been concomitantly proven during sleep in the posterior parietal neocortex and in the CA1 region of the hippocampus, conferring arguments for the idea that representations in the two areas may reflect the same experience and specific information transfer between the hippocampus and necortex (Qin, McNaughton et al. 1997). Along the same lines of evidence, Sirota et al (2003) found that the somatosensory cortex and hippocampus show oscillationmediated temporal correlations during sleep. Ji and Wilson (2007) described during SWS in rats, the reactivation of the same temporally organized spiking patterns evoking previous waking experience, in the visual cortex and the hippocampus. Euston et al. (2007) elegantly showed in the prefrontal cortex the compressed reactivation of spatiotemporal waking patterns, which could again reflect the memory consolidation processes and neural pattern rehearsal in an “off-line” manner. In support of a role of hippocampal-prefrontal interactions in memory processes, Peyrache et al. (2009) recently demonstrated that following the acquisition of new rules, prefrontal activity reflected neural patterns that occurred during active behavior and that this reactivation occurred predominantly when cortico-hippocampal interaction was enhanced. Thus, learning can influence the selection of neural patterns subsequently reactivated in hippocampal-prefrontal networks. The above mentioned studies bring valuable insights into the plastic changes that underlie memory consolidation across distributed brain networks, as reflected by the 41 coordinated reactivation of memory traces in the hippocampus and different neocortical regions. Reactivations at the brain areas level Functional brain imaging studies in humans found that following intensive training on perceptual or motor tasks, the same brain regions active during task performance showed changes in cerebral blood flow (Maquet 2001; Peigneux, Laureys et al. 2004) during sleep. Notably, by using positron emission tomography (PET), it has been shown that during REM sleep some brain areas were more active in subjects previously trained on a visuo-motor serial reaction time task than in nontrained, control subjects (Maquet, Laureys et al. 2000). The elegant experimental procedure consisted, first, in determining in a group of healthy subjects, the brain areas engaged in the performance of a sequence of events formed on a probabilistic grammar (probabilistic serial reaction time task). Then the subjects were scanned during post-training sleep, in order to identify the brain regions active during REM sleep. Another, group of subjects were also scanned during sleep, but without being trained on the task before sleep. The trained group showed during REM sleep compared to REM sleep of untrained subjects the activation of some some brain areas (left premotor area, bilateral cuneus, inferior part of the thalamus and mesencephalon) which were also previously found to be involved in the task execution during wakefulness. These results provided therefore the first evidence of off-line reprocessing of a recently established memory trace in human sleep. Behaviorally, the task execution improved after sleep in the trained group. The reshaping of this visuomotor network by reactivations during REM sleep could therefore sustain the gain in performance observed during the following day (Laureys, Peigneux et al. 2001). Post-training reactivations in the hippocampus have been also found during NREM sleep in humans. Healthy subjects were trained on a spatial task, consisting in learning to navigate in a virtual city (Peigneux, Laureys et al. 2004). The hippocampus activation was observed during the task performance and also during the SWS period after training. Moreover, individual hippocampus activity during sleep positively correlated with overnight improvement in performance, therefore arguing that hippocampus activity reinstated during sleep may play a critical role in memory trace consolidation. 42 Observations in rats led to the hypothesis that neurotransmitters modulation such as low cholinergic drive during SWS might be critical for the replay of newly acquired memory traces in the hippocampus and their long-term neocortical storage (Hasselmo 2008). In their study, Gais et al. (Gais and Born 2004), administered a cholinesterase inhibitor (physostigmine), and blocked SWS-related consolidation of hippocampusdependent declarative memories (word pairs test) in human subjects and had no effect on the consolidation of a procedural mirror tracing task, which was not supposed to relie on the hippocampus. These results show that the optimal re-organization of memory traces is also actively modulated by neurotransmitters, which could facilitate selective plasticity processes during sleep. The studies introduced so far show spontaneous reactivation of experiencedependent patterns of neural activity. By using stimulations applied during sleep, studies could also demonstrate externally induced neural reactivations (Marshall, Helgadottir et al. 2006; Rasch, Buchel et al. 2007). Adapting a cue-dependent recall strategy to a sleep-memory consolidation paradigm, Rasch and colleagues (2007) showed that the presentation during slow wave sleep of an odor, which had previously been associated with a declarative memory task, induced neural reactivations and subsequent declarative memory improvement. Furthermore, re-exposure to the same odor during REM sleep or wakefulness or omission of the odor presentation during prior learning did not impact memory performance. Neuroimaging data confirmed the hippocampus activation during SWS in response to odor presentation. This study suggests active reprocessing of recently acquired memory traces, triggered by a relevant context during sleep. The same research group (Marshall, Helgadottir et al. 2006) also showed in humans that by externally inducing cortical slow oscillations (and increased sleep spindles), during early nocturnal NREM sleep, it is possible to facilitate the retention of hippocampus-dependent declarative memories. The effect was proven to be selective for the slow oscillation frequency (0.75 Hz), while a 5 Hz stimulation decreased slow oscillations and had no impact on the memory performance (Marshall, Helgadottir et al. 2006). At the cognitive and behavioral level, it seems that selective cues presented to human subjects during sleep may target the reactivation and strengthening of individual memories (Rudoy, Voss et al. 2009). Moreover, recent human dreaming 43 studies propose that mental imagery observed during dreaming may reflect off-line reactivations of previously trained cognitive experiences and therefore, may subserve memory consolidation processes (Wamsley, Perry et al.; Wamsley and Stickgold). Taken together these studies suggest that sleep offers a favorable functional neurophysiological context for synaptic changes to occur. A still unanswered issue is whether changes in regional brain activity found in humans reflect offline experiencedependent processes, or use-dependent non-specific neurophysiological effects. In the next sections, I discuss these aspects in more details. 4.2.2. Neural reactivations during wakefulness Animal models of memory formation suggest that part of the post-training consolidation process takes place during wakefulness, in the periods of behavioral inactivity that follow the training on a new task (Buzsaki 1989). This means that recent memory traces are not only maintained during post-training wakefulness, but are also altered during this period of time (Frankland and Bontempi 2005). Convergent cellular data in animals and imaging data in humans, argue that following exposure to a new task, coordinated reactivations of practice-related neuronal patterns emerge in the waking period immediately preceding sleep (Pavlides and Winson 1989; Kudrimoti, Barnes et al. 1999; Peigneux, Orban et al. 2006). Wilson et al showed that during awake periods immediately after spatial learning, fragments of the spatial experience are replayed in a temporally reversed order within the rat hippocampus (Foster and Wilson 2006). However, the persistence of the temporal patterning of neural ensembles during post-training wakefulness is restricted to short time windows, which could reflect merely a consequence of intensive activation of learning-related neural networks, rather than an active role in the maintenance of newly acquired information (Pavlides and Winson 1989; Hoffman and McNaughton 2002). Evidence in favor of experience-dependent off-line processing of newly acquired information during post-training wakefulness comes from a functional magnetic resonance imaging study in humans (Peigneux, Orban et al. 2006). The authors showed that post-training modulation of brain responses during active wakefulness occurs in the same brain areas which were specifically involved in the task performance. Furthermore, the post-training activity correlated with behavioral performance and the observed modulations followed a different time course for the 44 hippocampus-dependent task than for hippocampus-independent task. This study argues therefore that during post-training wakefulness learning-dependent changes in spontaneous regional brain activity might also occur and contribute to the processing and stabilization of memories. *** As tested in the already mentioned imagery study by Maquet et al. (2000), experience-dependent brain activity assumes offline reprocessing of a recently acquired memory trace and reshaping of the areas selectively involved in the processing of the newly learned information. Furthermore, experience-dependent mechanisms taking place during sleep impact behavior in a stable and prolonged manner, as demonstrated by Stickgold et al (2000). The use-dependent perspective describes the restoration of optimal synaptic function after intensive neuronal usage during previous waking hours, as it is postulated by the downscaling hypothesis (Tononi and Cirelli 2003). Considering the above issues, it is debatable if memory trace consolidation relies on the spontaneous reinstatement of specific patterns of activity or/and on local homeostatic changes (e.g. synaptic downscaling). 4.3. Sleep homeostasis hypothesis The notion of “local sleep” has become a fundamental property of local neuronal networks in different brain regions involved in learning and memory processes (Huber, Ghilardi et al. 2004; Huber, Ghilardi et al. 2006). It was shown that SWA is regulated as a function of previous wakefulness (it increases with accumulating wakefulness and decreases during sleep) and therefore may be considered a marker of homeostatic sleep regulation (Borbely 1982; Tononi and Cirelli 2003). According to the hypothesis proposed by Tononi and Cirelli (2003), SWA is tied to synaptic downscaling, in order to preserve synaptic weight after learning and sustain improved performance. Using high-density EEG, it has been shown that local increases in slow-wave activity (SWA) during sleep after intensive learning of a motor adaptation task correlates with improved performance (Huber, Ghilardi et al. 2004). The authors proposed that by triggering local synaptic changes with learning of a new task, increased SWA will be induced in the specifically involved brain regions. Thus, 12h 45 of experimental sensorimotor deprivation (arm immobilization) was also found to decrease local SWA over the involved cortical regions (Huber, Ghilardi et al. 2006). In other words, increased synaptic strength after learning tasks would induce stronger synchronization within selective neuronal assemblies and thereby would lead to increased local SWA. This mechanism would prevent the “saturation” of brain plasticity and therefore, would allow more efficient shaping of memory representations after sleep as reflected by a better performance (Walker 2009). *** The present framework of memory consolidation give support to the observation by William James that “the tactile and muscular feelings of a day of skating or riding, after long disuse of exercise, will come back to us through the night … These revivals show that profound rearrangements and slow settlings into a new equilibrium are going on in the neural substance, and they form the transition to that more peculiar and proper phenomenon of memory” (James, W. Principles of psychology, 1890, p.647). 5. RATIONALE OF THE PRESENT WORK: MAIN QUESTION AND METHODOLOGICAL APPROACHES The aim of the present research is to bridge the gap between animal cellrecording data and human neuroimaging data by studying the temporally-structured dynamics of experience-specific neural and behavioral activity across wakefulness and sleep in humans. As the research framework implies the investigation of spatial and temporal dynamics of brain network activity, we considered that the most adequate tool to approach the main question is represented by electrical neuroimaging (EEG). The critical advantage of the EEG as a modern functional imaging method is the capacity to capture neural activity within millisecond temporal resolution. We will use both scalp EEG and intracranial electroencephalographic (iEEG) recordings in humans. The latter provides a unique opportunity to assess neural activity at both high temporal and spatial resolution, in particular for deep regions that cannot be easily accessible to surface EEG recordings. By processing event-related activity and using spatiotemporal analysis of EEG voltage maps, the electrical neuroimaging techniques 46 applied in the present studies, provides a direct assessment of the dynamics subtending learning and memory functions. Thus, the main aim of the experiments described hereafter was to assess learning-related neural reactivations by using the highly informative intracranial recordings in pharmaco-resistant epileptic patients and large-scale scalp recordings in healthy volunteers, and to reveal sleep-related behavioral reactivations by using video recordings during sleep in patients with specific parasomnia (sleepwalking and REM sleep behavior disorder, RBD). To address these issues, we developed and applied different experimental strategies. On the one hand, we studied the sequential encoding and processing of learned events by using versions of serial reaction time tasks, adapted for the evaluation of implanted epileptic patients and for the testing of sleepwalkers and RBD patients. On other hand, we used an association learning task to test the gradual integration of multisensory components into a coherent memory trace, measured by high-density scalp recordings in healthy volunteers. Finally, we also applied external sensory stimulations during short periods of daytime sleep, i.e. naps, to instrumentally modulate electrophysiological features of sleep, and further evaluate their relevance for memory processes. *** The main goal of present research work is to investigate the shaping of neural representations of acquired information across wakefulness and sleep dynamics, and thus evaluate the potential contribution of plasticity mechanisms to memory architecture. 47 Experimental part OVERVIEW The experiments performed during the present work deal with human wake and sleep data subtending brain plasticity processes, in a multi-level manner – from overt behavior to neural populations electrical activity. The thesis design promotes a transdisciplinar view on brain functioning, through the convergent theoretical and methodological approaches used. This contributes to the originality of the present thesis in cognitive neuroscience and provides a valuable perspective for research continuation. THESIS EXPERIMENTAL DESIGN 48 Neurophysiological evidence from human intracranial recordings of sequenced knowledge consolidation Experiment 1. CONTEXT It has been proven that skill for performing sequenced motor activities continues to develop after practice has ended, therefore suggesting an “off-line” process of consolidation (Doyon et al., 2009; Hotermans et al., 2006; Maquet, 2001). Important support for off-line memory reprocessing comes from cell-recording data in rodents showing during both sleep and wakefulness, hippocampal replay of the same sequentially-structured pattern of neural activity as found during previous active behavior (Louie and Wilson, 2001; Wilson and McNaughton, 1994; Foster and Wilson, 2006). At the macroscopic systems level, functional brain imaging studies in humans showed that intensive sequence learning can lead to regional changes in cerebral blood flow and in the scalp EEG activity, particularly within the hippocampus (Albouy et al., 2008; Hazeltine et al., 1997; Schendan et al., 2003). However, the exact contribution of the medial temporal structures to the consolidation of newly learned sequences of events remains not fully understood in humans. In the present context, the aim of this first study of the thesis was to combine elements from animal cellular studies in vivo and human brain neuroimaging approaches, to assess consolidation of recently acquired structured information and the underlying pattern of distributed neural activity. Sleep and wakefulness data were therefore acquired in drug-resistant epileptic patients with implanted electrodes covering several brain areas while they repetitively performed fixed visuomotor sequences known to benefit from sleep (serial reaction time task, SRTT) (Maquet, Laureys et al. 2000). METHODOLOGICAL HIGHLIGHTS Intracranial electroencephalographic (iEEG) recordings in humans allow a particularly valuable level of observation of brain processes in humans by capturing, with high temporal and spatial resolution, local field potentials (LFP) of distinct neuronal populations. 49 We implemented a classification method based on a statistical mixed-model and trained on single motor responses, by considering all implanted areas in each patient. By using the same statistical algorithm, but dropping in turn each of the recorded area and re-evaluating the corresponding classification performance, we were able to identify the areas which critically contributed to classification accuracy. Therefore, the designed classification algorithm could capture learning-dependent changes in iEEG signal related to single events, which renders this approach particularly adequate to study datasets from individual patients. SUMMARY OF RESULTS The classifier correctly assigned single iEEG trials from the trained sequence as belonging to either the initial training phase (day 1, before sleep) or a later consolidated phase (day 2, after sleep), whereas it failed to do so for trials belonging to a control condition (pseudo-random sequence). In both patients, the hippocampus provided a critical contribution to the classification accuracy. Fronto-striatal regions also contributed to the classification result in one patient with electrodes in this area. Complementary average event-related potential (ERP) analysis performed within the same hippocampal sites suggested amplitude modulation as a function of training phase, selectively for the trained sequence around 200 ms prior to keypress. CONCLUSION Together, these findings provide, for the first time to our knowledge, electrophysiological evidence from intracranial recordings in humans for the role of medial temporal regions in learning-related modulation of the neural representation of single events within sequentially-organized knowledge. 50 Article submitted to NeuroImage Title: Decoding sequence learning from single-trial intracranial EEG activation Article Type: Regular Article Section/Category: Cognitive Neuroscience Irina Constantinescu (1,2)*, Marzia De Lucia (3)*, Virginie Sterpenich (1,2), Gilles Pourtois (4), Margitta Seeck (5), Sophie Schwartz (1,2,6) *Contributed equally to this work (1) Department of Neuroscience, University of Geneva, Switzerland (2) Geneva Neuroscience Center, University of Geneva, Switzerland (3) EEG Brain Mapping Core, Center for Biomedical Imaging of Geneva and Lausanne, Switzerland (4) Department of Experimental clinical and health psychology, University of Ghent, Belgium (5) Department of Clinical Neurology, Geneva University Hospitals, Switzerland (6) Swiss Center for Affective Sciences, University of Geneva, Switzerland Corresponding author: Sophie Schwartz Department of Neuroscience, University Medical Center Michel-Servet 1, 1211 Geneva 4, Switzerland Phone: +41 22 3795376 Fax: +41 22 379 5402 Short title: Decoding learning-related neural responses Keywords: intracranial EEG; depth electrodes; local field potentials; single-trial classification; multivariate decoding; Hidden Markov Model; serial reaction time task; human memory; learning; hippocampus 51 ABSTRACT Continuous intracranial EEG (iEEG) data were acquired during two sessions (one before and one after a night of sleep) in two patients with depth electrodes implanted in several brain areas, while they performed a deterministic visuomotor sequence (serial reaction time task, SRTT). To identify brain areas implicated in the learning of temporally-structured information, we implemented a multivariate decoding algorithm at the single trial level of iEEG. The algorithm is based on a Hidden Markov Model (HMM) that captures spatio-temporal properties by identifying series of discrete states of stable voltage configuration. Our results show that the decoding algorithm correctly classifies single iEEG trials from the trained sequence as belonging to either the initial training phase (day 1, before sleep) or a later consolidated phase (day 2, after sleep), whereas it failed to do so for trials belonging to a control condition (pseudo-random sequence). Accurate single-trial classification was achieved by taking advantage of distributed pattern of neural activity. However, across all the contacts, only the hippocampus provided significant contribution to the classification accuracy for both patients, and one fronto-striatal region for one of the patients. We also show that learning increased the temporal stability of discrete neural states. Together, these human intracranial findings demonstrate that a multivariate decoding approach captures learning-related changes at the level of single-trial iEEG, and provide new evidence for the involvement of medial temporal (as well as fronto-striatal) regions in the learning of single visuomotor events within sequentially-organized knowledge. 1. INTRODUCTION A large variety of our daily life activities are organized into sequences of movements, whose precise and fluent execution depends on practice (e.g. talking, getting dressed, riding a bike, using a computer mouse, typing). Finger tapping tasks and serial reaction time tasks (SRTT) have proven to be extremely useful to investigate skills learning (e.g. Fischer et al., 2002; Karni et al., 1995; Pascual-Leone et al., 1999; Peigneux et al., 2003; Walker et al., 2002). In these tasks, subjects are required to perform rapid sequences of finger movements, much like when playing the piano. Sequence learning typically results in a better performance for trained sequences of movements compared to non-trained or random sequences. Importantly, 52 performance improvement may develop over time after practice has ended, particularly during sleep, suggesting an „off-line‟ process of consolidation (Diekelmann and Born, 2010; Diekelmann et al., 2009; Doyon et al., 2009; Hotermans et al., 2006; Korman et al., 2003; Maquet, 2001; Press et al., 2005; Stickgold et al., 2001). Strong support for off-line memory reprocessing comes from cell-recording data in rodents showing that temporally-structured hippocampal activity recorded during spatial navigation may be replayed during subsequent periods of sleep (Euston et al., 2007; Louie and Wilson, 2001; Wilson and McNaughton, 1994; see also Dave and Margoliash, 2000) and wakefulness (Foster and Wilson, 2006). However, while a number of functional MRI (fMRI) and scalp EEG studies investigated sequence learning in humans, the implication of the human hippocampus in the consolidation of freshly learned sequences is still debated (Albouy et al., 2008; Fletcher et al., 2005; Hazeltine et al., 1997; Schendan et al., 2003; Seidler et al., 2005). The goal of the present study is twofold: (1) to test the implication of medial temporal lobe (MTL) regions in visuomotor sequence learning by using human intracranial EEG recorded from several brain regions including the hippocampus; and (2), at a methodological 4 level, to demonstrate the feasibility and advantages of using a multivariate decoding approach to iEEG data collected in individual patients. Here, we recorded iEEG from distributed cerebral locations in two epileptic patients to identify selective and spatially-localized changes in neural activity related to visuomotor learning. Critically, depth-electrode recordings may allow the direct evaluation of hippocampus contribution to sequence learning. Other techniques in human studies are either constrained by limited access to deep regions (scalp EEG) or lack sufficient temporal resolution to capture variations at the level of singleresponse event-related activity within an SRT sequence (fMRI). Thus, while iEEG recordings in humans remain uncommon, they provide information about changes in neural activity at high temporal and spatial resolution, therefore bridging the gap between animal cell-recording data and human neuroimaging findings. To investigate the neural representation of single events (trials) within a trained sequence, we developed a multivariate decoding algorithm that first classifies learning-related changes in neural activity by exploiting distributed patterns of neural activity. We then estimate which electrodes mostly contribute to the discrimination power in order to identify brain regions implicated in learning-related changes. This 53 data-driven approach is challenging because it aims at extracting distinctive features of neural activity during a complex cognitive paradigm at the single-trial level and with minimal a priori constraints (for similar approaches, see De Lucia et al., 2007a, b; Murray et al., 2009; Tzovara et al., submitted). This effort is counterbalanced by the benefit of a statistical assessment of datasets from single individuals, which is particularly appropriate for the study of clinical cases with heterogeneous anatomical and functional characteristics. 2. MATERIAL AND METHODS 2.1. Patients We tested epileptic patients with depth-electrodes implanted in several brain regions for presurgical evaluation purposes. Here we report the findings in two patients, patient M.R. (male, left-handed, aged 35) and patient C.S. (female, righthanded, aged 25) who completed the experimental protocol without any major epileptic activity over the whole period of recording (about 18 hours over 2 days, see Figure 1a). During the whole experimental protocol, including one night of sleep, both patients were free of any medication. The ictal semiology consisted of generalized seizures alternating with partial seizures for patient M.R and of complex partial seizures for patient C.S. None of the patients had any detectable hippocampal damage (including sclerosis): the magnetic resonance imaging (MRI) exam was normal for patient M.R and showed bilateral occipital periventricular heterotopia without any hippocampal abnormality for patient C.S. Both patients had a good general clinical status, no cognitive impairment, and no history of sleep disorder. None of the patients had formerly exerted any activity that could influence performance on the main experimental task (SRTT, see below), such as playing a musical instrument or extensive practice with typing on a keyboard. The patients could execute the task without difficulty (see Results). Both patients judged the quality of the night sleep during the experiment as good (St Mary‟s Hospital Sleep Questionnaire and verbal interview) and polysomnographic sleep scoring showed good sleep efficiency (see Supplementary Material). Both patients provided written informed consent to participate to this study, which was approved by the ethical committee of the Geneva University Hospital. 54 2.2. Behavioral task and experimental procedure The patients were tested on a serial reaction time task (SRTT). During testing, the patients faced a computer screen (19 inches) displaying four grey rectangles (2.15 x 4.30 degrees of visual angle, each) arranged horizontally next to each other (2.15° gaps) on a homogeneous, light blue background, and a fixation cross at the center of screen (Figure 1b). The four rectangles and the fixation cross remained on the screen throughout the experiment. On each trial, one of the four grey rectangles briefly changed its color to yellow during 200 ms. The patients had to react as quickly and accurately as possible by pressing on a response-pad the spatially corresponding key to the flashed position within a 1000 ms interval. The patients responded with the four fingers of their non-dominant hand (right for M.R. and left for C.S.). Whenever they did not press the correct key or pressed no key within the response interval, an error feedback was displayed (background color turning to dark blue during 200 ms). The next trial started 500 ms after the end of the response period. The inter-stimulus interval was fixed and set to 1700 ms. On each trial in the sequence, reaction times (RT) and response accuracy were recorded. The SRTT was programmed using the EPrime software (Psychology Software Tools, Inc., Pittsburg, PA) to allow high temporal precision for stimulus presentation, RT data collection, and marking of the events on the iEEG recording. Two types of sequences were presented: a structured (S) sequence, requiring eight keypresses in a specific pre-determined order and a control (C) pseudo-random sequence. For both patients, the S-sequence used was 2-4-3-1-4-2-1-3, where 1 refers to the left-most rectangle and 4 to the right-most rectangle on the screen. The Csequence consisted of series of eight keypresses (as for the S-sequence) formed by randomly shuffling two sub-sequences of 1-2-3-4 positions. Hence, both sequences differed in the succession of single positions, but the C-sequence shared some common features with the S-sequence because the four distinct positions were flashed once in each of the two quartets forming the 8-position sequence. A 7 short pause of 2500 ms was inserted after the last trial of each sequence, i.e. after 8 keypresses. The patients were not informed about the regularity of the S-sequence. The patients were tested during two sessions on two successive days, including one night of sleep between the sessions (Figure 1a). On day 1, a training session 55 started at 7.45 p.m. and lasted about 30 min. On day 2, a test session started at 9.30 a.m. and lasted 30 min. Each session consisted in three blocks of the S-sequence (20 repetitions each) and one equivalent block of the C-sequence. The C-sequence was introduced in both sessions to allow the assessment of sequence-specific changes in behavior and neural activity, independent of non-specific improvements in executing the visuomotor task. The C-sequence was performed after two S-blocks to ensure that the patients had acquired good practice with the SRT task. The C-block was also followed by a last S-block to limit interference of the C-sequence on the consolidation of the S-sequence. To obtain information about explicit knowledge of the S-sequence, we asked the patients at the end of the second session on day 2 whether they had noticed any regularity regarding the succession of the positions (or keypresses). We also invited them to reproduce the motor sequence on the keypad. 2.3. Intracranial EEG recording We tested both patients while they underwent continuous long-term intracranial EEG (iEEG) recordings. Electrophysiological activity was recorded over arrays of depth electrodes surgically implanted to identify the epilepsy focus. Intracranial EEG was recorded (Ceegraph XL, Biologic System Corps.) using electrode arrays with 8 stainless contacts each (AD-Tech, electrode diameter: 3 mm, inter-contact spacing: 10 mm), orthogonally implanted in several brain regions. Patient M.R. had 64 contacts (8 arrays), covering, bilaterally, the anterior and posterior hippocampal regions, the amygdala, and the fronto-orbital cortex. For patient C.S., a total of 88 contacts (11 arrays) covered anterior and posterior hippocampal regions, the amygdala, the frontalcaudate area, and the occipital cortex, bilaterally, as well as the right fronto-orbital cortex (Figure 2a). For each patient, precise electrode location was determined by the co-registration of a post-operative computed tomography scan (CT) with a highresolution anatomical MRI. For the iEEG recordings, the reference in both patients was a scalp electrode, subcutaneously implanted, located at position Cz and the ground another scalp electrode at position FCz of the 10-20 international EEG system. The iEEG signal was sampled at 512 Hz and band-pass filtered between 0.1-200 Hz. DC correction and a 50 Hz notch filter were applied to the data. Intracranial EEG was recorded continuously during the training period on day 1 and testing period on day 2, 56 as well as during the night between the two sessions. Electrooculography using two electrodes placed on the eyes‟ external canthi and electromyography using chin muscle electrodes were also performed during the sleep periods. Sleep data were scored manually by two trained sleep scorers on 30s epochs based on Rechtschaffen and Kales standard scoring criteria (Iber et al., 2007). 2.4. Data analysis We first analyzed iEEG data from all implanted regions using a classification method based on single-trial responses. In short, this approach aims at classifying single trials of iEEG (epochs corresponding to single keypresses) in the S-sequence as belonging to day 1 or to day 2. We then performed a localization procedure to detect which areas contributed significantly to the classification accuracy. Additionally, we computed event-related potentials of iEEG data from the areas that mostly contributed to the classification to test for possible amplitude-related modulations on the averaged signal. We also used this amplitude modulation value for classifying single-trials belonging to day 1 and day 2. We performed this test to check whether amplitude modulation was sufficient to obtain significant classification accuracy. 2.4.1. Multivariate decoding approach to iEEG We implemented a multivariate approach to investigate the consolidation of a sequential motor skill based on distributed brain signals. This method presents several advantages for the analysis of intracranial recordings with respect to classic average event-related potentials. First, it exploits single-trial measurement of different duration therefore accounting for possible latency shifts in the electrophysiological response to similar stimuli and that are not time-locked to the visual cue or motor response. Second, it provides classification estimations for different conditions, whose accuracy can be tested statistically. Finally, by a recurrent procedure it allows to assess the contribution of each measurement site to the classification accuracy. The distinctive features of this method are particularly appropriate for the study of single-patients datasets, whose measurement quality can be affected to a different degree and at different site locations, making it difficult to statistically assess group-level effects. Moreover, in the context of intracranial data, the averaging of iEEG epochs rarely 57 generates classical ERP components, thus preventing a straightforward use of the knowledge derived from scalp EEG studies. While it provides a stringent test for the classification of single-trial data together with an identification of anatomical sites for conditions-dependent changes, this method takes advantage of several single-trial features simultaneously, including signal amplitude and spatio-temporal pattern of activity (see Hidden Markov Model of single-trial iEEG section for details). As described in more details below, the main steps for the multivariate decoding approach are: (i) the HHM model of single-trial iEEG, (ii) the accuracy estimation, and (iii) the localization estimation. Hidden Markov Model of single-trial iEEG To model the neural response in the S-sequence, we used a selection of contacts for each of the two patients, choosing the most distant contacts on each electrode array. This data selection procedure was motivated by the need to reduce the computational time in training the model and is justified by the observation that close contacts measure highly correlated brain activity. The number of selected contacts N was 16 for M.R. and 22 for C.S. (for Talairach coordinates of these contacts, see Supplementary Table). To achieve faster RTs, motor learning should predominantly modulate the electrical activity preceding the keypress. We therefore defined each individual trial (corresponding to iEEG epochs) as starting from the fixation cross and ending when the keypress was recorded. Because we aimed at characterizing neural responses when the patients performed the S-sequence, irrespective of the specific finger used, we pooled all the trials from the S-sequence in separate datasets, one for each of the two days. This approach of pooling together all the events corresponding to different fingers is also essential for allowing the use of the same model when classifying single trials of the C-sequence. Obviously, the model it is not informed by any feature of the sequence order. For each patient, we therefore created two datasets one for day 1 and one for day 2 including all the single trials (epochs) from the S-sequence. Each of these epochs comprises a set of voltage measurements Mtf at each time-frame tf, with Mtf = [v1(tf), v2(tf),…,vN(tf)] (Figure 2b,c). The aim of the HMM algorithm is to model the time series of vectors Mtf within each epoch {M1, M2,…, ML}, where L is the length of one epoch. 58 In an HMM, one considers a probabilistic model of two sets of random variables {H1,…, HQ} and {M1, M2,…, ML} (Rabiner, 1989). The variables {H1,…, HQ}, called hidden states, represent a stochastic process whose evolution over time cannot be observed directly. The property of this process can only be inferred through the realizations of the variables {M1, M2,…,ML}, that is to say, in our case, the EEG signal recorded from several electrodes. The HMM is characterized by the initial state probability vector π of elements πi = P(H1 = i); the state transition matrix A, with aij = P(Htf = i|Htf−1 = j) and the set of emission probability density function B = {bi(Mtf) = p(Mtf|Htf = i)}, which is, in our case, modeled by a Gaussian mixture (Gaussian mixture model; GMM). The first step of the algorithm is a GMM estimation of the set of voltage measurement for a given condition. Thus, the N-dimensional vectors {Mtf}, representing the instantaneous voltage measurement across the entire set of electrodes (Figure 2b), were extracted and pooled together regardless of the timing at which they were observed and of the trial to which they belonged (Figure 2c). The GMM estimation itself was initialized by a K-means clustering method (Bishop, 1995), which provides a first guess of the mean of each cluster, the prior probability for each of the clusters, and associated covariance. The latter were calculated considering, for each of the Q Gaussians, the set of vectors {Mtf} closest (on the basis of Euclidean distance) to each mean. The GMM parameters were estimated by an expectation-maximization algorithm for mixture of Gaussians (Dempster et al., 1977). The resulting GMM parameters were then used to initialize an HMM model with Q hidden states. This second step allows characterizing the temporal structure of the response as a series of states. The HMM model was estimated using Baum-Welch algorithm (Baum et al., 1970), a machine learning standard procedure which compute the values of π, A and B defined above. Both steps in the model estimation were computed using a toolbox for Matlab developed by Kevin Murphy (http://www.cs.ubc.ca/~murphyk/Software/HMM/hmm.html). In order to select the number of clusters Q providing the best classification between the trials on day 1 and day 2, we considered a range of possible values of Q between 3 and 8. We therefore obtained six HMM (one model for each of the Q values considered) for each of the two datasets and each of the patients. 59 2.4.2. Accuracy estimation To select which HMM provided the best discrimination power between day 1 and day 2, we validated the models across ten splits of the data. For each split, nine tenth of the data extracted from the S-sequence were used for training the models, the remaining trials were used for testing. For each test, we computed a Receiver Operating Characteristic (ROC), whose underlying area provides an unbiased measure of the classification accuracy (Swets et al., 1979). After selecting the parameters corresponding to the largest area lying beneath the ROC curve, we tested the model on the C-sequence. A significantly lower performance in classifying trials belonging to the C-sequence would confirm that the classification performance between day 1 and day 2 for the S-sequence was attributable to sequence-specific effects related to learning and neural plasticity, and not to non-specific task adaptation effects (e.g. more efficient visuomotor mapping with practice) nor to general differences in measurement conditions (e.g. different states of the patient). For testing the model on the C-sequence, we considered ten splits of the whole set of single trials and ran a test for each split. It is worth noting that the attempt to classify data belonging to the Csequence is a valid test because the model estimation was based on single trials from the S-sequence on day 1 and day 2, disregarding any information about the grammar of the sequence itself. As such, this test is essential for claiming that the algorithm captures neural changes between the day 1 and day 2 pertaining to the learning of the sequence, rather than reflecting other learning factors such as an improvement in the mapping between visual cues and response keys (which would also affect the control sequence), or non-specific effects including motivation or fatigue. As an additional estimation of the quality of the trained model, we assessed the accuracy obtained for new test data by measuring the ratio of trials correctly classified and the total number of trials when keeping the same priors as those obtained during the training. Finally, to exclude that the discrimination power reached when classifying the S-sequence could trivially be due to shorter trial duration on day 2 compared to day 1, we performed a control test by classifying the two datasets based on the reaction times (RTs) only (i.e. based on the single-trial duration). ROC curve areas based on the ten estimations in the cross validation procedure were compared using t-tests (p<0.01). To further assess any possible relation between 60 the estimated model accuracy and the RTs, we computed the Pearson correlation between the difference of the logarithm of the likelihoods of each of the two models (hereafter called discrimination function) and the RTs on a trial-by-trial basis in the test dataset. 2.4.3. Estimating contacts with higher classification power To test for the role of specific brain areas in the classification performance, we estimated the algorithm accuracy after dropping couple of contacts belonging to each electrode array, one at a time, and for each patient separately. At this stage, each couple of electrodes is considered together because they can reflect correlated activity along the strip and in order to shorten the computational time. For each of this electrodes selection, we estimated the parameters providing the highest classification accuracy for the S-sequence as we did above. We then compared the resulting classification performance with that obtained previously when keeping all the contacts. The same analysis was carried out with the data from the C-sequence based on the models estimated in the structure sequence. A further analysis was carried out focusing on those couple of electrodes that produced a significant drop of the classification accuracy. In the following we will refer to the string of contacts including this couple of electrodes as target string. In this further test, we trained two set of new models for day1 and day2 taking into account the same number of initially chosen selected contacts (i.e. 16 for M.R. and 22 for C.S.) but replacing one contact within the target string with another contact in the same string. The goal is to test how robust is the drop in classification accuracy against different choice of the electrodes along the strip and the critical contribution of each single contact while keeping the same number of total electrodes. 2.4.4. Event-related potentials To characterize the average time-course modulation of the electrical activity in the areas found relevant by the single-trial classification approach, we computed intracranial ERPs (iERPs) for the contacts along the strips corresponding to these areas: for patient C.S., the right anterior hippocampus and right frontal-caudate region; for patient M.R., the left posterior hippocampus (Figure 5). Intracranial data were preprocessed and 61 analyzed using the Cartool software (http://brainmapping.unige.ch/Cartool.htm). Individual epochs were timelocked to the presentation of the visual cue, as was done for the single-trial approach above. The duration of the epochs was 1000 ms, with a 200 ms baseline. Single-trial EEG epochs were analyzed offline, after removing all epochs including co-occurring artifacts or epileptic spikes (16.7% of all epochs removed for patient C.S. and 32.2% of all epochs removed for patient M.R., using stringent visual inspection). Note that this percentage of rejected epochs is acceptable when considering similar procedures in the human intracranial literature (Pourtois et al., 2007; Pourtois et al., 2010a; Pourtois et al., 2010b). We also excluded epochs corresponding to errors (wrong key pressed or misses; less than 2.25% in both patients). These preprocessing steps resulted in a total of 821 trials for the S-sequence (390 trials for day 1 and 431 trials for day 2) and 244 trials for the C-sequence (128 trials for day 1 and 116 trials for day 2) in patient C.S, and in 599 trials for the Ssequence (324 trials for day 1 and 275 trials for day 2) and 237 trials for the Csequence (128 trials for day 1 and 109 trials for day 2) in patient M.R. Individual epochs were low-pass filtered using a 30 Hz cutoff. Four different iERPs were computed, corresponding to the S-sequence and C-sequence for day 1 and day 2, for the considered contacts. The amplitude of the electrical signal at each time-point across all the trials was used as the dependent variable for within-subject statistical comparisons We tested for any modulation of response amplitude between day 1 and day 2 separately for each sequence type using non-parametric statistical analyses based on randomization tests (e.g. Pourtois et al., 2007). The randomization method tests for differences in any variable (here amplitude at each time-point) without any assumption regarding data distribution, by comparing the observed dataset with random shufflings of the same values over many iterations. Here, the randomization implied an iterative shuffling of 10‟000 times, which provides a robust estimation of the probability that the amplitude difference at any time-point is observed by chance. We report effects that survived a threshold of p<0.05 with a minimal temporal stability of at least 10 consecutive time-points (>20 ms at 512 Hz sampling rate; Guthrie and Buchwald, 1991; Pourtois et al., 2008). 62 3. RESULTS 3.1. Behavioral results For each patient, we first averaged the reaction times (RT) over the 8 keypresses of each sequence in each block (i.e. 20 sequences in each block). Note that only hits were included in the analysis and that the patients made very few errors (incorrect key pressed or misses) in each block (% of all keypresses ±SD; Patient M.R.: 2.31 ±2.27; Patient C.S: 0.50 ±1.07). The data were then subjected to an ANOVA with Day (day 1, day 2) and Blocks (3 blocks for the S-sequence, 1 block for the C-sequence) as factors. Additional t-tests were performed whenever interactions were significant. Both patients showed a main effect of Day (patient M.R.: F(1,152)=4.89, p<0.05; patient C.S.: F(1,152)=15.72, p<0.001) due to the RTs being faster on the second than first day (mean ±SD; M.R. Day 1: 597.11 ms ±66.26, Day 2: 575.10 ms ±66.01, T(158)=2.11, p<0.05; C.S. Day 1: 400.76 ms ±38.28, Day 2: 379.30 ms ± 41.65, T(158)=3.38, p<0.001). Critically, the analysis revealed a Day by Block interaction (M.R.: F(3,152)=3.62, p<0.05; C.S.: F(3,152)=2.72, p<0.05) due to greater performance improvement for the S-sequence blocks than the C-sequence blocks on day 2 (RT difference between day 1 versus day 2 for M.R. S-sequence: 24.35 ms, T(118)=2.21, p<0.05, C-sequence: 14.99 ms, T(38)=0.72, p=0.49; for C.S. S-sequence: 28.91 ms, T(118)=5.16, p<0.001, C-sequence: -0.90 ms, T(38)=-0.07, p=0.95). Consistent with previous studies (Albouy et al., 2006; Destrebecqz et al., 2005) none of the patient exhibited any explicit knowledge of the S-sequence or of three successive positions (i.e. no fragmentary rule knowledge). They reported that they did not notice any regularity in the succession of the yellow rectangles or keypresses. 3.2. Results from the multivariate decoding approach to single-trial iEEG 3.2.1. Accuracy estimation For patient M.R., the best classification performance was obtained for Q=3 on day 1 and Q=4 on day 2. The ROC area was 0.80 ±0.07 (mean ±SD; Figure 3a). For patient C.S., the selected parameters were Q=6 and Q=7 for day 1 and day 2, respectively. The average ROC curve area was 0.90 ±0.06 (Figure 3b). The accuracy 63 obtained when keeping the same priors as those obtained in the training, measured as the ratio of the number of trials correctly classified to the total number of trials, was 0.70 ±0.06 and 0.81 ±0.05 respectively. In both patients, the accuracy for classifying the S-sequence was significantly higher than that for classifying the control sequence (p<0.01), because the average ROC curve area for the C-sequence was 0.66 ±0.04 and 0.66 ±0.04 for day 1 and day 2, respectively. The corresponding accuracy when keeping the same bias as in the training was 0.60 ±0.06 and 0.63 ±0.04. When classifying the trials in the S-sequence based on their reaction times only, we obtained a classification accuracy considerably lower than that for the S- and C-sequences in both patients (Figure 3). In addition, the correlation between the discrimination function and the RTs evaluated on each of the ten test datasets was also negligible and never exceeded 0.37 (n.s.). 3.2.2. Estimating contacts with higher classification power When leaving out in turn each electrode array (2 contacts each), the accuracy for classifying the S-sequence dropped significantly (p<0.01) for one pair in patient MR and for two pairs in patient CS. For patient M.R., the critical array corresponded to left posterior hippocampus (Figure 4a and Figure 5a). For patient C.S., accuracy decreased when dropping arrays including the right anterior hippocampus and the right frontal-caudate array (Figure 4b and Figure 5b,c). For none of the other arrays, we obtained a significant drop in the classification accuracy. We report the results using model parameters that provided the highest classification performance for the Ssequence. Importantly, for none of the parameters choice did we obtain higher classification accuracy when dropping any of these areas. This last result provides a quality check on the contribution from each electrode included in the present analysis, because dropping an electrode with noisy signal might improve the classification accuracy. When applying the same procedure on the data from the C-sequence, we found that, in both patients, many areas were associated with a significant drop in the accuracy when they were not included in the model estimation (Figure 4a,b) but, critically, the accuracy for the S-sequence remained always significantly higher than that of the C-sequence. Again, as for the S-sequence, for none of the parameters choice was any increase in the discrimination power observed. All together these 64 results show that in both patients the electrode including the hippocampus was critically contributing to the classification accuracy. We further analyzed how specific was the contribution of the hippocampus by estimating two new sets of models for day 1 and day 2 by considering all the initially chosen contacts (i.e. 16 for M.R. and 22 for C.S.) but replacing the one in the hippocampus (LPH1 and RAH1 for MR and CS respectively) with one external to the hippocampus within the same target string. For patient MR, the ROC area dropped to 0.78±0.07 which was significantly lower than the area obtained using all the initially chosen contacts (p<0.05). For patient CS, the ROC curve area dropped to 0.88±0.04, significantly lower than when including hippocampus (p<0.05). We can conclude that for both patients within the string that included hippocampus, the contact placed in the hippocampus was contributing more to the classification performance other that the other contact. Note also that these effects were found for hippocampal contacts in the hemisphere contralateral to the executing hand in both patients. 3.3.3. Relation between classification accuracy and spatio-temporal pattern of single-trial events We investigated which HMM models‟ parameters were most informative in classifying single-trials from day 1 and day 2 and what signal properties they reflected. To this aim, we quantified the contribution to the classification accuracy of each of the parameters that provided the best classification accuracy for the two HMM models (i.e. priors, means, covariances, and transition probabilities). This was done by swapping the values of each of these parameters between the two models and repeating the testing as explained in the section „Accuracy estimation‟. We found that the values of the covariances were the most informative for discriminating day 1 and day 2 and that none of the other parameters were significantly impacting the classification accuracy. The next step was to gain a better insight on the neurophysiological interpretability of the HMM models‟ parameters captured during the day 1 and day 2. As mentioned above (section „Hidden Markov Model of single-trial iEEG‟), the HMM model can be used to segment the single-trials into series of momentary states, that is to say momentary states of stable voltage configurations. We therefore investigated how 65 differences in the covariance matrices (which were found above to play a significant role in the classification) may be reflected in the spatio-temporal pattern of these momentary states. We found that the average duration of these states was longer during day 2 and in comparison to day 1 only for those single-trials belonging to the C-sequence in both patients. The average duration of these momentary states for subject MR was 97.1 ms and 110.8 ms during day 1 and day 2 respectively and significantly differed (p<0.05; Fig. S1a). The average duration for subject CS was 62.7 ms and 71.1 ms during day 1 and day 2 (significantly different, p<0.05; Fig. S1b). Importantly, this difference in the average duration was no longer significant when considering single trials belonging to the random sequence in both subjects (during day 1 and day 2 average duration was 74.9 ms and 75.3 ms for MR; 60.1 ms and 64.3 ms for CS). We concluded that the pattern of momentary states and their typical temporal duration was a function of the learning stage of the subject. In addition, when omitting the hippocampus contribution, for patient MR the difference in the average duration for the S sequence was not anymore significant (60.8 ms and 63.9 ms during day 1 and day 2 respectively; p>0.05), and for patient CS, although this difference was still significant, it was significantly lower than when including all the contacts (58.3 ms and 61.7 ms during day 1 and day 2 respectively; p>0.05). 3.3. Intracranial event-related potentials We report the ERP results for these two representative contacts, for the strips that contributed significantly to the classification accuracy in the single-trial approach (Figure 6). For the S-sequence, a period of significant amplitude difference between day 1 and day 2 was observed, in both patients. For patient M.R., the amplitude modulation started 293 ms after the visual cue onset (i.e. 211 ms before the average keypress time) and lasted for 43 ms (Figure 6a). For patient C.S., this amplitude modulation started 186 ms after the visual cue onset (i.e. 219 ms before the average keypress) and lasted for 61 ms (Figure 6b). Overall, the iERPs in both patients shared some general shape characteristics with an amplitude peak at around 400 ms followed by a steep amplitude decrease up to 500-600 ms. For the contacts of the frontal-caudate strip present in patient C.S. only, we found a similar amplitude effect, which started just before the average keypress (72 ms before 66 keypress; 332 ms after the visual cue onset) and lasted until the end of the epoch. Figure 7 shows the ERP modulation for the contact in the medial part of the caudate For both patients and for all electrodes of interest (e.g. the hippocampal contacts in patients C.S. and M.R. and the frontal-caudate contact in patient C.S.), iERP amplitude for the C-sequence did not differ between day 1 and day 2 at any time during the whole epoch of interest (Figures 6 and 7). Finally, we tested whether the amplitude modulation at the hippocampal sites could be used for classifying single-trials as belonging to day 1 or day 2. This test provides a lower bound for the classification accuracy that can be obtained based on time-locked signal. We computed the average amplitude of the single-trials along the temporal periods where the significant amplitude modulation was observed at average-level. We extracted these averages for each day and each single trial from the hippocampal sites. We then computed the ROC curve based on these average amplitudes, separately for each patient (as we did for the 21 analysis based on the reaction time in Figure 3). We found that the ROC underlying area was 0.53 for subject CS and 0.54 for subject MR. This additional analysis confirms that timelocked amplitude information does not allow accurate classification of single trials, even when selecting the most likely informative portion of the ERP (which also does not guarantee non-circularity), and thus cannot be used to generate statistically robust inferences, unlike the GMM-based multivariate decoding of raw single-epochs. 4. DISCUSSION The present study provides evidence of learning-related changes of intracranial electrical activity corresponding to single events (individual keypresses) belonging to a deterministic visuomotor sequence. Specifically, we show that a multivariate classification algorithm can accurately assign single-trial iEEG responses to either the initial training phase (day 1) or to the later consolidated phase (day 2), i.e. after sequence-specific improvement occurred. We first demonstrate that the classification results relied on neural features selectively associated to the learning of the regularity of the 8-item sequence, as evidenced by the comparatively low classification accuracy obtained for single-trials from a random sequence. We then found that the classification failed when applied to the single-trial reaction-times, thus indicating that the neuralrelated changes captured by the decoding algorithm cannot be trivially explained in 67 terms of speeding of motor response. Finally, while the localization of these learningrelated changes involved a distributed pattern of neural activity, we identified the hippocampus as contributing critically to the reliable classification of the trained sequence – independently in each patient, with an additional contribution from frontostriatal regions for the patient implanted with electrodes in these brain areas. 4.1. Learning-related changes in the stability of momentary neural states The multivariate decoding approach implemented here offers new insights into spatio-temporal patterns of distributed activity and how they change with learning. In particular, we show that each single trial can be represented as a sequence of momentary states, whose corresponding durations may change as a function of learning. This change in duration was observed only for trials belonging to the S-sequence, and critically related to the presence of the hippocampus in both subjects. The existence of short periods of stability of voltage configurations (often referred to as functional microstates) is a well established empirical observation at the level of the scalp electroencephalography (Lefevre and Baillet, 2009; Lehmann, 1987; Michel et al., 2004; Michel et al., 2001). Indeed, their spatio-temporal properties have been extensively used to analyze both event-related potentials (De Lucia et al., 2010; Murray et al., 2006) as well as resting state EEG (Britz et al., 2010). Our finding demonstrates that the statistical properties of distributed voltage configurations carry the signature of functional-related changes also at the level of intracranial responses and that it is detectable by a multivariate decoding approach at the single-trial level. The significant change in average duration of these momentary states suggests that the temporal properties rather than the actual amplitude values of these states are critically related to learning stage. Indeed, this is also confirmed by the poor classification accuracy obtained when considering amplitude modulation only. At the level of scalp EEG, temporal duration of microstates has been reported to be linked to functional deficits in specific clinical populations (Kindler et al., 2010; Lehmann et al., 2005; Strik et al., 1997). Very recently, it has been shown that resting state in humans is characterized by a multi-fractal organization of miscrostates sequence and that its degree of complexity is related to the temporal duration of microstates but not to their actual values (Van de Ville et al., 2010). These studies together with our current 68 findings suggest that temporal scale of momentary states carries crucial information about the subject‟s cognitive states emphasizing the importance of investigating the dynamics of brain activity together with its spatial distribution. 4.2. Role of the hippocampus in sequence learning Using a multivariate classification approach, we found that for both patients the hippocampus provided a critical contribution to the classification accuracy, which relied on the temporal stability of underlying neural states (average state duration is increased after learning for both patients). Increasing the stability of neural states after learning may reflect a major function of the hippocampus in associative processes, including the integration of temporally- or spatially-organized information (Agster et al., 2002; Degonda et al., 2005; Ergorul and Eichenbaum, 2004; Fortin et al., 2002; Moscovitch et al., 2006; Nadel et al., 2000; Ryan et al.; Wallenstein et al., 1998). By implementing a multivariate decoding approach to singletrial iEEG data in patients with intact hippocampal regions, our study suggests that the learning process conferred some local „contextual‟ information to individual items (or trials) within the trained sequence so that the decoding algorithm could accurately discriminate between hippocampal responses generated at different stages of the learning. Our results therefore highlight the implication of the MTL in the integration of single events into structured representations (Moscovitch et al., 2006; Winocur et al., 2007), such as the integration of constituent parts of motor sequences (Albouy et al., 2008; Eichenbaum, 2004; Levy, 1996; Schendan et al., 2003; Spencer et al., 2006; Wallenstein et al., 1998). The formation of local contexts or predictions within the sequence supports the „glueing‟ together of the successive elements in the sequence with repeated exposure (i.e. after training on the sequence; see Kumaran and Maguire, 2006; Levy et al., 2005), and may be thus consistent with enhanced temporal stability of neural states as found here. For one patient in whom we could measure neural activity along the lateral prefrontal cortex (PFC) and caudate regions, the classification showed additional contributions from these regions. Because of its dense interactions with both MTL structures and the basal ganglia, it has been suggested that the PFC may participate to the extraction of regularities based on internal representations, so as to improve behavioral control (Robertson et al., 2001; Shima et al., 2007). In support of a role of 69 hippocampal-prefrontal interactions in memory processes, Peyrache and al. (2009) recently demonstrated that following the acquisition of new rules, PCF activity patterns reflected the neural patterns that occurred during the training phase (see also Euston et al., 2007), and that this reactivation occurred predominantly when hippocampal and cortico-hippocampal interaction was enhanced (see also, Clemens et al., 2007; Diekelmann and Born, 2010; Frankland and Bontempi, 2005; Ji and Wilson, 2007; Kali and Dayan, 2004; Qin et al., 1997; Rasch and Born, 2007). While this could only be observed in one patient, the present finding of a contribution of both the hippocampus and PFC activity to the classification of learning stages would be consistent with these findings. 4.3. Multivariate decoding approach to single-trial iEEG data The present iEEG results do not only support a critical function of the hippocampalneocortical circuitry in sequence learning, but they significantly extend previous findings by showing that neural representation of single visuomotor events within a learned sequence is selectively modulated by training only when embedded in a structured sequence. Indeed, electrical activity of the single events was accurately identified by a classification algorithm as belonging to an early versus more consolidated learning phase, and classification accuracy relied on the contribution of the hippocampus to increased enhanced temporal stability of voltage configuration. The present study demonstrates that such multivariate decoding approach to singletrial datasets from individual patients offer an important methodological alternative to group studies of averaged data. Indeed, grouping iEEG data from different patients can be extremely challenging because the configuration of electrode placement varies across individuals and pathological conditions (e.g. epilepsy, Parkinson disease), and because iEEG data quality is often artefacted at different recording sites. Multivariate decoding approaches can however capture task-related effects at the single-trial level, that are not timelocked to the visual cue or motor response, and do not require a fixed trial length. The restricted availability of such iEEG recordings is an additional factor to motivate the development of methods to fully exploit individual patient datasets. We therefore developed a procedure that classifies learning-related changes at the single-trial level and establishes a causal link between specific electrode contribution and discrimination power (Haynes and Rees, 2006; Norman et al., 2006; Tzovara et 70 al., submitted). This approach is essentially different from classical inferential analysis in that it makes use of independent splits of the available data to validate differences in the temporal and spatial configuration of the signal (Formisano et al., 2008; Haxby et al., 2001; Staeren et al., 2009). Such pattern information analysis offers a general solution to the issue of „circularity‟ in neuroimaging studies (Kriegeskorte et al., 2009), which typically occurs when hypothesis and inferential analyses are not independent (e.g. selection of few electrodes in ERP studies). Pattern information analysis has predominantly been developed for fMRI studies while less effort has been devoted to its application to electrophysiological data. As illustrated by the present study, one main advantage of this methodological framework is that it does not require any a priori selection of the relevant neural sites or time-window of activity measurements. We complemented our approach by a localization procedure and showed that we can identify the regions contributing most to the performance of the classifier. Our results demonstrate that this methodological strategy is particularly adapted to test the effect of learning-related changes in neural responses across distinct brain regions and for datasets obtained from individual patients. Finally, because we obtained highly consistent findings in both patients whose data were analyzed independently and who had heterogeneous electrode implantations, we think that our study may suggest general conclusions about the role of the hippocampus in deterministic sequence processing. More specifically, independently in both patients (i) we could classify single trials based on distributed activity and only in relation to the structural sequences; (ii) the hippocampus provided the highest contribution to the classification accuracy; (iii) the learning stage was paralleled by a difference in the average temporal duration of momentary neural states. Finally, the behavioral results from both patients concord with previous SRTT studies in normal subjects (Maquet et al., 2000; Walker et al., 2002), by showing that motor performance improved selectively for the S-sequence after a delay that included one night of sleep. These data also demonstrate that sequence-selective motor learning might occur even after a relatively short training session (when compared to other studies of motor learning in healthy subjects), confirming that the use of such SRT tasks is both valid and appropriate for the study of rapid and implicit motor learning in clinical patients, who may have elevated levels of fatigability. 71 5. CONCLUSIONS Intracranial electroencephalographic (iEEG) recordings in humans provide a unique opportunity to assess neural activity at high temporal and spatial resolution, in particular for deep regions that cannot be easily accessible to surface EEG recordings. These data can thus provide an intermediate level of observation linking animal cellrecording data and human neuroimaging findings. However, much like cell-recordings in animals, iEEG studies have a sparse distribution of recordings sites. Our study provides a new multivariate decoding strategy to optimize the use of such distributed neural signals by allowing the full analysis of datasets from individual patients at the single-trial level and by offering an unbiased test for the contribution of individual electrodes to the observed effects. We also show here that this approach may also constitute an independent first step enabling an unbiased selection of recording sites of interest for subsequent ERP analyses. Finally, the present study may also offer new perspectives for the application of single-trial classification approaches to EEG-fMRI whole-brain measurements. Acknowledgments We thank Peter Dayan (University College London, UK) for insightful theoretical and methodological comments. We also thank Laurent Spinelli for technical support and the patients for participating in the study. This work was supported by Grants from the Swiss National Science Foundation (K33K1_122518/1 to M.D.L. and 310000-114008 to S.S.). 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(b) On each trial in the sequence, one of the four grey rectangles briefly flashed (yellow during 200 ms), indicating which button to press next. One sequence in this serial reaction time task required 8 keypresses in a specific order. Figure 2 Classification procedure. (a) Representation of the implanted areas in patient C.S, lateral view of both hemispheres; (b) intracranial EEG (iEEG) recorded over the N contacts at each timeframe form an N-dimensional vector; (c) iEEG measures are pooled together within an Ndimensional space irrespective of their temporal order and a GMM is used to estimate Q Gaussian parameters (here Q = 3); (d) a Hidden Markov Model with Q hidden states, initialized by the GMM parameters, is used to update the Gaussian estimations as well as the transition matrix between the hidden states. 77 4 a b 1 M.R. True positive rate (sensitivity) True positive rate (sensitivity) 1 0.8 0.6 0.4 iEEG S-sequence iEEG C-sequence 0.2 RTs S-sequence RTs C-sequence 0 C.S. 0.8 0.6 0.4 0.2 0 0 0.2 0.4 0.6 0.8 1 0 False positive rate (1-specificity) False pos b True positive rate (sensitivity) 1 iEEG S-sequence iEEG C-sequence RTs S-sequence RTs C-sequence C.S. 0.8 0.6 0.4 0.2 0 0.6 0.8 1 ve rate (1-specificity) 0 0.2 0.4 0.6 0.8 0.2 1 False positive rate (1-specificity) Figure 3 Classification results. ROC curves for MR (a) and CS (b) representing the classification results when taking into account all contacts, comparing the iEEG data from S-sequence (plain red line) and those from the C-sequence (plain blue line). The same model was used to classify reaction times from the S-sequence (dotted red line) and from the C-sequence (dotted blue line). Accuracy for classifying single-trials belonging to S-sequence was always significantly higher than that for the C-sequence and for the reaction times, suggesting that the classification algorithm captured information in the signal that was specific for the learning of a deterministic visuomotor sequence. 78 S-sequence C-sequence S-sequence one area out C-sequence one area out 0.9 b a 0.8 ROC area M.R. 0.7 0.6 0.5 LPH1 RFO2 RA1 RAH2 RPH1 LFO2 LPH8 RFO8 RA7 RAH8 RPH8 LFO8 LPH1 LPH8 LA1 LA8 LAH1 LAH8 0.9 c d ROC area 0.8 C.S. 0.7 0.6 0.5 RAH1 RC1 RFO1 RA2 RAH8 RC8 RFO8 RA8 RAH1 RFC1 RAH8 RFC8 RO2 RO8 LA1 LA7 LO1 LO8 Figure 4 Localization results. ROC areas for MR (a) and CS (b), comparing classification performance when taking into account all implanted areas versus after dropping in turn one area. Red bars refer to the S-sequence, blue bars to the C-sequence. Significant differences between keeping all the contacts and dropping in turn couples of electrodes were observed for the S-sequence only for the string including the hippocampus and right frontal caudate contact for CS. By contrast for the C-sequence, a significant drop in the classification accuracy was evident for many areas. Importantly single-trial classification remains always lower in the CS than in the S-sequence. Abbreviations: LA = left amygdala; RA = right amygdala; LAH = left anterior hippocampus; LPH = left posterior hippocampus; RAH = right anterior hippocampus; RPH = right posterior hippocampus; LFO = left fronto-orbital area; RFO = right frontoorbital area; LO = left occipital; RO = right occipital; RFC = right frontal-caudate. Standard errors are shown. a c b RFC1 LPH1 LPH8 M.R. Coronal section, left posterior hippocampus RAH8 RFC8 RAH1 C.S. Coronal section, right anterior hippocampus C.S. Axial section, right frontalcaudate Figure 5 Visualization of the electrode arrays targeting the critical areas revealed by the classification. (a) Left posterior hippocampus for patient M.R. (b) Right anterior hippocampus and (c) right frontal-caudate region for patient C.S. Electrodes localized by the CT scan were coregistered to the MRI T1-weighted brain volumes. 79 a Epoch Origin 40 S-sequence day1 S-sequence day2 Keypress Visual cue C-sequence day1 C-sequence day2 0 1 -20 .95 -40 .90 M.R. LPH1 -60 Confidence level Amplitude ( V) 20 .85 .80 -200 -100 0 100 200 300 400 500 600 700 800 Time (ms) b 15 Epoch Origin Visual cue Keypress 5 1 0 1 -5 .95 -10 .90 C.S. RAH1 -15 .85 Confidence level Amplitude ( V) 10 .80 -200 -100 0 100 200 300 400 600 500 700 800 Time (ms) Figure 6 Illustration of stimulus-locked ERP results for the hippocampal contacts contributing most to the classification results. (a) Patient M.R., left posterior hippocampus showed a positive amplitude modulation starting 293 ms after the visual cue onset (i.e. 211 ms before the average keypress time) and lasting for 43 ms. (b) Patient C.S., right anterior hippocampus showed a positive amplitude modulation starting 186 ms after visual cue onset (i.e. 219 ms before the keypress) and lasting for 61 ms. The time window of significant difference between day 1 and day2 (p<.05, stability > 20ms) is indicated in yellow. Note a similar overall morphology of the averaged potential modulation in the two different patients. 8 Epoch Origin Visual cue S-sequence day1 S-sequence day2 C-sequence day1 C-sequence day2 Keypress 6 4 2 1 1 0 .95 -2 .90 -4 -6 C.S. RFC1 .85 Confidence level Amplitude ( V) a .80 -200 -100 0 100 200 300 400 500 600 700 800 Time (ms) Figure 7 Illustration of the stimulus-locked ERP modulation for the frontal-caudate strip. Here, the positive amplitude modulation started 332 ms after visual cue onset (i.e.72 ms before keypress) and lasted until the end of the epoch. The time window of significant difference between day 1 and day2 (p<.05, stability > 20ms) is indicated in yellow. 80 Evidence of overt replay of a recently learned motor sequence during human sleep Experiment 2. CONTEXT Sleep facilitates memory consolidation. According to this hypothesis, brain structures engaged in the learning process may be reactivated during sleep possibly by replaying newly acquired information. While temporally-organized sequences of neural activity have been found to be replayed in animals, there is up to date no direct evidence for such replay in humans. METHODOLOGICAL HIGHLIGHTS Based on the observation that sleepwalkers and patients with rapid eye movement (REM) sleep behavior disorder (RBD) may overtly act out their sleep mentations, respectively during non-REM and REM sleep, we thought to test these patients for a possible behavioral replay of recent waking events. These parasomnia models may provide a new window into the cognitive processes during sleep and dreaming. We trained subjects on a modified version of a serial reaction time task (SRTT) sequence, consisting in complex and large arm movements, which could be easily detected if overtly replayed during sleep. Video-polysomnographic recordings were performed to assess sleep structure and sleep-related behavior. SUMMARY OF RESULTS Both patients groups showed sleep-related performance improvement of the trained sequence. Importantly, one (possibly two) sleepwalker overtly replayed part of the trained motor sequence during slow-wave sleep. CONCLUSION This study provides, to our knowledge, the first demonstration for a realistic, temporally-structured replay of a recently-learned behavior during sleep in humans. 81 Article submitted to PLoS ONE Evidence for the re-enactment of a recently learned behavior during sleepwalking Irina Constantinescu*4, MD, Delphine Oudiette*1,3, MSc, Laurène Leclair-Visonneau1,3, MD, Marie Vidailhet2,3, MD, Sophie Schwartz4,5, PhD, and Isabelle Arnulf1,2,3, MD, PhD * These authors contributed equally to this work 1 Sleep Disorders Unit, Pitié-Salpêtrière Hospital, APHP, Paris, France 2 Inserm, U975, Paris, France 3 Université Pierre et Marie Curie-Paris6, Centre de Recherche de l'Institut du Cerveau et de la Moelle epiniere, UMR-S975, Paris, France 4 Department of Neuroscience, and Geneva Neuroscience Center, University of Geneva, Switzerland 5 Swiss Center for Affective Sciences (NCCR), University of Geneva, Switzerland Correspondence to: Dr Isabelle Arnulf Unité des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière 47-83 boulevard de l‟Hôpital 75651 Paris Cedex 13 Phone: 01 42 16 77 02 E mail: [email protected] ABSTRACT Animal studies have shown that sequenced patterns of neuronal activity may be replayed during sleep. However, the existence of such replay in humans has not yet been directly demonstrated. Here we studied patients who exhibit overt behaviors during sleep to test whether sequences of movements trained during the day may be spontaneously reenacted by the patients during sleep. We recruited 19 sleepwalkers (who displayed complex and purposeful behaviors emerging from non REM sleep), 20 patients with REM sleep behavior disorder (who enacted their dreams in REM sleep) and 18 healthy controls. Continuous video sleep recordings were performed during sleep following intensive training on a sequence of large movements (learned during a variant of the serial reaction time task). 82 Both patient groups showed learning of the intensively trained motor sequence after sleep. We report the re-enactement of a fragment of the recently trained motor behavior during one sleepwalking episode. This study provides, to our knowledge, the first evidence of a temporally-structured replay of a learned behavior during sleep in humans. Our observation also suggests that the study of such sleep disorders may provide unique and critical information about cognitive functions operating during sleep. Keywords: learning, replay, REM sleep behavior disorder, sleepwalking, parasomnia INTRODUCTION It is well established that sleep facilitates plastic changes that underlie the consolidation of recently acquired knowledge [1,2,3,4]. The prevailing hypothesis states that the neural traces coding for the newly acquired information are reactivated during sleep, thus fostering memory consolidation. In rats and birds, specific patterns of neural activity associated with recent waking behavior are spontaneously replayed during subsequent sleep [5,6]. Similarly, functional neuroimaging studies in humans have shown that brain regions involved in motor skill learning are reactivated during post-training sleep [7]. These regional increases in cerebral blood flow could correspond to the replay during sleep of patterns of neural activity coding for newly acquired information, as observed in animals, or reflect other experience-dependent brain processes, such as local homeostasis [4]. Replay during sleep is also suggested by two recent studies in which sensory cues, previously associated with learned material, were presented during sleep, yielding better memory performance [8,9]. Dreams also contain a high proportion of recent waking experiences [10,11,12]. However, direct evidence for a replay of temporally-structured information during human sleep is still lacking. Here we propose to address this question by studying patients who exhibit overt behaviors while asleep, such as patients with REM sleep behavior disorder (RBD) or sleepwalkers. RBD is a recently-discovered parasomnia characterized by a loss of the physiological REM sleep-associated muscle atonia [13], which results in motor activity reflecting the enactment of violent and vivid dreams [13,14]. The behaviors during RBD are various, purposeful and complex [14,15,16,17]. Chronic RBD mainly affects middle-aged men, as an isolated condition (idiopathic RBD) or associated with 83 narcolepsy and neurodegenerative diseases (mainly synucleinopathies) [18]. Sleepwalking affects mostly children and young adults and is characterized by overt and complex motor behaviors initiated during slow-wave sleep [13]. Dreaming during sleepwalking is sometimes reported in adults, which constitutes a form of dreamenacting behavior much like RBD [19]. In the present study, we trained both patients with RBD and sleepwalkers on a modified version of a serial reaction time task (SRTT), which is known to robustly benefit from sleep [7,20,21]. We tested whether, during sleep, the patients would replay fragments of a recently trained sequence involving large arm movements. METHODS Ethic Statement The institutional review board 06-03 gave its approval for the study, which was considered as non invasive. Subjects A total of 20 patients with RBD (mean age 66.5 ± 6.5 years; 16 males, 4 females), 19 sleepwalking patients (mean age 34.4 ± 15.4 years; 6 males, 13 females), and 18 healthy controls (mean age 57.9 ± 5.3 years; 14 males, 4 females) took part in this study. As expected from these pathologies, the population of sleepwalkers was younger than the population of RBD patients (p<0.001). We also tested a group of healthy controls whose mean age would lie between those of the patient groups. It is important to note that the inclusion of the control group mainly serves to confirm that the sequence of ample movements could be learned equally by all these distinct populations. The critical measures of learning involve within-subject comparisons, while differences in mean reaction-times due to age are expected but not relevant here. RBD was defined according to standard criteria [13], including i) a positive clinical history (bed partners reporting most often violent, purposeful limb or body movements, as if the patients were acting out their dreams), and ii) the presence of abnormally enhanced chin or phasic muscle tone and/or complex and non-stereotyped movements (such as gesturing, reaching, grabbing, punching, kicking, talking, laughing, running, chewing, feeding, drinking) during REM sleep on video sleep 84 recording. In the RBD group, 13 patients had idiopathic RBD and 7 patients had Parkinson disease, with a mild to moderate motor disability (Hoehn and Yahr score between I and III) [22], which did not impact their daily activities, and no dementia (Mini-Mental State Examination score higher than 23) [23]. Sleepwalking was defined according to clinical international criteria [13], plus at least one arousal during slow-wave sleep associated with a motor episode suggestive of surprise, confusion, or fear (startle response, sitting up in the bed, looking around surprised), or numerous sudden arousals during slow-wave sleep and no epilepsy or sleep-disordered breathing. We included in the study primary sleepwalking patients, without any pre-existent psychiatric and/or neurological illness. Subjects were informed that we tested their performance in the task execution, but they were not aware of the regularity of the trained sequence, nor that we expected a potential replay during sleep. All participants gave informed consent to participate in this study, which was approved by the local ethics committee. Healthy volunteers (but not the patients) were paid for their participation. Behavioral task and experimental procedure The subjects were trained on a modified version of the SRTT [24], which was previously shown to elicit sleep-related performance improvement [7,20,21]. Instead of requiring finger movements, the present task involved large hand, forearm and arm movements that would be clearly visible on the video recorded during sleep. Note that twitches of finger muscles are extremely frequent during normal REM sleep, and even more during RBD [25], so that a replay of learned fingers movements could not be easily distinguished from multiple and non-specific twitches during the REM sleep. The subjects sat comfortably facing the computer screen; they were asked to react as quickly and accurately as possible when a large, colored rectangle appeared on the screen by pressing the corresponding colored response button (e.g., when the rectangle on the screen was green, the subject had to press the green button). The four response buttons were attributed four different colors (red, yellow, blue, or green) and were placed at different spatial localizations, as shown in Figure 1. The subjects were asked to use their left hand for the blue and green buttons and their right hand for the 85 red and yellow buttons so that all participants carried out the same sequence of movements, including movements crossing the midline (see Supplemental Video). Each correct response was immediately followed by the presentation of the next stimulus on the screen, thus eliciting a new response, and so on. If the subject failed to press the appropriate button, visual (a white rectangle) and auditory (a simple beep) feedback were simultaneously delivered followed by the presentation of the next visual stimulus. We used E-Prime (Psychology Software Tools, Inc.) for stimulus presentation and response recordings. The subjects were intensively trained on a fixed 8-item sequence (Blue-YellowGreen-Red-Yellow-Blue-Red-Green) and were not informed about the regularity of the sequence. To distinguish between structured sequence learning and improvement in visuomotor responses independent of the sequence, a random sequence was also presented. Like the structured sequence, the random sequence was composed of two series of four colors, in which each of the four buttons was pressed once, but in a completely random order. Because each color appeared twice in each eight-item sequence of the random condition, only the order of the colors was altered between the random and the structured conditions. Subject performance was quantified by measuring reaction time and response accuracy (correct hand and correct button use). We developed this version of the SRTT to optimize the detection of spontaneous replay during a subsequent REM sleep behavior or a sleepwalking episode. In particular, the task involved ample movements, with the response buttons placed about 50 cm apart in the peripersonal space, and the movements executed during the task were unusual as compared to the behaviors generally observed during parasomnia episodes (our task included pronating forearm and flexing hand movements, as well as arms crossing the midline). Supplemental Video shows the sequence performed by a healthy control subject during a training session and, after acquisition, while lying in a bed and performing the sequence from memory to facilitate later visual comparison with any potential replay during sleep. The experimental procedure consisted of a training session at 6 pm and an initial test session at 8 pm, followed by a night of sleep. The training session consisted of four consecutive blocks of structured sequences (10 sequences in each block, 80 trials per block). The initial test session consisted of four such blocks and one additional block of random sequences placed in the middle of the session (third block of the five86 block session). The following morning, the subjects were retested at 9 am with the same series of blocks as during the initial test session. In this protocol, each subject performed a total of 1,120 trials. On the morning immediately after awakening from sleep and before the test session, the participants were asked about their night dreams the previous night. A summary of the experimental procedure is provided in Figure 2. Sleep and nocturnal behavior monitoring All subjects underwent video and sleep monitoring during the night immediately following the training; 7 sleepwalkers and 7 patients with RBD were recorded over two consecutive nights, with no additional training or retesting in between the two nights. Scalp electroencephalography included three bipolar channels for the patients with RBD and the controls (Fp1/Cz, O2/Cz, C3/A2) and eight bipolar channels for sleepwalkers (FP1/C3, C3/O1, C3/T3, T3/O1, FP2/C4, C4/O2, C4/T4, T4/O2) to exclude nocturnal frontal lobe epilepsy. Monitoring also included EEG-synchronized infrared video-monitoring and sound recording in the room (Brainet®, Medatec Ltd, France), a right and left electro-oculogram, submentalis and tibialis anterior muscle electromyogram, nasal pressure through a cannula, tracheal sound recording through a microphone placed at the surface of the trachea, thoracic and abdominal strain jauges to assess respiratory efforts, electrocardiography, and pulse oximetry. Sleep stages, EEG arousals, muscle activity, periodic leg movements and respiratory events were scored by visual inspection of the multimodal recordings, using standard criteria [26], by two independent and experienced scorers. Statistical analyses of motor performance Statistical analyses of behavioral measurements were performed using Statistical Package for Social Sciences (SPSS Inc, Chicago, IL, USA). For each of the three groups of subjects (sleepwalking group, RBD patients group and control group) we performed a repeated-measures ANOVA with sessions (training, testing) and type of sequence (structured, random) as factors. For the type of sequence factor, we selected the random block and the structured block performed just afterwards, because they were close in time (respectively block 3 and block 4), which was important given the 87 fatigability of some of the patients. The selected blocks were also contextually very similar (both blocks implied a switch of sequence type, from structured to random and from random to structured sequence). In these analyses, we considered each group separately because the subjects in the different groups were not matched for age (e.g., RBD patients were significantly older and had significantly slower reaction times than the sleepwalkers, as expected in these disorders) and because the goal of these analyses was to test for sequence-specific learning by comparing change in performance for the structured sequence and for the random sequence between the pre-sleep and post-sleep testing sessions. Assessment of sequence replay during sleep To confirm the putative replay of a fragment of the sequence observed in one sleepwalker (see Results), we asked 11 independent judges blind to the aim of the experiment to assess resemblance of 113 video clips of sleepwalking episodes with a video showing an awake subject performing the task from memory while lying in a bed, in the same recording conditions as the patients (Supplemental Video). For each video clip, the judges were asked six questions concerning the sleepwalking episode (see Supplemental Material), including a final assessment of the resemblance of sleepwalking movements with the movements performed by the awake subject on a scale from 0 (no resemblance at all) to 10 (identical movement sequence). Note that because we did not observe any sign of replay in the RBD, a similar procedure was not used with RBD episodes. RESULTS Sleep and cognitive performances Sleep recordings confirmed a normal sleep pattern in the night following training in all the three tested groups. Expected differences were found for some sleep parameters when comparing RBD patients with healthy controls (such as total sleep time and sleep efficiency, see Table 1). Of note, the duration of slow-wave sleep was longer in controls than in RBD patients (p<0.001) but remained within normal values. Upon testing after one night of sleep, both groups performed better than during the pre-sleep session (Figure 3). Improvement after sleep was greater for the trained, 88 structured sequence than for the random sequence. Furthermore, the results showed an interaction between session (pre-sleep or post-sleep) and condition (structured sequence or random sequence) (F(1,16)=9.456, p=0.007 in controls; F(1,18)=6.670, p=0.019 in RBD patients; F(1,18)=20.247, p<0.001 in sleepwalkers), confirming sequence-specific learning for our task, which was more complex than the classical SRTT. It is already known that sleep may facilitate learning of sequences of movements [7,20]. In the present work, our aim was not to re-validate pre-existent knowledge about sleep-related memory consolidation, but to make use of a task that may benefit from sleep to increase the probability to observe task-related behaviors during sleep. Dreams content after the post-training night of sleep On the morning following each of the first night of recorded sleep, only seven subjects out of the 57 reported some dream content. Most (40/57) tested subjects did not recall any dreams, and 10 subjects reported a „blank dream‟ (feeling of having dreamt but no memory of it). There was no difference in dream recall frequency between the controls, the patients with RBD and the sleepwalkers. Interestingly, 2 out of the 7 subjects who recalled a dream reported some content related to the recently learned task. One sleepwalker, who spontaneously used the word “cross” to verbally characterize part of the motor sequence required by the task, reported following the night of sleep, a “cross” dream involving two diagonal paths. In his dream, the patient was driving to school to register his children (this path corresponded to the first diagonal). Suddenly, an unknown driver struck the patient‟s parked car and fled to the airport located in the opposite direction (second diagonal). The second report of dream content related to the learned task came from a healthy control subject who dreamed that he was concerned about respecting the order of the colors in the sequential task and tapped the colored response buttons in his dream. Behaviors exhibited during post-training sleep RBD patients The patients with RBD exhibited several complex behaviors during REM sleep of the two experimental nights (i.e., hand movements, defense posture, kicking, 89 punching, reaching, smiling, pointing, leaping out of bed, whispering and speaking). No obvious motor replay of the task was identified among these REM sleepassociated behaviors. Sleepwalkers During the two recorded nights following training, the sleepwalking patients exhibited several typical behaviors of sleepwalking during slow-wave sleep (startling, looking around confused, speaking, raising the head and the chest, touching the bedside table), the part of these enacted behaviors corresponding only to a mean of one minute of non REM sleep per night. Furthermore, we observed one uncommon behavior in a sleepwalker, suggestive of a replay of the recently trained motor task: during slow-wave sleep of the second post-training night, at 00:58 am, Patient 1 initially startled, then opened her eyes, stood up, laid down again, whispered, and engaged in a sequence of hand and arm movements. She sequentially raised her left arm with her hand extended and pronated like when executing the recently learned task, raised her right arm with her fingers outspread, waited in this raised position, and slowly pressed down with the right hand, left hand and then right hand, as if pressing down invisible pads (Figure 4 and Supplemental Video). The unusual behavior described in this sleepwalking patient reflected obvious and accurate re-enactment of a short fragment of the recently learned sequence of movements (as later confirmed by the independent judges, see below). The next morning, the patient had the feeling of having dreamt but could not remember any dream content. The sleepwalking patient who described the cross dream (Patient 2) also displayed an uncommon behavior for a sleepwalking episode (he raised and dropped his right hand twice and his left hand once) when emerging from slow-wave sleep, before being fully awake. While the observed movements in this patient presented some analogy with the gestures of the task, they cannot be considered as a replay of the sequence itself. Evidence for behavioral replay during sleep Only the putative replay of the first sleepwalker was judged resembling with the wake task movements, with an average score of 7.2±2.6 (score/10); the others 90 movements displayed by sleepwalkers during the experimental nights were rated below 5/10 by the judges (Supplemental Figure 1). Because the judges differed in the way they used the scoring scale (some being more conservative than others), the 0-10 score was converted to a 0-1 scale (1 corresponding to the maximal rate given over 10 by each judge), with a resulting average resemblance score of 0.93/1. Note that the other behavioral episode possibly related to task re-enactement (Patient 2; sleepwalker who experienced the “cross” dream) was evaluated below 5/10 (0.6/1). We also computed the average resemblance score (with the trained motor sequence) separately for sleepwalking episodes from patients who were trained on the task (47 episodes corresponding to 14 patients) and for episodes from patients not trained on the task (68 episodes corresponding to 30 patients). The average resemblance was higher in the trained compared to the untrained group (p<0.00001) (Figure 3). A summary of the movements‟ description of the sleepwalking videos by the eleven judges is provided in the Supplementary data. DISCUSSION To our knowledge, the present findings represent the first direct and unambiguous demonstration of overt behavioral replay of a recently learned skill during human sleep. Several lines of evidence support our claim that the behavior observed during an episode of sleepwalking (Patient 1) is a true re-enactment of the trained serial reaction time task. First, there is a striking similarity between the hand movements displayed by Patient 1 and those of the waking subject performing the sequence from memory: 11 judges blind to the experimental procedure scored this episode as closely similar to the trained sequence, after careful observation of 113 video sleepwalking episodes (Supplemental Figure1). Second, the complex motor patterns performed by Patient 1 during slow-wave sleep are consistent with activation of large-scale, distributed brain networks during slow-wave sleep-associated replay, as previously suggested by animal studies [27]. Finally, our finding that the behavioral replay concerned only a part of the sequence is in line with the fragmentary replay observed in animal studies and in human dream studies [28]. 91 Actually, the probability of observing overt behaviors in patients with RBD and in sleepwalkers is low, making our finding of overt replay highly remarkable. Indeed, patients with RBD exhibit complex, purposeful behaviors during only 0.1% to 20% of the total time spent in REM sleep [29]. In sleepwalkers, overt behavior is even rarer, corresponding to a mean of 0.7% (or ~one minute) of non REM sleep per night. These estimations suggest that the observed behavior in the first sleepwalking patient may emerge from “a strong pressure”, probably arising from active neural processes of reshaping and strengthening of the intensively trained information during post-training sleep, related to off-line recapitulation of the newly acquired cognitive schema. Furthermore, because elements from recent memory are frequent in dreams [30] and may correlate with learning [31], it is likely that mental replay did occur in other trained patients in the absence of overt behavioral expression. Further support for a replay of waking motor behavior during subsequent episodes of sleepwalking is also provided by the fact that sleepwalkers who performed the task were more likely to show movements that were on averaged rated as more similar to the trained motor task compared to sleepwalkers who were not trained on the task (Figure 3). Such complex motor patterns performed by the sleepwalker showing evidence of experience-dependent behavior during slow-wave sleep is consistent with data in animal studies, showing activation of large-scale, distributed brain networks during slow-wave sleep-associated replay [27]. The evidence for a behavioral replay reflecting only a part of the sequence is in line with the fragmentary replay observed in animal studies and in human dream studies [28]. We would like to suggest that the study of motor behaviors in sleepwalkers provides highly valuable information about cognitive and motor processes occurring during sleep. Indeed, sleep macro- and micro-structure (e.g. rapid eye movement density, EEG) is normal in patients with RBD and sleepwalkers [29,32]. Sleepwalking results from concomitant local sleep in the frontoparietal associative cortices and local arousal in motor and cingular cortices, as shown by recent functional brain imaging and deep brain monitoring in humans during sleepwalking [33,34]. Therefore, except for their motor aspects, the mechanisms regulating sleep in sleepwalkers are mostly intact. Furthermore, like healthy controls, both sleepwalkers and the patients with RBD improved their performance, thus showing spared overnight memory consolidation processes. 92 Our work therefore demonstrates that parasomnias such as sleepwalking and RBD are useful neurological models for studying cognitive functions during sleep, and may for example motivate further investigations on the respective contribution of non REM and REM sleep on learning and brain plasticity. 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The task involved a sequence of ample and uncommon movements (e.g., crossing arms, pronated forearm, flexed and extended hand) that would be unambiguously recognized if replayed during sleep. Dream reports S S Structured block R R Random block S S S S S S S S Training S R S S S S R S S S Video Video--PSG PSG S R S S S S R S S S Pre-sleep testing Sleep Post-sleep testing Figure 2 Experimental procedure. The experimental procedure included one training session immediately followed by an initial testing session in the evening, and one testing session the following morning after one night of sleep. The training session consisted of four consecutive blocks of ten repetitions of the structured sequence. The testing sessions before and after sleep consisted each of four blocks of ten repetitions of the structured sequence, with one block of ten random sequences. 95 Reaction time (ms) 1300 1200 1100 1000 900 800 700 600 500 400 300 Controls RBD patients Sleepwalkers R Training R Pre-sleep testing R SLEEP Post-sleep testing Figure 3 Improvement in tapping speed for all groups. Mean reaction times (RT) showing a reduction during training session and a further decrease between pre and post-sleep testing. Persistence of increased RT for the random blocks relative to decreased RT for the structured blocks within the same session of testing (before-sleep and post-sleep sessions) confirmed sequence-specific learning with training. Faster RT in sleepwalkers may be explained by their lower mean age, as compared to RBD patients (sleepwalkers: 34.42 ± 15.35; RBD: 66.45 ±6.46 yrs). R = random sequence A B 1 2 3 4 Figure 4 Snapshots extracted from video recordings. (A) Execution of the sequence by a wake control subject lying in a bed. The subject reaches toward the imaginary location of the yellow response button (left arrow) while preparing to press the next (green) button (right arrow). (B) Overt replay of the structured sequence by a sleepwalker during slowwave sleep. After a sudden arousal, the patient raised both arms, with pronated forearm, and waited two seconds as if preparing to perform the task (1). Then, she appeared to press imaginary response buttons sequentially with the right, left and right hand (2, 3, and 4, respectively). Note the striking similarity between the posture displayed in A and in the fourth panel in B. 96 EOG1 EOG2 Fp1-C3 C3-O1 C3-T3 T3-O1 Fp2-C4 C4-O2 C4-T4 A B C D T4-O2 EMG1 EKG 5s Figure 5 Sleep-monitoring during the overt replay of the sequence in a sleepwalker. During slow-wave sleep (non-REM stage 4), the patient first startled (A), raised her left arm (B) and then sequentially pressed invisible response buttons with the right and left hands (between C and D). During the episode, the associated EEG showed persistent slow background activity with mixed delta, theta and alpha frequencies. A mild heart rate increase was also observed on the electrocardiogram. After the replay, a spindle was observed on the EEG recording. EOG1 and EOG2, electrooculograms, FP1-C3, C3-O1, C3-T3, T3-O1, FP2-C4, C4O2, C4-T4; T4-O2, 8 channels of electroencephalograms; EMG1, electromyogram of the submentalis muscle; EKG, electrocardiogram. Table 1. Sleep measures in sleepwalkers, patients with REM sleep behavior disorders (RBD), and healthy middle-aged controls Sleepwalkers Number of subjects 19 Age (y) 34.4 ± 15.4 Night-time sleep Total sleep time (min) 488 ± 66 Sleep efficiency (%) 88.5 ± 10.8 Latency to sleep onset (min) 25.5 ± 15.5 Number of REM sleep episodes 4.6 ± 0.9 Sleep duration (% total sleep time) Stage N1 4.7 ± 2.5 Stage N2 49.6 ± 8.0 Stage N3 26.1 ± 6.5 (former stage 3-4, slow-wave sleep) REM sleep 19.5 ± 4.1 Sleep fragmentation (No events/h) Arousals 13.8 ± 7.0 Apnea/hypopnea 1.1 ± 1.6 Periodic leg movements 4.6 ± 6.7 *p<0.05 comparison patients with RBD and controls. Patients with RBD 20 66.5 ± 6.5* Healthy controls 18 57.9 ± 5.3 376 ± 75* 78.6 ± 11.4* 40.5 ± 33.8* 3.1 ± 1.6* 428 ± 73 86.4 ± 6.6 22.3 ± 16.0 4.5 ± 1.1 8.5 ± 6.9 55.5 ± 9.6* 6.0 ± 6.9 48.3 ± 8.6 19.1 ± 6.4* 25.9 ± 6.8 16.8 ± 7.9 19.6 ± 5.2 19.2 ± 9.2 8.0 ± 10.4 33.9 ± 37.4 20.1 ± 9.5 12.1 ± 10.2 14.4 ± 29.9 97 SUPPLEMENTAL DATA Video recordings of 113 sleepwalking episodes were edited into short clips and unique numerical identifiers were inserted before each clip. The order of the episodes was randomized and the clips were then copied one after the other into a single movie file that was shown to 11 judges, blind to the experimental hypotheses and conditions. The judges were asked to answer five yes/no questions for each of the video clip, as well as final evaluation of the global resemblance with the clip of learned sequence performed from memory during wakefulness (recorded with the same infrared camera). This procedure provided an independent assessment of the similarity of several motor aspects in each sleepwalking episode and the learned motor sequence. Questions to judges Question 1. During this episode, did the subject perform any movements involving the superior limbs (e.g. arm, hand movements)? If the answer to Question 1 was no, then the judge could skip the remaining questions and watch the next clip. If the answer was yes, then the judge had to answer the next 5 questions. Question 2. During this episode, did the observed behavior include movements of both superior limbs (left AND right hand, arm movements)? Question 3. During this episode, were the movements of superior limbs ample (i.e., more than 10 cm amplitude)? Question 4. During this episode, did the movements of superior limbs include the use of the environment (e.g. touch the electrodes, grab an object on the bed table). Question 5. During this episode, did the movements of superior limbs include a crossing of the body midline? After the 5 yes/no questions, the judges were asked to evaluate the similarity of the current episode with the learned motor sequence on a scale ranging from 0 (no resemblance at all) to 10 (very high resemblance). Based on the answers provided by the 11 judges, our database of 113 sleepwalking episodes contained: 92 clips with at least one movement of superior limbs, 60 clips with movements of both superior limbs, 60 clips with ample 98 movements of superior limbs, 12 clips with alternating movements of the superior limbs and 5 clips with a crossing of the midline. Only 10 clips (9%) showed, at the same time, ample and alternating movements of both right and left superior limb, confirming that a behavior resembling to the learned sequence is not typical during sleepwalking episodes. Only one sleepwalking episode was rated with a resemblance score above 5 (7.2±2.6, or 0.93 when converting the range of responses for each judge to a 0-1 scale), thus pointing to one of the episodes as a potential replay of the learned motor sequence (Supplemental Figure 1). Supplemental Figure 1 Evaluation of the resemblance between the sleepwalking episodes and the sequence performed during wakefulness. Each point corresponds to one of the 113 video clips. Most sleepwalking episodes were rated below 2/10 by the 11 judges. Only one clip (number 93) obtained a mean rate greater than 5/10: this clip is the putative replay performed by Patient 1. Video Caption Execution of the structured sequence in the training setting by a wake control (Part 1); execution of the sequence from memory by a wake control lying in a bed (Part 2); overt replay of a part of the structured sequence during slow-wave sleep in a sleepwalker (Part 3); 99 Experience-dependent induced reactivations during post-training wakefulness Experiment 3. CONTEXT The same neural patterns may be specifically induced by presentation of paired associated stimulus (Toita 1991, Rasch 2007, Rudoy 2009). Peigneux et al (2006) have showed that recently learned information is spontaneously replayed during the first hours of post-training wakefulness, thus allowing memory trace reorganization immediately post acquisition. Face processing includes distinct steps, reflected by distinct potential modulation within millisecond scale. The N170 negative component, peaking around 170 ms post stimulus, reflects early encoding of structural face features. Specific maps of stable potential configuration characterize at scalp level the perceptual learning of faces (Ganis and Schendan 2008). In the present study, by training human subjects on sound-visual associations, we aimed at showing that a specifically trained sound elicits the same potential configuration as the actual presentation of visual stimuli. METHODOLOGICAL HIGHLIGHTS We used a combination of signal processing methods: event-related potential (ERP) and functional microstate approach. Unlike electrode-wise approach that takes into account only one electrode or a limited set of electrode (c.f. ERPs), the microstates model provides information from large-scale neural networks, as it allows the exploitation of distribution of voltage over the whole scalp. We therefore determined the specific configuration maps reflecting particular steps of information processing (Michel et al 2009) and statistically evaluate the presence of specific maps across experimental conditions. SUMMARY OF RESULTS Our results show that sounds previously associated with a visual stimulation generate a potential modulation corresponding to N170, which is not the case for the sounds associated with no visual stimulation. Furthermore, by analyzing the sequence 100 of stable map configurations, we found that the same specific voltage map corresponding to the presentation of the face is reactivated during the presentation of the sound previously associated with faces, and that this is more important than when presenting the sounds previously associated with scrambled faces or no stimuli. CONCLUSIONS Our results show that a specifically trained sound elicits the same potential configuration as the actual presentation of visual stimuli. The associated sound may trigger recently acquired memory traces during immediate post training period. We believe that our results may have new implications for the understanding the plasticity of the neural representations reflected by the N170, especially those concerning feature-binding processes. Article in preparation Title: Reactivation of scalp EEG microstates after audio-visual training Authors: I.Constantinescu, L. Ceravolo, G. Pourtois, S.Schwartz INTRODUCTION Important insights into the brain mechanisms of learning and memory have been provided by the study of learned associations between initially naive and uncoupled stimuli (Suzuki 2007). It has been shown that experience-dependent reactivations of neural patterns can be induced by the presentation of an associated cue (e.g. odor as a context, Rasch, Buchel et al. 2007, sound specifically reactivating individual visual locations, Rudoy, Voss et al. 2009). During sleep, it has been shown in animals that the same patterns of neural activity can be reinstated following intensive training (Wilson 1994); in humans, it has been shown that the same brain areas previously engaged in performing a task are active during post-training sleep (Peigneux 2004; Maquet 2000). Face recognition represents one of the most important acquired perceptual skills in humans (Haxby 2000). Face recognition has been intensively studied by using different neuroimaging (Haxby 1993; Puce 1995) and electrophysiological approaches (Bentin 1996; Allison 1994; Seeck 1992). Event-related studies have identified few 101 components corresponding to different steps of face processing, at millisecond scale. The early perceptual categorization of faces is reflected by a negativity peaking between 140-200 ms (N170). This component is larger over the right occipitotemporal regions (Bentin 1996; Eimer 2000) and it seems to correspond to structural encoding of faces. It has been shown that relatively early visual areas are involved not only in lowelevel visual processing, but also in higher-level cognitive processes, such as featurebinding across associative processes (Ganis and Schendan 2008). Functional brain imaging studies show that perception of faces and visual mental imagery of faces activates the same temporal and occipito-temporal regions (Ishai et al 2002; O‟Craven and Kanwisher 2000). Visual mental imagery may recruit the same neural machinery as for visual processing, yet the pathways that influence these processes seem to be different (bottom-up mechanisms for early visual processing and top-down mechanisms for visualized stimuli). These effects seem to apply for other visual categories too, like test objects (Ganis, Schendan 2008). Moreover, visual mental imagery may involve the reactivation of previously acquired memory traces, as shown in non-human primate work (Tomita 1999): specific neuronal long-term memory reactivations may be elicited by the presentation of a paired associates stimulus, in the absence of the corresponding external stimulus. Cognitive processes involve a succession of functionally distinct brain microstates variable duration and strength (Michel et al 2009; Lehman, 1987). According to the microstate model, different steps of information processing imply a sequence of stable and distinct potential map configurations. The transition from one map to another reflects the change in signal stability. The aim of the present study was show that a sound that had previously been associated to a face can elicit similar topographic maps when presented alone than when presented with the face. EXPERIMENTAL PROCEDURE Subjects A total of 15 healthy right-handed participants, free of any medication, without neurological or psychiatric history, with normal or corrected-to-normal vision and 102 normal hearing were included in the experiment (8 females, age range 25-33 yr, mean 28.45 (±2.81), 6-13 years university education). All participants gave informed consent according to the local ethic committee regulations. Two subjects could not complete the entire experimental procedure, due to technical problems and data for two subjects had to be removed from further analysis because they had too much artifacts. Therefore, data from 11 subjects were included in the final results. Stimuli and task Auditory stimuli consisted in three different sounds and of a simple tone. The sounds duration was of 500 ms each and the simple tone lasted for 100 ms. Triggers marked the sound onset and respectively the tone onset. All acoustic stimuli had an audio sampling rate of 44 kHz and were presented to the subjects binaurally via headphones. The sounds and the tone were presented at an unobtrusive intensity. The visual stimuli were photos of human faces with either a happy or a neutral expression, and scrambled versions of these face stimuli forming either vertical or horizontal patterns. The faces were either of neutral expression or happy and they were taken from a series of photographs from the Ekman and Friesen (1976), representing different emotional expressions in human subjects. Scrambled images contained the same luminance as the faces images and were created by first partitioning each human face image into a predetermined number of rectangular segments (either horizontal or vertical), and then randomly repositioning these segments. The images resolution was of 302 x 460 pixels. Visual stimuli subtending 100 at 50 cm viewing distance were presented in grayscale on the center of a computer screen. Behavioral task and experimental procedure Subjects sat comfortably in front of a computer screen, in an electrical and sound shielded room. They were asked not to move their eyes and to avoid blinking as much as possible, throughout the whole experiment. 103 Figure 1. Experimental design with three distinct phases: perceptual, training and testing The experimental protocol consisted in three phases (see Figure 1): an initial phase, where subjects were first familiarized with the three distinct sounds. A visual block followed, in which faces and scramble images were presented repetitively. A simple tone accompanied the beginning of each visual stimulus presentation. Trials with only the tone alone and no visual stimulus were added. Therefore, for the visual condition, we had three possibilities: tone coupled with a face (either happy or neutral), tone coupled with scramble (either horizontal or vertical) and tone only. There were 60 trials for each type of tone-visual stimulus association. We will further refer to the visual block as the “perceptual” phase. Subjects were simply asked to pay attention to the different sounds during the presentation of the sounds and to the different types of images during the visual block. Throughout this initial phase, subjects kept their eyes opened (as monitored by a video camera) and they were fixating a cross in the center of the computer screen. The second phase consisted in “training” on associations among sounds and visual stimuli. For each subject, one sound was specifically associated with either faces (happy and neutral), scrambled images (horizontal and vertical), or with no visual stimulus (e.g. sound A was specifically associated with faces, sound B was specifically associated with scrambled and sound C was always alone). The specific associations between sounds and visual stimuli were counterbalanced across subjects. Figure 2 presents the timeline of one experimental trial. During the audio-visual association condition, the sound presentation preceded with a variable interval (from 500 to 750 ms) the image onset (and the coincident tone). Stimuli included 3 different short sounds that were presented either before a face stimulus, a scrambled version of a face stimulus, or no visual stimulus. 104 Figure 2. Time line of one training trial During the learning phase, subjects watched these audio-visual sequences and had to discriminate the gender of the faces for face stimuli, and discriminate the predominant orientation -horizontal or vertical- for the scrambled stimuli. The trials with no visual stimulation did not require any response from the subjects. Thus, three distinct auditory-visual associations were created, by using three different sounds each coupled with one specific visual condition and task. Subjects were instructed to promptly react when seeing the image on the screen by respecting the following configuration: when the image represented a face, they had to press with the right hand the “x” keypress for the “happy” faces and the “c” keypress for the “neutral” faces on the computer keyboard. For the scrambled stimuli, they had to press with the left hand, the “n” keypress for horizontally scrambled images and the “m” keypress for the vertically scrambled images. The hands response assigned for each visual category was counterbalanced across subjects. When no image was presented on the screen, the subjects were asked to refrain from pressing any response button. In the absence of a visual stimulus, the fixation cross remained on the screen. There was a reaction time limit, pre-determined at 600 ms after the delivery of the visual stimulus. The time allocated for a motor answer was therefore very short, so that subjects had to answer very quickly; therefore, in order to get a good performance on the task, the subjects had to prepare to provide a response either to a face or to a scrambled or no answer at all (when it was no visual stimulus) during the presentation of the sound. Feedback was provided on the screen, when the response was not fast enough, or when the subject pressed a button when no visual stimulus was presented on the screen, or when the wrong hand or the wrong button press were used for an answer. The feedback duration was of 200 milliseconds. No feedback was provided for the 105 correct answers. The order of the trials was randomized within a block. At the end of each block a global performance score was given to the subjects, consisting in mean reaction time and total number of errors. This was meant to motivate subjects to continuously improve their performance. There were two blocks of training on the audio-visual associations. One training block of trials consisted in 90 sound-visual sensory associations, with 30 trials associating a sound to a face, 30 trials associating a sound to scrambled stimuli, 30 trials where a sound was not associated to any visual stimulus. A third phase of the experiment, immediately following the previous phase consisted in “testing” the learned associations. By presenting only the sounds and the accompanying tone (identically organized as in the first phase) and asking subjects to visually project in front of their eyes kept opened, the visual “category” when a specific sound is delivered (e.g. if the subjects heard the sound A, which has been previously associated with faces, the subject had to imagine a face). Like in the first phase, the trials were equally distributed across the three sound types (30 trials per distinct sound) and a tone followed the sound presentation. No motor response was required for this experimental part. A questionnaire assessing the vividness of mental imagery (Marks, 1973) was filled in after the tests, by asking to rate some visual images from 1 to 5 according to the vividness of the visual representation (see Supplementary data). Electrophysiological data acquisition EEG data were recorded using the 64 active-electrode Biosemi system (32 electrodes for each hemisphere). Sampling rate was 2048Hz, bandwidth 417Hz and no external reference. The electroencephalogram (EEG) data was collected using Biosemi system. Data was first pre-processed using BrainVision, by performing the following steps: downsampling at 512 Hz (sinc interpolation), average reference (the electrode Fp1 was excluded from the average because of eye movements contamination). A high-pass filter was set at 0.05 Hz, with a 50 Hz notch filter added. Electrode impedance was kept below 5 kΏ. Ocular artefacts were manually detected at frontal electrodes and than automatic ocular correction was performed. A low-pass filter of 30 Hz was set. 106 Event-related potential analysis Event-related potentials (ERPs), locked to the tone for the “perceptive” and “imagery” condition were averaged off-line for an epoch of 1300 ms (500 ms prestimulus baseline, 800 ms post-stimulus period). Trials contaminated by muscle artifact, eye movements and blinks were thoroughly eliminated. Peak analyses was performed for the N170 (negativity peaking around 170 ms for faces and 165 ms for scrambled), measured at temporo-occipital sites (P8, P7, Po8, Po7 contacts) which have been previously shown to provide the best representation of this component (Itier 2004). Peaks were measured within a ± 40 ms window centered on the maximum of the grand-average (group average, N=11 subjects) means for faces and scrambled faces and for both “perceptive” and “imagery” conditions. Component latencies were measured at their maximum over each hemisphere and the amplitudes at each of the chosen electrodes were considered at this latency (Picton et al 2000). Peak latencies and amplitudes were analyzed with repeated measures analyses of variance (ANOVA). First, we determined the contact which showed the best representation among the selected contacts. For the best contact, we than preformed peak and latency comparisons across conditions. Segmentation analyses Functional microstates (Michel et al. 1992, Lehman, 1987) refer to time segments of stable potential map configuration supposed to reflect different steps of information processing. The transition from one map to another reflects the change in signal stability. According to the microstate model, the brain activity can be seen as a sequence of non-overlapping microstates of variable duration and strength. We used a statistical approach in order to determine the temporal sequence of microstates within the spontaneous EEG map series. The statistical analysis is based on the global map dissimilarity (i.e. the spatial correlation between maps) (Pasqual-Marqui et al 1995). This parameters is taken into consideration while performing a cluster-analysis which allows the grouping of maps which are highly correlated. The algorithm determines for each number of clusters, the most dominant topographies in a given ERP map series, that best explain the variance of the data. The microstate segmentation of the ERPs therefore proposes to define ERP components in terms of the sequentially 107 appearing map topographies. We assessed for a defined component, the spatial configuration of the scalp potential that characterizes it. Since different potential configurations are caused by different intracranial generators, the characterization of the ERP‟s as a sequence of spatially distinct maps aims to define the different large-scale neuronal networks that are activated by the performed mental operation. As for the spontaneous EEG, the microstate analysis of the ERPs proposes that each global network is activated during a certain period of time and then it is replaced by a new network that remains stable for a certain time period, and so on. The second step within the segmentation analyses is the fitting procedure, which allows to check statistically the presence of the most representatiive segmentation maps in the individual ERPs of each subject. The fitting uses the spatial correlation to establish the time when these topographies are present in the data (Pegna et al., 1997). Thus, at each time point in the individual ERPs, the scalp topography was compared to the segmentation maps of grand averages and labeled according to the one with which is the best correlated. This allowed us to quantify how much of the global explained variance (GEV) of one condition is explained by a given segmentation map. Repetitive measures ANOVA were performed on the GEV using conditions (face, scramble and tone only) and percetive-imagery as within-subject factors (2x3 ANOVA). All electrophysiological analysis (ERP‟s, topography, segmentation) were performed by using Cartool software (Denis Brunet, Brain Mapping Group, Geneva). RESULTS Behavioral results Subjects show learning on the discrimination tasks with training of the three different categories of associations through an improvement in RT with training (p=0.05, t=2.16, paired t-test) and also an increase in the number of correct answers (p=10-5, t=-6.21, paired t-test), reflecting learning of the precise associations (Figure 3). The mean reaction time for the correct answers was 436.62 (standard deviation 44.16) for the first block and 422.62 (standard deviation 49.76) for the second block. The mean number of correct answers was 39 in the first block as compared to 51.50 in the second block. 108 a. b. Figure 3. Behavioral results. Increased performance with training of the audio-visual associations a. decreased reaction times with training; b. increased accuracy of response with training ELECTROPHYSIOLOGICAL RESULTS ERPs Perception condition N170 amplitude was larger for faces and scrambled stimuli in the right hemisphere (contacts PO8 and P8) than in the left hemisphere (contacts PO7 and P7; paired t-test, t=2.94, p=0.05) which is in agreement with literature data (Rossion 2008). Between the two right hemisphere contacts (P8 and PO8), N170 amplitude for faces was stronger for the PO8 contact (paired t-test, t=3.02, p=0.01). No significant difference was found for the scrambled faces between these two contacts. For the next analysis steps, we will refer to the PO8 contact. At the chosen contact, faces elicited a larger N170 than scrambled stimuli (mean amplitude for faces: -12.68 μV; mean amplitude for scrambled stimuli: - 4.90 μV, paired t-test, t=7.48, p=10-5), consistent with reports in the literature (Bentin et al 1996). N170 peak latency was similar for the faces and scrambled stimuli (mean latency for faces: 157.18 ms; scrambled: 153.09 ms). 109 a. left b. right P7 P8 uv F ace uv 6 6 4 2 4 2 -2 -4 -2 -4 -6 1.75 PO7 -6 P7 0 500 4 2 -2 -4 -2 -4 -6 -6 500 0 6 4 2 0 P8 ms ms 6 PO8 500 S cramble -1.75 ms 0 P O7 ms 500 PO7 P O8 PO8 P7 P8 Figure 4. a. ERPs for faces (black) and scrambled stimuli (red) for each of the two contacts from the left and right hemisphere; b. Overview of the contacts distribution over the scalp; the chosen temporo-occipital contacts are highlighted. Mental imagery condition At the chosen contact (PO8), imagined faces elicited a N170-like negative deflection peaking at 190.09 ms after the tone onset with a mean amplitude of -3.71 μV (Figure 5). Imagined scrambled stimuli also triggered a negative potential peaking at 189.55 ms post tone onset with a peak amplitude of -3.97 μV. + PO8 100 200 300 400 500 ms PO8 100 200 300 400 500 ms Figure 5. ERP’s for faces (up) ad scramble (bottom) in the imaginary condition and the corresponding map configuration at maximum of amplitude A 2x2 ANOVA was performed for the amplitude and latency of the components, with condition (perception, imagery) and stimulus (face, scrambled faces) as within subject factors. The results for the amplitude, showed a main effect of condition 110 (F(1.10)= 12.41, p=0.06) and stimulus (F(1, 10)= 41.89, p=10-5), and an interaction condition by stimulus, F(1,10) = 52.34, p = 10-5). The modulation for scrambled stimuli was similar in the perception and imagery condition (two-tailed, paired t-test, t=-0.74, p=0.48) while it differed for faces between perception and imagery condition (twotailed, paired t-test, t=5.23, p=0.0003). For the latencies of this component, a 2x2 ANOVA showed a phase effect, F(1, 10)=42.40, p=10-5, which was due to triggered modulations appearing later than the perceptual representations; post-hoc comparisons were significant for both faces (t= 6.91, p=10-5) and for scramble (t=4.65, p=0.01). faces uv 6 4 2 -2 -4 -6 ms -200 0 200 400 scramble uv 6 4 2 -2 -4 ms -6 -200 0 200 400 tone alone uv 6 4 2 -2 -4 ms -6 -200 0 200 400 Figure 6. Grand-average ERPs for the three visual stimulations (faces, scrambled, none) and for the two conditions (perception in black, imagery in red) at the PO8 contact Scalp topography analysis A segmentation was performed on the grand averages for the three stimulus categories during the perception condition (faces, scrambled, none) for the whole post-origin period (0-800 ms). Figure 7 shows the temporal distribution of the maps, 111 as well as the voltage topography for the 4 maps that dominated during periods with highest global field power (GFP). According to the timing and to the topography of the voltage distribution, map number 4 corresponds to the P100 (temporo-occipital positivity peaking starting around 70 ms post stimulus and ending around 130 ms post stimulus); map number 5 corresponds to N170 (temporo-occipital negativity, starting around 130 ms post faces presentation and ending around 193 ms post face presentation, with a maximum around 157 ms for faces, which corresponds to the found peak latency; for the scrambled stimuli, the map 5 starts at 115 ms and it ends at 183 ms). Map 5 is not found in the no-stimuli condition (tone alone). Map 7 is characterized by a temporo-occipital positivity, starting around 181 ms post stimulus and ending around 368 ms post stimulus, with a maximum around 250 ms. Map 6 ends starts around 138 ms post stimulus and end around 267 ms. Map 6 is found only in the tone alone condition. Map 4 (P100-like), map 5 (N170-like) and map 7 (P250like) appeared in both face and scrambled conditions. Figure 7. a.The results of the segmentation analysis performed on grand averages of the three categories of stimuli (faces, scrambled stimuli, none) in the perception condition. b. Display of the voltage configuration for the most representative maps To test whether the topography of the N170 could also be found during the imagery condition, we assessed how much of the variance was explained by map 5 (corresponding to the N170) in each subject for each stimulus condition. Thus, map 5 found for the average ERP was „back-fitted‟ at the single individual level. We used a 112 repeated measure ANOVA of global explained variance (GEV) to evaluate the contribution of this map across conditions (perception and imagery) and for the different stimuli (face, scrambled, none). Figure 8a presents the results of the statistical back fitting across subjects for the map 5. As expected, we found a main effect of condition (F(1,10)=22.87, p=0.0002), suggesting that the map corresponding to N170 is differentially present between the two conditions, namely it is more present in the condition perception as compared to imagery; we also found a main effect of stimulus (F(1,10)= 5.67, p=0.03), showing that the map was more present in the face condition than for scrambled and tone alone (t-tests comparing faces to scramble and tone alone respectively for each condition: t=3.17, p=0.01 when comparing faces to scramble in the perceptual condition, t=-4.72, p=0.001 for tone in the perceptual condition; t=1.97, p= 0.03 when comparing face and tone alone in the imagery condition and no statistical difference when comparing face and scramble stimuli in the imagery condition). The lack of interaction (F(1,10)= 1.43, p=0.28) shows that the map corresponding to the N170 presents the same profile (face > scrambled > none) in both perception and imagery phases (Figure 8b). Figure 8. a. Global variance explained by map 5 corresponding to N170 across all subjects in each condition: condition 1, 2, 3 represent the perceptual phase for face, scramble and tone alone respectively; condition 4, 5, 6 represent the imagery phase for face, scramble and tone alone respectively. b. Map 5 shows the same trend in both perception (series 1, in blue) and in imagery condition (series 2, in red) 113 DISCUSSION We show that the presentation of the three sounds previously associated with visual stimuli shows a differential modulation of EEG from 150-200 ms post-stimulus, corresponding to an N170 topography for both faces and scrambled faces. Specifically, our results also show that the stable neural configuration (functional microstate) corresponding to the presentation of the face is reactivated during the presentation of the sound previously associated with the face, and this significantly more than during the sounds previously associated with the scrambled stimuli or no stimuli. Unlike electrode-wise approach that takes into account only one electrode or a limited set of electrode, the microstate approach that we used here allows exploiting the distribution of voltage over the whole scalp (Michel et al 2009). Fitting of the map on the individual ERPs showed that the map was more present in the „face‟ trials during both perceptual and imagery conditions, thus demonstrating a category-specific re-activation of large-scale neural configurations corresponding to a very restricted step (i.e. N170) in the processing of visual stimuli. We believe that our results may have new implications for the understanding of the neural processes reflected by the N170. Building a perceptual representation can be done by feature-binding mechanisms: Bentin et al (2002) have shown that stimuli that are not normally perceived as face components may trigger face-specific activity (N170) when primed by a face context. Here, we show that sound stimuli, which do not normally activate face processing may prompt an N170 after associative learning. Thus, context (as in Bentin, 2002) or associative learning (as in the present study) may early steps during visual processing, most probably via top-down modulation (Rauss 2010 and 2009, Pourtois 2008). These results thus highlight the flexibility of early perceptual mechanisms (here for face processing). Peigneux et al. (2006) have showed that recent learned information is spontaneously replayed during the first hours of post-training wakefulness. The posttraining reinstatement of a specific neural configuration as found in our data may also be interpreted in the context of the offline processing and early reorganization of the recently acquired memories during wakefulness. 114 SUPPLEMENTARY DATA VIVIDNESS OF VISUAL IMAGERY QUESTIONNAIRE (VVIQ) adapted from Marks, 1973 Instructions Visual imagery refers to the ability to visualize, that is, the ability to form mental pictures, or to „see in the mind‟s eye‟. Marked individual differences have been found in the strength and clarity of reported visual imagery and these differences are of considerable psychological interest. The aim of this test is to determine the vividness of your visual imagery. The items of the test will possibly bring certain images to your mind. You are asked to rate the vividness of each image by reference to the 5-point scale given below. For example, if your image is "vague and dim" then give it a rating of 4. After each item write the appropriate number in the box provided. The first box is for an image obtained with your eyes open and the second box is for an image obtained with your eyes closed. Before you turn to the items on the next page, familiarize yourself with the different categories on the rating scale. Throughout the test, refer to the rating scale when judging the vividness of each image. Try to do each item separately, independent of how you may have done other items. Complete all items for images obtained with the eyes open and then return to the beginning of the questionnaire and rate the image obtained for each item with your eyes closed. Try and give your ‘eyes closed’ rating independently of the ‘eyes open’ rating. The two ratings for a given item may not in all cases be the same. Rating Scale The image aroused by an item might be: Perfectly clear and as vivid as normal vision rating 1 Clear and reasonably vivid rating 2 Moderately clear and vivid rating 3 Vague and dim rating 4 No image at all, you only "know" that you are thinking of an object rating 5 115 Eyes Opened In answering items 1 to 4, think of some relative or friend whom you frequently see (but who is not with you at present) and consider carefully the picture that comes before your mind’s eye. 1. 2. 3. 4. The exact contour of face, head, shoulders and body. Characteristic poses of head, attitudes of body etc. The precise carriage, length of step, etc. in walking. The different colors worn in some familiar clothes. Visualize the rising sun. Consider carefully the picture that comes before your mind’s eye. 5. 6. 7. 8. The sun is rising above the horizon into a hazy sky. The sky clears and surrounds the sun with blueness. Clouds. A storm blows up, with flashes of lightening. A rainbow appears. Think of the front of a shop which you often go to. Consider the picture that comes before your mind’s eye. 9. The overall appearance of the shop from the opposite side of the road. 10. A window display including colors, shape and details of individual items for sale. 11. You are near the entrance. The color, shape and details of the door. 12. You enter the shop and go to the counter. The counter assistant serves you. Money changes hands. Cui et al – Supplementary Material –3 Finally, think of a country scene which involves trees, mountains and a lake. Consider the picture that comes before your mind’s eye. 13. 14. 15. 16. The contours of the landscape. The color and shape of the trees. The color and shape of the lake. A strong wind blows on the tree and on the lake causing waves. 116 Eyes Closed In answering items 1 to 4, think of some relative or friend whom you frequently see (but who is not with you at present) and consider carefully the picture that comes before your mind’s eye. 1. 2. 3. 4. The exact contour of face, head, shoulders and body. Characteristic poses of head, attitudes of body etc. The precise carriage, length of step, etc. in walking. The different colors worn in some familiar clothes. Visualize the rising sun. Consider carefully the picture that comes before your mind’s eye. 5. 6. 7. 8. The sun is rising above the horizon into a hazy sky. The sky clears and surrounds the sun with blueness. Clouds. A storm blows up, with flashes of lightening. A rainbow appears. Think of the front of a shop which you often go to. Consider the picture that comes before your mind’s eye. 9. The overall appearance of the shop from the opposite side of the road. 10. A window display including colors, shape and details of individual items for sale. 11. You are near the entrance. The color, shape and details of the door. 12. You enter the shop and go to the counter. The counter assistant serves you. Money changes hands. Cui et al – Supplementary Material –3 Finally, think of a country scene which involves trees, mountains and a lake. Consider the picture that comes before your mind’s eye. 13. 14. 15. 16. The contours of the landscape. The color and shape of the trees. The color and shape of the lake. A strong wind blows on the tree and on the lake causing waves. 117 REFERENCES Allison, T., H. Ginter, et al. (1994). "Face recognition in human extrastriate cortex." J Neurophysiol 71(2): 821-5. Allison, T., G. McCarthy, et al. (1994). "Human extrastriate visual cortex and the perception of faces, words, numbers, and colors." Cereb Cortex 4(5): 544-54. Allison, T., A. Puce, et al. (1999). "Electrophysiological studies of human face perception. 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CONTEXT It has been shown that sleep physiological features may be externally manipulated by applying rhythmic sensory inputs. One explanation would be that the monotonous external information induces brain synchrony, which may modulate sleep/arousal systems (Sato 2007; Gao 2009). One of the most common and archaic way to facilitate sleep is rocking: we irresistibly fall asleep in a rocking-chair and, since immemorial times, we cradle our babies to sleep. Yet, no clear physiological explanation has been provided to this observed effect. In our study, we aimed at answering to this question, by studying if a low and repeated stimulation mimicking rocking could modify sleep architecture in humans, using a swinging-bed during afternoon naps. METHODOLOGICAL HIGHLIGHTS We used standard scalp EEG recordings in healthy young people, while they were performing a nap in a swinging bed. The bed (Figure1) was specifically designed to allow slow and repetitive horizontal movements (the frequency which provided the best sleep conditions was of 0.25 Hz). Subjects were recorded in two conditions: bed moving and bed stationary. Sleep physiological parameters were recorded and quantified in the two conditions. SUMMARY OF RESULTS We observed a faster transition to sleep in each and every subject in the swinging condition, a result which supports the intuitive notion of facilitation of sleep associated with this procedure. 120 Figure 1. a. Experimental «hammock», motorized bed producing a linear accelerated lateral movement; b. Detail of the rotor Surprisingly however, we also found a dramatic boosting of certain types of sleep-related oscillations (sleep spindles, occurring during sleep stage 2). Importantly, we found that some of these EEG changes lasted throughout the entire duration of the swinging condition. Importantly, we found that some of these EEG changes lasted throughout the entire duration of the swinging condition. CONCLUSION From these findings, we conclude that rocking beneficial impact on sleep is related to a synchronizing effect on brain circuits implicated in sleep, leading not only to a faster transition from waking to sleep but also to a consolidation into more profound sleep. This is in agreement with very recent data, proving that spindle rate may predict sleep stability (Dang-Vu et al, 2010). 121 Furthermore, we advance the hypothesis that the influence of rocking on sleep rhythms may be similar to that observed using transcranial direct current stimulation: Marshall, Helgadottir et al. 2006 and Marshall 2007 have shown by applying an external electrical stimulation over the frontal regions that inducing cortical slow oscillations facilitates the retention of hippocampus-dependent declarative memories. We believe that our study will motivate the development of new nonpharmacological strategies to cope with sleep initiation (or sleep maintenance) difficulties, which may be important in a sleep deprived society. Article submitted in Current Biology Rocking to sleep. Rocking synchronizes sleep brain waves Irina Constantinescu1*, Laurence Bayer1*, Stephen Perrig2, Julie Vienne3, Pierre-Paul Vidal4, Michel Mühlethaler1*, Sophie Schwartz1,5* * These authors contributed equally to the work 1 Department of Neuroscience, University of Geneva, Switzerland 2 Sleep Laboratory, Geneva University Hospital, Switzerland 3 Center for Integrative Genomics, University of Lausanne, Switzerland 4 Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8194- Université Paris Descartes, France 5 Swiss Center for Affective Sciences, University of Geneva, Switzerland Corresponding authors: Sophie Schwartz and Michel Muhlethaler, University Medical Center, Dept. of Neuroscience, Michel-Servet 1, 1211 Geneva 4, Switzerland Email: [email protected] and [email protected] Acknowledgments: This work was supported by the Swiss National Science Foundation. We thank A. Borbély, P. Franken, C. Frith, B. E. Jones, C. Leonard, and M. Tafti for their comments on previous versions of the manuscript. 122 Why do we cradle babies or irresistibly fall asleep in a hammock? Although such simple behaviors are common across cultures and generations, the nature of the link between rocking and sleep is poorly understood [1, 2]. Here we aimed at demonstrating that swinging can modulate physiological parameters of human sleep. To this end, we chose to study sleep during an afternoon nap using polysomnography and EEG spectral analyses. We show that lying on a slowly rocking bed (0.25 Hz) facilitates the transition from waking to sleep, and increases the duration of stage N2 sleep. Rocking also induces a sustained boosting of slow oscillations and spindle activity. It is proposed that sensory stimulation associated with a swinging motion exerts a synchronizing action in the brain that reinforces endogenous sleep rhythms. These results thus provide a scientific support to the traditional belief that rocking can sooth our sleep. In the present study, we asked twelve healthy male volunteers (22-38 year old) to nap on a custom-made bed or “experimental hammock” that could either remain stationary or rock gently (0.25 Hz, Figure 1A). All the participants were good sleepers, non-habitual nappers with no excessive daytime sleepiness; they had low anxiety level. Sleep quality and quantity were assessed by questionnaires and actimetry recordings. The experimental procedure involved spending two 45-minute afternoon naps (2:30 to 3:15 PM): one with the bed stationary, one with the bed put in motion (condition order randomized). The motion parameters were set to stimulate vestibular and proprioceptive sensory systems, without causing nausea or any entrainment of cardiac rhythm. In both conditions the naps were spent in complete darkness in a controlled room temperature (21° ± 1° C) and the level of auditory stimulation was around 37 dB. During both sessions, polysomnography data were recorded continuously. Sleep stages and sleep spindles were visually identified by two experienced scorers, blind to the experimental conditions. We also performed spectral analysis (FFT routine) using the frontocentral derivation (Fz). The data from two participants were excluded from the final analyses; all statistical tests were performed using paired 2-tailed t-tests (Supplemental Information). All participants had a good quality of sleep and regular hours of night sleep (mean ± s.e.m.; 7.32 ± 0.78 h), as assessed by self-rated sleep questionnaires over 3 consecutive nights preceding each experimental day, with no difference for these measurements between stationary and swinging conditions. Wrist actimetry did not 123 show any difference in sleep efficiency between conditions (mean ± s.e.m.; swinging: 86.63 ± 1.95%; stationary: 86.71 ± 1.23%). Participants were more alert (on visual analogue scale) after napping than before [ANOVA, 2 conditions (swinging, stationary) by 2 time-points (before, after nap); main effect of time-point: F(1,9) = 8.4, P = 0.018; no effect of condition, no interaction]. Eight participants rated the swinging condition as “more pleasant” than the stationary condition; for one participant both sessions were equally pleasant and for one participant the stationary condition was more pleasant. We found that rocking accelerated sleep onset, as evidenced by a shorter duration of stage N1 sleep and a reduction of stage N2 latency, compared to the stationary condition (Table S1). Rocking also affected deeper sleep stages by increasing the duration of stage N2 sleep and the mean spindle density per 30-s epoch (Table S1, Fig. 1B). The latter effect persisted throughout the entire duration of stage N2 (Fig. 1C). All these modifications were observed in each and every participant (all P<0.009; Table S1). In the only previous study investigating the effect of rocking on sleep, Woodward et al. [1] found no consistent modulation for the percentage of stage 1 sleep and an overall reduction of the percentage of stage 2 sleep during the motion condition. However, these data were computed over whole nights of sleep recordings, and did not address the question of whether vestibular/somatosensory inputs influence the transition from wakefulness to sleep (i.e., stage 1 and 2 sleep early in the night after sleep onset), in contrast to the present study. Rocking also increased EEG power within the slow oscillation band (<1 Hz), as well as in adjacent delta 1 and delta 2 bands (Fig. 1D), as revealed by EEG spectral analyses of frontocentral electrode (Fz) during stage N2 [3]. A significant increase of EEG power within spindle frequency bands was also observed. Together these results show that rocking induces a speeded transition to an unambiguous sleep state, and may enhance sleep by boosting slow oscillations and spindle activity. How can we explain that rocking may accelerate wake-sleep transition and promote sleep consolidation? Below we propose three main plausible neural mechanisms. First, because vestibular/somatosensory pathways have anatomical links with structures implicated in emotions such as the amygdala [4] and because the amygdala affects the regulation of sleep-wake states [5], faster sleep onset could be due to a “relaxing” feeling associated with the rocking condition, which most of our participants (8 out of 10) found pleasant. Second, rhythmic vestibular/somatosensory 124 inputs associated with rocking may modulate sleep-wake centres via direct or indirect connections between sensory systems and hypothalamic [6] or brainstem areas [7]. Third, sensory inputs could affect the synchrony of neural activity within thalamocortical networks because both somatosensory and vestibular inputs send direct projections to thalamic nuclei [8]. Consistent with this view, slow rhythmic cortical stimulation was recently found to increase EEG slow oscillations and spindles [3, 9], which are both hallmarks of deep sleep. The latter hypothesis of an influence on neural synchrony fits best the present observation that rocking does not only facilitate sleep onset but has a persistent effect on brain oscillations and spindles. Recent evidence that increased spindle activity protects sleep against disruptive stimuli is in agreement with this interpretation [10]. We propose that rhythmic rocking enhances synchronous activity within thalamo-cortical networks, which in turn could promote the onset of sleep and its maintenance. The use of rocking to sooth sleep thus belongs to our repertoire of adaptive behaviours in which a natural mechanism of sleep (i.e. thalamo-cortical synchronization) has been harnessed in the simplest manner since immemorial times. Figure 1 Legend. (A) Schema of bed rocking. (B) Decreased stage N1 and increased stage N2 during rocking compared to stationary condition. ** P < 0.001. (C) Evolution of spindle density (mean of spindle per 30-s epoch) during stage N2, n: number of subjects. ** P < 0.005, * P < 0.05. (D) Spectral profile during stage 2. * P< 0.05, ** P< 0.005. 125 SUPPLEMENTAL DATA Table S1. Sleep parameters in each experimental condition (n=10, mean ± s.e.m) Latency to stage N1 (min) Latency to stage N2 (min)* Stage N1 (min)* Stage N2 (min)* Stage N3 (min) Total sleep time (min) Total sleep period (min) Awakenings nb Sleep efficiency Total spindles number* Bed stationary Bed swinging 8.75 ± 2.45 7.75 ± 1.48 8.85± 2.05 12.4 ± 1.61 12.2 ± 1.94 0.3 ± 0.3 24.9 ± 3.07 34.05 ± 2.61 5.45 ± 1.08 73.1 ± 5.74 29.15 ± 6.27 5.35± 1.56 8.05 ± 1.15 17.8 ± 1.38 1.1 ± 0.52 26.95 ± 1.6 36.85 ± 8.24 4.85 ± 0.9 73.13 ± 2.79 60.15 ± 10.7 Note: mean alpha frequency of the population was within normal ranges: 9.68 +/- 0.77 Hz *significant difference between bed stationary and swinging, t-student, d.f.=9, all P < 0.001 except for latency to stage N2 P < 0.01 SUPPLEMENTAL EXPERIMENTAL PROCEDURES Participants Twelve healthy male volunteers gave informed consent to participate in this study according to the ethical regulations of the Geneva University Hospitals. Female participants were not included because of the effects of menstrual cycle on EEG and sleep [1] All participants included in the study were good sleepers, with normal and regular sleep-wake habits, and were non-habitual nappers (taking a short nap less than once per week in the last two years). None of them suffered from excessive daytime sleepiness (as assessed by Epworth sleepiness scale [2]. They had no psychiatric or neurological history, had never suffered from any vestibular disorder, and did not take any medication during the whole experimental period. The data from two participants had to be excluded from the analyses: one because of elevated anxiety before one experimental session, and the other one because of technical problems with the EEG recording. The remaining 10 participants had a mean age of 30.1 (range of 22-38 years) and had low anxiety level, as assessed by State Trait Anxiety Inventory [3] (mean score ± s.d.; 32.56 ± 3.68). Sleep quality and quantity were assessed by self-rated sleep questionnaires over 3 consecutive nights before each experimental session. Wrist actimetry was also recorded during the last night preceding each experimental session. 126 Protocol The experimental procedure consisted in a 45-minute afternoon nap spent in a custom-made bed that could either remain stationary or rock gently (Figure 1A in main text). This bed was suspended by four metal rods to a metallic frame and connected to an electrical motor that produced sinusoidally-modulated horizontal accelerations. The electrical engine and the experimental bed were built to be silent (adding only 2.5 dB to background noise). During pilot testing, we selected a set of motion parameters that generated stimulation while minimizing physical discomfort. The optimal parameters were obtained for total lateral excursion of 10.5 cm amplitude at the level of the bed and a swinging frequency of 0.25 Hz. Data recorded with an accelerometer (sampling frequency: 500 Hz; 3D motion tracker; Xsens MTx, Netherlands) on the bed and on the participants‟ head measured a peak horizontal acceleration of 0.1 m/s2 (g load = 0.01) and confirmed a negligible (non-detectable) vertical acceleration. The nap protocol consisted of two sessions: one with the bed stationary, one with the bed put in motion. The order of the experimental conditions was randomized across participants and the two sessions were at least one week apart. Time in bed from lights off (2:30 PM) to lights on (3:15 PM) was controlled by the experimenters. The naps were spent in complete darkness and the temperature of the sleep room was controlled (21° ± 1° C). During the stationary condition, the motor was turned on, but disconnected from the bed, so that both conditions involved the same level of auditory stimulation (37 dB in each condition). In these conditions, auditory input can be excluded. Visual input can indeed discounted since in both controls and experimental conditions subjects hold their eyes closed and lights were off. During both sessions, polysomnography data were recorded continuously with a sampling rate of 1024 Hz (Vitaport3, TEMEC, Netherlands). The montage included 10 scalp electrodes placed according to International 10-20 system (Fz, Cz, C3, C4, Pz, Oz, O1, O2, A1, A2), plus electrooculogram and electromyogram contacts. EEG data analyses Sleep polysomnography was scored over 30s epochs interval, according to standard criteria [4], by two experienced scorers blind to the experimental conditions. 127 Several sleep parameters during the naps were determined: latencies to stage N1 and N2 (from lights-off), time and percentage of each sleep stage, total sleep time (TST; sum of the time spent in different sleep stages), total sleep period (TSP; total time from sleep onset to final awakening, including intra-sleep wake intervals), sleep efficiency (defined as TST/TSP x 100) and number of intra-sleep awakenings (Table S1). sleep spindles were visually quantified at Cz contact referenced against mastoid channels, based on their typical fuiform morphology, frequency of 11-16 Hz, [4] (Table S1). EEG spectral analysis was applied at frontocentral site (fz) on stage N2. Fast Fourier transform was performed on average, 25% overlapping, 10 s windows, with a Hanning window, free of artefacts resulting in a frequency resolution of 0.1 Hz. Values below 0.6 Hz and above 15 Hz were omitted. Analyzes were performed using the Cartool software by Denis Brunet (http://brainmapping.unige.ch/Cartool.htm). Mean power in the following bands was calculated: slow oscillations (0.6-1 Hz), delta 1 (1-2 Hz), delta 2 (2-4 Hz), theta (4-8 Hz), slow spindles (8-12 Hz) and fast spindles (12-15 Hz). Frequency bands were chosen as previously reported [5]. Comparisons between rocking and stationary conditions were performed using paired 2-tailed t-tests. References and Notes 1. Woodward, S., Tauber, E.S., Spielmann, A.J., and Thorpy, M.J. (1990). Effects of otolithic vestibular stimulation on sleep. Sleep 13, 533-537. 2. Krystal, A.D., Zammit, G.K., Wyatt, J.K., Quan, S.F., Edinger, J.D., White, D.P., Chiacchierini, R.P., and Malhotra, A. (2010). The effect of vestibular stimulation in a four-hour sleep phase advance model of transient insomnia. J Clin Sleep Med 6, 315321. 3. Marshall, L., Helgadottir, H., Molle, M., and Born, J. (2006). Boosting slow oscillations during sleep potentiates memory. Nature 444, 610-613. 4. Carmona, J.E., Holland, A.K., and Harrison, D.W. (2009). Extending the functional cerebral systems theory of emotion to the vestibular modality: a systematic and integrative approach. Psychol Bull 135, 286-302. 5. Chou, T.C., Bjorkum, A.A., Gaus, S.E., Lu, J., Scammell, T.E., and Saper, C.B. (2002). Afferents to the ventrolateral preoptic nucleus. J Neurosci 22, 977-990. 6. Horowitz, S.S., Blanchard, J., and Morin, L.P. (2005). Medial vestibular connections with the hypocretin (orexin) system. J Comp Neurol 487, 127-146. 7. Jones, B.E. (2003). Arousal systems. Front Biosci 8, s438-451. 8. Moruzzi, G. (1972). The sleep-waking cycle. In Reviews of Physiology : Biochemistry and experimental pharmacology, R.H. Adrian, E. Helmreich, H. Holzer, R. Young, K. Kramer, O. Kreayer, F. Lynen, P.A. Miescher, H. Rasmussen, A.E. Renold, et al., eds. (Berlin, Heidelberg, New York: Springer-Verlag), pp. 1-165. 128 9. Massimini, M., Ferrarelli, F., Esser, S.K., Riedner, B.A., Huber, R., Murphy, M., Peterson, M.J., and Tononi, G. (2007). Triggering sleep slow waves by transcranial magnetic stimulation. Proc Natl Acad Sci U S A 104, 8496-8501. 10. Dang-Vu, T.T., McKinney, S.M., Buxton, O.M., Solet, J.M., and Ellenbogen, J.M. (2010). Spontaneous brain rhythms predict sleep stability in the face of noise. Curr Biol 20, R626-627. Supplemental References 1. Baker, F.C., and Driver, H.S. (2007). Circadian rhythms, sleep, and the menstrual cycle. Sleep Med 8, 613-622. 2. Johns, M.W. (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14, 540-545. 3. Spielberger, C.D. (1983). Manual for the State-Trait Anxiety Inventory, (Palo Alto, California: Consulting Psychologist Press Inc.). 4. Iber, C., Ancoli-Israel, S., Chesson, A., and Quan, S.F. (2007). The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, (Westchester, Illinois: American Academy of Sleep Medicine). 5. Marshall, L., Helgadottir, H., Molle, M., and Born, J. (2006). Boosting slow oscillations during sleep potentiates memory. Nature 444, 610-613. 129 GENERAL DISCUSSION The aim of the present work was to study the influence of sleep-wake states on human memory and underlying neural plasticity by using EEG recordings and neurological models as parasomnia. MULTIMODAL APPROACH TO MEMORY CONSOLIDATION We investigated the physiological and cognitive processes related to the consolidation of recently acquired knowledge using converging neuroscience and clinical approaches. We also looked at memory (re)processing across different vigilance states. Here I show how the integration of these multimodal data (behavior, brain networks, local field potentials) contributes to our understanding of experiencedependent changes in the human brain. At the behavioral level, we showed in Experiment 2 that trained sequences of large movements may be spontaneous replayed during post-training sleep in parasomnia patients. This study brings the first evidence to our knowledge of an experience-related behavioral replay in humans. Indeed, overt and spontaneous replay of waking behavior during sleep had never been previously shown in humans. These data also support the interpretation, proposed by human neuroimaging studies, that observed local neural reactivations during sleep in regions previously involved in some trained waking behavior reflect a replay of the behavior (Maquet 2000). Of course, during normal sleep, overt motor behavior is inhibited at the level of the medulla, thus preventing dreams to be enacted. By demonstrating the influence of recent waking learning experiences on mentation during sleep, this study also provides some support to recent dream studies that suggested a causal link between dream content and the consolidation of a recent task (Wamsley 2009). This study opens up a new, promising perspective for the use of neurological sleep disorders as models to investigate cognitive processes in humans. At the local field potential (LFP) level, in Experiment 1, we studied experience-related neural dynamics in pharmaco-resistant epileptic patients while they learned to perform sequences of finger movements. We demonstrate that the learning visuomotor events within sequentially-organized knowledge relies on the hippocampus and on distributed pattern of neural activity. We show that hippocampus 130 contributes importantly to assembling and processing sequences of motor episodic events. These results are in line with very recent views on hippocampal functioning, and provide further support for a role of the medial temporal lobe in procedural memory. Our study also suggests that sleep may influence the re-shaping of neural representations related to learning. Moreover, the single-trial processing approach (classification method) that we developed allows the study of individual patients (important for clinical purposes). We believe that the present study may motivate further translational perspectives on brain dynamics related to learning, from the individual studies in animals (place cells) to humans. Furthermore, an exciting extension of the present study would be to apply the same method to study experience-related replay of sequences of activity during sleep. In Experiment 3, we studied induced reactivation and reorganization of neural traces during post-training wakefulness at the scalp level by using high-density recordings in humans. Specifically, we investigated the learning of audio-visual associations and related temporal dynamics of high-density EEG topographies. By using the momentary configuration of functional potential maps and their transition with time, we show that induced-visual imagery (triggered by sounds previously associated with a visual image) may reactivate the same neural representations as when actually presenting the stimulus (visual perception). We also show that the induced reactivation is specific to the category of audio-visual learned association. To our knowledge, this is the first study that investigates induced reactivation of maps specific to visual categories at the milliseconds scale. Our results open important new perspective for the study of the spontaneous re-instatement of neural patterns during post-training sleep in humans Finally, in Experiment 4, we sought to experimentally induce neurophysiological changes during sleep. To this end, we built a motorized bed that produced a slow swinging motion. By using this special bed during afternoon naps we found that sleep dynamics can be successfully manipulated instrumentally. Specifically, rocking motion led to a persistent increase in stage 2 sleep and to increased spindle density. The present results related to sleep physiology motivate a second study where the impact of sleep modulation on different cognitive aspects (e.g. memory consolidation) in humans may be explored. Indeed, previous work suggests that increased spindle density and slow wave activity may enhance memory 131 consolidation (Marshall 2006 and 2007). If we can show that rocking enhances memory consolidation, this could ultimately have practical implications for education or rehabilitation purposes. NOVELTY OF THE TECHNIQUES What makes brain so special is its organized action in time. The temporal domain is fundamental when talking about the brain mechanisms (Buzsaki 2006). The EEG reflects the immediate mass action of neural populations, and thus provides a particularly direct and accurate window onto human brain functions (Michel 2009). In the present thesis, we used different EEG techniques, i.e., intracranial recordings, high-density scalp recordings, sleep rythms recordings, to better understand the neural mechanisms underlying memory consolidation and the putative role of sleep in this process. This led us to apply or develop different methods to analyse these electrophysiological data. While cellular studies in animals provide invaluable data on brain functioning, in humans, the use of a similar approach using intracranial recordings in populations of patients, during cognitive studies, is still very limited. A first reason is the small population of patients requiring presurgical implantation of electrodes, and second reason is the lack of standard for the analysis of the data recorded. In the world, there are still only few centers in which this unique approach can be performed. Therefore, in the present thesis we highlight the value of the intracranial EEG for human brain mapping. Due to the spatio-temporal resolution (almost “millimetermillisecond” resolution), human intracranial studies approach the “gold standard” of human brain study (Lachaux, Rudrauf et al. 2003). Another major advantage of intracranial techniques is that they allow the recording of deep brain structures that are not normally accessible via scalp recordings. In the first project (Experiment 1), we developed a multivariate decoding algorithm that can capture learning-dependent changes in intracranial EEG signal at the single trial level. By using this multivariate approach, we could establish a causal link between specific electrode contribution and discrimination power classification. The developed method is particularly suitable when analyzing unique sets of data from unique patients, which may be an extremely valuable tool in clinical settings. 132 Based on the present results, we are strongly convinced that the present work may motivate further development of new ways of exploring the human brain functioning, The development of standard and robust signal processing methods to analyze intracranial recordings may also be extremely important for the detection of pathological features and confer therefore a clinical significance to the obtained results. The biological rule that information processing in the brain depends on successions of millisecond-scale and transient functional states, also holds at the global brain level, analyzed via high-density scalp recordings. For example, while specific microstates do characterize cerebral dynamics of mental imagery (Pegna 1997), here we show that this approach can reveal the re-presentation of learningrelated associations (Experiment 3). All in all, from the methodological perspective, we believe that our work contributes to the understanding of state-dependency of brain information processing in the millisecond time range. CONCLUSIONS AND PERSPECTIVES Experience-related plasticity phenomena undergo different stages during wakefulness and sleep. Thus, research in the domains of sleep and memory may reveal new and fundamental cues for our understanding of human brain functioning and plasticity. In the present thesis, we used the concept of experience-related neural reactivations to study brain dynamics subtending memory. We assessed re-shaping of neural representations during post-training wakefulness (project 3) and sleep (project 1), either produced spontaneously or induced by presentation of learning-related external cues. We also assessed experience-related behavioral re-enactment during sleep states in parasomnia patients. The replay phenomenon is a recently described mechanism in animals and in humans (McNaughton 1994, Maquet 2000). Since the end of 20th century, despite growing number of studies in the field, the precise functional relevance of replay mechanisms in learning and memory processing is not completely understood. It seems that the replay phenomena reflect more complex processes than believed (Gupta, van der Meer et al. 2010). We believe that our work may contribute at further understanding learning-related reorganization of brain activity. We also hope that the results of our work may prompt new studies in this field. 133 Memory systems may be characterized according to the information input (e.g. sequential learning), to the type of operation (e.g. forming of new associations) and to the subtending brain structures (e.g. the hippocampus) (Schacter and Tulving, 1994). In this thesis, we proposed a multimodal approach to memory functions. This was done by performing a combination of techniques allowing for temporal and spatial fine observation of neural activity. This could promote animal-human translational studies, to assess different aspects of brain plasticity in a unitary way. We believe that this multimodal approach (c.f. Figure 1 – in the beginning of the experimental part) is innovative and useful to integrate data from animal studies with data from human studies in neuroscience. One of the most enigmatic natural processes is falling asleep. Yet, there are too few scientifical demonstrations on this topic. We approached this challenging subject, by analyzing one of the simplest and most well maintained behaviors- rocking to sleep in human subjects. We showed that a rhythmic rocking enhances synchronous activity within thalamo-cortical networks, which in turn could promote the onset of sleep and its maintenance. One of the nowadays challenges in science is the growing complexity of the questions and the multitude of ways to explore them. One of the highlights of this PhD work is the multidisciplinary approach (physics, biology, medicine) used, thus promoting team-work and joint views, which make science evolve in an integrative way. We like to believe that the present work opened constructive dialogues and new collaborations among scientifical teams, into a multidisciplinary network. The present work represents the finality of a first step of research, as new projects emerged as a natural continuation of the previous ones throughout the thesis. 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