ERP Assessments in Rare Pediatric Conditions

Context‍

Event-related potentials (ERPs) are changes in neural activity recorded with scalp EEG, triggered by a specific sensory, cognitive, or motor event. They are often used to quantify the cognitive and socio-emotional development in children and adults. ERPs track the dynamic brain activity triggered by the event with an excellent temporal resolution. This makes ERPs useful for evaluating the neural effort required for tasks, the timing of cognitive processes, and the progression of neural functions over time. This precision allows ERPs to serve as objective endpoints in conditions related to attention, cognition, and development.

‍Challenge‍

ERP assessments in a pediatric population, both with and withoutdevelopmental delay, bring technical and operational challenges. Therefore, development-and age-appropriate considerations need to be made in terms of hardware setup, acquisitionprotocol, paradigm selection, and task design to ensure high-quality endpoints.‍

Solution‍

To address these challenges, Clouds of Care provides an ERP study design that finetunes operational, hardware, and analysis considerations tailored to the subject’s age and development.

• Based on the clinical hypothesis, the appropriate ERP components such as P300, Mismatch Negativity (MMN), Auditory Brainstem Response (ABR), N170, or Error-Related Negativity (ERN) are selected and translated into the ERP paradigm.
• For ERP studies, standardizing the recording equipment is essential to ensure a consistent acquisition, therefore, only one hardware setup is preferred. If participating sites don’t have the required equipment, pre-configured hardware can be supplied through 3^rd parties.
• Aside from equipment, the appropriate electrode setup needs to be considered to reduce EEG application time and minimize invasiveness while optimizing signal quality.
• All ERP-related procedures are collected in our ERP charter to guide proper acquisition.
• As part of the onboarding, training of all participating EEG technicians is organized to ensure proficiency in the ERP procedures.
• To further harmonize and standardize the ERP interpretation, preprocessing and automated ERP extraction are applied, if needed, in combination with ERP verification by an expert reader. 

Impact‍

By accommodating the unique circumstances and challenges of measuring ERPs in pediatric subjects, we unlock a direct and non-invasive method to reveal critical aspects of processing, attention, and cognition. Such a development- and age-appropriate ERP approach can enhance our understanding of the disorder and ultimately speed up the clinical development and delivery of new treatment options for pediatric patients.