Acknowledgement to Reviewers of OBM Neurobiology in 2021

The editors of OBM Neurobiology would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2021. We greatly appreciate the contribution of expert reviewers, which is crucial to the journal's editorial process. We aim to recognize reviewer contributions through several mechanisms, of which the annual publication of reviewer names is one. Reviewers receive a voucher entitling them to a discount on their next LIDSEN publication and can download a certificate of recognition directly from our submission system. Additionally, reviewers can sign up to the service Publons (https://publons.com) to receive recognition. Of course, in these initiatives we are careful not to compromise reviewer confidentiality. Many reviewers see their work as a voluntary and often unseen part of their role as researchers. We are grateful to the time reviewers donate to our journals and the contribution they make.

Neuronal Coherence Agent for Shared Intentionality: A Hypothesis of Neurobiological Processes Occurring during Social Interaction

The present interdisciplinary study discusses the physical foundations of the neurobiological processes occurring during social interaction. The review of the literature establishes the difference between Intentionality and Intention, thereby proposing the theoretical basis of Shared Intentionality in humans. According to the present study, Shared Intentionality in humans (Goal-directed coherence of biological systems), which is the ability among social organisms to instantly select just one stimulus for the entire group, is the outcome of evolutionary development. Therefore, this interaction modality should be the preferred, archetypal, and most propagated modality in organisms, attributed to the Model of Hierarchical Complexity Stage 3. This characteristic of biological systems facilitates the training of the new members of the group and also ensures efficient cooperation among the members of the group without requiring communication. In humans, Shared Intentionality contributes to the learning of newborns. The neurons of a mature organism may teach the neonate neurons regarding the fitting reactions to the excitatory inputs of the specific structural organization. This enables the neonate neurons to develop a Long-Term Potentiation that links particular stimuli with specific embodied sensorimotor neural networks. The present report discusses three possible neuronal coherence agents that could involve quantum mechanisms in cells, thereby enabling the distribution of the quality of goal-directed coherence in biological systems (Shared Intentionality in humans). Recently reported case studies conducted online with the task of conveying the meaning of numerosity to the children of age 18–33 months revealed the occurrence of Shared Intentionality in mother-child dyads in the absence of sensory cues between the two, which promoted cognitive development in the children. The findings of these case studies support the concept of physical foundations and the hypothesis of the neurophysiological process of social interaction proposed in the present study.

The Relationship between Sensory Reactivity Differences and Mental Health Symptoms in Children with Neurodevelopmental Conditions and Their Neurotypical Peers

Children with neurodevelopmental conditions (NDC) often have sensory reactivity differences, such as being overwhelmed by sounds, which can elicit distress in their everyday life. Furthermore, children with an NDC often present with a greater frequency of mental health symptoms compared to their typically developing peers. However little research has examined the relationship of these sensory reactivity differences on broader mental health. This study set out to explore the relationship between sensory reactivity and mental health symptoms. Data from parent-reported measures of sensory reactivity and mental health symptoms were collected for 49 children presenting with a neurodevelopmental condition and 42 typically developing (TD) controls. Partial correlational analyses, controlling for IQ, were used to elucidate the relationship between sensory reactivity and mental health symptoms. Children with an NDC were significantly more likely to present with a sensory reactivity difference or mental health symptom. Sensory seeking was found to be the sensory subtype most related to mental health symptoms, especially in externalising conditions. There was evidence also found for a relationship between depression, sensory seeking and sensory hypo-reactivity, and GAD and hyper-reactivity. Findings suggest a relationship between sensory reactivity and mental health symptoms in children with a neurodevelopmental condition. There is also preliminary evidence of unique sensory-based profiles of mental health. Assessment of sensory difficulties as part of more rigorous mental health assessments within mental health services will support more accurate diagnoses and intervention.

Narrative Review of Surgery for Myasthenia Gravis

Myasthenia Gravis (MG) is a rare autoimmune disorder characterized by antibody mediated blockade of neuromuscular transmission. Up until the last decade, evidence suggesting benefit of thymectomy for myasthenia gravis has been based on non-randomized control studies. Our paper serves as an expert narrative review of new literature pertaining to surgical management of myasthenia gravis based on review of articles from PubMed and Cochrane database from date of inception through June 14, 2021. We used the MeSH search terms: “myasthenia gravis”; “thymectomy”; “thymoma”; and “surgery” to identify any new relevant articles for inclusion in our review. The results of these studies are summarized below. We reviewed multiple articles including two randomized control trials. As a result of these studies over the past decade, the American Academy of Neurology’s most recent practice advisory, published online March 25, 2020, gives a level ‘B’ recommendation for thymectomy for MG in patients with acetylcholine receptor antibody-positive generalized MG age 18-65 years old. They additionally noted the need for further discussion surrounding the benefits and risks of surgery and whether minimally invasive approaches to thymectomy would provide the same benefits as the traditional transsternal approach. Evidence recommending thymectomy during pregnancy remains limited due to lack of available data. Emerging evidence suggests that performance of video-assisted or robotic-assisted thymectomy is feasible, but further study is needed due to a lack of randomized control trials.

Effects of Circadian Rhythm on Migraine Therapy

Circadian rhythms are 24-hour cycles of physical, mental, and behavioral changes regulated and maintained by the internal primary circadian clock, however modifiable by a number of external cues or “zeitgebers”, the most powerful one being light. Core set of clock genes regulate the whole-body metabolism and transcription of over 40% of mammalian RNA, including that for drug transporters, binding and metabolizing proteins responsible for regulation of pharmacokinetics of vast array of medications. Growing amount of evidence also shows circadian rhythmicity of a number of patho-physiological processes, such as are migraine, chronic pain, and epilepsy, suggesting amenability to chronotherapy. Chronotherapy involves behavioral and pharmacological strategies to restore or correct ill-functioning circadian rhythm as well as manipulation of standardized treatments throughout the day to maximize therapeutic and minimize side effects, termed chronopharmacology. Chronotherapy for chronic migraines and headache variants using synchronization techniques as well as chronopharmacology of abortive and preventive migraine medications is being actively researched. In this review, we summarize current state of chronotherapy for headache variants and discuss future prospects in circadian optimization of migraine headaches treatment.

Neural Response to High and Low Energy Food Images in Anorexia Nervosa

To compare neural responses to high and low-energy food images in patients with Anorexia Nervosa (AN) and an age-matched Healthy Control (HC) group. 25 adolescents with AN and 21 HCs completed a diagnostic interview, self-report questionnaires and fMRI, during which they viewed food images evoking responses of disgust, happiness, or fear. Following whole brain analyses, neural responses in six regions of interest were examined in a series of between-group contrasts, across the three emotive categories. Compared to the HCs, people in the AN group showed increased responsivity to high-energy (1) disgust images in temporal lobe, frontal lobe, insula, and cerebellum anterior lobe; (2) fear images in occipital lobe, temporal, and frontal lobes and (3) happy images in frontal lobe, cerebellum anterior lobe, sub-lobar, and cuneus. More activity was observed in response to low-energy (1) disgust food images in the temporal lobe, frontal lobe, insula, cerebellum anterior and posterior lobes, parietal lobe, occipital lobe, and limbic lobe; (2) and happy food images in frontal lobes. Few correlations were found with levels of eating disorder symptoms. The findings highlight the emotional impact of diverse high and low-energy foods for people with AN. People without AN may have a better capacity to filter salient from non-salient information relating to the current task when viewing high energy foods. In summary, for those with AN, it would seem their ability to efficiently ‘sort-out’ information (especially information pertaining to disorder-relevant stimuli such as food images) to complete the task at hand, may be diminished.

Why the Quantum Brain?

This article reviews the modern approaches to the quantum brain hypothesis. The aim is to consider the hypothesis and its classical brain-machine alternative from a broad perspective, including physics, biology, computer science, cosmology, and metaphysics. My starting point is that asking whether consciousness can or cannot have free will is fundamentally incorrect. This aspect is challenged by both physics and neuroscience. The paper argues that the search for conscious free will, as it is typically tested in Libet-type experiments, implies putting the cart before the horse. From the evolutionary perspective, a more correct question is this. Might primitive neural networks of simple organisms have possessed free volitional mechanisms (quantum in origin) as an extremely valuable acquisition for the flourishing of life? Might then the mechanisms have evolved from primary (rapid and random) reflexes in the oldest brain regions such as the brainstem to give rise to conscious cortex-centered properties in later stages of the brain evolution?

Psilocybin as a Novel Pharmacotherapy for Treatment-Refractory Anorexia Nervosa

Anorexia Nervosa (AN) is a major health problem with one of the highest mortalities and treatment costs of any psychiatric condition. Cognitive behavioural therapy (CBT) is currently the most widely used treatment for AN in adults but provides remission rates ≤ 50%. Treatment drop-out is exceedingly high and those that persevere with treatment often relapse, causing increased risk of morbidity and mortality. There is an urgent need to find new interventions, especially as there are no approved pharmacological treatments for AN. Ideally, new treatments would target treatment-resistance and to decrease the chronicity associated with the disorder. Over the past two decades, emerging research into classic psychedelic substances (lysergic diethylamide acid (LSD), 5-Methoxy-N,N-Dimethyltryptamine (5-MeO-DMT), N,N-Dimethyltryptamine (DMT) and psilocybin), indicates that marked reductions in anxiety and depression-like symptoms, and lasting improvement in mental health, can follow from one or two exposures to these psychedelic substances. Anxiety and depression are the most prevalent co-morbid psychiatric symptoms in AN. Here we suggest that classic psychedelics, particularly psilocybin, have the potential to normalise dysfunctional neurobiological systems in AN and provide a novel treatment intervention that is worthy of consideration, particularly for treatment-resistant patients.

Management of Agitation, Delirium, and Catatonia in Intubated COVID-19 Patients: A Case Series & Rationale for Valproate Sodium Use During Extubation

The complete spectrum of neuropsychiatric effects of SARS-CoV-2 acute respiratory distress syndrome has yet to be fully appreciated, particularly in intubated patients. Manifestations including delirium and catatonia need to be considered in intubated COVID-19 patients. Medications known to exhibit neuroprotective effects, like valproate, can assist in agitation related to sedative withdrawal during extubation. This case series reports on the management of agitation, delirium, and catatonia in COVID-19 patients during and after extubation efforts. We present three cases in which Psychiatry was consulted for agitation in intubated COVID-19 patients. These patients were managed for severe agitation during weaning from extubation as well as for subsequent psychiatric challenges, including catatonia. Patient 1: 26-year-old female with bipolar I with psychotic features who was admitted for acute hypoxic respiratory failure from COVID-19 pneumonia. After an emergency C-section at 31 weeks’ gestation, she was intubated for 9 days and started on valproate 250 mg BID for agitation. She was extubated successfully and discharged home. Patient 2: 42-year-old female with bipolar I and PTSD who was intubated following COVID-19-related acute hypoxic respiratory failure. She received valproate 250mg BID and was extubated successfully. She became catatonic when home quetiapine was resumed and recovered following quetiapine discontinuation and lorazepam. She was discharged on valproic acid and alprazolam. Patient 3: 23-year-old female with bipolar I with psychotic features who was admitted for COVID-19 acute hypoxic respiratory failure and intubated. She received valproate 250 mg BID and was extubated successfully. She became catatonic when risperidone was re-initiated, but recovered following risperidone discontinuation and addition of lorazepam, gabapentin, and duloxetine. Quetiapine was added before discharge. Valproate was effective for managing delirium and agitation during extubation, as evidenced by normalizing Richmond Agitation and Sedation Scale scores. Additionally, valproate aided in managing catatonia post-extubation. This case series reports on the management of agitation in COVID-19 patients during extubation efforts with valproate sodium, due to its ability to manage delirium and catatonia. Valproate is known to exhibit neuroprotective effects, which possibly explains successful management of agitation during the extubation process.