AU2007200577B2 - Method and apparatus for objective electrophysiological assessment of visual function - Google Patents

Description

S&F Ref: 502610AUD1 AUSTRALIA PATENTS ACT 1990 COMPLETE SPECIFICATION FOR A STANDARD PATENT Name and Address Alex Kozlovski, of Applicants: Australian Citizen, of 46 Parklands Road, Mt Colah, 2079, Australia Alexander Klistorner, Australian Citizen, of 10 Kalang Road, Mt Colah, New South Wales, 2074, Australia Iouri Malov, Australian Citizen, of 49 Holmes Street, Turramurra, New South Wales, 2074, Australia Stuart Graham, Australian Citizen, of 6 Kiparra Street, West Pymble, New South Wales, 2073, Australia Actual Inventor(s): Stuart Graham Alexander Klistorner Alex Kozlovski Iouri Malov Address for Service: Spruson & Ferguson St Martins Tower Level 35 31 Market Street Sydney NSW 2000 (CCN 3710000177) Invention Title: Method and apparatus for objective electrophysiological assessment of visual function The following statement is a full description of this invention, including the best method of performing it known to me/us: 5845c(667138_ ) Method and Apparatus for objective electrophysiological assessment of visual function Technical Field This invention relates to the electrophysiological assessment of visual function using 5 a head mounted stereo display (eg virtual reality goggles) for displaying a stimulus which is used to generate a retinal or cortical response. In particular, the integrity of the visual field can be assessed objectively by measuring retinal or cortical responses to a multifocal visual stimulus presented by a head mounted virtual reality display instead of a conventional monitor. This provides advantages of space, patient acceptance, standardising distance to 10 the display, and the possibility of monocular or binocular simultaneous recording. The invention also describes scaling of the multifocal visual evoked potential (VEP) signals according to background electroencephalogram (EEG) levels, which reduces inter individual variability. Background Art 15 The objective assessment of the visual field using multi-focal stimulation has been reported recently (refs 1-7). Using different types of multifocal stimulus presentation (Sutter US Patent 4846567; Malov, Intemational Patent Application No PCT/AUOO/01483; and refs 14-17, the disclosures of which are hereby being incorporated by reference), stimulation of a large number of locations of the visual field can be performed 20 simultaneously. Visually evoked cortical potentials (VEP) and electroretinograms (ERG) can be recorded from all areas of the field. For the VEP various electrode placements have been used. The best representation of the visual field was reported by the inventors with multichannel bipolar recordings (Klistorner and Graham, International Patent Application No. PCT/AU99/00340). Multifocal ERG recording has been performed with various 25 electrodes (gold foil, DTL, Burian-Allen, gold lens). Good correlation was reported between the multifocal VEP and visual field loss in glaucoma (refs 2,5-7), and between the multifocal ERG and local retinal disease (ref 8), but not between the multifocal ERG and glaucoma (ref 9,10). However, these recordings require a high resolution, large screen display (22 inch or 30 larger), and subjects are required to sit close to the screen. The distance of the subject from the screen changes the area of field stimulated, and also changes the focal length and thus the required spectacle correction, so must be closely controlled during the recording. The CRT monitor also produces a large electromagnetic field which may affect the recordings when the subject is in close proximity to the screen. Recording is limited to one eye at the 35 time, whereas with goggles it is possible to present a different stimulus to the two eyes at 2 the same time. Therefore the concept of using a head mounted display provides a solution to these problems, and saves significantly on space requirements. It also allows for portability of the system. Binocular simultaneous multifocal recording reduces the recording time up to 50% by allowing two eyes to be tested simultaneously using different stimulus sequences 5 for the two eyes. A significant problem with multifocal VEP recordings has been the large inter individual variability seen among the normal population, which limits the sensitivity of applying values from a normal data base when looking for small changes early in the disease process. A scaling algorithm has previously been reported by us (Klistorner & 10 Graham, International patent application No. PCT/AU99/00340) which helped to reduce this variability. However, the scaling of VEP amplitudes according to background electroencephalogram levels as described in this patent has been found to be a superior technique for reducing inter-individual variability and increasing the sensitivity of the test. Disclosure of the Invention 15 The derivation of a functional map of the human visual field can be achieved from analysis of either multifocal VEP or ERG responses. The VEP responses tend to reflect losses at all stages of the visual pathway, whereas the ERG responses tend to correlate with local retinal disease. It has been demonstrated by Malov, International Patent Application No PCT/AUOO/01483 that using a multifocal stimulus driven by a spread spectrum 20 technique, (such that different parts of the visual field are stimulated by different random sequences), and by using appropriately placed recording electrodes on the scalp with multiple recording channels, that accurate maps of visual function can be recorded in the form of multifocal pattern VEPs. Disease states such as glaucoma or optic nerve disorders that cause blind spots in the vision (eg optic neuritis in multiple sclerosis) can be detected 25 and mapped. Both amplitudes and latencies of the signals can be compared to normal reference values or compared between the two eyes of a subject. We have found that a head mounted stereo display (eg virtual reality goggles) can be applied to these recording techniques, providing significant advantages. It reduces the space required in the laboratory or test area by removing the need for a large monitor. It 30 makes the test potentially portable, and it standardises the distance to the display reducing problems of refraction, variable head position and thus area of field tested. It removes the problem of electromagnetic noise emanating from the screen when the subject sits close to the monitor. A head mounted stereo display has good patient acceptance, and both monocular or binocular recording can be performed.

-3 Simultaneous binocular recording can be achieved with the application of the spread spectrum technique (Malov, International Patent Application No PCT/AUOO/01483) and a head mounted stereo display to provide different pseudorandom stimulus patterns to the two eyes at the same time. The stimulus algorithm is divided into twice the number of segments and these 5 can be distributed between the two eyes, still providing different stimulus sequences to each part of the field and with each subsequent run. The cross-correlations can derive VEP results from each eye independently, with minimal auto-correlation of the signals within or between eyes. This has the advantage of shortening the test time significantly. It also standardises conditions of the recording such that the two eyes are recorded under the same conditions in terms of the io subject's visual attention and extraneous noise levels. This aids in the reliability of direct comparisons between eyes of an individual. The invention thus provides a method and apparatus for objectively assessing the visual field using virtual reality goggles to present a multifocal stimulus and then recording of either retinal (ERG) or cortical (VEP) responses to that stimulus. It includes simultaneous binocular is recording of the VEP, using different stimuli for the two eyes. It also includes a new scaling method to reduce inter-subject variability in the recorded multifocal VEP amplitudes by scaling the VEP response according to overall electroencephalogram activity. A suitable head mounted stereo display is what is commonly known as virtual reality goggles. Other head mounted displays which are able to present a suitable stimulus which can 20 generate a retinal or cortical response would also be appropriate. "Virtual reality" is a term applied to the experience of an individual when viewing through a head-mounted display an image presented immediately before the eyes which has the appearance of being viewed at a distance from the eye. Different images can be presented to the two eyes to give a three dimensional effect. 25 It is a purpose of this invention to provide a method of analysis multifocal visual evoked potentials recorded from the responses from multiple parts of the visual field using virtual reality goggles, and thus provide a robust method which is able to minimize inter-individual (or inter subject) variability between studies of at least two or a plurality of subjects in a population. Also disclosed is a compact, portable system for implementation of the method that is acceptable for 30 the patient and clinician, and removes the need for close monitoring of recording distances from the viewing screen. According to a first aspect, there is provided a method for analysing at least one multifocal visual evoked potential recording from any mode of multifocal stimulation of a subject -4 comprising scaling the visual evoked potential recording output from computer software according to overall spontaneous brain activity levels (ie. electroencephalogram levels) of the subject during the recording in order to minimise inter-subject variability. The EEG scaling is more reliable if a method for removing high alpha-rhythm signals or 5 electrocardiogram contamination is employed when calculating the background EEG levels. The mode of multifocal stimulation includes conventional CRT or LCD monitors or plasma screens for example. In an arrangement of the first aspect, there is provided a method for analysing at least one multifocal visual evoked potential recording of at least two subjects to minimise inter-subject io variability, the method comprising: (a) for each subject, recording the at least one visual evoked potential and the subject's overall spontaneous brain activity levels; (b) for each subject, calculating a corresponding scaling factor, the scaling factor being derived from the subject's overall spontaneous brain activity levels output from the computer 15 software; and (c) said scaling of the output comprising scaling each subject's visual evoked potential recording by that subject's corresponding scaling factor such that the variability of the visual evoked potential recordings induced by the multifocal stimulation between the at least two subjects is minimised. 20 In a further arrangement of the first aspect, there is provided a method for analysing at least one multifocal visual evoked potential recording of the subject to minimise inter-subject variability between individuals of a population, the method comprising: (a) recording the at least one visual evoked potential and the subject's overall spontaneous brain activity levels; 25 (b) calculating a corresponding scaling factor, the scaling factor being derived from the subject's overall spontaneous brain activity levels output from the computer software; and (c) said scaling of the output comprising scaling each the subject's visual evoked potential recording by the subject's corresponding scaling factor such that the variability of the visual evoked potential recordings induced by the multifocal stimulation between individuals of a 30 population is minimised. According to a second aspect of this invention there is provided a method for objective electrophysiological assessment of visual function of at least one eye of a patient, which method -5 comprises presenting a visual stimulus to at least one eye of the patient, recording at least one resultant response, selected from the group consisting of a retinal response and a cortical response, generated as a result of the presenting; analysing said response; and as a result of said analysing, forming a map of the visual function of the at least one eye of the patient. 5 Usually, the presenting of the visual stimulus is achieved by a head mounted display, in particular a head mounted stereo display such as a head mounted virtual reality According to a third aspect of this invention there is provided a method of identifying alpha-rhythm spikes or electrocardiogram signals in raw data by application of Fourier spectrum analysis. (It is important to identify these spikes prior to scaling since they may alert the operator 10 to lack of visual attention of the patient.) According to a still further aspect of this invention there is provided a system for electrophysiological assessment of visual function of at least one eye of a patient, comprising a head-mounted stereo display for presenting a stimulus to at least one eye of the patient; electrodes placed on the scalp or in contact with the eye; a computer which generates an algorithm for driving the stimulus; and a means for recording at least one is resultant response, selected from the group consisting of a retinal response and a cortical response, generated as a result of presenting said stimulus; and means for recording the resultant retinal or cortical response; and software for analysing the retinal or cortical response to said stimulus. In any of the above aspects, the stimulus may be presented by a head mounted display, in 20 particular a head mounted stereo display such as a head mounted virtual reality stereo display. The head-mounted stereo display suitably comprises virtual reality goggles. The head-mounted stereo display may be used to derive a signal from the cortical visual evoked potentials. It may also be used to derive an electroretinogram signal from the eye. This display shows any type of multifocal stimulation directly to the eye. The stimulus presented to the eye may be a flash 25 stimulus or a pattern stimulus. The stimulus may vary in luminance, colour or stimulus duration to elicit visual responses. The head-mounted stereo display suitably uses a liquid crystal display or plasma screen, for example. The stimulus may be presented monocularly or binocularly. The same stimulus may be presented binocularly for simultaneously recording of signals from both eyes. Where different stimuli are presented to the two eyes, they may be simultaneously 30 presented binocularly for simultaneous recording to signals from the two eyes. For analysis of multifocal visual evoked potential recordings, the results are scaled according to the overall spontaneous brain activity (i. e. electroencephalogram levels) of the subject during the recording to minimise variability. The invention utilises multifocal stimulation techniques. Any multifocal stimulator -5a (either existing equipment such as ObjectiVision, VERIS, Retiscan, or future systems) can be used to generate a stimulus which is then projected into virtual reality goggles using monocular or binocular displays. We have established that both the ObjectiVision and VERIS systems can be used in recording with virtual reality goggles. The stimulus can be diffuse (flash) or structured 5 (pattern) and can vary in intensity, colour, size or temporal characteristics. Appropriate electrodes placed on the scalp for the VEP, or in the eye for the ERG, allow for recording of the electrophysiological response, which is then amplified by a conventional amplifier. Cross correlation techniques (eg, Malov, International Patent Application No PCT/AUOO/01483) allow for derivation of the signal from background noise. A topographical map of the responses can io then be derived corresponding to the field of view of the subject. The output can displayed as a printout of results, and comparisons made with a normal data base of responses. To reduce the inter-individual variability of the multifocal VEP recordings the inventors have applied a scaling factor based on background electroencephalogram (EEG) levels. Scaling of the VEP amplitude based on amplitude of spontaneous brain activity eliminates part of the is variability between individuals caused by differences in conductivity of underlying tissues (eg bone, muscle, skin and subcutaneous fat). This also reduces the differences seen between males and females, since it is known that women have generally higher amplitude VEP signals when compared to men, presumably due to sex differences in 6 tissue thickness and conductivity. Scaling according to EEG signals removes this difference, rendering final signals equivalent between the sexes. By reducing the range of variability between subjects it improves the sensitivity of the test for detecting abnormality. Brief Description of the Drawings 5 A number of embodiments of the present invention will now be described with reference to the drawings in which: Figure 1 is a schematic representation of the apparatus for VEP recording including virtual reality goggles; Figure 2 is a schematic of the apparatus for ERG recording including virtual reality 10 goggles; Figure 3 is an example of a multifocal multichannel VEP recording from a normal subject using conventional screen (Fig 3A) and goggles (Fig 3B); Figure 4A shows the printout from a subjective Humphrey visual field test with a scotoma demonstrated in the inferior visual field of the right eye of a glaucoma patient; 15 Figure 4B shows a multifocal multichannel VEP recording using virtual reality goggles from the same eye as in Figure 4A; Figure 5 shows the correlation between multifocal VEP amplitude and electroencephalogram (EEG) levels during recording; Figure 6A shows an example of normal Fourier spectrum of EEG used for scaling 20 VEP results; Figure 6B shows a trace with strong alpha-rhythm activity around 8 Hz which must be removed before scaling (for example by using a polynomial algorithm); and Figure 6C shows rhythmic electrocardiogram spikes which also need to be excluded. Description of the Invention 25 Figure I shows a schematic of the apparatus for VEP recording using virtual reality goggles (1), which present the display to the subject. The goggles are connected to a computer (2) with a linked video board that generates the multifocal stimulus. Recording electrodes on the scalp (5) and a ground reference electrode (shown on the earlobe), detect the VEP signal from one or more recording channels (in this case four channels are shown). 30 The signals are conducted to an amplifier (3), before being processed by software for presentation on the operators display (4). Results can be compared for each eye, or between the two eyes of a subject, with respect to normal reference values. Figure 2 shows a schematic of the apparatus for multifocal ERG recording using virtual reality goggles (1). The set up is the same as in Figure 1 except that the recording 7 electrode is placed in contact with the eye or eyelid. A ground electrode is required (shown on the earlobe). Only one channel recording is required for the ERG. Figure 3 is an example of a multifocal multichannel VEP recording from the right and left eye of a normal subject. Figure 3A shows the responses achieved using a conventional 5 screen (22 inch Hitachi monitor) to present the stimulus. A cortically scaled dartboard stimulus was generated with 60 different areas of pattern stimulation using the ObjectiVision perimeter. The trace array shown in the figure represents the responses generated from each part of the visual field tested out to 27 degrees of eccentricity temporally and 34 degrees nasally. For graphics purposes the central areas are relatively 10 enlarged to show the raw VEP signal within that area. Figure 3B shows a multifocal multichannel VEP recordings from the same normal subject as in Figure 3A, recorded using virtual reality goggles to present the same stimulus instead of the conventional monitor. The same ObjectiVision system was used. The responses are of similar order of magnitude in the two techniques, although there is some variation in amplitude across the field. Due to 15 the specifications of the goggles used, the display was limited to 21 degrees temporally and 27 degrees nasally. Figure 4 provides a comparison between subjective perimetry findings and the objective VEP assessment of the visual field using virtual reality goggles. Figure 4A shows the grayscale and pattern deviation printout from a subjective Humphrey visual field test of 20 the right eye of a glaucoma patient. An inferior arcuate scotoma (blind spot) is shown in the visual field. Figure 4B shows the multifocal multichannel VEP recording from the same eye as in Figure 4A, recorded using virtual reality goggles. Analysis of the signals demonstrates loss of VEP responses corresponding to the inferior scotoma in Figure 4A, with more extensive reductions in the superior field than seen on the Humphrey. The amplitude 25 deviation plot shades areas according to probability of abnormality when compared to a reference range of normal values extrapolated from the conventional screen ObjectiVision system. This suggests that the technique is capable of detecting visual field loss in glaucoma, just as it is with the use of the conventional large screen. It may also demonstrate more significant glaucomatous damage than suspected on conventional Humphrey field 30 testing. Five glaucoma patients have been tested with the virtual reality goggles and the scotomas were detected in all five cases. Examination of multifocal VEP data from normal subjects using conventional CRT monitors demonstrated that the amplitude of the multi-focal VEP is not age-dependant (contrary to most electrophysiology parameters, eg the pattern ERG). In fact, some elderly 8 people produce VEP responses of higher amplitude. Individual variation in the thickness of the scalp or subcutaneous tissue may cause inter-individual differences in VEP amplitude due to variable impedance of bone and fat. Direct measurement of the thickness or impedance of these tissues is not currently practical. However, the impedance will also 5 affect the amplitude of the spontaneous brain activity (EEG) in a similar fashion to the VEP. To confirm this we conducted a study using the ObjectiVision VEP perimeter of the correspondence between spontaneous EEG amplitude (99% confidence interval) and multifocal VEP amplitude (largest amplitude of a trace). The study included 34 normal subjects. The results demonstrated a strong correlation between the EEG amplitude and 10 VEP (correlation coefficient r=0.81). The scatterplot for the correlation is shown in Figure 5. An alternative method to measure background EEG activity is to calculate a Fourier power spectrum of the EEG. Therefore, if the level of spontaneous EEG activity is calculated during the recording, it provides an indirect measure of the overall registration of brain signals for that individual 15 for the electrode positions used. Whilst it is recognised that EEG amplitude is determined by many additional factors other than conductivity, it is proposed that scaling of an individual's VEP responses according to their EEG levels, relative to normal population EEG values, helps to reduce inter-individual VEP variability. The EEG amplitude is approximately 1000x the amplitude of the VEP, so it is 20 reasonable to assume that the VEP signals themselves will have little contribution to the raw EEG levels. In analysis of multifocal VEP recordings the EEG raw data is actually examined by cross-correlation techniques to extract the VEP signals. When recording from an individual, the overall level of the raw EEG (99% confidence interval) as recorded during each run of the VEP recording, can be used to provide an individual's scaling factor. 25 The VEP extracted is then scaled by the EEG scaling factor. The value of the technique of the invention of VEP scaling was confirmed by examining the data from 50 normals. The coefficient of variation for all 60 visual field test points had a mean value of 50.1%. When the results were scaled according to background EEG values the coefficient of variation for all 60 visual field test points was reduced to 30 28.2%. By using EEG scaling, the sensitivity of the test was also improved. In a study of 60 glaucoma cases using the ObjectiVision system for multifocal VEP perimetry, several glaucoma cases were not flagged as abnormal using the unscaled data since the subjects had overall large signals compared with normal, even though focal relative reductions could be 9 seen when examining the trace arrays. With the data scaled according to EEG levels however, these subjects were identified as having localised reductions in their VEP amplitudes and the scotomas were flagged appropriately. The EEG raw data can contain a large component of alpha rhythm signals and also 5 spikes of electrocardiogram signals. If these are not excluded from the scaling factor applied, then some subjects will have their data inadvertently scaled down lower than is appropriate. This can introduce false positive results in the VEP. One technique for rectifying this problem is to examine the raw signal by Fourier analysis and any alpha rhythm spikes and electrocardiogram signals can be identified. These can then be excluded 10 from the spectrum before calculating a scaling coefficient. Therefore scaling of the VEP amplitude based on amplitude of spontaneous brain activity eliminates part of the variability between individuals caused by differences in conductivity of tissues. This technique has application in analysing multifocal VEP signals recorded with conventional CRT monitors, plasma screens, LCD screens, or with virtual 15 reality goggles. Industrial Applicability The method and system of this invention will find wide use in the medical field, specifically in the field of ophthalmology. The foregoing describes only some embodiments of the invention and modifications 20 can be made thereto without departing from the scope of the invention. References 1. Baseler HA & Sutter EE. Vis Research 1997; 37(6):675-790 25 2. Klistorner Al, et al Invest Ophthalmol Vis Sci 1998; 39(6):937-950 3. Klistorner Al, et al Aust N Z J Ophthalmol 1998;26:91-94. 4. Graham SL, & Klistomer A. Aust N Z J Ophthalmol 1998;26:71-85 5. Graham SL, et al Surv Ophthalmol 1999; 43 (Suppll):s199-209 6. Graham SL & Klistorner A. Curr Opin Ophthalmol 1999; 10:140-146. 30 7. Graham SL, et al J Glaucoma 2000;9,10-19 8. Kondo, M, et al Invest Ophthalmol Vis Sci, 1995;36:2146-2150 9. Vaegan & Buckland L. ANZ J Ophthalmol 1996; 24(2):28-31 10. Johnson CA, et al J Glaucoma 2000;9(AGS abstract): 110 11. US Patent 4,846,567 (Sutter) 35 12. Graham S et al Vol 40 Invest Ophthalmol Vis Sci, 1999, 40 (4) ARVO Abstract #318 10 13. US Patent 5,539,482 (James & Maddess) 14. GoldR IEEE Trans, 1967, V.IT- 13 (4) 619-621 15. Sarwate & Pursley. Proc IEEE, 1980, Vol 68 (5) 593-619 16. Olsen et al IEEE Trans, 1982, V.IT-28(6) 858-864 5 17. Kamaletdinov B. Problems of Information Transmission, 1988, Vol 23 (2) 104-107 18. Klistorner PCT/AU99/00340

Claims (15)

1. A method for analysing at least one multifocal visual evoked potential recording from any mode of multifocal stimulation of a subject comprising scaling the visual evoked potential recording output from computer software according to overall 5 spontaneous brain activity levels (ie. electroencephalogram levels) of the subject during the recording in order to minimise inter-subject variability.

2. A method according to claim 1 for analysing at least one multifocal visual evoked potential recording of at least two subjects to minimise inter-subject variability, the method comprising: 10 (a) for each subject, recording the at least one visual evoked potential and the subject's overall spontaneous brain activity levels; (b) for each subject, calculating a corresponding scaling factor, the scaling factor being derived from the subject's overall spontaneous brain activity levels output from the computer software; and is (c) said scaling of the output comprising scaling each subject's visual evoked potential recording by that subject's corresponding scaling factor such that the variability of the visual evoked potential recordings induced by the multifocal stimulation between the at least two subjects is minimised.

3. A method according to claim I for analysing at least one multifocal visual 20 evoked potential recording of the subject to minimise inter-subject variability between individuals of a population, the method comprising: (a) recording the at least one visual evoked potential and the subject's overall spontaneous brain activity levels; (b) calculating a corresponding scaling factor, the scaling factor being derived from 25 the subject's overall spontaneous brain activity levels output from the computer software; and (c) said scaling of the output comprising scaling each the subject's visual evoked potential recording by the subject's corresponding scaling factor such that the variability of the visual evoked potential recordings induced by the multifocal stimulation between 30 individuals of a population is minimised.

4. The method of either claim 2 or 3 wherein step (b) comprises for the or each subject, calculating a corresponding scaling factor, the scaling factor being derived from the or each subject's overall spontaneous brain activity levels after the component of alpha rhythm is identified and high alpha rhythm signals are removed in the scaling. 12

5. The method of claim 4 wherein the component of alpha rhythm is identified by Fourier analysis.

6. The method of either claim 2 or 3 wherein step (b) comprises for the or each subject, using Fourier power spectrum analysis to determine the or each subject's overall 5 spontaneous brain activity levels, thereby to calculate a scaling factor.

7. The method of any one of claims 1 to 6 wherein the or each subject's overall spontaneous brain activity levels are recorded simultaneously during the recording of at least one visual evoked potential.

8. The method of any one of claims I to 7 wherein the multifocal stimulation is io adapted to stimulate different parts of the visual field of an eye of the or each subject.

9. The method of claim 8 wherein each of the different parts of the visual field are stimulated with random sequences of different timing or character.

10. The method of either claim 8 or 9 wherein each of the different parts of the visual field is stimulated with diffuse or structured stimuli which can vary in intensity, 15 colour, size or temporal characteristics.

11. The method of any one of claims 8 to 10 wherein the responses from each of the different parts of the visual field are recorded simultaneously.

12. The method of any one of the preceding claims wherein the multifocal stimulation is adapted to simultaneously stimulate different parts of the visual field of two 20 eyes of the or each subject, wherein different stimuli are presented to the two eyes for simultaneous recording of signals from the two eyes.

13. The method of any one of the preceding claims further comprising the step of identifying and removing effect of electrocardiogram spikes.

14. The method of claim 13 wherein the electrocardiogram spikes are identified 25 by Fourier analysis of the or each subject's recorded overall spontaneous brain activity levels.

15. A method for analysing at least one multifocal visual evoked potential recording substantially as herein described with reference to any one of the embodiments of the invention illustrated in the accompanying drawings and/or examples. 30 Dated 18 February 2010 The University of Sydney Patent Attorneys for the Applicant/Nominated Person SPRUSON & FERGUSON