Ictal EEG Source Imaging in Frontal Lobe Epilepsy Leads to Improved Lateralization Compared With Visual Analysis

The effect of apolipoprotein E ɛ4 (APOE E4) on visuospatial working memory in healthy elders and amnestic mild cognitive impairment patients: An event-related potentials study

Clinical Neurophysiology: EEG–Video Monitoring

INTRODUCTION Localization-related epilepsy frequently involves mesial temporal lobe structures (MTLS), but sometimes presurgical workup can be confusing since shortage of definite structural lesional evidence or inconsistency among multimodal tools. Occasionally invasive workup is applied. This study evaluates the application of multimodal workup in surgical strategy making of localization-related epilepsy involving MTLS. METHODS Our study includes patients with significant or subtle MTLS abnormality (or magnetic resonance imaging (MRI) negative) in 3.0T MRI and then underwent resective surgeries encompassing MTLS. In addition to conventional workup tools, accurate EEG source imaging (ESI) technique based on individual head models is available. Patients accepted either 1-stage resective surgeries or staged surgeries (SEEG implantation + stage-2 resective surgeries). Contributions of structural MRI, fluorodeoxyglucose-positron emission tomography (FDG-PET), accurate ESI, and ictal EEG to surgical strategies were evaluated by criteria defining epileptogenic zone (resective scope in cases with good outcome). RESULTS Thirty-five patients who achieved Engel grade I + II outcome after resective surgeries were included. All together, 68.6% cases showed ESI sources totally falling into resective scope. 42.9% ictal EEG estimates, 57.1% PET focal hypometabolistic regions, 74.3% MRI structural lesions fitted the resective scope/side. In total, 75% 1-stage cases showed ESI sources being confined in MTLS region, while PET showed focal hypometabolism in 66.7% and MRI indicated single MTLS lesions (including subtle ones) in 79.2% cases. In total, 54.5% ESI sources and 63.6% MRI abnormality (single, including subtle ones) in staged cases showed complete concordance with SEEG findings. In subtle lesional/MRI negative cases, ESI generated sources confined within MTLS in 77.8% cases, while PET estimates are focally localizing in 44.4% cases and 55.6% showed subtle MRI lesions which were firstly diagnosed “negative.” CONCLUSION Multimodal noninvasive workup are contributable to help decide strategy of 1-stage resective surgeries and SEEG plans in localization-related epilepsy. High-quality structural MRI, accurate ESI technique based on scalp EEG as well as FDG-PET are key to presurgical planning of epilepsy involving MTLS.

Localizable scalp EEGs, during ictal episodes, appear to be rare in neocortical epileptic syndromes. However, studies based on large numbers of patients are also rare. This study aims to identify the characteristic patterns of variable neocortical epilepsies and to evaluate their clinical usefulness in the localization of epileptogenic focuses. We retrospectively assessed 394 noninvasive ictal recordings from 86 patients who subsequently underwent invasive study and resective surgery. Ictal EEGs were recorded using a video-EEG monitoring system with electrodes placed according to the International 10-20 system, with additional anterior temporal electrodes. The ictal recordings were analyzed according to localizing accuracy and frequency characteristics. The durations of discrete or regional ictal rhythms were also measured. The percentage of discrete or regional EEGs was 23% in frontal lobe epilepsy, 52% in lateral temporal lobe epilepsy, 70% in occipital lobe epilepsy, and 10% in parietal lobe epilepsy. In order of frequency, the localizable ictal rhythms were theta, beta, alpha, delta, and rhythmic spike-and-wave. The duration of discrete or regional ictal rhythms was significantly shorter in frontal lobe epilepsy and parietal lobe epilepsy than in other epilepsies. Ictal beta activity was the most common rhythm in discrete-patterned EEGs. Structural lesions found on MRI did not significantly affect the localization of epileptogenic focuses in the patients. The type of seizure was not related to the degree of localization, with the exception of simple partial seizure. Ictal surface EEG was clinically helpful in the localization of epileptogenic focuses in at least some neocortical epileptic syndromes.

The aims of this analysis were to: (1) determine the value of ictal SPECT in the localization of neocortical epileptogenic foci, (2) evaluate the relationships between the results of ictal SPECT and other potential affecting factors, and (3) compare traditional visual analysis and the subtraction method. We retrospectively analyzed 81 consecutive patients with neocortical epilepsy who underwent epilepsy surgery and achieved a favourable surgical outcome, including 36 patients with normal MRI. Side-by-side visual analysis and subtraction images were classified as correctly localizing,correctly lateralizing, or non-localizing/non-lateralizing images according to the resected lobe. Side-by-side visual analysis and subtraction SPECT correctly localized the epileptogenic lobe in 58.9% and 63.0% of patients, respectively. The two methods were complementary and the diagnostic sensitivity of ictal SPECT using the two methods was 79.0%. Ictal SPECT using the visual method correctly localized the epileptogenic lobe more frequently in patients with a localizing pattern of ictal scalp EEG at the time of radioligand injection. When using subtraction images, an injection delay of less than 20 s after seizure onset was significantly correlated with correct localization. The subtraction method was superior to the visual method for localizing frontal lobe epilepsy (FLE) and parietal lobe epilepsy (PLE), and in patients with non-localizing/non-lateralizing EEG at onset. Ictal SPECT analyses using visual and subtraction methods are useful and complementary for the localization of the epileptogenic foci of neocortical epilepsy. Early radioligand injection and ictal EEG patterns are related to ictal SPECT localization. The subtraction method may be more useful in some epileptic syndromes.

The curtain of technical limitations impeding rat multichannel non-invasive electroencephalography (EEG) has risen. Given the importance of this preclinical model, development and validation of EEG source imaging (ESI) is essential. We investigate the validity of well-known human ESI methodologies in rats which individual tissue geometries have been approximated by those extracted from an MRI template, leading also to imprecision in electrode localizations. With the half and fifth sensitivity volumes we determine both the theoretical minimum electrode separation for non-redundant scalp EEG measurements and the electrode sensitivity resolution, which vary over the scalp because of the head geometry. According to our results, electrodes should be at least ~3 to 3.5mm apart for an optimal configuration. The sensitivity resolution is generally worse for electrodes at the boundaries of the scalp measured region, though, by analogy with human montages, concentrates the sensitivity enough to localize sources. Cramér-Rao lower bounds of source localization errors indicate it is theoretically possible to achieve ESI accuracy at the level of anatomical structures, such as the stimulus-specific somatosensory areas, using the template. More validation for this approximation is provided through the comparison between the template and the individual lead field matrices, for several rats. Finally, using well-accepted inverse methods, we demonstrate that somatosensory ESI is not only expected but also allows exploring unknown phenomena related to global sensory integration. Inheriting the advantages and pitfalls of human ESI, rat ESI will boost the understanding of brain pathophysiological mechanisms and the evaluation of ESI methodologies, new pharmacological treatments and ESI-based biomarkers.

To evaluate magnetic resonance imaging (MRI) and electro-encephalogram (EEG) findings of patients with therapy-resistant partial seizures due to neuronal migration disorders (NMD), and compare them with each other and with surgery outcome. The MRI, interictal and ictal EEG findings, and their relations to each other in 41 patients with NMD were compared with class IA surgery outcome. The patients showed an MRI lesion in decreasing frequency from the frontal to the occipital areas. A predominantly extratemporal location of the interictal EEG foci (73.3%) and ictal patterns (82.4%) was therefore apparent, also showing a diminishing frequency from the anterior to the posterior areas. Comparing the EEG foci with the MRI lesions, the same location of the interictal foci was found in 68.4% and of the ictal foci in 52.7%, including several cases with a more widespread EEG focus or MRI lesion. The same location of interictal as well as ictal foci was evident in 85.7%. The most favourable surgery outcome (class IA) was, on average, apparent in patients with an MRI lesion (28.6% vs 25%), a main interictal EEG focus (50% vs 18%) and an ictal seizure pattern (37.5% vs 16.7%) located in the temporal area; likewise, if the interictal focus (30.8% vs 18.2%) and the ictal pattern (31.8% vs 12.5%) showed the same location as the MRI lesion, as well as when the interictal and ictal EEG changes had an equal location (30% vs 20%). MRI and EEG recordings show relatively close relations to each other and might be important methods to predict surgery outcome in NMD patients.

Correlation between scalp-recorded electroencephalographic and electrocorticographic activities during ictal period

To determine whether a focal beta-frequency discharge at seizure onset on scalp EEG predicts outcome of frontal lobe epilepsy (FLE) surgery. We identified 54 consecutive patients with intractable FLE who underwent epilepsy surgery between December 1987 and December 1996. A blind review of EEGs and magnetic resonance images (MRIs) was performed. Lesional epilepsy is defined as presence of an underlying structural abnormality on MRI. Overall, 28 (52%) patients were seizure free, with a mean follow-up of 46.5 months. Presence of a focal beta-frequency discharge at seizure onset on scalp EEG predicted seizure-free outcome in lesional (p = 0.02) and non-lesional (p = 0.01) epilepsy patients. At least 90% of patients who had either lesional or non-lesional epilepsy were seizure free if scalp EEG revealed a focal beta discharge at ictal onset. Moreover, logistic regression analysis showed that focal ictal beta pattern and completeness of lesion resection were independently predictive of seizure-free outcome. Ictal onset with lateralized EEG activity of any kind and postresection electrocorticographic spikes did not predict surgical outcome (p > 0.05). Only about 25% of FLE surgical patients have a focal beta-frequency discharge at seizure onset on scalp EEG. However, its presence is highly predictive of excellent postsurgical seizure control in either lesional or non-lesional FLE surgical patients.

Brain computer interface (BCI) is a technology recording brain signals and translate into machine language to drive device movement. To improve the convenience and practicability of BCI systems, it is necessary to reduce the number of channels of EEG without reducing classification accuracy. In this paper, a channel selection method was proposed. Combine continuous wavelet transform (CWT) with EEG source imaging (ESI), we can find out the source distribution of two kinds of motor imagery (MI) tasks on the cortex. Then the different value of source distribution on the cortex was projected to scalp. The value on the scalp was treated as a criterion for channel selection. While ESI was applied for locating the active areas, we can not only find out the prior channels clearly, but also figure out the expected areas briefly. The satisfying results show that the combination of CWT and ESI is a potential method for dealing with MI tasks.

Ictal unilateral eye blinking and contralateral blink inhibition — A video-EEG study and review of the literature☆

Epilepsy is a relatively frequent disease in children, with considerable impact on cognitive and social life. Successful epilepsy surgery depends on unambiguous focus identification and requires a comprehensive presurgical workup, including several neuroimaging techniques [magnetic resonance imaging, positron emission tomography (PET), and single-photon emission computed tomography (SPECT)]. These may be difficult to apply in younger or developmentally delayed children or both, requiring sedation, and hence, a significant workforce. Modern electric source imaging (ESI) provides accurate epileptic source-localization information in most patients, with minimal patient discomfort or need for cooperation. The purpose of the present study was to determine the usefulness of ESI in pediatric EEG recordings performed with routine electrode arrays. Preoperative EEGs recorded from 19 to 29 scalp electrodes were reviewed, and interictal epileptiform activity was analyzed by using a linear source-imaging procedure (depth-weighted minimum norm) in combination with statistical parametric mapping. In 27 (90%) of 30 patients, the ESI correctly localized the epileptogenic region. These numbers compare favorably with the results from other imaging techniques in the same patients (PET, 82%; ictal SPECT, 70%). In extratemporal epilepsy, ESI was correct in all cases, and in temporal lobe epilepsy, in 10 of 13 cases. In two temporal lobe patients showing less-accurate ESI results, 128-electrode data could be analyzed, and in both cases, the 128-electrode ESI was correct. ESI with standard clinical EEG recordings provides excellent localizing information in pediatric patients, in particular in extratemporal lobe epilepsy. The lower yield in temporal lobe epilepsy seems to be due to undersampling of basal temporal areas with routine scalp recordings.

The brain-to-skull conductivity ratio (BSCR) is an important parameter in EEG source imaging and localization. Misspecification of this value may introduce localization errors in the estimation of brain electrical activity. However, the effect of this ratio has not been well understood despite many investigations. In the present study, we conducted a series of computer simulations to investigate the relationship between BSCR and EEG source localization accuracy. Furthermore, we have attempted to correlate the localization accuracy of epileptogenic regions with the BSCR in epilepsy patients. Our results indicate that the dipole localization errors ranged from 10 to 20 mm. The localization accuracy resulting when the conductivity ratio used in the inverse calculation was set at 20 was better than those resulting when the ratio was set at 80 in epilepsy patients with a deep tumor. Future work is needed to validate this finding by experimental investigations in a large patient population.

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