Sleep affects cortical source modularity in temporal lobe epilepsy: A high-density EEG study

Objective: Interictal epileptiform discharges (IEDs) constitute a perturbation of ongoing cerebral rhythms, usually more frequent during sleep. The aim of the study was to determine whether sleep influences the spread of IEDs over the scalp and whether their distribution depends on vigilance-related modifications in cortical interactions. Methods: Wake and sleep 256-channel electroencephalography (EEG) data were recorded in 12 subjects with right temporal lobe epilepsy (TLE) differentiated by whether they had mesial or neocortical TLE. Spikes were selected during wake and sleep. The averaged waking signal was subtracted from the sleep signal and projected on a bidimensional scalp map; sleep and wake spike distributions were compared by using a t-test. The superimposed signal of sleep and wake traces was obtained; the rising phase of the spike, the peak, and the deflections following the spike were identified, and their cortical generator was calculated using low-resolution brain electromagnetic tomography (LORETA) for each group. Results: A mean of 21 IEDs in wake and 39 in sleep per subject were selected. As compared to wake, a larger IED scalp projection was detected during sleep in both mesial and neocortical TLE (p<0.05). A series of EEG deflections followed the spike, the cortical sources of which displayed alternating activations of different cortical areas in wake, substituted by isolated, stationary activations in sleep in mesial TLE and a silencing in neocortical TLE. Conclusion: During sleep, the IED scalp region increases, while cortical interaction decreases. Significance: The interaction of cortical modules in sleep and wake in TLE may influence the appearance of IEDs on scalp EEG; in addition, IEDs could be proxies for cerebral oscillation perturbation

Quantification of the TMS-EEG response in epilepsy

Dissertação para obtenção do Grau de Mestre em Engenharia BiomédicaPurpose: The purpose of this thesis was to provide quantitative measures of the co-registration of transcranial magnetic stimulation (TMS) and electroencephalogram (EEG). The EEG is used to study changes in the neuronal activity evoked by the non-invasive technique TMS. These effects are determined mainly based on clinical judgment. Current uses in the diagnosis of epilepsy are based only on EEG, not taking into consideration the low sensitivity in the interictal period, in particular if routine recordings are used. Methods: Patient data was gathered, analyzed and compared to healthy controls. A total of ten patients and eighteen healthy subjects underwent sessions of 75 TMS pulses. The responses to the pulses were filtered and averaged. The use of topographical scalp plots of amplitude and power, and time-series analysis of power in search for late responses provide results which enable separation of epilepsy patients and healthy controls. By investigating the significance of the results it is also possible to determine, in a quantitative way how reliable the methods are for distinguishing between the two groups. Results: The definition of what is a response is critical in this project, and as such must consider: significant power change, be above a certain amplitude, and be localized. Still, this procedure results in a non distinguishable threshold to separate both groups. Conclusions: Analysis of the receiver operating characteristic (ROC) curves also led to the understanding the method established is not entirely reliable because it cannot in fact determine differences. Since all patients were under treatment with anti-epileptic drugs(AEDs), it becomes necessary to elaborate a pilot study with recently diagnosed subjects where hyperexcitability is still present

A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations over time in the blood-oxygenation level dependent signal. rs-fcMRI has been applied extensively to identify abnormalities in brain connectivity in different neurologic and psychiatric diseases. However, the relationship among rs-fcMRI connectivity abnormalities, brain electrophysiology and disease state is unknown, in part because the causal significance of alterations in functional connectivity in disease pathophysiology has not been established. Transcranial Magnetic Stimulation (TMS) is a technique that uses electromagnetic induction to noninvasively produce focal changes in cortical activity. When combined with electroencephalography (EEG), TMS can be used to assess the brain's response to external perturbations. Here we provide a protocol for combining rs-fcMRI, TMS and EEG to assess the physiologic significance of alterations in functional connectivity in patients with neuropsychiatric disease. We provide representative results from a previously published study in which rs-fcMRI was used to identify regions with abnormal connectivity in patients with epilepsy due to a malformation of cortical development, periventricular nodular heterotopia (PNH). Stimulation in patients with epilepsy resulted in abnormal TMS-evoked EEG activity relative to stimulation of the same sites in matched healthy control patients, with an abnormal increase in the late component of the TMS-evoked potential, consistent with cortical hyperexcitability. This abnormality was specific to regions with abnormal resting-state functional connectivity. Electrical source analysis in a subject with previously recorded seizures demonstrated that the origin of the abnormal TMS-evoked activity co-localized with the seizure-onset zone, suggesting the presence of an epileptogenic circuit. These results demonstrate how rs-fcMRI, TMS and EEG can be utilized together to identify and understand the physiological significance of abnormal brain connectivity in human diseases

Studying Network Mechanisms Using Intracranial Stimulation in Epileptic Patients

Patients suffering from focal drug-resistant epilepsy who are explored using intracranial electrodes allow to obtain data of exceptional value for studying brain dynamics in correlation with pathophysiological and cognitive processes. Direct electrical stimulation (DES) of cortical regions and axonal tracts in those patients elicits a number of very specific perceptual or behavioral responses, but also abnormal responses due to specific configurations of epileptic networks. Here, we review how anatomo-functional brain connectivity and epilepsy network mechanisms can be assessed from DES responses measured in patients. After a brief summary of mechanisms of action of brain electrical stimulation, we recall the conceptual framework for interpreting DES results in the context of brain connectivity and review how DES can be used for the characterization of functional networks, the identification of the seizure onset zone, the study of brain plasticity mechanisms, and the anticipation of epileptic seizures. This pool of exceptional data may be underexploited by fundamental research on brain connectivity and leaves much to be learned

Influence of deep structures on the EEG and their invasive and non-invasive assessment

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Fisiología, leída el 22-11-2019El EEG es la prueba diagnóstica de mayor utilidad en el diagnóstico de la epilepsia. Consiste esencialmente en la representación gráfica de los potenciales postsinápticos generados en las neuronas piramidales de la corteza. Los campos eléctricos registrados en la superficie tienen principalmente dos mecanismos de origen: conducción de volumen desde regiones adyacentes y propagación interneuronal sináptica. Las neuronal piramidales se agrupan formando microcircuitos locales siendo estos circuitos los responsables de la generación delos ritmos registrados en el EEG. Uno de los principales retos de la electroencefalografía consiste en descifrar la relación entre la actividad registrada y la actividad subyacente en las redes neuronales. Para encontrar la fuente de dichas actividades, es necesario tener en cuenta complejos mecanismos tanto no lineales como lineales, así como el efecto de la conducción de volumen y la influencia de la morfología y las propiedades eléctricas del cerebro y el cráneo. Además, las regiones cerebrales se encuentran profusamente interconectadas a menudo produciendo una modulación recíproca que añade un mayor grado complejidad...The EEG is the most valuable diagnostic test in epilepsy. In essence, it mainly consists in agraphical representation of the summated postsynaptic potentials generated in the pyramidal neurons from the cortex. The electrical fields can be generated on the scalp by two mechanisms: volume conduction from nearby regions and synaptic inter‐neuronal propagation. Pyramidal cells align conforming local microcircuit configurations which activation lead to the generation of EEG rhythms. One of the main challenges of EEG is to decipher the relation between the recorded EEG activity and the activity in the neuronal networks. To find the source of EEG activity, complex non‐linear and linear mechanisms as well as volume conduction effect and influence of the shape and electrical properties of the brain and skull need to be taken in consideration. In addition, brain regions are profusely interconnected and functionally connected regions often produce mutual modulation that adds additional complexity...Depto. de FisiologíaFac. de MedicinaTRUEunpu

On mapping epilepsy : magneto- and electroencephalographic characterizations of epileptic activities

Epilepsy is one of the most common neurological disorder, affecting up to 10 individuals per 1000 persons. The disorder have been known for several thousand years, with the first clinical descriptions dating back to ancient times. Nonetheless, characterization of the dynamics underlying epilepsy remains largely unknown. Understanding these patophysiological processes requires unifying both a neurobiological perspective, as well as a technically advanced neuroimaging perspective. The incomplete insight into epilepsy dynamics is reflected by the insufficient treatment options. Approximately 30% of all patients do not respond to anti-epileptic drugs (AEDs) and thus suffers from recurrent seizures despite adequate pharmacological treatments. These pharmacoresistant patients often undergo epilepsy surgery evaluations. Epilepsy surgery aims to resect the part of the brain that generates the epileptic seizure activity (seizure onset zone, SOZ). Nonetheless, up to 50% of all patients relapse after surgery. This can be due to incomplete mapping of both the SOZ and of other structures that might be involved in seizure initiation and propagation. Such cortical and subcortical structures are collectively referred to as the epileptic network. Historically, epilepsy was considered to be either a generalized disorder involving the entire brain, or a highly localized, focal, disorder. The modern technological development of both structural and functional neuroimaging has drastically altered this view. This development has made significant contributions to the now prevailing view that both generalized and focal epilepsies arise from more or less widespread pathological network pathways. Visualization of these pathways play an important role in the presurgical planning. Thus, both improved characterization and understanding of such pathways are pivotal in improvement of epilepsy diagnostics and treatments. It is evident that epilepsy research needs to stand on two legs: Both improved understanding of pathological, neurobiological and neurophysiological process, and improved neuroimaging instrumentation. Epilepsy research do not only span from visualization to understanding of neurophysiological processes, but also from cellular, neuronal, microscopic processes, to dynamical, large-scale network processes. It is well known that neurons involved in epileptic activities exhibit specific, pathological firing patterns. Genetic mutations resulting in neuronal ion channel defects can cause severe, and even lethal, epileptic syndromes in children, clearly illustrating a role for neuron membrane properties in epilepsy. However, cellular processes themselves cannot explain how epileptic seizures can involve, and propagate across, large cortical areas and generate seizure-specific symptomatologies. A strict cellular perspective can neither explain epilepsy-associated pathological interactions between larger distant regions in between seizures. Instead, the dynamical effects of cellular synchronization across both mesoscopic and macroscopic scales also need to be considered. Today, the only means to study such effects in human subjects are by combinations of neuroimaging modalities. However, as all measurement techniques, these exhibit individual limitations that affect the kind of information that can be inferred from these. Thus, once more we reach the conclusion that epilepsy research needs to rest upon both a neurophysiological/neurobiological leg, and a technical/instrumentational leg. In accordance with this necessity of a dual approach to epilepsy, this thesis covers both neurophysiological aspects of epileptic activity development, as well as functional neuroimaging instrumentation development with focus on epileptic activity detection and localization. Part 1 (neurophysiological part) is concerned with the neurophysiological dynamical changes that underlie development of so called interictal epileptiform discharges (IEDs) with special focus on the role of low-frequency oscillations. To this aim, both conventional magnetoencephalography (MEG) and intracranial electroencephalography (iEEG) with neurostimulation is analyzed. Part 2 (instrumentation part) is concerned with development of cutting-edge, novel on-scalp magnetoencephalography (osMEG) within clinical epilepsy evaluations and research with special focus on IEDs. The theses cover both modeling of osMEG characteristics, as well as the first-ever osMEG recording of a temporal lobe epilepsy patient