106 research outputs found

    Kurtosis-based detection of intracranial high-frequency oscillations for the identification of the seizure onset zone

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    Pathological High-Frequency Oscillations (HFOs) have been recently proposed as potential biomarker of the seizure onset zone (SOZ) and have shown superior accuracy to interictal epileptiform discharges in delineating its anatomical boundaries. Characterization of HFOs is still in its infancy and this is reflected in the heterogeneity of analysis and reporting methods across studies and in clinical practice. The clinical approach to HFOs identification and quantification usually still relies on visual inspection of EEG data. In this study, we developed a pipeline for the detection and analysis of HFOs. This includes preliminary selection of the most informative channels exploiting statistical properties of the pre-ictal and ictal intracranial EEG (iEEG) time series based on spectral kurtosis, followed by wavelet-based characterization of the time-frequency properties of the signal. We performed a preliminary validation analyzing EEG data in the ripple frequency band (80-250[Formula: see text]Hz) from six patients with drug-resistant epilepsy who underwent pre-surgical evaluation with stereo-EEG (SEEG) followed by surgical resection of pathologic brain areas, who had at least two-year positive post-surgical outcome. In this series, kurtosis-driven selection and wavelet-based detection of HFOs had average sensitivity of 81.94% and average specificity of 96.03% in identifying the HFO area which overlapped with the SOZ as defined by clinical presurgical workup. Furthermore, the kurtosis-based channel selection resulted in an average reduction in computational time of 66.60%

    EPINETLAB:a software for seizure-onset zone identification from intracranial EEG signal in epilepsy

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    The pre-operative workup of patients with drug-resistant epilepsy requires in some candidates the identification from intracranial EEG (iEEG) of the seizure-onset zone (SOZ), defined as the area responsible of the generation of the seizure and therefore candidate for resection. High-frequency oscillations (HFOs) contained in the iEEG signal have been proposed as biomarker of the SOZ. Their visual identification is a very onerous process and an automated detection tool could be an extremely valuable aid for clinicians, reducing operator-dependent bias and computational time. In this manuscript we present the EPINETLAB software, developed as a collection of routines integrated in the EEGLAB framework that aim to provide clinicians with a structured analysis pipeline for HFOs detection and SOZ identification. The tool implements an analysis strategy developed by our group and underwent a preliminary clinical validation that identifies the HFOs area by extracting the statistical properties of HFOs signal and that provides useful information for a topographic characterization of the relationship between clinically defined SOZ and HFO area. Additional functionalities such as inspection of spectral properties of ictal iEEG data and import and analysis of source-space MEG data were also included. EPINETLAB was developed with user-friendliness in mind to support clinicians in the identification and quantitative assessment of HFOs in iEEG and source space MEG data and aid the evaluation of the SOZ for pre-surgical assessment

    Detection of Pathological HFO Using Supervised Machine Learning and iEEG Data

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    Epilepsy is the second most common neurological disorder and it affects approxi mately 50 million people worldwide. One of the main characteristics of this disorder is the presence of recurrent seizures which tend to be controlled through medication. Nonetheless, 20% of the patients with this disorder are resistant to drug treatment meaning that they need to go through alternative procedures

    Interictal magnetoencephalographic findings related with surgical outcomes in lesional and nonlesional neocortical epilepsy

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    Purpose: To investigate whether interictal magnetoencephalography (MEG) concordant with other techniques can predict surgical outcome in patients with lesional and nonlesional refractory neocortical epilepsy (NE). Methods: 23 Patients with lesional NE and 20 patients with nonlesional NE were studied. MEG was recorded for all patients with a 275 channel whole-head system. Synthetic aperture magnetometry (SAM) with excess kurtosis (g2) and conventional Equivalent Current Dipole (ECD) were used for MEG data analysis. 27 Patients underwent long-term extraoperative intracranial video electroencephalography (iVEEG) monitoring. Surgical outcomes were assessed based on more than 1-year of post-surgical follow-up using Engel classification system. Results: As we expected, both favorable outcomes (Engel class I or II) and seizure freedom outcomes (Engel class IA) were higher for the concordance condition (MEG findings are concordant with MRI or iVEEG findings) versus the discordance condition. Also the seizure free rate was significantly higher (x2 = 5.24, P \u3c 0.05) for the patients with lesional NE than for the patients with nonlesional NE. In 30% of the patients with nonlesional NE, the MEG findings proved to be valuable for intracranial electrode implantation. Conclusions: This study demonstrates that a favorable post-surgical outcome can be obtained in most patients with concordant MEG and MRI results even without extraoperative iVEEG monitoring, which indicates that the concordance among different modalities could indicate a likelihood of better postsurgical outcomes. However, extraoperative iVEEG monitoring remains prerequisite to the patients with discordant MEG and MRI findings. For nonlesional cases, our results showed that MEG could provide critical information in the placement of intracranial electrodes

    Localising epileptiform activity and eloquent cortex using magnetoencephalography

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    In patients with drug resistant epilepsy, the surgical resection of epileptogenic cortex allows the possibility for seizure freedom, provided that epileptogenic and eloquent brain tissue can be accurately identified prior to surgery. This is often achieved using various techniques including neuroimaging, electroencephalographic (EEG), neuropsychological and invasive measurements. Over the last 20 years, magnetoencephalography (MEG) has emerged as a non-invasive tool that can provide important clinical information to patients with suspected neocortical epilepsy being considered for surgery. The standard clinical MEG analyses to localise abnormalities are not always successful and therefore the development and evaluation of alternative methods are warranted. There is also a continuous need to develop MEG techniques to delineate eloquent cortex. Based on this rationale, this thesis is concerned with the presurgical evaluation of drug resistant epilepsy patients using MEG and consists of two themes: the first theme focuses on the refinement of techniques to functionally map the brain and the second focuses on evaluating alternative techniques to localise epileptiform activity. The first theme involved the development of an alternative beamformer pipeline to analyse Elekta Neuromag data and was subsequently applied to data acquired using a pre-existing and a novel language task. The findings of the second theme demonstrated how beamformer based measures can objectively localise epileptiform abnormalities. A novel measure, rank vector entropy, was introduced to facilitate the detection of multiple types of abnormal signals (e.g. spikes, slow waves, low amplitude transients). This thesis demonstrates the clinical capacity of MEG and its role in the presurgical evaluation of drug resistant epilepsy patients

    Interictal Network Dynamics in Paediatric Epilepsy Surgery

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    Epilepsy is an archetypal brain network disorder. Despite two decades of research elucidating network mechanisms of disease and correlating these with outcomes, the clinical management of children with epilepsy does not readily integrate network concepts. For example, network measures are not used in presurgical evaluation to guide decision making or surgical management plans. The aim of this thesis was to investigate novel network frameworks from the perspective of a clinician, with the explicit aim of finding measures that may be clinically useful and translatable to directly benefit patient care. We examined networks at three different scales, namely macro (whole brain diffusion MRI), meso (subnetworks from SEEG recordings) and micro (single unit networks) scales, consistently finding network abnormalities in children being evaluated for or undergoing epilepsy surgery. This work also provides a path to clinical translation, using frameworks such as IDEAL to robustly assess the impact of these new technologies on management and outcomes. The thesis sets up a platform from which promising computational technology, that utilises brain network analyses, can be readily translated to benefit patient care

    An evaluation of kurtosis beamforming in magnetoencephalography to localize the epileptogenic zone in drug resistant epilepsy patients

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    OBJECTIVE: Kurtosis beamforming is a useful technique for analysing magnetoencephalograpy (MEG) data containing epileptic spikes. However, the implementation varies and few studies measure concordance with subsequently resected areas. We evaluated kurtosis beamforming as a means of localizing spikes in drug-resistant epilepsy patients. METHODS: We retrospectively applied kurtosis beamforming to MEG recordings of 22 epilepsy patients that had previously been analysed using equivalent current dipole (ECD) fitting. Virtual electrodes were placed in the kurtosis volumetric peaks and visually inspected to select a candidate source. The candidate sources were compared to the ECD localizations and resection areas. RESULTS: The kurtosis beamformer produced interpretable localizations in 18/22 patients, of which the candidate source coincided with the resection lobe in 9/13 seizure-free patients and in 3/5 patients with persistent seizures. The sublobar accuracy of the kurtosis beamformer with respect to the resection zone was higher than ECD (56% and 50%, respectively), however, ECD resulted in a higher lobar accuracy (75%, 67%). CONCLUSIONS: Kurtosis beamforming may provide additional value when spikes are not clearly discernible on the sensors and support ECD localizations when dipoles are scattered. SIGNIFICANCE: Kurtosis beamforming should be integrated with existing clinical protocols to assist in localizing the epileptogenic zone

    Temporal Characteristics of High-Frequency Oscillations as a Biomarker of Human Epilepsy

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    Epilepsy is a debilitating neurological disorder characterized by recurrent spontaneous seizures. While seizures themselves adversely affect physiological function for short time periods relative to normal brain states, their cumulative impact can significantly decrease patient quality of life in myriad ways. For many, anti-epileptic drugs are effective first-line therapies. One third of all patients do not respond to chemical intervention, however, and require invasive resective surgery to remove epileptic tissue. While this is still the most effective last-line treatment, many patients with ‘refractory’ epilepsy still experience seizures afterward, while some are not even surgical candidates. Thus, a significant portion of patients lack further recourse to manage their seizures – which additionally impacts their quality of life. High-frequency oscillations (HFOs) are a recently discovered electrical biomarker with significant clinical potential in refractory human epilepsy. As a spatial biomarker, HFOs occur more frequently in epileptic tissue, and surgical removal of areas with high HFO rates can result in improved outcomes. There is also limited preliminary evidence that HFOs change prior to seizures, though it is currently unknown if HFOs function as temporal biomarkers of epilepsy and imminent seizure onset. No such temporal biomarker has ever been identified, though if it were to exist, it could be exploited in online seizure prediction algorithms. If these algorithms were clinically implemented in implantable neuromodulatory devices, improvements to quality of life for refractory epilepsy patients might be possible. Thus, the overall aim of this work is to investigate HFOs as potential temporal biomarkers of seizures and epilepsy, and further to determine whether their time-varying properties can be exploited in seizure prediction. In the first study we explore population-level evidence for the existence of this temporal effect in a large clinical cohort with refractory epilepsy. Using sophisticated automated HFO detection and big-data processing techniques, a continuous measure of HFO rates was developed to explore gradual changes in HFO rates prior to seizures, which were analyzed in aggregate to assess their stereotypical response. These methods resulted in the identification of a subset of patients in whom HFOs from epileptic tissue gradually increased before seizures. In the second study, we use machine learning techniques to investigate temporal changes in HFO rates within individuals, and to assess their potential usefulness in patient-specific seizure prediction. Here, we identified a subset of patients whose predictive models sufficiently differentiated the preictal (before seizure) state better than random chance. In the third study, we extend our prediction framework to include the signal properties of HFOs. We explore their ability to improve the identification of preictal periods, and additionally translate their predictive models into a proof-of-concept seizure warning system. For some patients, positive results from this demonstration show that seizure prediction using HFOs could be possible. These studies overall provide convincing evidence that HFOs can change in measurable ways prior to seizure start. While this effect was not significant in some individuals, for many it enabled seizures to be predicted above random chance. Due to data limitations in overall recording duration and number of seizures captured, these findings require further validation with much larger high-density intracranial EEG datasets. Still, they provide a preliminary framework for the eventual use of HFOs in patient-specific seizure prediction with the potential to improve the lives of those with refractory epilepsy.PHDBiomedical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/168079/1/jaredmsc_1.pd

    Advanced neuroimaging techniques in epilepsy

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    PURPOSE OF REVIEW: We review significant advances in epilepsy imaging in recent years. RECENT FINDINGS: Structural MRI at 7T with optimization of acquisition and postacquisition image processing increases the diagnostic yield but artefactual findings remain a challenge. MRI analysis from multiple sites indicates different atrophy patterns and white matter diffusion abnormalities in temporal lobe and generalized epilepsies, with greater abnormalities close to the presumed seizure source. Structural and functional connectivity relate to seizure spread and generalization; longitudinal studies are needed to clarify the causal relationship of these associations. Diffusion MRI may help predict surgical outcome and network abnormalities extending beyond the epileptogenic zone. Three-dimensional multimodal imaging can increase the precision of epilepsy surgery, improve seizure outcome and reduce complications. Language and memory fMRI are useful predictors of postoperative deficits, and lead to risk minimization. FDG PET is useful for clinical studies and specific ligands probe the pathophysiology of neurochemical fluxes and receptor abnormalities. SUMMARY: Improved structural MRI increases detection of abnormalities that may underlie epilepsy. Diffusion, structural and functional MRI indicate the widespread associations of epilepsy syndromes. These can assist stratification of surgical outcome and minimize risk. PET has continued utility clinically and for research into the pathophysiology of epilepsies
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