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

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

Encoding cortical dynamics in sparse features.

Distributed cortical solutions of magnetoencephalography (MEG) and electroencephalography (EEG) exhibit complex spatial and temporal dynamics. The extraction of patterns of interest and dynamic features from these cortical signals has so far relied on the expertise of investigators. There is a definite need in both clinical and neuroscience research for a method that will extract critical features from high-dimensional neuroimaging data in an automatic fashion. We have previously demonstrated the use of optical flow techniques for evaluating the kinematic properties of motion field projected on non-flat manifolds like in a cortical surface. We have further extended this framework to automatically detect features in the optical flow vector field by using the modified and extended 2-Riemannian Helmholtz-Hodge decomposition (HHD). Here, we applied these mathematical models on simulation and MEG data recorded from a healthy individual during a somatosensory experiment and an epilepsy pediatric patient during sleep. We tested whether our technique can automatically extract salient dynamical features of cortical activity. Simulation results indicated that we can precisely reproduce the simulated cortical dynamics with HHD; encode them in sparse features and represent the propagation of brain activity between distinct cortical areas. Using HHD, we decoded the somatosensory N20 component into two HHD features and represented the dynamics of brain activity as a traveling source between two primary somatosensory regions. In the epilepsy patient, we displayed the propagation of the epileptic activity around the margins of a brain lesion. Our findings indicate that HHD measures computed from cortical dynamics can: (i) quantitatively access the cortical dynamics in both healthy and disease brain in terms of sparse features and dynamic brain activity propagation between distinct cortical areas, and (ii) facilitate a reproducible, automated analysis of experimental and clinical MEG/EEG source imaging data

Evidence for the role of magnetic source imaging in the presurgical evaluation of refractory epilepsy patients

Magnetoencephalography (MEG) in the field of epilepsy has multiple advantages; just like electroencephalography (EEG), MEG is able to measure the epilepsy specific information (i.e., the brain activity reflecting seizures and/or interictal epileptiform discharges) directly, non-invasively and with a very high temporal resolution (millisecond-range). In addition MEG has a unique sensitivity for tangential sources, resulting in a full picture of the brain activity when combined with EEG. It accurately allows to perform source imaging of focal epileptic activity and functional cortex and shows a specific high sensitivity for a source in the neocortex. In this paper the current evidence and practice for using magnetic source imaging of focal interictal and ictal epileptic activity during the presurgical evaluation of drug resistant patients is being reviewed

Improved localization of seizure onset zones using spatiotemporal constraints and time-varying source connectivity

Presurgical evaluation of brain neural activity is commonly carried out in refractory epilepsy patients to delineate as accurately as possible the seizure onset zone (SOZ) before epilepsy surgery. In practice, any subjective interpretation of electroencephalographic (EEG) recordings is hindered mainly because of the highly stochastic behavior of the epileptic activity. We propose a new method for dynamic source connectivity analysis that aims to accurately localize the seizure onset zones by explicitly including temporal, spectral, and spatial information of the brain neural activity extracted from EEG recordings. In particular, we encode the source nonstationarities in three critical stages of processing: Inverse problem solution, estimation of the time courses extracted from the regions of interest, and connectivity assessment. With the aim to correctly encode all temporal dynamics of the seizure-related neural network, a directed functional connectivity measure is employed to quantify the information flow variations over the time window of interest. Obtained results on simulated and real EEG data confirm that the proposed approach improves the accuracy of SOZ localization

Methodological and clinical aspects of ictal and interictal MEG

During the last years magnetoencephalography (MEG), has become an important part of the pre-surgical epilepsy workup. Interictal activity is usually recorded. Nevertheless, the technological advances now enable ictal MEG recordings as well. The records of 26 pharmaco-resistant focal epilepsy patients, who underwent ictal MEG and epilepsy surgery, were reviewed. In 12 patients prediction of ictal onset zone (IOZ) localization by ictal and interictal MEG was compared with ictal intracranial EEG (icEEG). On the lobar surface level the sensitivity of ictal MEG in IOZ location was 0.71 and the specificity 0.73. The sensitivity of the interictal MEG was 0.40 and specificity 0.77. The records of 34 operated epilepsy patients with focal cortical dysplasia (FCD) were retrospectively evaluated. The resected proportion of the source cluster related to interictal MEG was evaluated in respect to postoperative seizure outcome. 17 out of 34 patients with FCD (50%) achieved seizure freedom. The seizure outcome was similar in patients with MR-invisible and MR-visible FCD. With MEG source clusters and favorable seizure outcome (Engel class I and II) the proportion of the cluster volume resection was 49% - significantly higher (p=0.02) than with MEG clusters but unfavorable outcome (5.5% of cluster volume resection). Median nerve somatosensory evoked MEG responses were processed by movement compensation based on signal space separation (MC-SSS) and on spatio-temporal signal space separation (MC-tSSS). MEG was recorded in standard and deviant head positions. With up to 5 cm head displacement, MC-SSS decreased the mean localization error from 3.97 to 2.13 cm, but increased noise of planar gradiometers from 3.4 to 5.3 fT/cm. MC-tSSS reduced noise from 3.4 to 2.8 fT/cm and reduced the mean localization error from 3.91 to 0.89 cm. The MEG data containing speech-related artifacts and data containing alpha rhythm were processed by tSSS with different correlation limits. The speech artifact was progressively suppressed with the decreasing tSSS correlation limit. The optimal artifact suppression was achieved at correlation of 0.8. The randomly distributed source current (RDCS), and auditory and somatosensory evoked fields (AEFs and SEFs) were simulated. The information was calculated employing Shannon's theory of communication for a standard 306-sensor MEG device and for a virtual MEG helmet (VMH), which was constructed based on simulated MEG measurements in different head positions. With the simulation of 360 recorded events using RDCS model the maximum Shannon's number was 989 for single head position in standard MEG array and 1272 in VMH (28.6% additional information). With AEFs the additional contribution of VMH was 12.6% and with SEFs only 1.1%. To conclude, ictal MEG predicts IOZ location with higher sensitivity than interictal MEG. Resection of larger proportion of the MEG source cluster in patients with FCD is associated with a better seizure outcome, however, complete resection of MEG source cluster is often not required for achievement of favorable seizure outcome. The seizure outcome is similar in patients having MR-positive and MR-negative FCD. MC-tSSS decreases the source localization error to less than 1 cm, when the head is displaced up to 5 cm; however, it is reasonable to limit use of movement compensation for no more than 3-cm head displacement to keep the head inside sensor helmet. The optimization of the tSSS correlation limit to about 0.8 can improve the artifact suppression in MEG without substantial change of brain signals. MEG recording of the same brain activity in different head positions with subsequent construction of VMH can improve the information content of the data.Magnetoenkefalografia (MEG) on menetelmä, jolla mitataan aivojen tuottamia heikkoja magneettikenttiä. Yksi menetelmän tärkeimmistä kliinisistä käyttö-tarkoituksista on paikantaa epilepsiapesäkkeitä aivoissa. Tämä on tärkeää epilepsiakirurgian suunnittelussa. Potilaan liikkeet mittauksen aikana ovat aiheuttaneet epätarkkuutta pesäkkeiden paikannukseen ja häiriösignaaleja mittauksiin. Ongelma on ollut erityisen korostunut lasten mittauksissa ja epileptisten kohtausten rekisteröinneissä. Useimmissa potilaissa MEG-paikannus onkin perustunut kohtausten välisten epileptiformisten aivosähköilmiöiden paikannukseen. Pitkät MEG-rekisteröinnit ovat myös olleet haastavia koska yhteistyökykyisten potilaidenkin on vaikea olla liikkumatta pitkiä aikoja. Viime vuosien tekninen kehitys on mahdollistanut MEG-mittaukset myös pään liikkeiden aikana. Myös aivosignaalien ja kehossa olevien magneettisten materiaalien (esim hammaspaikat, sydämen tahdistimet tai aivostimulaattorit) aiheuttamien magneettisten häiriöiden erottaminen on nykyisin toteutettavissa. Tämä kehitys on mahdollistanut MEG-mittaukset potilailla, joilla aiemmin ei ollut mahdollisuutta hyötyä MEG-paikannuksista ja myös MEG-mittaukset epileptisten kohtausten aikana. Tärkeä osa väitöskirjaa on epilepsiakohtausten aikaisten MEG-mittausten kliinisen hyödyn arviointi. Tulokset osoittavat, että kohtauksenaikaiset MEG-mittaukset paikantavat herkemmin epilepsiakohtauksen lähdealueen aivoissa kuin kohtausten välisten epilepsiailmiöiden lähdepaikannus. Lähdealueiden paikannus on yhtä tarkka sekä aivokuoren pinnalla että 4 cm syvyydessä aivouurteissa. Pää ei kuitenkaan saisi liikkua 3 cm enempää MEG-mittauksen aikana, ja menetelmän herkkyys paranee oilennaisesti magneettikenttien matemaattiseen mallinnukseen perustuvalla magneettisten liikehäiriöiden poistolla. Väitöskirja tutkii lisäksi aivokuoren rakennemuutosten (paikallinen aivokuoridysplasia) aiheuttaman epilepsian kohtausten välisiä MEG-mittauksia. Päinvastoin kuin aiemmin on väitetty, ei aina ole tarpeen poistaa koko epileptisia lähdealueita sisältävää aivojen aluetta hyvän leikkaustuloksen saamiseksi. Väitöskirja esittelee myös laskennallisen MEG-anturiston määritysmenetelmän , joka lisää MEG-mittausten informaatiosisältöä huomioimalla pään liikkeet tulosten analyysissä

Localising epileptiform activity and eloquent cortex using magnetoencephalography

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

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

Epilepsy

With the vision of including authors from different parts of the world, different educational backgrounds, and offering open-access to their published work, InTech proudly presents the latest edited book in epilepsy research, Epilepsy: Histological, electroencephalographic, and psychological aspects. Here are twelve interesting and inspiring chapters dealing with basic molecular and cellular mechanisms underlying epileptic seizures, electroencephalographic findings, and neuropsychological, psychological, and psychiatric aspects of epileptic seizures, but non-epileptic as well

Methods for noninvasive localization of focal epileptic activity with magnetoencephalography

Magnetoencephalography (MEG) is a noninvasive brain signal acquisition technique that provides excellent temporal resolution and a whole-head coverage allowing the spatial mapping of sources. These characteristics make MEG an appropriate technique to localize the epileptogenic zone (EZ) in the preoperative evaluation of refractory epilepsy. Presurgical evaluation with MEG can guide the placement of intracranial EEG (iEEG), the current gold standard in the clinical practice, and even supply sufficient information for a surgical intervention without invasive recordings, reducing invasiveness, discomfort, and cost of the presurgical epilepsy diagnosis. However, MEG signals have low signal-to-noise ratio compared with iEEG and can sometimes be affected by noise that masks or distorts the brain activity. This may prevent the detection of interictal epileptiform discharges (IEDs) and high-frequency oscillations (HFOs), two important biomarkers used in the preoperative evaluation of epilepsy. In this thesis, the reduction of two kinds of interference is aimed to improve the signal-to-noise ratio of MEG signals: metallic artifacts mask the activity of IEDs; and the high-frequency noise, that masks HFO activity. Considering the large number of MEG channels and the long duration of the recordings, reducing noise and marking events manually is a time-consuming task. The algorithms presented in this thesis provide automatic solutions aimed at the reduction of interferences and the detection of HFOs. Firstly, a novel automatic BSS-based algorithm to reduce metallic interference is presented and validated using simulated and real MEG signals. Three methods are tested: AMUSE, a second-order BSS technique; and INFOMAX and FastICA, based on high-order statistics. The automatic detection algorithm exploits the known characteristics of metallic-related interferences. Results indicate that AMUSE performes better when recovering brain activity and allows an effective removal of artifactual components.Secondly, the influence of metallic artifact filtering using the developed algorithm is evaluated in the source localization of IEDs in patients with refractory focal epilepsy. A comparison between the resulting positions of equivalent current dipoles (ECDs) produced by IEDs is performed: without removing metallic interference, rejecting only channels with large metallic artifacts, and after BSS-based reduction. The results show that a significant reduction on dispersion is achieved using the BSS-based reduction procedure, yielding feasible locations of ECDs in contrast to the other approaches. Finally, an algorithm for the automatic detection of epileptic ripples in MEG using beamformer-based virtual sensors is developed. The automatic detection of ripples is performed using a two-stage approach. In the first step, beamforming is applied to the whole head to determine a region of interest. In the second step, the automatic detection of ripples is performed using the time-frequency characteristics of these oscillations. The performance of the algorithm is evaluated using simultaneous intracranial EEG recordings as gold standard.The novel approaches developed in this thesis allow an improved noninvasive detection and localization of interictal epileptic biomarkers, which can help in the delimitation of the epileptogenic zone and guide the placement of intracranial electrodes, or even to determine these areas without additional invasive recordings. As a consequence of this improved detection, and given that interictal biomarkers are much more frequent and easy to record than ictal episodes, the presurgical evaluation process can be more comfortable for the patient and in a more economic way.La magnetoencefalografía (MEG) es una técnica no invasiva de adquisición de señales cerebrales que proporciona una excelente resolución temporal y una cobertura total de la cabeza, permitiendo el mapeo espacial de las fuentes cerebrales. Estas características hacen del MEG una técnica apropiada para localizar la zona epileptogénica (EZ) en la evaluación preoperatoria de la epilepsia refractaria. La evaluación prequirúrgica con MEG puede orientar la colocación del EEG intracraneal (iEEG), el actual modelo de referencia en la práctica clínica, e incluso suministrar información suficiente para una intervención quirúrgica sin registros invasivos; reduciendo la invasividad, la incomodidad y el costo del diagnóstico de la epilepsia prequirúrgica. Sin embargo, las señales MEG tienen baja relación señal ruido en comparación con el iEEG pudiendo imposibilitar la detección de descargas epileptiformes interictales (IEDs) y oscilaciones de alta frecuencia (HFOs), dos importantes biomarcadores utilizados en la evaluación preoperatoria de la epilepsia.En esta tesis, la reducción de dos tipos de interferencia está dirigida a mejorar la relación señal-ruido de la señal MEG: los artefactos metálicos que enmascaran la actividad de las IEDs; y el ruido de alta frecuencia, que enmascara la actividad de las HFOs. Debido al gran número de canales MEG y la larga duración de los registros, tanto reducir el ruido como seleccionar los biomarcadores manualmente es una tarea que consume mucho tiempo. Los algoritmos presentados en esta tesis aportan soluciones automáticas dirigidas a la reducción de interferencias y la detección de HFOs. En primer lugar, se presenta y valida un nuevo algoritmo automático basado en BSS para reducir interferencias metálicas mediante señales simuladas y reales. Se prueban tres métodos: AMUSE, una técnica BSS de segundo orden; y INFOMAX y FastICA, basados en estadísticos de orden superior. El algoritmo de detección automático utiliza las características conocidas de la señal producida por la interferencia metálica. Los resultados indican que AMUSE recupera mejor la actividad cerebral y permite una eliminación efectiva de componentes artefactuales.Posteriormente, se evalúa la influencia del filtrado de artefactos metálicos en la localización de IEDs en pacientes con epilepsia focal refractaria. Se realiza una comparación entre las posiciones resultantes de dipolos de corriente equivalentes (ECDs) producidos por IEDs: sin eliminar interferencias metálicas, rechazando solamente canales con elevados artefactos metálicos y, por último, después de una reducción utilizando el algoritmo BSS desarrollado. Los resultados muestran que se logra una reducción significativa en la dispersión utilizando el procedimiento de reducción basado en BSS, lo que produce ubicaciones factibles de los dipolos en contraste con los otros enfoques.En segundo lugar, se desarrolla un algoritmo para la detección automática ripples epilépticos en MEG utilizando sensores virtuales basados en la técnica de beamformer. La detección de ripples se realiza mediante un enfoque en dos etapas. Primero, se determina el área de interés usando beamformer. Posteriormente, se realiza la detección automática de ripples utilizando las características en tiempo-frecuencia. El rendimiento del algoritmo se evalúa utilizando registros iEEG simultáneos.Los nuevos enfoques desarrollados en esta tesis permiten una detección no invasiva mejor de los biomarcadores interictales, que pueden ayudar a delimitar la zona epileptogénica y guiar la colocación de electrodos intracraneales, o incluso determinar estas áreas sin este tipo de registros. Como consecuencia de esta mejora en la detección, y dado que los biomarcadores interictales son mucho más frecuentes y fáciles de registrar que los episodios ictales, la evaluación prequirúrgica puede ser más cómoda y menos costosa para el paciente.Postprint (published version