A multimodal imaging approach for quantitative assessment of epilepsy

Le tecniche di coregistrazione elettroencefalogramma-risonanza magnetica funzionale (EEG-fMRI) ed EEG ad alta densità (hdEEG) consentono di mappare attivazioni cerebrali anomale evocate da processi epilettici. L’EEG-fMRI è una tecnica di imaging non invasivo che permette la localizzazione delle variazioni del livello di ossigenazione nel sangue presente nelle regioni irritative (segnale BOLD). Diversamente, l’analisi di sorgente stima, a partire da un potenziale elettrico misurato sullo scalpo (EEG), la densità di corrente della sorgente elettrica a livello corticale producendo una plausibile localizzazione del dipolo nelle regioni irritative. Lo scopo di questa tesi è quello di sviluppare un approccio multimodale attraverso l’uso di dati di coregistrazione EEG-fMRI e hdEEG al fine di localizzare l’attività epilettica e verificare l’affidabilità sia dell’attivazione BOLD che della localizzazione della sorgente. Nel Capitolo I si introduce il concetto di approccio multimodale. Il capitolo è suddiviso principalmente in due parti: la prima descrive la tecnica di coregistrazione EEG-fMRI e la seconda la tecnica di localizzazione della sorgente in epilessia. La prima parte consiste in una breve analisi delle basi fisiologiche del dato di coregistrazione EEG-fMRI, nella descrizione di tecniche di registrazione simultanea e nell’introduzione del metodo convenzionale di analisi dei dati. Sono inoltre descritti problemi tecnici, problemi di sicurezza, modalità di scansione e strategie di rimozione degli artefatti EEG. È quindi presentata una panoramica sullo stato dell’arte delle coregistrazioni EEG-fMRI con discussione dei problemi aperti riguardanti l’analisi convenzionale. La seconda parte introduce i principi di base della stima delle sorgenti da dati hdEEG ed i loro limiti. Il primo capitolo fornisce un quadro generale, mentre i due capitoli successivi sono dedicati ad introdurre approcci di tipo diverso. Nell’analisi convenzionale di dati EEG-fMRI, l’apparizione di eventi interictali (IED) guida l’analisi dei dati fMRI. Il neurologo identifica gli intervalli degli eventi IED, che sono rappresentati da un’onda quadra, e successivamente questo protocollo viene convoluto con una risposta emodinamica (HRF) canonica per la costruzione di un modello o regressore da impiegare nell’analisi con modelli lineari generalizzati (GLM). I problemi principali dell’analisi convenzionale consistono nel fatto che essa non è automatica, ossia soffre di soggettività nella classificazione degli IED, e che, se la scelta dell’HRF non è ottimale, l’attivazione può essere sovra o sotto stimata. Il nuovo metodo proposto integra nell’analisi GLM convenzionale due nuove funzioni: il regressore basato sul segnale EEG (Capitolo II), e l’individuazione di una risposta emodinamica individual-based (ibHRF) (Capitolo III). Nel Capitolo IV le prestazioni del nuovo metodo per l’analisi di dati EEG-fMRI sono validate su dati in silico. A questo scopo sono stati creati dati fMRI simulati per testare la scelta dell’HRF ottima tra cinque modelli: quattro standard ed un modello HRF individual-based. Le prestazioni del metodo sono state valutate utilizzando come selezione il criterio di Akaike. Le simulazioni dimostrano la superiorità del nuovo metodo rispetto a quelli convenzionali e mostrano come la variazione del modello HRF influisce sui risultati dell’analisi statistica. Il Capitolo V introduce un criterio automatico volto a separare le componenti del segnale fMRI relative a network interni dal rumore. Dopo il processo di decomposizione probabilistico delle componenti indipendenti (PICA), si seleziona il numero ottimale di componenti applicando un nuovo algoritmo che tiene conto, per ciascuna componente, dei valori medi delle mappe spaziali di attivazione seguito da passaggi di clustering, segmentazione ed analisi spettrale. Confrontando i risultati dell’identificazione visiva dei network neuronali con i risultati di quella automatica, l’algoritmo mostra elevata accuratezza e precisione. In questo modo, il metodo di selezione automatica permette di separare ed individuare i network in stato di riposo, riducendo la soggettività nella valutazione delle componenti indipendenti. Nel Capitolo VI sono descritti il design sperimentale e l’analisi dei dati reali. Il capitolo illustra i risultati di dodici pazienti epilettici, concentrandosi sull’attività BOLD, sulla localizzazione della sorgente e sulla concordanza con il quadro clinico del paziente. Lo scopo è quello di applicare un approccio multimodale che combini tecniche non invasive di acquisizione ed analisi. Sequenze di EEG standard e fMRI sono acquisite nel corso della stessa sessione di scansione. L’analisi dei dati EEG-fMRI è eseguita utilizzando l’approccio GLM tradizionale, il nuovo approccio e l’analisi PICA. La sorgente dell’attività epilettica è stimata a partire da tracciati EEG a 256-canali. L’attivazione BOLD è confrontata con la ricostruzione della sorgente EEG. Questi risultati sono infine confrontati con l’attività epilettica definita da EEG standard ed esiti clinici. La combinazione di tecniche multimodali ed i loro rispettivi metodi di analisi sono strumenti utili per creare un workup prechirurgico completo dell’epilessia, fornendo diversi metodi di localizzazione dello stesso focolaio epilettico. L’approccio non invasivo di integrazione multimodale di dati EEG-fMRI e hdEEG sembra essere uno strumento molto promettente per lo studio delle scariche epilettiche.Electroencephalography-functional magnetic resonance imaging (EEG-fMRI) coregistration and high density EEG (hdEEG) can be combined to noninvasively map abnormal brain activation elicited by epileptic processes. EEG-fMRI can provide information on the pathophysiological processes underlying interictal activity, since the hemodynamic changes are a consequence of the abnormal neural activity generating interictal epileptiform discharges (IEDs). The source analysis estimates the current density of the source that generates a measured electric potential and it yields a plausible dipole localization of irritative regions. The aim of this thesis is to develop a multimodal approach with hdEEG and EEG-fMRI coregistration in order to localize the epileptic activity and to verify the reliability of source localization and BOLD activation. In Chapter I the multimodal approach is introduced. The chapter is divided in two main parts: the first is based on EEG-fMRI coregistration and the second on the source localization in epilepsy. The first part consists of a brief review of the physiologic basis of EEG and fMRI and the technical basics of simultaneous recording, examining the conventional method for EEG-fMRI data. Technical challenges, safety issues, scanning modalities and EEG artifact removal strategies are also described. An overview of the state of EEG-fMRI is presented and the open problems of conventional analysis are discussed. The second part introduces the basic principles of the source estimation from EEG data in epilepsy and their limitations. The first chapter provides a general framework. The next two are devoted to introduce different approaches. Conventional analysis of EEG-fMRI data relies on spike-timing of epileptic activity: the neurologist identifies the intervals of the IEDs events, as represented by a square wave; this protocol is then convolved with a canonical hemodynamic response function (HRF) to construct a model for the general linear model (GLM) analysis. There are limitations to the technique, however. The conventional analysis is not automatic, suffers of subjectivity in IEDs classification, and using a suboptimal HRF to model the BOLD response the activation map may result over or under estimated. The novel method purposed integrates in the conventional GLM two new features: the regressor based on the EEG signal (Chapter II) and the individual-based hemodynamic response function (ibHRF) (Chapter III). In Chapter IV the performance of the novel method of EEG-fMRI data was tested on in silico data. Simulated fMRI datasets were created and used for the choice of the optimal HRF among five models: four standard and an individual-based HRF models. The performance of the method was evaluated using the Akaike information criterion as selection. Simulations would demonstrate the superiority of the novel method compared with the conventional ones and assess how the variations in HRF model affect the results of the statistical analysis. Chapter V introduces an automatic criterion aiming to separate in fMRI data the signal related to an internal network from the noise. After the decomposition process (probabilistic independent component analysis [PICA]), the optimal number of components was selected by applying a novel algorithm which takes into account, for each component, the mean values of the spatial activation maps followed by clustering, segmentation and spectral analysis steps. Comparing visual and automatic identification of the neuronal networks, the algorithm demonstrated high accuracy and precision. Thus, the automatic selection method allows to separate and detect the resting state networks reducing the subjectivity of the independent component assessment. In Chapter VI experimental design and analysis on real data are described. The chapter focuses on BOLD activity, source localization and agreement with the clinical history of twelve epileptic patients. The scope is to apply a multimodal approach combining noninvasive techniques of acquisition and analysis. Standard EEG and fMRI data were acquired during a single scanning session. The analysis of EEG-fMRI data was performed by using both the conventional GLM, the new GLM and the PICA. Source localization of IEDs was performed using 256-channels hdEEG. BOLD localizations were then compared to the EEG source reconstruction and to the expected epileptic activity defined by standard EEG and clinical outcome. The combination of multimodal techniques and their respectively methods of analysis are useful tools in the presurgical workup of epilepsy providing different methods of localization of the same epileptic foci. Furthermore, the combined use of EEG-fMRI and hdEEG offers a new and more complete approach to the study of epilepsy and may play an increasingly important role in the evaluation of patients with refractory focal epilepsy

Sleep brain networks and sleep depth during somatosensory stimulation

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Graph analysis of TMS–EEG connectivity reveals hemispheric differences following occipital stimulation

(1) Background: Transcranial magnetic stimulation combined with electroencephalography (TMS–EEG) provides a unique opportunity to investigate brain connectivity. However, possible hemispheric asymmetries in signal propagation dynamics following occipital TMS have not been investigated. (2) Methods: Eighteen healthy participants underwent occipital single-pulse TMS at two different EEG sites, corresponding to early visual areas. We used a state-of-the-art Bayesian estimation approach to accurately estimate TMS-evoked potentials (TEPs) from EEG data, which has not been previously used in this context. To capture the rapid dynamics of information flow patterns, we implemented a self-tuning optimized Kalman (STOK) filter in conjunction with the information partial directed coherence (iPDC) measure, enabling us to derive time-varying connectivity matrices. Subsequently, graph analysis was conducted to assess key network properties, providing insight into the overall network organization of the brain network. (3) Results: Our findings revealed distinct lateralized effects on effective brain connectivity and graph networks after TMS stimulation, with left stimulation facilitating enhanced communication between contralateral frontal regions and right stimulation promoting increased intra-hemispheric ipsilateral connectivity, as evidenced by statistical test (p < 0.001). (4) Conclusions: The identified hemispheric differences in terms of connectivity provide novel insights into brain networks involved in visual information processing, revealing the hemispheric specificity of neural responses to occipital stimulation

Editorial: Chasing brain dynamics at their speed: what can time-varying functional connectivity tell us about brain function?

In the past decades, the growing field of network neuroscience has opened new perspectives on the study of the brain and its function. The integration of tools from network analysis and system neuroscience has allowed researchers to explore the properties of brain networks, offering a valuable alternative to traditional methods based on simple subtraction and mass univariate analysis (Sporns, 2010; Behrens and Sporns, 2012). This has led to an exponential growth of connectivity algorithms and methods designed to capture the intrinsic dynamics of human brain networks, both at rest and during active tasks. As a result, a new research direction has emerged. The quantification of spatio-temporal dynamics of functional connectivity (FC) is offering new means to observe a vast repertoire of brain functions. Despite significant advances in this domain, there are still major challenges to address. This is partly due to the rapid and distributed nature of brain interactions, with large-scale networks that constantly evolve and coordinate activity to produce human perception, cognition, and behavior at sub-second timescales. Additionally, brain network activity can vary widely within and across individuals (Finn et al., 2015; Van De Ville et al., 2021), as well as in clinical conditions and brain disorders (see Miao et al.). Thus, modeling whole-brain network dynamics, accounting for the necessary spatial and temporal resolution at both individual and population levels, remains a crucial goal yet to be fully achieved. The present Research Topic contains a collection of methodological and empirical studies that touch upon some of the main challenges in the field, collectively providing insight into the current state of research and the potential solutions for advancing the field of dynamic network neuroscience in the future

Assessment of Event-Related EEG Power After Single-Pulse TMS in Unresponsive Wakefulness Syndrome and Minimally Conscious State Patients

In patients without a behavioral response, non-invasive techniques and new methods of data analysis can complement existing diagnostic tools by providing a method for detecting covert signs of residual cognitive function and awareness. The aim of this study was to investigate the brain oscillatory activities synchronized by single-pulse transcranial magnetic stimulation (TMS) delivered over the primary motor area in the time\u2013frequency domain in patients with the unresponsive wakefulness syndrome or in a minimally conscious state as compared to healthy controls. A time\u2013frequency analysis based on the wavelet transform was used to characterize rapid modifications of oscillatory EEG rhythms induced by TMS in patients as compared to healthy controls. The pattern of EEG changes in the patients differed from that of healthy controls. In the controls there was an early synchronization of slow waves immediately followed by a desynchronization of alpha and beta frequency bands over the frontal and centro-parietal electrodes, whereas an opposite early synchronization, particularly over motor areas for alpha and beta and over the frontal and parietal electrodes for beta power, was seen in the patients. In addition, no relevant modification in slow rhythms (delta and theta) after TMS was noted in patients. The clinical impact of these findings could be relevant in neurorehabilitation settings for increasing the awareness of these patients and defining new treatment procedures

Voxel-based morphometry and task functional magnetic resonance imaging in essential tremor: evidence for a disrupted brain network

The pathophysiology of essential tremor (ET) is controversial and might be further elucidated by advanced neuroimaging. Focusing on homogenous ET patients diagnosed according to the 2018 consensus criteria, this study aimed to: (1) investigate whether task functional MRI (fMRI) can identify networks of activated and deactivated brain areas, (2) characterize morphometric and functional modulations, relative to healthy controls (HC). Ten ET patients and ten HC underwent fMRI while performing two motor tasks with their upper limb: (1) maintaining a posture (both groups); (2) simulating tremor (HC only). Activations/deactivations were obtained from General Linear Model and compared across groups/tasks. Voxel-based morphometry and linear regressions between clinical and fMRI data were also performed. Few cerebellar clusters of gray matter loss were found in ET. Conversely, widespread fMRI alterations were shown. Tremor in ET (task 1) was associated with extensive deactivations mainly involving the cerebellum, sensory-motor cortex, and basal ganglia compared to both tasks in HC, and was negatively correlated with clinical tremor scales. Homogeneous ET patients demonstrated deactivation patterns during tasks triggering tremor, encompassing a network of cortical and subcortical regions. Our results point towards a marked cerebellar involvement in ET pathophysiology and the presence of an impaired cerebello-thalamo-cortical tremor network

Patient-specific detection of cerebral blood flow alterations as assessed by arterial spin labeling in drug-resistant epileptic patients

Electrophysiological and hemodynamic data can be integrated to accurately and precisely identify the generators of abnormal electrical activity in drug-resistant focal epilepsy. Arterial Spin Labeling (ASL), a magnetic resonance imaging (MRI) technique for quantitative noninvasive measurement of cerebral blood flow (CBF), can provide a direct measure of variations in cerebral perfusion associated with the epileptic focus. In this study, we aimed to confirm the ASL diagnostic value in the identification of the epileptogenic zone, as compared to electrical source imaging (ESI) results, and to apply a template-based approach to depict statistically significant CBF alterations. Standard video-electroencephalography (EEG), high-density EEG, and ASL were performed to identify clinical seizure semiology and noninvasively localize the epileptic focus in 12 drug-resistant focal epilepsy patients. The same ASL protocol was applied to a control group of 17 healthy volunteers from which a normal perfusion template was constructed using a mixed-effect approach. CBF maps of each patient were then statistically compared to the reference template to identify perfusion alterations. Significant hypo- and hyperperfused areas were identified in all cases, showing good agreement between ASL and ESI results. Interictal hypoperfusion was observed at the site of the seizure in 10/12 patients and early postictal hyperperfusion in 2/12. The epileptic focus was correctly identified within the surgical resection margins in the 5 patients who underwent lobectomy, all of which had good postsurgical outcomes. The combined use of ESI and ASL can aid in the noninvasive evaluation of drug-resistant epileptic patients

Editorial: Brain-connectivity-based computer interfaces

Editorial on the Research Topic Brain-connectivity-based computer interface

Time-frequency analysis of short-lasting modulation of EEG induced by TMS during wake, sleep deprivation and sleep

The occurrence of dynamic changes in spontaneous electroencephalogram (EEG) rhythms in the awake state or sleep is highly variable. These rhythms can be externally modulated during transcranial magnetic stimulation (TMS) with a perturbation method to trigger oscillatory brain activity. EEG-TMS co-registration was performed during standard wake, during wake after sleep deprivation and in sleep in six healthy subjects. Dynamic changes in the regional neural oscillatory activity of the cortical areas were characterized using time-frequency analysis based on the wavelet method, and the modulation of induced oscillations were related to different vigilance states. A reciprocal synchronizing/desynchronizing effect on slow and fast oscillatory activity was observed in response to focal TMS after sleep deprivation and sleep. We observed a sleep-related slight desynchronization of alpha mainly over the frontal areas, and a widespread increase in theta synchronization. These findings could be interpreted as proof of the interference external brain stimulation can exert on the cortex, and how this could be modulated by the vigilance state. Potential clinical applications may include evaluation of hyperexcitable states such as epilepsy or disturbed states of consciousness such as minimal consciousness

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