Correlation between computed tomography and voltage and current source density spectral EEG parameters in patients with brain lesions

Effects of an Adaptogenic Extract on Electrical Activity of the Brain in Elderly Subjects with Mild Cognitive Impairment: A Randomized, Double-Blind, Placebo-Controlled, Two-Armed Cross-Over Study

Background: The current and potential uses of adaptogens are mainly related to treatment of stress-induced fatigue, impaired cognitive function, mental illness, and behavioral- and age-related disorders. However, clinical evidence regarding the efficacy of adaptogens is limited. The primary aim of this study is to determine whether a combination of adaptogenic plant extracts from Andrographis paniculata and Withania somnifera (Adaptra^® Forte) could be used as effective and safe treatment for impaired cognitive, memory, or learning ability functions and sleep disorders. Methods: The changes in electroencephalogram (EEG) frequency ranges in 17 different brain regions, psychometric tests of cognitive performance, as well as standard questionnaires of assessment of mood and sleep were measured after single and repeated administration of Adaptra^® or placebo for four weeks and after a two-week treatment-free follow-up period within a randomized, double-blind, placebo-controlled two-armed cross-over study. Results: Adaptra^® Forte significantly improved cognitive performance in the d2-Test for attention and the concentration performance test after four weeks’ treatment, and was positively correlated with increases in δ and θ power in the quantitative EEG compared with placebo during cognitive challenges. Conclusion: The results of this study suggest that Adaptra^® Forte exhibits a calming and anxiolytic effect without sedation, and is associated with overall stress-protective activity.

Permutation entropy in intraoperative ECoG of brain tumour patients in awake tumour surgery- a robust parameter to separate consciousness from unconsciousness

Awake craniotomies represent an essential opportunity in the case of lesions in eloquent areas. Thus, optimal surveillance of the patient during different stages of sedation, as well as the detection of seizure activity during brain surgery, remains difficult, as skin electrodes for electroencephalographic (EEG) analysis are not applicable in most cases. We assessed the applicability of ECoG to monitor different stages of sedation, as well as the influence of different patient characteristics, such as tumour volume, size, entity, and age or gender on permutation entropy (PeEn). We conducted retrospective analysis of the ECoG data of 16 patients, who underwent awake craniotomies because of left-sided brain tumours at our centre between 2014 and 2016. PeEn could be easily calculated and compared using frontal and parietal cortical electrodes. A comparison of PeEn scores showed significantly higher values in awake patients than in patients under anaesthesia (p ≤ 0.004) and significantly higher ones in the state of transition than under general anaesthesia (p = 0.023). PeEn scores in frontal and parietal leads did not differ significantly, making them both applicable for continuous surveillance during brain surgery. None of the following clinical characteristics showed significant correlation with PeEn scores: tumour volume, WHO grade, first or recurrent tumour, gender, and sex. Being 50 years or older led to significantly lower values in parietal leads but not in frontal leads. ECoG and a consecutive analysis of PeEn are feasible and suitable for the continuous surveillance of patients during awake craniotomies. Hence, the analysis is not influenced by patients' clinical characteristics.

In Vivo Tumour Mapping Using Electrocorticography Alterations During Awake Brain Surgery: A Pilot Study

During awake brain surgery for tumour resection, in situ EEG recording (ECoG) is used to identify eloquent areas surrounding the tumour. We used the ECoG setup to record the electrical activity of cortical and subcortical tumours and then performed frequency and connectivity analyses in order to identify ECoG impairments and map tumours. We selected 16 patients with cortical (8) and subcortical (8) tumours undergoing awake brain surgery. For each patient, we computed the spectral content of tumoural and healthy areas in each frequency band. We computed connectivity of each electrode using connectivity markers (linear and non-linear correlations, phase-locking and coherence). We performed comparisons between healthy and tumour electrodes. The ECoG alterations were used to implement automated classification of the electrodes using clustering or neural network algorithms. ECoG alterations were used to image cortical tumours.Cortical tumours were found to profoundly alter all frequency contents (normalized and absolute power), with an increase in the δ activity and a decreases for the other bands (P < 0.05). Cortical tumour electrodes showed high level of connectivity compared to surrounding electrodes (all markers, P < 0.05). For subcortical tumours, a relative decrease in the γ1 band and in the alpha band in absolute amplitude (P < 0.05) were the only abnormalities. The neural network algorithm classification had a good performance: 93.6 % of the electrodes were classified adequately on a test subject. We found significant spectral and connectivity ECoG changes for cortical tumours, which allowed tumour recognition. Artificial neural algorithm pattern recognition seems promising for electrode classification in awake tumour surgery.

The use of current source density as electrophysiological correlates in neuropsychiatric disorders: A review of human studies

The use of current source density (CSD), the Laplacian of the scalp surface voltage, to map the electrical activity of the brain is a powerful method in studies of cognitive and affective phenomena. During the last few decades, mapping of CSD has been successfully applied to characterize several neuropsychiatric conditions such as alcoholism, schizophrenia, depression, anxiety disorders, childhood/developmental disorders, and neurological conditions (i.e., epilepsy and brain lesions) using electrophysiological data from resting state and during cognitive performance. The use of CSD and Laplacian measures has proven effective in elucidating topographic and activation differences between groups: i) patients with a specific diagnosis vs. healthy controls, ii) subjects at high risk for a specific diagnosis vs. low risk or normal controls, and iii) patients with specific symptom(s) vs. patients without these symptom(s). The present review outlines and summarizes the studies that have employed CSD measures in investigating several neuropsychiatric conditions. The advantages and potential of CSD-based methods in clinical and research applications along with some of the limitations inherent in the CSD-based methods are discussed in the review, as well as future directions to expand the implementation of CSD to other potential clinical applications. As CSD methods have proved to be more advantageous than using scalp potential data to understand topographic and source activations, its clinical applications offer promising potential, not only for a better understanding of a range of psychiatric conditions, but also for a variety of focal neurological disorders, including epilepsy and other conditions involving brain lesions and surgical interventions.

Neurophysiological characterization of a functionally active drink containing extracts of ginkgo and ginseng by source density analysis of the human EEG

Functional food products should provide scientifically proven beneficial effects in healthy subjects. The highly sensitive method of EEG recording from healthy human volunteers was used in a randomized, placebo controlled crossover study to investigate the effects of a change in physiological parameters after ingestion of a total of 750 ml of a softdrink containing 0.232 g of ginseng and 2 g of ginkgo extract, both produced by water extraction. Application of a random, placebo controlled crossover design was done with 10 healthy male volunteers. EEG recordings were performed 1, 2, 3 and 4 h under the conditions of 10 min eyes open, 5 min eyes closed and 5 min reading short stories. Auditory P300 potentials were recorded every hour in addition to the EEG recordings. Source density analysis of the data revealed an attenuation of circadian induced electrical delta power decreases under the condition of eyes open and closed recording from centro-parieto-occipital electrode positions. During a reading test even absolute increases of delta power were observed at these electrode sites. These changes were statistically significant at p < 2% for the second hour (eyes open and reading) and are interpreted to indicate a higher degree of emotional well-being. Decreases in latency (from 333.9 to 321.3 ms) as well as increases of amplitude (from 2.07 to 3.95 microV) of the auditory P300 potential at the electrode position Pz point to a possible improvement of attention, however, the difference did not reach statistical significance.

Resting state cortical electroencephalographic rhythms are related to gray matter volume in subjects with mild cognitive impairment and Alzheimer's disease

Cortical gray matter volume and resting state cortical electroencephalographic rhythms are typically abnormal in subjects with amnesic mild cognitive impairment (MCI) and Alzheimer's disease (AD). Here we tested the hypothesis that in amnesic MCI and AD subjects, abnormalities of EEG rhythms are a functional reflection of cortical atrophy across the disease. Eyes-closed resting state EEG data were recorded in 57 healthy elderly (Nold), 102 amnesic MCI, and 108 AD patients. Cortical gray matter volume was indexed by magnetic resonance imaging recorded in the MCI and AD subjects according to Alzheimer's disease neuroimaging initiative project (http://www.adni-info.org/). EEG rhythms of interest were delta (2-4 Hz), theta (4-8 Hz), alpha1 (8-10.5 Hz), alpha2 (10.5-13 Hz), beta1 (13-20 Hz), beta2 (20-30 Hz), and gamma (30-40 Hz). These rhythms were indexed by LORETA. Compared with the Nold, the MCI showed a decrease in amplitude of alpha 1 sources. With respect to the Nold and MCI, the AD showed an amplitude increase of delta sources, along with a strong amplitude reduction of alpha 1 sources. In the MCI and AD subjects as a whole group, the lower the cortical gray matter volume, the higher the delta sources, the lower the alpha 1 sources. The better the score to cognitive tests the higher the gray matter volume, the lower the pathological delta sources, and the higher the alpha sources. These results suggest that in amnesic MCI and AD subjects, abnormalities of resting state cortical EEG rhythms are not epiphenomena but are strictly related to neurodegeneration (atrophy of cortical gray matter) and cognition.

3D statistical parametric mapping of quiet sleep EEG in the first year of life

This paper extends previously developed 3D SPM for Electrophysiological Source Imaging (Bosch et al., 2001) for neonate EEG. It builds on a prior paper by our group that established age dependent means and standard deviations for the scalp EEG Broad Band Spectral Parameters of children in the first year of life. We now present developmental equations for the narrow band log spectral power of EEG sources, obtained from a sample of 93 normal neonates from age 1 to 10 months in quiet sleep. The main finding from these regressions is that EEG power from 0.78 to 7.5 Hz decreases with age and also for 45-50 Hz. By contrast, there is an increase with age in the frequency band of 19-32 Hz localized to parietal, temporal and occipital areas. Deviations from the norm were analyzed for normal neonates and 17 with brain damage. The diagnostic accuracy (measured by the area under the ROC curve) of EEG source SPM is 0.80, 0.69 for average reference scalp EEG SPM, and 0.48 for Laplacian EEG SPM. This superior performance of 3D SPM over scalp qEEG suggests that it might be a promising approach for the evaluation of brain damage in the first year of life.

Early effect of NEURAPAS® balance on current source density (CSD) of human EEG

Psychiatric patients often suffer from stress, anxiety and depression. Various plant extracts are known to fight stress (valerian), anxiety (passion flower) or depression (St. John's wort). NEURAPAS® balance is a mixture of these three extracts and has been designed to cover this complex of psychiatric conditions. The study was initiated to quantitatively assess the effect of this combination on brain electric activity.

METHOD

Quantitative electroencephalogram (EEG) current source density (CSD) recording from 16 healthy male and female human volunteers (average age 49 years) was used in a randomized, placebo-controlled cross over study. Recordings were performed 0. 5, 1. 5, 3 and 4 hours after administration of the preparations under the conditions of 6 min eyes open and 5 min d2 concentration test, mathematical calculation test and memory test, respectively. All variables (electric power within 6 frequency ranges at 17 electrode positions) were fed into a linear discriminant analysis (eyes open condition). In the presence of mental load these variables were used to construct brain maps of frequency changes.

RESULTS

Under the condition of mental load, centro-parietal spectral power remained statistically significantly lower within alpha1, alpha2 and beta1 frequencies in the presence of verum in comparison to placebo. Discriminant analysis revealed a difference to placebo 3 and 4 hours after intake of 6 tablets of NEURAPAS® balance. Data location within the polydimensional space was projected into the area of the effects of sedative and anti-depressive reference drugs tested earlier under identical conditions. Results appeared closer to the effects of fluoxetine than to St. John's wort.

CONCLUSIONS

Analysis of the neurophysiological changes following the intake of NEURAPAS® balance revealed a similarity of frequency changes to those of calming and anti-depressive drugs on the EEG without impairment of cognition.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01047605.

Ibuprofen treatment modifies cortical sources of EEG rhythms in mild Alzheimer's disease

OBJECTIVE

Non-steroidal anti-inflammatory drugs such as ibuprofen have a protective role on risk of Alzheimer's disease (AD). Here we evaluated the hypothesis that long-term ibuprofen treatment affects cortical sources of resting electroencephalographic (EEG) rhythms in mild AD patients.

METHODS

Twenty-three AD patients (13 treated AD IBUPROFEN; 10 untreated AD PLACEBO) were enrolled. Resting EEG data were recorded before and 1 year after the ibuprofen/placebo treatment. EEG rhythms were delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), and beta 2 (20-30 Hz). LORETA was used for EEG source analysis.

RESULTS

In the AD PLACEBO group, amplitude of delta sources was globally greater at follow-up than baseline. Instead, amplitude of delta sources remained stable or decreased in the majority of the AD IBUPROFEN patients. Clinical (CDR) but not global cognitive status (MMSE) reflected EEG results.

CONCLUSIONS

These results suggest that in mild AD patients, a long-term ibuprofen treatment slightly slows down the progressive increment of delta rhythms as a sign of contrast against the neurodegenerative processes.

SIGNIFICANCE

They motivate future investigations with larger population and extended neuropsychological testing, to study the relationships among ibuprofen treatment, delta cortical sources, and higher order functions.

Resting EEG sources correlate with attentional span in mild cognitive impairment and Alzheimer's disease

Previous evidence has shown that resting delta and alpha electroencephalographic (EEG) rhythms are abnormal in patients with Alzheimer's disease (AD) and its potential preclinical stage (mild cognitive impairment, MCI). Here, we tested the hypothesis that these EEG rhythms are correlated with memory and attention in the continuum across MCI and AD. Resting eyes-closed EEG data were recorded in 34 MCI and 53 AD subjects. EEG rhythms of interest were delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), and beta 2 (20-30 Hz). EEG cortical sources were estimated by low-resolution brain electromagnetic tomography (LORETA). These sources were correlated with neuropsychological measures such as Rey list immediate recall (word short-term memory), Rey list delayed recall (word medium-term memory), Digit span forward (immediate memory for digits probing focused attention), and Corsi span forward (visuo-spatial immediate memory probing focused attention). A statistically significant negative correlation (Bonferroni corrected, P < 0.05) was observed between Corsi span forward score and amplitude of occipital or temporal delta sources across MCI and AD subjects. Furthermore, a positive correlation was shown between Digit span forward score and occipital alpha 1 sources (Bonferroni corrected, P < 0.05). These results suggest that cortical sources of resting delta and alpha rhythms correlate with neuropsychological measures of immediate memory based on focused attention in the continuum of MCI and AD subjects.

Homocysteine and electroencephalographic rhythms in Alzheimer disease: a multicentric study

High plasma concentration of homocysteine is an independent risk factor for Alzheimer's disease (AD), due to microvascular impairment and consequent neural loss [Seshadri S, Beiser A, Selhub J, Jacques PF, Rosenberg IH, D'Agostino RB, Wilson PW, Wolf PA (2002) Plasma homocysteine as a risk factor for dementia and Alzheimer's disease. N Engl J Med 346(7):476-483]. Is high plasma homocysteine level related to slow electroencephalographic (EEG) rhythms in awake resting AD subjects, as a reflection of known relationships between cortical neural loss and these rhythms? To test this hypothesis, we enrolled 34 mild AD patients and 34 subjects with mild cognitive impairment (MCI). Enrolled people were then subdivided into four sub-groups of 17 persons: MCI and AD subjects with low homocysteine level (MCI- and AD-, homocysteine level <11 micromol/l); MCI and AD subjects with high homocysteine level (MCI+ and AD+, homocysteine level >or=11 micromol/l). Resting eyes-closed EEG data were recorded. EEG rhythms of interest were delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), and beta 2 (20-30 Hz). EEG cortical sources were estimated by low-resolution brain electromagnetic tomography (LORETA). Results showed that delta (frontal and temporal), theta (central, frontal, parietal, occipital, and temporal), alpha 1 (parietal, occipital, and temporal), and alpha 2 (parietal and occipital) sources were stronger in magnitude in AD+ than AD- group. Instead, no difference was found between MCI- and MCI+ groups. In conclusion, high plasma homocysteine level is related to unselective increment of cortical delta, theta, and alpha rhythms in mild AD, thus unveiling possible relationships among that level, microvascular concomitants of advanced neurodegenerative processes, and synchronization mechanisms generating EEG rhythms.

Variable resolution electromagnetic tomography (VARETA) in evaluation of compression of cerebral arteries due to deep midline brain lesions

BACKGROUND

Hemispheric tumors produced electroencephalographic (EEG) delta activity mainly due to deafferentation of cerebral cortex. In small, deep midline lesions that compressed cerebral arteries, the most important abnormality should have been in EEG theta band that selectively responded to brain ischemia. Frequency domain-variable resolution electromagnetic tomography (FD-VARETA) has been applied satisfactorily to the study of brain tumors, cerebral infarcts, and brain hemorrhages and was shown to localize areas of hypoperfusion.

METHODS

Twelve patients with deep midline lesions compressing different cerebral arteries were studied. Computer tomography (CT) and/or magnetic resonance imaging (MRI) as well as quantitative EEG with source calculation in frequency domain were obtained. Brain electromagnetic tomographies (BETs) were calculated to evaluate localization and extension of functional abnormalities.

RESULTS

Ten of twelve cases presented abnormal sources in theta band as main abnormal source. In only two cases was the main source in delta band, but these cases also had abnormal Z values in theta band. In four patients there were only abnormal values in theta range. Sources of abnormal theta activity were observed in regions irrigated by the arteries compressed.

CONCLUSIONS

In deep midline lesions, compression of cerebral arteries producing relative ischemia may explain abnormal EEG sources in theta band. Patients with main source in theta band showed vascular compression and some patients exhibited vasogenic edema. Thus, theta might be due to relative ischemia produced by both hypoperfusion and edema. Once again, VARETA has found to be very useful in evaluation of functional abnormalities.

EEG and behavioral changes following neurofeedback treatment in learning disabled children

Neurofeedback (NFB) is an operant conditioning procedure, by which the subject learns to control his/her EEG activity. On one hand, Learning Disabled (LD) children have higher values of theta EEG absolute and relative power than normal children, and on the other hand, it has been shown that minimum alpha absolute power is necessary for adequate performance. Ten LD children were selected with higher than normal ratios of theta to alpha absolute power (theta/alpha). The Test Of Variables of Attention (TOVA) was applied. Children were divided into two groups in order to maintain similar IQ values, TOVA values, socioeconomical status, and gender for each group. In the experimental group, NFB was applied in the region with highest ratio, triggering a sound each time the ratio fell below a threshold value. Noncontingent reinforcement was given to the other group. Twenty half-hour sessions were applied, at a rate of 2 per week. At the end of the 20 sessions, TOVA, WISC and EEG were obtained. There was significant improvement in WISC performance in the experimental group that was not observed in the control group. EEG absolute power decreased in delta, theta, alpha and beta bands in the experimental group. Control children only showed a decrease in relative power in the delta band. All changes observed in the experimental group and not observed in the control group indicate better cognitive performance and the presence of greater EEG maturation in the experimental group, which suggests that changes were due not only to development but also to NFB treatment.

Sources of abnormal EEG activity in spontaneous intracerebral hemorrhage

This report describes the results obtained with EEG source analysis in the frequency domain (FD-VARETA), in 14 patients with brain hemorrhages; 6 hemorrhages were located in the putaminal region, 1 was mesencephalic and 7 were lobar cerebral hemorrhages. Our goal was to evaluate FD-VARETA accuracy for the localization of fast growth expansive brain lesions. FD-VARETA produces brain electromagnetic tomography images of EEG sources in every frequency. The location of the most abnormal or the maximum Z value across all frequencies was compared with the location of spontaneous hemorrhages in computed tomographies (CT). In all patients the main source was within delta or theta bands. The spatial extent of the sources, in the brain atlas, at these frequency values was almost the same as the volume of hematoma in CT. Putaminal lesions produced larger regions of cortical deafferentation than lobar hematomas, with higher abnormal Z values. FD-VARETA was more accurate in locating the lesions than traditional maps of absolute and relative power in delta, theta, alpha and beta bands.

CONCLUSION

FD-VARETA is a valuable procedure for the functional evaluation of brain hemorrhages.

Cerebral blood flow and sources of abnormal EEG activity (VARETA) in neurocysticercosis

OBJECTIVES

To compare two different functional procedures in the assessment of brain ischemia in patients with neurocysticercosis (NCC): (1) electroencephalography (EEG) evaluated by brain maps and EEG current sources in the frequency domain using variable resolution electromagnetic tomography and (2) blood flow analyzed by computerized tomography assessed with stable Xe (Xe-CT).

METHODS

Eleven patients with NCC at different evolution stages were studied. CT and Xe-CT scans, as well as quantitative electroencephalography with source calculation in the frequency domain, were obtained. All patients showed cysts and in 6 of them there were also vascular complications: two of them presented calcifications of the middle cerebral artery, two other subjects showed calcifications of the vessels in the circle of Willis and the remaining two had brain infarctions.

RESULTS

In the cyst areas important hypoperfused zones were observed, as intense as those observed in infarcted areas. Damage to the blood-brain barrier was originated by parasites in colloidal phase (final cysticerci stage) producing large areas of edema and hypoperfusion. Abnormal delta EEG activity was observed in very large lesions, probably generated by partial cortical deafferentation; and abnormal theta activity was mainly related to the presence of edema.

CONCLUSIONS

Sources of abnormal EEG activity were very similar in topography to the hypoperfused areas.

Delta activity as an early indicator for soman-induced brain damage: a review

The organophosphorus (OP) compound soman is known to produce long-lasting epileptic seizure activity and associated brain damage. The present paper reviews the findings of five recent studies that tentatively established correlations between the development of soman-induced neuropathology and some subtle changes in the electrocortigraphic (ECoG) power spectrum. It is important to note that the reported experiments have been performed independently by three different teams (France, The Netherlands, USA) in various animal models (rat, guinea-pig, cynomolgus monkey) through different protocols of intoxication, pharmacological environments, and methods for ECoG spectral analysis. Despite these disparities, the five studies show that a suistained shift of ECoG power toward the lowest frequency range, i.e. the delta band, occurs within the first hours of soman-induced seizures. This early ECoG spectral change is concurrent with the first neuropathological changes in brain and is almost constantly followed, days or weeks later, by at least minimal neuropathology. Moreover the relative contribution of delta activity to the ECoG power spectrum still remains abnormally high for 1-3 days after seizure onset, i.e. within the phase of damage maturation. On the other hand, somnan-induced neuropathology was not observed in non-seizuring animals in which the delta activity was not increased above the pre-soman baseline. Similarly, no brain damage was ever shown in seizuring subjects in which the initial delta change eventually normalized after the curative administration of efficient anticonvulsant drugs such as the non-competitive antagonists of the NMDA receptor. These results, in agreement with previously published observations, strongly suggest that an increase of the relative power in the delta band might be a real-time marker of the ongoing development of soman-induced, seizure-related cerebral lesions and a reliable predictor for the final neuronal losses to come. Therefore, the monitoring of delta activity during the 24-72 h period that follows soman exposure may potentially be a useful tool to follow "on-line" the progression of brain damage and to control the neuroprotective activity of'a medication. Moreover since the method is non-invasive in man and since the above-presented results have been partly found in primates, the applicability of spectral analysis as a prognostic means in human OP poisoning ought to be seriously considered.

Sources of abnormal EEG activity in brain infarctions

EEGs from 16 patients with stroke in three different stages of evolution were recorded. EEG sources were calculated every 0.39 Hz by frequency domain VARETA. The main source was within the delta band in 2 out of 4 chronic patients, and in 67% of the patients in the acute or subacute stages when edema (cytotoxic or vasogenic) was present. Moreover, all patients showed abnormal activity in the theta band. Sources of abnormal activity in cortical or corticosubcortical infarcts were located in the cortex, surrounding the lesion. At the site of the infarct, a decrease of EEG power was observed. Sources of abnormal theta power coincided with edema and/or ischemic penumbra.

Sources of abnormal EEG activity in the presence of brain lesions

In routine clinical EEG, a common origin is assumed for delta and theta rhythms produced by brain lesions. In previous papers, we have provided some experimental support, based on High Resolution qEEG and dipole fitting in the frequency domain, for the hypothesis that delta and theta spectral power have independent origins related to lesion and edema respectively. This paper describes the results obtained with Frequency Domain VARETA (FD-VARETA) in a group of 13 patients with cortical space-occupying lesions, in order to: 1) Test the accuracy of FD-VARETA for the localization of brain lesions, and 2) To provide further support for the independent origin of delta and theta components. FD VARETA is a distributed inverse solution, constrained by the Montreal Neurological Institute probabilistic atlas that estimates the spectra of EEG sources. In all patients, logarithmic transformed source spectra were compared with age-matched normative values, defining the Z source spectrum. Maximum Z values were found in 10 patients within the delta band (1.56 to 3.12 Hz); the spatial extent of these sources in the atlas corresponded with the location of the tumors in the CT. In 2 patients with small metastases and large volumes of edema and in a patient showing only edema, maximum Z values were found between 4.29 and 5.12 Hz. The spatial extent of the sources at these frequencies was within the volume of the edema in the CT. These results provided strong support to the hypothesis that both delta and theta abnormal EEG activities are the counterparts of two different pathophysiological processes.

Evolution of cerebral edema and its relationship with power in the theta band

In previous papers we have proposed that in patients with space-occupying lesions, delta power was related with the volume of the lesion and theta power with the volume of the edema. In this report we analyze the evolution of 10 patients with space-occupying lesions in whom we measured the volume of the lesion and of the edema before and after treatment that produced changes in these volumes. EEGs were recorded in the leads of the 10-20 system referenced to linked earlobes. Delta and theta powers were calculated for voltage and current source densities (CSD) and compared with age-norms to compute conventional Z-maps. These maps provide probability statements about the deviation of observed values from the norm. Rank correlations between the change in the volume of the lesion before and after treatment and the change in Z-values before and after treatment were significant only in the delta band. However, rank correlations between the change in the volume of the edema and the change in EEG Z-values were only significant in the theta band. These correlations were higher for CSD than for voltage estimates. We also observed that the site of the lesion and of the edema was better represented by CSD maps than by voltage maps. These results are also in agreement with our previous reports, in which we observed more precise localization of brain lesions by CSD than by voltage estimates.

Frequency source analysis in patients with brain lesions

In a previous study (Harmony et al. 1993) we observed that the volume of lesions was correlated only with delta power, while the volume and density of edema showed a significant correlation with theta and alpha power, suggesting two independent origins of activity in the delta and theta bands in patients with space-occupying lesions. Our goal in this paper is to show, through a different technique, in a narrow band spectral analysis, that brain lesions are characterized by activity in the delta domain and that edema is better correlated with activity within the theta range. Frequency source analysis based on the Maximum Likelihood (ML) test for rejection of isotropicity was applied to the EEG at rest of 36 patients with space-occupying intracranial lesions. The ML test was rejected at frequencies below 1 Hz and in the low range of the delta rhythm in 31 patients. The origin of the equivalent dipoles at these frequencies was within the volume of the lesion in 27 patients. In 15 patients out of 19 with vasogenic edema the ML test was rejected at frequencies in the theta range. The equivalent dipoles at these frequencies were all within the volume of the edema.

Comparison of Z and multivariate statistical brain electromagnetic maps for the localization of brain lesions

Conventional Z maps provide probability statements about the deviation of observed values from the norm. Galán et al. (1994) introduced Simultaneous Significance Probability Scales to detect abnormalities over the whole map, making use of the information provided by the topographic structure of dependencies. They also described multivariate brain electromagnetic (MBE) maps for compact presentation of complex spatio-temporal information. In this paper, using the distance-based localization receiver operating characteristic curves (DL-ROC curves), we compare the localization provided by computed tomography with that provided by Z and MBE maps in 61 patients with brain lesions. Maps were calculated for absolute power and relative power in delta, theta, alpha and beta bands for voltage and current source densities (CSD). In each patient, all maps were compared and the map with the highest value of the area of the DL-ROC curve was considered to be the "best map." Z maps of CSD were the "best maps" in 24 patients. In the voltage montage, we observed that multivariate maps add some information not contained in the Z maps. However, for CSD, Z maps were more accurate than multivariate maps. A very consistent finding was the observation that lesions were better detected by maps analyzing the delta band, while edema was better represented by maps in the theta range.