Seizure source imaging by means of FINE spatio-temporal dipole localization and directed transfer function in partial epilepsy patients

Enhancing non-invasive pre-surgical evaluation through functional connectivity and graph theory in drug-resistant focal epilepsy

BACKGROUND

Epilepsy, characterized as a network disorder, involves widely distributed areas following seizure propagation from a limited onset zone. Accurate delineation of the epileptogenic zone (EZ) is crucial for successful surgery in drug-resistant focal epilepsy. While visual analysis of scalp electroencephalogram (EEG) primarily elucidates seizure spreading patterns, we employed brain connectivity techniques and graph theory principles during the pre-ictal to ictal transition to define the epileptogenic network.

METHOD

Cortical sources were reconstructed from 40-channel scalp EEG in five patients during pre-surgical evaluation for focal drug-resistant epilepsy. Temporal Granger connectivity was estimated ten seconds before seizure and at seizure onset. Results have been analyzed using some centrality indices taken from Graph theory (Outdegree, Hubness). A new lateralization index is proposed by taking into account the sum of the most relevant hubness values across left and right regions of interest.

RESULTS

In three patients with positive surgical outcomes, analysis of the most relevant Hubness regions closely aligned with clinical hypotheses, demonstrating consistency in EZ lateralization and location. In one patient, the method provides unreliable results due to the abundant movement artifacts preceding the seizure. In a fifth patient with poor surgical outcome, the proposed method suggests a wider epileptic network compared with the clinically suspected EZ, providing intriguing new indications beyond those obtained with traditional electro-clinical analysis.

CONCLUSIONS

The proposed method could serve as an additional tool during pre-surgical non-invasive evaluation, complementing data obtained from EEG visual inspection. It represents a first step toward a more sophisticated analysis of seizure onset based on connectivity imbalances, electrical propagation, and graph theory principles.

Electroencephalography derived connectivity informing epilepsy surgical planning: Towards clinical applications and future perspectives

Epilepsy is one of the most diffused neurological disorders, affecting 50 million people worldwide. Around 30% of patients have drug-resistant epilepsy (DRE), defined as failure of at least two tolerated antiseizure medications (ASMs) to achieve sustained seizure freedom. Brain surgery is an effective therapeutic approach in this group, hinging on the accurate localization of the epileptic focus. The latter task is complex and requires multimodal investigation methods. Epilepsy is also a network disorder and represents one of the best application scenarios of methods leveraging brain functional organization at large scales. Connectivity analysis represents a promising tool for improving surgical assessment, enabling better identification of candidates who could benefit the most from epilepsy surgery. The scalp electroencephalography (EEG) is the most relevant tool to characterize epileptic activity. The EEG has benefited significantly from technological advancement across the last decades. Firstly, electrical source imaging (ESI) allows the reconstruction of electrical activity detected by EEG at the cortex level; secondly, functional connectivity (FC) allows the assessment of functional dependencies across brain areas. The EEG has therefore expanded potential applications in the localization and characterization of the epileptogenic network for surgical planning. As the translation of these methods in clinical practice is little discussed in the literature, we reviewed the investigations using EEG-derived FC. We showed that the FC-informed identification of the epileptic networks improves the localization precision in focal epilepsy. We discussed the heterogeneity in the results and methodology preventing prompt research-to-clinic translation. We finally provided practical suggestions for promoting the applicability of FC-based research in real clinical practice, looking for future research.

Human brain imaging with high-density electroencephalography: Techniques and applications

Electroencephalography (EEG) is a technique for non-invasively measuring neuronal activity in the human brain using electrodes placed on the participant's scalp. With the advancement of digital technologies, EEG analysis has evolved over time from the qualitative analysis of amplitude and frequency modulations to a comprehensive analysis of the complex spatiotemporal characteristics of the recorded signals. EEG is now considered a powerful tool for measuring neural processes in the same time frame in which they happen (i.e. the subsecond range). However, it is commonly argued that EEG suffers from low spatial resolution, which makes it difficult to localize the generators of EEG activity accurately and reliably. Today, the availability of high-density EEG (hdEEG) systems, combined with methods for incorporating information on head anatomy and sophisticated source-localization algorithms, has transformed EEG into an important neuroimaging tool. hdEEG offers researchers and clinicians a rich and varied range of applications. It can be used not only for investigating neural correlates in motor and cognitive neuroscience experiments, but also for clinical diagnosis, particularly in the detection of epilepsy and the characterization of neural impairments in a wide range of neurological disorders. Notably, the integration of hdEEG systems with other physiological recordings, such as kinematic and/or electromyography data, might be especially beneficial to better understand the neuromuscular mechanisms associated with deconditioning in ageing and neuromotor disorders, by mapping the neurokinematic and neuromuscular connectivity patterns directly in the brain.

Ictal EEG Source Imaging

SUMMARY

Ictal EEG source imaging (ESI) is an advancing and growing application for presurgical epilepsy evaluation. For far too long, localization of seizures with scalp EEG has continued to rely on visual inspection of tracings arranged in a variety of montages allowing, at best, rough estimates of seizure onset regions. This most critical step is arguably the weakest point in epilepsy localization for surgical decision-making in clinical practice today. This review covers the methods and strategies that have been developed and tested for the performance of ictal ESI. It highlights practical issues and solutions toward sound implementation while covering differing methods to tackle the challenges specific to ictal ESI-noise and artifact reduction, component analysis, and other tools to increase seizure-specific signal for analysis. Further, validation studies to date-those with both high and low density numbers of electrodes-are summarized, providing a glimpse at the relative accuracy of ictal ESI in all types of focal epilepsy patients. Finally, given the added noninvasive information (greater degree of spatial resolution compared with standard ictal EEG review), the role of ictal ESI and its clinical utility in the presurgical evaluation is discussed.

Disentanglement of Resting State Brain Networks for Localizing Epileptogenic Zone in Focal Epilepsy

The objective of this study is to extract pathological brain networks from interictal period of E/MEG recordings to localize epileptic foci for presurgical evaluation. We proposed here a resting state E/MEG analysis framework, to disentangle brain functional networks represented by neural oscillations. By using an Embedded Hidden Markov Model, we constructed a state space for resting state recordings consisting of brain states with different spatiotemporal patterns. Functional connectivity analysis along with graph theory was applied on the extracted brain states to quantify the network features of the extracted brain states, based on which the source location of pathological states is determined. The method is evaluated by computer simulations and our simulation results revealed the proposed framework can extract brain states with high accuracy regarding both spatial and temporal profiles. We further evaluated the framework as compared with intracranial EEG defined seizure onset zone in 10 patients with drug-resistant focal epilepsy who underwent MEG recordings and were seizure free after surgical resection. The real patient data analysis showed very good localization results using the extracted pathological brain states in 6/10 patients, with localization error of about 15 mm as compared to the seizure onset zone. We show that the pathological brain networks can be disentangled from the resting-state electromagnetic recording and could be identified based on the connectivity features. The framework can serve as a useful tool in extracting brain functional networks from noninvasive resting state electromagnetic recordings, and promises to offer an alternative to aid presurgical evaluation guiding intracranial EEG electrodes implantation.

Targeted density electrode placement achieves high concordance with traditional high-density EEG for electrical source imaging in epilepsy

OBJECTIVE

High-density (HD) electroencephalography (EEG) is increasingly used in presurgical epilepsy evaluation, but it is demanding in time and resources. To overcome these issues, we compared EEG source imaging (ESI) solutions with a targeted density and HD-EEG montage.

METHODS

HD-EEGs from patients undergoing presurgical evaluation were analyzed. A low-density recording was created by selecting the 25 electrodes of a standard montage from the 83 electrodes of the HD-EEG and adding 8-11 electrodes around the electrode with the highest amplitude interictal epileptiform discharges. The ESI solution from this "targeted" montage was compared to that from the HD-EEG using the distance between peak vertices, sublobar concordance and a qualitative similarity measure.

RESULTS

Fifty-eight foci of forty-three patients were included. The median distance between the peak vertices of the two montages was 13.2 mm, irrespective of focus' location. Tangential generators (n = 5/58) showed a higher distance than radial generators (p = 0.04). We found sublobar concordance in 54/58 of the foci (93%). Map similarity, assessed by an epileptologist, had a median score of 4/5.

CONCLUSIONS

ESI solutions obtained from a targeted density montage show high concordance with those calculated from HD-EEG.

SIGNIFICANCE

Requiring significantly fewer electrodes, targeted density EEG allows obtaining similar ESI solutions as traditional HD-EEG montage.

An Explainable Statistical Method for Seizure Prediction Using Brain Functional Connectivity from EEG

Background. Epilepsy is a group of chronic neurological disorders characterized by recurrent and abrupt seizures. The accurate prediction of seizures can reduce the burdens of this disorder. Now, existing studies use brain network features to classify patients’ preictal or interictal states, enabling seizure prediction. However, most predicting methods are based on deep learning techniques, which have weak interpretability and high computational complexity. To address these issues, in this study, we proposed a novel two-stage statistical method that is interpretable and easy to compute. Methods. We used two datasets to evaluate the performance of the proposed method, including the well-known public dataset CHB-MIT. In the first stage, we estimated the dynamic brain functional connectivity network for each epoch. Then, in the second stage, we used the derived network predictor for seizure prediction. Results. We illustrated the results of our method in seizure prediction in two datasets separately. For the FH-PKU dataset, our approach achieved an AUC value of 0.963, a prediction sensitivity of 93.1%, and a false discovery rate of 7.7%. For the CHB-MIT dataset, our approach achieved an AUC value of 0.940, a prediction sensitivity of 93.0%, and a false discovery rate of 11.1%, outperforming existing state-of-the-art methods. Significance. This study proposed an explainable statistical method, which can estimate the brain network using the scalp EEG method and use the net-work predictor to predict epileptic seizures. Availability and Implementation. R Source code is available at https://github.com/HaoChen1994/Seizure-Prediction.

Imaging the extent and location of spatiotemporally distributed epileptiform sources from MEG measurements

Non-invasive MEG/EEG source imaging provides valuable information about the epileptogenic brain areas which can be used to aid presurgical planning in focal epilepsy patients suffering from drug-resistant seizures. However, the source extent estimation for electrophysiological source imaging remains to be a challenge and is usually largely dependent on subjective choice. Our recently developed algorithm, fast spatiotemporal iteratively reweighted edge sparsity minimization (FAST-IRES) strategy, has been shown to objectively estimate extended sources from EEG recording, while it has not been applied to MEG recordings. In this work, through extensive numerical experiments and real data analysis in a group of focal drug-resistant epilepsy patients' interictal spikes, we demonstrated the ability of FAST-IRES algorithm to image the location and extent of underlying epilepsy sources from MEG measurements. Our results indicate the merits of FAST-IRES in imaging the location and extent of epilepsy sources for pre-surgical evaluation from MEG measurements.

Design of MRI structured spiking neural networks and learning algorithms for personalized modelling, analysis, and prediction of EEG signals

This paper proposes a novel method and algorithms for the design of MRI structured personalized 3D spiking neural network models (MRI-SNN) for a better analysis, modeling, and prediction of EEG signals. It proposes a novel gradient-descent learning algorithm integrated with a spike-time-dependent-plasticity algorithm. The models capture informative personal patterns of interaction between EEG channels, contrary to single EEG signal modeling methods or to spike-based approaches which do not use personal MRI data to pre-structure a model. The proposed models can not only learn and model accurately measured EEG data, but they can also predict signals at 3D model locations that correspond to non-monitored brain areas, e.g. other EEG channels, from where data has not been collected. This is the first study in this respect. As an illustration of the method, personalized MRI-SNN models are created and tested on EEG data from two subjects. The models result in better prediction accuracy and a better understanding of the personalized EEG signals than traditional methods due to the MRI and EEG information integration. The models are interpretable and facilitate a better understanding of related brain processes. This approach can be applied for personalized modeling, analysis, and prediction of EEG signals across brain studies such as the study and prediction of epilepsy, peri-perceptual brain activities, brain-computer interfaces, and others.

Ictal EEG source localization in focal epilepsy: Review and future perspectives

Electroencephalographic (EEG) source imaging localizes the generators of neural activity in the brain. During presurgical epilepsy evaluation, EEG source imaging of interictal epileptiform discharges is an established tool to estimate the irritative zone. However, the origin of interictal activity can be partly or fully discordant with the origin of seizures. Therefore, source imaging based on ictal EEG data to determine the seizure onset zone can provide precious clinical information. In this descriptive review, we address the importance of localizing the seizure onset zone based on noninvasive EEG recordings as a complementary analysis that might reduce the burden of the presurgical evaluation. We identify three major challenges (low signal-to-noise ratio of the ictal EEG data, spread of ictal activity in the brain, and validation of the developed methods) and discuss practical solutions. We provide an extensive overview of the existing clinical studies to illustrate the potential clinical utility of EEG-based localization of the seizure onset zone. Finally, we conclude with future perspectives and the needs for translating ictal EEG source imaging into clinical practice.

Noninvasive electromagnetic source imaging of spatiotemporally distributed epileptogenic brain sources

Brain networks are spatiotemporal phenomena that dynamically vary over time. Functional imaging approaches strive to noninvasively estimate these underlying processes. Here, we propose a novel source imaging approach that uses high-density EEG recordings to map brain networks. This approach objectively addresses the long-standing limitations of conventional source imaging techniques, namely, difficulty in objectively estimating the spatial extent, as well as the temporal evolution of underlying brain sources. We validate our approach by directly comparing source imaging results with the intracranial EEG (iEEG) findings and surgical resection outcomes in a cohort of 36 patients with focal epilepsy. To this end, we analyzed a total of 1,027 spikes and 86 seizures. We demonstrate the capability of our approach in imaging both the location and spatial extent of brain networks from noninvasive electrophysiological measurements, specifically for ictal and interictal brain networks. Our approach is a powerful tool for noninvasively investigating large-scale dynamic brain networks.

Noninvasive electromagnetic measurements are utilized effectively to estimate large scale dynamic brain networks. Sohrabpour et al. propose a novel electrophysiological source imaging approach to estimate the location and size of epileptogenic tissues in patients with epilepsy.

Model-based design for seizure control by stimulation

OBJECTIVE

Current brain stimulation paradigms are largely empirical rather than theoretical. An opportunity exists to improve upon their modest effectiveness in closed-loop control strategies with the development of theoretically grounded, model-based designs.

APPROACH

Inspired by this need, here we couple experimental data and mathematical modeling with a control-theoretic strategy for seizure termination. We begin by exercising a dynamical systems approach to model seizures (n = 94) recorded using intracranial EEG (iEEG) from 21 patients with medication-resistant, localization-related epilepsy.

MAIN RESULTS

Although each patient's seizures displayed unique spatial and temporal patterns, their evolution can be parsimoniously characterized by the same model form. Idiosyncracies of the model can inform individualized intervention strategies, specifically in iEEG samples with well-localized seizure onset zones. Temporal fluctuations in the spatial profiles of the oscillatory modes show that seizure onset marks a transition into a regime in which the underlying system supports prolonged rhythmic and focal activity. Based on these observations, we propose a control-theoretic strategy that aims to stabilize ictal activity using static output feedback for linear time-invariant switching systems. Finally, we demonstrate in silico that our proposed strategy allows us to dampen the emerging focal oscillatory sources using only a small set of electrodes.

SIGNIFICANCE

Our integrative study informs the development of modulation and control algorithms for neurostimulation that could improve the effectiveness of implantable, closed-loop anti-epileptic devices.

Computational modelling in source space from scalp EEG to inform presurgical evaluation of epilepsy

OBJECTIVE

The effectiveness of intracranial electroencephalography (iEEG) to inform epilepsy surgery depends on where iEEG electrodes are implanted. This decision is informed by noninvasive recording modalities such as scalp EEG. Herein we propose a framework to interrogate scalp EEG and determine epilepsy lateralization to aid in electrode implantation.

METHODS

We use eLORETA to map source activities from seizure epochs recorded from scalp EEG and consider 15 regions of interest (ROIs). Functional networks are then constructed using the phase-locking value and studied using a mathematical model. By removing different ROIs from the network and simulating their impact on the network's ability to generate seizures in silico, the framework provides predictions of epilepsy lateralization. We consider 15 individuals from the EPILEPSIAE database and study a total of 62 seizures. Results were assessed by taking into account actual intracranial implantations and surgical outcome.

RESULTS

The framework provided potentially useful information regarding epilepsy lateralization in 12 out of the 15 individuals (p=0.02, binomial test).

CONCLUSIONS

Our results show promise for the use of this framework to better interrogate scalp EEG to determine epilepsy lateralization.

SIGNIFICANCE

The framework may aid clinicians in the decision process to define where to implant electrodes for intracranial monitoring.

Network Perspectives on Epilepsy Using EEG/MEG Source Connectivity

The evolution of EEG/MEG source connectivity is both, a promising, and controversial advance in the characterization of epileptic brain activity. In this narrative review we elucidate the potential of this technology to provide an intuitive view of the epileptic network at its origin, the different brain regions involved in the epilepsy, without the limitation of electrodes at the scalp level. Several studies have confirmed the added value of using source connectivity to localize the seizure onset zone and irritative zone or to quantify the propagation of epileptic activity over time. It has been shown in pilot studies that source connectivity has the potential to obtain prognostic correlates, to assist in the diagnosis of the epilepsy type even in the absence of visually noticeable epileptic activity in the EEG/MEG, and to predict treatment outcome. Nevertheless, prospective validation studies in large and heterogeneous patient cohorts are still lacking and are needed to bring these techniques into clinical use. Moreover, the methodological approach is challenging, with several poorly examined parameters that most likely impact the resulting network patterns. These fundamental challenges affect all potential applications of EEG/MEG source connectivity analysis, be it in a resting, spiking, or ictal state, and also its application to cognitive activation of the eloquent area in presurgical evaluation. However, such method can allow unique insights into physiological and pathological brain functions and have great potential in (clinical) neuroscience.

Neurobiological mechanisms of TENS-induced analgesia

Pain inhibition by additional somatosensory input is the rationale for the widespread use of Transcutaneous Electrical Nerve Stimulation (TENS) to relieve pain. Two main types of TENS produce analgesia in animal models: high-frequency (∼50-100 Hz) and low-intensity 'conventional' TENS, and low-frequency (∼2-4 Hz) and high-intensity 'acupuncture-like' TENS. However, TENS efficacy in human participants is debated, raising the question of whether the analgesic mechanisms identified in animal models are valid in humans. Here, we used a sham-controlled experimental design to clarify the efficacy and the neurobiological effects of 'conventional' and 'acupuncture-like' TENS in 80 human volunteers. To test the analgesic effect of TENS we recorded the perceptual and brain responses elicited by radiant heat laser pulses that activate selectively Aδ and C cutaneous nociceptors. To test whether TENS has a long-lasting effect on brain state we recorded spontaneous electrocortical oscillations. The analgesic effect of 'conventional' TENS was maximal when nociceptive stimuli were delivered homotopically, to the same hand that received the TENS. In contrast, 'acupuncture-like' TENS produced a spatially-diffuse analgesic effect, coupled with long-lasting changes both in the state of the primary sensorimotor cortex (S1/M1) and in the functional connectivity between S1/M1 and the medial prefrontal cortex, a core region in the descending pain inhibitory system. These results demonstrate that 'conventional' and 'acupuncture-like' TENS have different analgesic effects, which are mediated by different neurobiological mechanisms.

Electrophysiological Brain Connectivity: Theory and Implementation

We review the theory and algorithms of electrophysiological brain connectivity analysis. This tutorial is aimed at providing an introduction to brain functional connectivity from electrophysiological signals, including electroencephalography (EEG), magnetoencephalography (MEG), electrocorticography (ECoG), stereoelectroencephalography (SEEG). Various connectivity estimators are discussed, and algorithms introduced. Important issues for estimating and mapping brain functional connectivity with electrophysiology are discussed.

Epileptic source connectivity analysis based on estimating of dynamic time series of regions of interest

We propose a new source connectivity method by focusing on estimating time courses of the regions of interest (ROIs). To this aim, it is necessary to consider the strong inherent non-stationary behavior of neural activity. We develop an iterative dynamic approach to extract a single time course for each ROI encoding the temporal non-stationary features. The proposed approach explicitly includes dynamic constraints by taking into account the evolution of the sources activities for further dynamic connectivity analysis. We simulated an epileptic network with a non-stationary structure; accordingly, EEG source reconstruction using LORETA is performed. Using the reconstructed sources, the spatially compact ROIs are selected. Then, a single time course encoding the temporal non-stationarity is extracted for each ROI. An adaptive directed transfer function (ADTF) is applied to measure the information flow of underlying brain networks. Obtained results demonstrate that the contributed approach is more efficient to estimate the ROI time series and ROI to ROI information flow in comparison with existing methods. Our work is validated in three drug-resistance epilepsy patients. The proposed ROI time series estimation directly affects the quality of connectivity analysis, leading to the best possible seizure onset zone (SOZ) localization verified by electrocorticography and post-operational results.

Modified Dominant Mode Rejection Beamformer for Localizing Brain Activities When Data Covariance Matrix Is Rank Deficient

OBJECTIVE

Minimum variance beamformer (MVB) and its extensions fail in localizing short time brain activities particularly evoked potentials because of rank deficiency or inaccurate estimation of a data covariance matrix. In this paper, the conventional dominant mode rejection (DMR) adaptive beamformer is modified to localize brain short time activities.

METHODS

In the modified DMR, it is attempted to obtain a well-conditioned covariance matrix by dividing the eigenvalues of the data covariance matrix into dominant, medium, and small eigenvalues and then modifying medium and small parts. The performance of the proposed approach is compared with diagonal loading MVB (DL_MVB) and fast fully adaptive (FFA) beamformer by using simulated event-related potentials and real event-related field data. Eigenspace versions of DL_MVB and modified DMR are also implemented.

RESULTS

In all simulations, the modified DMR obtains the least localization error (0-5 mm) and spread radius (0-8 mm) when the signal-to-noise ratio (SNR) varies from 0 to 10 dB with step 1 dB. In real data, the new approach in comparison to two other ones attains the most concentrated power spectrum. Eigenspace projection of DL_MVB presents better results than DL_MVB but worse results than the modified DMR. Applying eigenspace projection on the proposed method improves its performance at high SNR levels.

CONCLUSION

Empirical results illustrate the superiority of the proposed DMR method to the DL_MVB and FFA in localizing brain short time activities.

SIGNIFICANCE

The proposed method can be utilized in source localization of epilepsy for presurgical clinical evaluation purpose and also in applications dealing with the localization of evoked potentials and fields.

Phase Synchronization Dynamics of Neural Network during Seizures

Epilepsy has been considered as a network-level disorder characterized by recurrent seizures, which result from network reorganization with evolution of synchronization. In this study, the brain networks were established by calculating phase synchronization based on electrocorticogram (ECoG) signals from eleven refractory epilepsy patients. Results showed that there was a significant increase of synchronization prior to seizure termination and no significant difference of the transitions of network states among the preseizure, seizure, and postseizure periods. Those results indicated that synchronization might participate in termination of seizures, and the network states transitions might not dominate the seizure evolution.

Electrophysiological Source Imaging: A Noninvasive Window to Brain Dynamics

Brain activity and connectivity are distributed in the three-dimensional space and evolve in time. It is important to image brain dynamics with high spatial and temporal resolution. Electroencephalography (EEG) and magnetoencephalography (MEG) are noninvasive measurements associated with complex neural activations and interactions that encode brain functions. Electrophysiological source imaging estimates the underlying brain electrical sources from EEG and MEG measurements. It offers increasingly improved spatial resolution and intrinsically high temporal resolution for imaging large-scale brain activity and connectivity on a wide range of timescales. Integration of electrophysiological source imaging and functional magnetic resonance imaging could further enhance spatiotemporal resolution and specificity to an extent that is not attainable with either technique alone. We review methodological developments in electrophysiological source imaging over the past three decades and envision its future advancement into a powerful functional neuroimaging technology for basic and clinical neuroscience applications.

Automatic ictal onset source localization in presurgical epilepsy evaluation

OBJECTIVE

To test the diagnostic accuracy of a new automatic algorithm for ictal onset source localization (IOSL) during routine presurgical epilepsy evaluation following STARD (Standards for Reporting of Diagnostic Accuracy) criteria.

METHODS

We included 28 consecutive patients with refractory focal epilepsy (25 patients with temporal lobe epilepsy (TLE) and 3 with extratemporal epilepsy) who underwent resective epilepsy surgery. Ictal EEG patterns were analyzed with a novel automatic IOSL algorithm. IOSL source localizations on a sublobar level were validated by comparison with actual resection sites and seizure free outcome 2 years after surgery.

RESULTS

Sensitivity of IOSL was 92.3% (TLE: 92.3%); specificity 60% (TLE: 50%); positive predictive value 66.7% (TLE: 66.7%); and negative predictive value 90% (TLE: 85.7%). The likelihood ratio was more than ten times higher for concordant IOSL results as compared to discordant results (p = 0.013).

CONCLUSIONS

We demonstrated the clinical feasibility of our IOSL approach yielding reasonable high performance measures on a sublobar level.

SIGNIFICANCE

Our IOSL method may contribute to a correct localization of the seizure onset zone in temporal lobe epilepsy and can readily be used in standard epilepsy monitoring settings. Further studies are needed for validation in extratemporal epilepsy.

Electromagnetic source imaging using simultaneous scalp EEG and intracranial EEG: An emerging tool for interacting with pathological brain networks

OBJECTIVE

The goal of this study is to investigate the performance, merits and limitations of source imaging using intracranial EEG (iEEG) recordings and to compare its accuracy to the results of EEG source imaging. Accuracy in this study, is measured both by determining the location and inter-nodal connectivity of underlying brain networks.

METHODS

Systematic computer simulation studies are conducted to evaluate iEEG-based source imaging vs. EEG-based source imaging, and source imaging using both EEG and iEEG. To test the source imaging models, networks of inter-connected nodes (in terms of activity) are simulated. The location of the network nodes is randomly selected within a realistic geometry head model and a connectivity link is created among these nodes based on a multi-variate auto-regressive (MVAR) model. Then the forward problem is solved to calculate the potentials at the electrodes and noise (white and correlated) is added to these simulated potentials to simulate realistic measurements. Subsequently, the inverse problem is solved and an algorithm based on principle component analysis is performed on the estimated source activities to determine the location of the simulated network nodes. The activity of these nodes (over time), is then extracted, and used to estimate the connectivity links among the mentioned nodes using Granger causality analysis.

RESULTS

Source imaging based on iEEG recordings may or may not improve the accuracy in localization, depending on the number and location of active nodes relative to iEEG electrodes and to other nodes within the network. However, our simulation results suggest that combining EEG and iEEG modalities (simultaneous scalp and intracranial recordings) can improve the imaging accuracy significantly.

CONCLUSIONS

While iEEG source imaging is useful in estimating the exact location of sources near the iEEG electrodes, combining EEG and iEEG recordings can achieve a more accurate imaging due to the high spatial coverage of the scalp electrodes and the added near field information provided by the iEEG electrodes.

SIGNIFICANCE

The present results suggest the feasibility of localizing brain electrical sources from iEEG recordings and improving EEG source localization using simultaneous EEG and iEEG recordings to cover the whole brain. The hybrid EEG and iEEG source imaging can assist the clinicians when unequivocal decisions about determining the epileptogenic zone cannot be reached using a single modality.

EEG source connectivity to localize the seizure onset zone in patients with drug resistant epilepsy

Electrical source imaging (ESI) from interictal scalp EEG is increasingly validated and used as a valuable tool in the presurgical evaluation of epilepsy as a reflection of the irritative zone. ESI of ictal scalp EEG to localize the seizure onset zone (SOZ) remains challenging. We investigated the value of an approach for ictal imaging using ESI and functional connectivity analysis (FC). Ictal scalp EEG from 111 seizures in 27 patients who had Engel class I outcome at least 1 year following resective surgery was analyzed. For every seizure, an artifact-free epoch close to the seizure onset was selected and ESI using LORETA was applied. In addition, the reconstructed sources underwent FC using the spectrum-weighted Adaptive Directed Transfer Function. This resulted in the estimation of the SOZ in two ways: (i) the source with maximal power after ESI, (ii) the source with the strongest outgoing connections after combined ESI and FC. Next, we calculated the distance between the estimated SOZ and the border of the resected zone (RZ) for both approaches and called this the localization error ((i) LE_pow and (ii) LE_conn respectively). By comparing LE_pow and LE_conn, we assessed the added value of FC. The source with maximal power after ESI was inside the RZ (LE_pow = 0 mm) in 31% of the seizures and estimated within 10 mm from the border of the RZ (LE_pow ≤ 10 mm) in 42%. Using ESI and FC, these numbers increased to 72% for LE_conn = 0 mm and 94% for LE_conn ≤ 10 mm. FC provided a significant added value to ESI alone (p < 0.001). ESI combined with subsequent FC is able to localize the SOZ in a non-invasive way with high accuracy. Therefore it could be a valuable tool in the presurgical evaluation of epilepsy.

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ESI + functional connectivity analysis allows localizing the SOZ with high accuracy.

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Functional connectivity analysis offered a significant added value to ESI.

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The method is robust for inter- and intra-patient variability.

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The method could be a useful tool in the presurgical evaluation of epilepsy.

Time-Varying Networks of Inter-Ictal Discharging Reveal Epileptogenic Zone

The neuronal synchronous discharging may cause an epileptic seizure. Currently, most of the studies conducted to investigate the mechanism of epilepsy are based on EEGs or functional magnetic resonance imaging (fMRI) recorded during the ictal discharging or the resting-state, and few studies have probed into the dynamic patterns during the inter-ictal discharging that are much easier to record in clinical applications. Here, we propose a time-varying network analysis based on adaptive directed transfer function to uncover the dynamic brain network patterns during the inter-ictal discharging. In addition, an algorithm based on the time-varying outflow of information derived from the network analysis is developed to detect the epileptogenic zone. The analysis performed revealed the time-varying network patterns during different stages of inter-ictal discharging; the epileptogenic zone was activated prior to the discharge onset then worked as the source to propagate the activity to other brain regions. Consistence between the epileptogenic zones detected by our proposed approach and the actual epileptogenic zones proved that time-varying network analysis could not only reveal the underlying neural mechanism of epilepsy, but also function as a useful tool in detecting the epileptogenic zone based on the EEGs in the inter-ictal discharging.

High density scalp EEG in frontal lobe epilepsy

PURPOSE

Localization of seizures in frontal lobe epilepsy using the 10-20 system scalp EEG is often challenging because neocortical seizure can spread rapidly, significant muscle artifact, and the suboptimal spatial resolution for seizure generators involving mesial frontal lobe cortex. Our aim in this study was to determine the value of visual interpretation of 76 channel high density EEG (hdEEG) monitoring (10-10 system) in patients with suspected frontal lobe epilepsy, and to evaluate concordance with MRI, subtraction ictal SPECT co-registered to MRI (SISCOM), conventional EEG, and intracranial EEG (iEEG).

METHODS

We performed a retrospective cohort study of 14 consecutive patients who underwent hdEEG monitoring for suspected frontal lobe seizures. The gold standard for localization was considered to be iEEG. Concordance of hdEEG findings with MRI, subtraction ictal SPECT co-registered to MRI (SISCOM), conventional 10-20 EEG, and iEEG as well as correlation of hdEEG localization with surgical outcome were examined.

RESULTS

hdEEG localization was concordant with iEEG in 12/14 and was superior to conventional EEG 3/14 (p<0.01) and SISCOM 3/12 (p<0.01). hdEEG correctly lateralized seizure onset in 14/14 cases, compared to 9/14 (p=0.04) cases with conventional EEG. Seven patients underwent surgical resection, of whom five were seizure free.

CONCLUSIONS

hdEEG monitoring should be considered in patients with suspected frontal epilepsy requiring localization of epileptogenic brain. hdEEG may assist in developing a hypothesis for iEEG monitoring and could potentially augment EEG source localization.

Noninvasive Electromagnetic Source Imaging and Granger Causality Analysis: An Electrophysiological Connectome (eConnectome) Approach

OBJECTIVE

Combined source-imaging techniques and directional connectivity analysis can provide useful information about the underlying brain networks in a noninvasive fashion. Source-imaging techniques have been used successfully to either determine the source of activity or to extract source time-courses for Granger causality analysis, previously. In this work, we utilize source-imaging algorithms to both find the network nodes [regions of interest (ROI)] and then extract the activation time series for further Granger causality analysis. The aim of this work is to find network nodes objectively from noninvasive electromagnetic signals, extract activation time-courses, and apply Granger analysis on the extracted series to study brain networks under realistic conditions.

METHODS

Source-imaging methods are used to identify network nodes and extract time-courses and then Granger causality analysis is applied to delineate the directional functional connectivity of underlying brain networks. Computer simulations studies where the underlying network (nodes and connectivity pattern) is known were performed; additionally, this approach has been evaluated in partial epilepsy patients to study epilepsy networks from interictal and ictal signals recorded by EEG and/or Magnetoencephalography (MEG).

RESULTS

Localization errors of network nodes are less than 5 mm and normalized connectivity errors of ∼20% in estimating underlying brain networks in simulation studies. Additionally, two focal epilepsy patients were studied and the identified nodes driving the epileptic network were concordant with clinical findings from intracranial recordings or surgical resection.

CONCLUSION

Our study indicates that combined source-imaging algorithms with Granger causality analysis can identify underlying networks precisely (both in terms of network nodes location and internodal connectivity).

SIGNIFICANCE

The combined source imaging and Granger analysis technique is an effective tool for studying normal or pathological brain conditions.

The Concept of Effective Inflow: Application to Interictal Localization of the Epileptogenic Focus From iEEG

GOAL

Accurate determination of the epileptogenic focus is of paramount diagnostic and therapeutic importance in epilepsy. The current gold standard for focus localization is from ictal (seizure) onset and thus requires the occurrence and recording of multiple typical seizures of a patient. Localization of the focus from seizure-free (interictal) periods remains a challenging problem, especially in the absence of interictal epileptiform activity.

METHODS

By exploring the concept of effective inflow, we developed a focus localization algorithm (FLA) based on directed connectivity between brain sites. Subsequently, using the measure of generalized partial directed coherence over a broad frequency band in FLA for the analysis of interictal periods from long-term (days) intracranial electroencephalographic signals, we identified the brain region that is the most frequent receiver of maximal effective inflow from other brain regions.

RESULTS

In six out of nine patients with temporal lobe epilepsy, the thus identified brain region was a statistically significant outlier (p < 0.01) and coincided with the clinically assessed epileptogenic focus. In the remaining three patients, the clinically assessed focus still exhibited the highest inflow, but it was not deemed an outlier (p > 0.01).

CONCLUSIONS

These findings suggest that the epileptogenic focus is a region of intense influence from other regions interictally, possibly as a mechanism to keep it under control in seizure-free periods.

SIGNIFICANCE

The developed framework is expected to assist with the accurate epileptogenic focus localization, reduce hospital stay and healthcare cost, and provide guidance to treatment of epilepsy via resective surgery or neuromodulation.

Seizure Onset Zone Localization from Ictal High-Density EEG in Refractory Focal Epilepsy

Epilepsy surgery is the most efficient treatment option for patients with refractory epilepsy. Before surgery, it is of utmost importance to accurately delineate the seizure onset zone (SOZ). Non-invasive EEG is the most used neuroimaging technique to diagnose epilepsy, but it is hard to localize the SOZ from EEG due to its low spatial resolution and because epilepsy is a network disease, with several brain regions becoming active during a seizure. In this work, we propose and validate an approach based on EEG source imaging (ESI) combined with functional connectivity analysis to overcome these problems. We considered both simulations and real data of patients. Ictal epochs of 204-channel EEG and subsets down to 32 channels were analyzed. ESI was done using realistic head models and LORETA was used as inverse technique. The connectivity pattern between the reconstructed sources was calculated, and the source with the highest number of outgoing connections was selected as SOZ. We compared this algorithm with a more straightforward approach, i.e. selecting the source with the highest power after ESI as the SOZ. We found that functional connectivity analysis estimated the SOZ consistently closer to the simulated EZ/RZ than localization based on maximal power. Performance, however, decreased when 128 electrodes or less were used, especially in the realistic data. The results show the added value of functional connectivity analysis for SOZ localization, when the EEG is obtained with a high-density setup. Next to this, the method can potentially be used as objective tool in clinical settings.

Imaging brain source extent from EEG/MEG by means of an iteratively reweighted edge sparsity minimization (IRES) strategy

Estimating extended brain sources using EEG/MEG source imaging techniques is challenging. EEG and MEG have excellent temporal resolution at millisecond scale but their spatial resolution is limited due to the volume conduction effect. We have exploited sparse signal processing techniques in this study to impose sparsity on the underlying source and its transformation in other domains (mathematical domains, like spatial gradient). Using an iterative reweighting strategy to penalize locations that are less likely to contain any source, it is shown that the proposed iteratively reweighted edge sparsity minimization (IRES) strategy can provide reasonable information regarding the location and extent of the underlying sources. This approach is unique in the sense that it estimates extended sources without the need of subjectively thresholding the solution. The performance of IRES was evaluated in a series of computer simulations. Different parameters such as source location and signal-to-noise ratio were varied and the estimated results were compared to the targets using metrics such as localization error (LE), area under curve (AUC) and overlap between the estimated and simulated sources. It is shown that IRES provides extended solutions which not only localize the source but also provide estimation for the source extent. The performance of IRES was further tested in epileptic patients undergoing intracranial EEG (iEEG) recording for pre-surgical evaluation. IRES was applied to scalp EEGs during interictal spikes, and results were compared with iEEG and surgical resection outcome in the patients. The pilot clinical study results are promising and demonstrate a good concordance between noninvasive IRES source estimation with iEEG and surgical resection outcomes in the same patients. The proposed algorithm, i.e. IRES, estimates extended source solutions from scalp electromagnetic signals which provide relatively accurate information about the location and extent of the underlying source.

Dynamic Network Connectivity Analysis to Identify Epileptogenic Zones Based on Stereo-Electroencephalography

Objectives: Accurate localization of epileptogenic zones (EZs) is essential for successful surgical treatment of refractory focal epilepsy. The aim of the present study is to investigate whether a dynamic network connectivity analysis based on stereo-electroencephalography (SEEG) signals is effective in localizing EZs.

Methods: SEEG data were recorded from seven patients who underwent presurgical evaluation for the treatment of refractory focal epilepsy and for whom the subsequent resective surgery gave a good outcome. A time-variant multivariate autoregressive model was constructed using a Kalman filter, and the time-variant partial directed coherence was computed. This was then used to construct a dynamic directed network model of the epileptic brain. Three graph measures (in-degree, out-degree, and betweenness centrality) were used to analyze the characteristics of the dynamic network and to find the important nodes in it.

Results: In all seven patients, the indicative EZs localized by the in-degree and the betweenness centrality were highly consistent with the clinically diagnosed EZs. However, the out-degree did not indicate any significant differences between nodes in the network.

Conclusions: In this work, a method based on ictal SEEG signals and effective connectivity analysis localized EZs accurately. The results suggest that the in-degree and betweenness centrality may be better network characteristics to localize EZs than the out-degree.

Directed Functional Brain Connectivity Based on EEG Source Imaging: Methodology and Application to Temporal Lobe Epilepsy

OBJECTIVE

The importance of functional brain connectivity to study physiological and pathological brain activity has been widely recognized. Here, we aimed to 1) review a methodological pipeline to investigate directed functional connectivity between brain regions using source signals derived from high-density EEG; 2) elaborate on some methodological challenges; and 3) apply this pipeline to temporal lobe epilepsy (TLE) patients and healthy controls to investigate directed functional connectivity differences in the theta and beta frequency bands during EEG epochs without visible pathological activity.

METHODS

The methodological pipeline includes: EEG acquisition and preprocessing, electrical-source imaging (ESI) using individual head models and distributed inverse solutions, parcellation of the gray matter in regions of interest, fixation of the dipole orientation for each region, computation of the spectral power in the source space, and directed functional connectivity estimation using Granger-causal modeling. We specifically analyzed how the signal-to-noise ratio (SNR) changes using different approaches for the dipole orientation fixation. We applied this pipeline to 20 left TLE patients, 20 right TLE patients, and 20 healthy controls.

RESULTS

Projecting each dipole to the predominant dipole orientation leads to a threefold SNR increase as compared to the norm of the dipoles. By comparing connectivity in TLE versus controls, we found significant frequency-specific outflow differences in physiologically plausible regions.

CONCLUSION

The results suggest that directed functional connectivity derived from ESI can help better understand frequency-specific resting-state network alterations underlying focal epilepsy.

SIGNIFICANCE

EEG-based directed functional connectivity could contribute to the search of new biomarkers of this disorder.

Identification of Interictal Epileptic Networks from Dense-EEG

Epilepsy is a network disease. The epileptic network usually involves spatially distributed brain regions. In this context, noninvasive M/EEG source connectivity is an emerging technique to identify functional brain networks at cortical level from noninvasive recordings. In this paper, we analyze the effect of the two key factors involved in EEG source connectivity processing: (i) the algorithm used in the solution of the EEG inverse problem and (ii) the method used in the estimation of the functional connectivity. We evaluate four inverse solutions algorithms (dSPM, wMNE, sLORETA and cMEM) and four connectivity measures (r ², h ², PLV, and MI) on data simulated from a combined biophysical/physiological model to generate realistic interictal epileptic spikes reflected in scalp EEG. We use a new network-based similarity index to compare between the network identified by each of the inverse/connectivity combination and the original network generated in the model. The method will be also applied on real data recorded from one epileptic patient who underwent a full presurgical evaluation for drug-resistant focal epilepsy. In simulated data, results revealed that the selection of the inverse/connectivity combination has a significant impact on the identified networks. Results suggested that nonlinear methods (nonlinear correlation coefficient, phase synchronization and mutual information) for measuring the connectivity are more efficient than the linear one (the cross correlation coefficient). The wMNE inverse solution showed higher performance than dSPM, cMEM and sLORETA. In real data, the combination (wMNE/PLV) led to a very good matching between the interictal epileptic network identified from noninvasive EEG recordings and the network obtained from connectivity analysis of intracerebral EEG recordings. These results suggest that source connectivity method, when appropriately configured, is able to extract highly relevant diagnostic information about networks involved in interictal epileptic spikes from non-invasive dense-EEG data.

Spectral and spatial changes of brain rhythmic activity in response to the sustained thermal pain stimulation

The aim of this study was to investigate the neurophysiological correlates of pain caused by sustained thermal stimulation. A group of 21 healthy volunteers was studied. Sixty-four channel continuous electroencephalography (EEG) was recorded while the subject received tonic thermal stimulation. Spectral changes extracted from EEG were quantified and correlated with pain scales reported by subjects, the stimulation intensity, and the time course. Network connectivity was assessed to study the changes in connectivity patterns and strengths among brain regions that have been previously implicated in pain processing. Spectrally, a global reduction in power was observed in the lower spectral range, from delta to alpha, with the most marked changes in the alpha band. Spatially, the contralateral region of the somatosensory cortex, identified using source localization, was most responsive to stimulation status. Maximal desynchrony was observed when stimulation was present. The degree of alpha power reduction was linearly correlated to the pain rating reported by the subjects. Contralateral alpha power changes appeared to be a robust correlate of pain intensity experienced by the subjects. Granger causality analysis showed changes in network level connectivity among pain-related brain regions due to high intensity of pain stimulation versus innocuous warm stimulation. These results imply the possibility of using noninvasive EEG to predict pain intensity and to study the underlying pain processing mechanism in coping with prolonged painful experiences. Once validated in a broader population, the present EEG-based approach may provide an objective measure for better pain management in clinical applications. Hum Brain Mapp 37:2976-2991, 2016. © 2016 Wiley Periodicals, Inc.

Electrical source imaging of interictal spikes using multiple sparse volumetric priors for presurgical epileptogenic focus localization

Electrical source imaging of interictal spikes observed in EEG recordings of patients with refractory epilepsy provides useful information to localize the epileptogenic focus during the presurgical evaluation. However, the selection of the time points or time epochs of the spikes in order to estimate the origin of the activity remains a challenge. In this study, we consider a Bayesian EEG source imaging technique for distributed sources, i.e. the multiple volumetric sparse priors (MSVP) approach. The approach allows to estimate the time courses of the intensity of the sources corresponding with a specific time epoch of the spike. Based on presurgical averaged interictal spikes in six patients who were successfully treated with surgery, we estimated the time courses of the source intensities for three different time epochs: (i) an epoch starting 50 ms before the spike peak and ending at 50% of the spike peak during the rising phase of the spike, (ii) an epoch starting 50 ms before the spike peak and ending at the spike peak and (iii) an epoch containing the full spike time period starting 50 ms before the spike peak and ending 230 ms after the spike peak. To identify the primary source of the spike activity, the source with the maximum energy from 50 ms before the spike peak till 50% of the spike peak was subsequently selected for each of the time windows. For comparison, the activity at the spike peaks and at 50% of the peaks was localized using the LORETA inversion technique and an ECD approach. Both patient-specific spherical forward models and patient-specific 5-layered finite difference models were considered to evaluate the influence of the forward model. Based on the resected zones in each of the patients, extracted from post-operative MR images, we compared the distances to the resection border of the estimated activity. Using the spherical models, the distances to the resection border for the MSVP approach and each of the different time epochs were in the same range as the LORETA and ECD techniques. We found distances smaller than 23 mm, with robust results for all the patients. For the finite difference models, we found that the distances to the resection border for the MSVP inversions of the full spike time epochs were generally smaller compared to the MSVP inversions of the time epochs before the spike peak. The results also suggest that the inversions using the finite difference models resulted in slightly smaller distances to the resection border compared to the spherical models. The results we obtained are promising because the MSVP approach allows to study the network of the estimated source-intensities and allows to characterize the spatial extent of the underlying sources.

•

A Bayesian ESI technique is evaluated to localize interictal spike activity.

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Averaged spikes in six patients were used that were seizure free after surgery.

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We compared the technique with the LORETA an ECD technique.

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We evaluated both spherical and 5-layered finite difference forward models.

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Our approach is potentially useful to delineate the irritative zone.

A Space-Time-Frequency Dictionary for Sparse Cortical Source Localization

OBJECTIVE

Cortical source imaging aims at identifying activated cortical areas on the surface of the cortex from the raw electroencephalogram (EEG) data. This problem is ill posed, the number of channels being very low compared to the number of possible source positions.

METHODS

In some realistic physiological situations, the active areas are sparse in space and of short time durations, and the amount of spatio-temporal data to carry the inversion is then limited. In this study, we propose an original data driven space-time-frequency (STF) dictionary which takes into account simultaneously both spatial and time-frequency sparseness while preserving smoothness in the time frequency (i.e., nonstationary smooth time courses in sparse locations). Based on these assumptions, we take benefit of the matching pursuit (MP) framework for selecting the most relevant atoms in this highly redundant dictionary.

RESULTS

We apply two recent MP algorithms, single best replacement (SBR) and source deflated matching pursuit, and we compare the results using a spatial dictionary and the proposed STF dictionary to demonstrate the improvements of our multidimensional approach. We also provide comparison using well-established inversion methods, FOCUSS and RAP-MUSIC, analyzing performances under different degrees of nonstationarity and signal to noise ratio.

CONCLUSION

Our STF dictionary combined with the SBR approach provides robust performances on realistic simulations. From a computational point of view, the algorithm is embedded in the wavelet domain, ensuring high efficiency in term of computation time.

SIGNIFICANCE

The proposed approach ensures fast and accurate sparse cortical localizations on highly nonstationary and noisy data.

Ictal EEG Source Imaging for Presurgical Evaluation of Refractory Focal Epilepsy

BACKGROUND

Electroencephalography source imaging (ESI) is a promising tool for localizing the cortical sources of both ictal and interictal epileptic activities. Many studies have shown the clinical usefulness of interictal ESI, but very few have investigated the utility of ictal ESI. The aim of this article is to examine the clinical usefulness of ictal ESI for epileptic focus localization in patients with refractory focal epilepsy, especially extratemporal lobe epilepsy.

METHODS

Both ictal and interictal ESI were performed by the use of patient-specific realistic forward models and 3 different linear distributed inverse models. Lateralization as well as concordance between ESI-estimated focuses and single-photon emission computed tomography (SPECT) focuses were assessed.

RESULTS

All the ESI focuses (both ictal and interictal) were found lateralized to the same hemisphere as ictal SPECT focuses. Lateralization results also were in agreement with the lesion sides as visualized on magnetic resonance imaging. Ictal ESI results, obtained from the best-performing inverse model, were fully concordant with the same cortical lobe as SPECT focuses, whereas the corresponding concordance rate is 87.50% in case of interictal ESI.

CONCLUSIONS

Our findings show that ictal ESI gives fully lateralized and highly concordant results with ictal SPECT and may provide a cost-effective substitute for ictal SPECT.

EEGNET: An Open Source Tool for Analyzing and Visualizing M/EEG Connectome

The brain is a large-scale complex network often referred to as the “connectome”. Exploring the dynamic behavior of the connectome is a challenging issue as both excellent time and space resolution is required. In this context Magneto/Electroencephalography (M/EEG) are effective neuroimaging techniques allowing for analysis of the dynamics of functional brain networks at scalp level and/or at reconstructed sources. However, a tool that can cover all the processing steps of identifying brain networks from M/EEG data is still missing. In this paper, we report a novel software package, called EEGNET, running under MATLAB (Math works, inc), and allowing for analysis and visualization of functional brain networks from M/EEG recordings. EEGNET is developed to analyze networks either at the level of scalp electrodes or at the level of reconstructed cortical sources. It includes i) Basic steps in preprocessing M/EEG signals, ii) the solution of the inverse problem to localize / reconstruct the cortical sources, iii) the computation of functional connectivity among signals collected at surface electrodes or/and time courses of reconstructed sources and iv) the computation of the network measures based on graph theory analysis. EEGNET is the unique tool that combines the M/EEG functional connectivity analysis and the computation of network measures derived from the graph theory. The first version of EEGNET is easy to use, flexible and user friendly. EEGNET is an open source tool and can be freely downloaded from this webpage: https://sites.google.com/site/eegnetworks/.

Thalamocortical relationship in epileptic patients with generalized spike and wave discharges--A multimodal neuroimaging study

Unlike focal or partial epilepsy, which has a confined range of influence, idiopathic generalized epilepsy (IGE) often affects the whole or a larger portion of the brain without obvious, known cause. It is important to understand the underlying network which generates epileptic activity and through which epileptic activity propagates. The aim of the present study was to investigate the thalamocortical relationship using non-invasive imaging modalities in a group of IGE patients. We specifically investigated the roles of the mediodorsal nuclei in the thalami and the medial frontal cortex in generating and spreading IGE activities. We hypothesized that the connectivity between these two structures is key in understanding the generation and propagation of epileptic activity in brains affected by IGE. Using three imaging techniques of EEG, fMRI and EEG-informed fMRI, we identified important players in generation and propagation of generalized spike-and-wave discharges (GSWDs). EEG-informed fMRI suggested multiple regions including the medial frontal area near to the anterior cingulate cortex, mediodorsal nuclei of the thalamus, caudate nucleus among others that related to the GSWDs. The subsequent seed-based fMRI analysis revealed a reciprocal cortical and bi-thalamic functional connection. Through EEG-based Granger Causality analysis using (DTF) and adaptive DTF, within the reciprocal thalamocortical circuitry, thalamus seems to serve as a stronger source in driving cortical activity from initiation to the propagation of a GSWD. Such connectivity change starts before the GSWDs and continues till the end of the slow wave discharge. Thalamus, especially the mediodorsal nuclei, may serve as potential targets for deep brain stimulation to provide more effective treatment options for patients with drug-resistant generalized epilepsy.