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Dmytriw AA, Hadjinicolaou A, Ntolkeras G, Tamilia E, Pesce M, Berto LF, Grant PE, Pang E, Ahtam B. Magnetoencephalography for the pediatric population, indications, acquisition and interpretation for the clinician. Neuroradiol J 2024:19714009241260801. [PMID: 38864180 DOI: 10.1177/19714009241260801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Magnetoencephalography (MEG) is an imaging technique that enables the assessment of cortical activity via direct measures of neurophysiology. It is a non-invasive and passive technique that is completely painless. MEG has gained increasing prominence in the field of pediatric neuroimaging. This dedicated review article for the pediatric population summarizes the fundamental technical and clinical aspects of MEG for the clinician. We discuss methods tailored for children to improve data quality, including child-friendly MEG facility environments and strategies to mitigate motion artifacts. We provide an in-depth overview on accurate localization of neural sources and different analysis methods, as well as data interpretation. The contemporary platforms and approaches of two quaternary pediatric referral centers are illustrated, shedding light on practical implementations in clinical settings. Finally, we describe the expanding clinical applications of MEG, including its pivotal role in presurgical evaluation of epilepsy patients, presurgical mapping of eloquent cortices (somatosensory and motor cortices, visual and auditory cortices, lateralization of language), its emerging relevance in autism spectrum disorder research and potential future clinical applications, and its utility in assessing mild traumatic brain injury. In conclusion, this review serves as a comprehensive resource of clinicians as well as researchers, offering insights into the evolving landscape of pediatric MEG. It discusses the importance of technical advancements, data acquisition strategies, and expanding clinical applications in harnessing the full potential of MEG to study neurological conditions in the pediatric population.
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Affiliation(s)
- Adam A Dmytriw
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
- Division of Neuroradiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aristides Hadjinicolaou
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, USA
| | - Georgios Ntolkeras
- Department of Pediatrics, Division of Newborn Medicine, Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Eleonora Tamilia
- Department of Pediatrics, Division of Newborn Medicine, Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Matthew Pesce
- Department of Pediatrics, Division of Newborn Medicine, Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Laura F Berto
- Department of Pediatrics, Division of Newborn Medicine, Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - P Ellen Grant
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Division of Newborn Medicine, Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth Pang
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Banu Ahtam
- Department of Pediatrics, Division of Newborn Medicine, Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
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2
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Ntolkeras G, Makaram N, Bernabei M, De La Vega AC, Bolton J, Madsen JR, Stone SSD, Pearl PL, Papadelis C, Grant EP, Tamilia E. Interictal EEG source connectivity to localize the epileptogenic zone in patients with drug-resistant epilepsy: A machine learning approach. Epilepsia 2024; 65:944-960. [PMID: 38318986 PMCID: PMC11018464 DOI: 10.1111/epi.17898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To deconstruct the epileptogenic networks of patients with drug-resistant epilepsy (DRE) using source functional connectivity (FC) analysis; unveil the FC biomarkers of the epileptogenic zone (EZ); and develop machine learning (ML) models to estimate the EZ using brief interictal electroencephalography (EEG) data. METHODS We analyzed scalp EEG from 50 patients with DRE who had surgery. We reconstructed the activity (electrical source imaging [ESI]) of virtual sensors (VSs) across the whole cortex and computed FC separately for epileptiform and non-epileptiform EEG epochs (with or without spikes). In patients with good outcome (Engel 1a), four cortical regions were defined: EZ (resection) and three non-epileptogenic zones (NEZs) in the same and opposite hemispheres. Region-specific FC features in six frequency bands and three spatial ranges (long, short, inner) were compared between regions (Wilcoxon sign-rank). We developed ML classifiers to identify the VSs in the EZ using VS-specific FC features. Cross-validation was performed using good outcome data. Performance was compared with poor outcomes and interictal spike localization. RESULTS FC differed between EZ and NEZs (p < .05) during non-epileptiform and epileptiform epochs, showing higher FC in the EZ than its homotopic contralateral NEZ. During epileptiform epochs, the NEZ in the epileptogenic hemisphere showed higher FC than its contralateral NEZ. In good outcome patients, the ML classifiers reached 75% accuracy to the resection (91% sensitivity; 74% specificity; distance from EZ: 38 mm) using epileptiform epochs (gamma and beta frequency bands) and 62% accuracy using broadband non-epileptiform epochs, both outperforming spike localization (accuracy = 47%; p < .05; distance from EZ: 57 mm). Lower performance was seen in poor outcomes. SIGNIFICANCE We present an FC approach to extract EZ biomarkers from brief EEG data. Increased FC in various frequencies characterized the EZ during epileptiform and non-epileptiform epochs. FC-based ML models identified the resection better in good than poor outcome patients, demonstrating their potential for presurgical use in pediatric DRE.
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Affiliation(s)
- Georgios Ntolkeras
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Navaneethakrishna Makaram
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matteo Bernabei
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aime Cristina De La Vega
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Bolton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Scellig S D Stone
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christos Papadelis
- Jane and John Justin Institute for Mind Health, Cook Children's Health Care System, Fort Worth, Texas, USA
| | - Ellen P Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuroradiology, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eleonora Tamilia
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Feys O, De Tiège X. From cryogenic to on-scalp magnetoencephalography for the evaluation of paediatric epilepsy. Dev Med Child Neurol 2024; 66:298-306. [PMID: 37421175 DOI: 10.1111/dmcn.15689] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 07/09/2023]
Abstract
Magnetoencephalography (MEG) is a neurophysiological technique based on the detection of brain magnetic fields. Whole-head MEG systems typically house a few hundred sensors requiring cryogenic cooling in a rigid one-size-fits-all (commonly adult-sized) helmet to keep a thermal insulation space. This leads to an increased brain-to-sensor distance in children, because of their smaller head circumference, and decreased signal-to-noise ratio. MEG allows detection and localization of interictal and ictal epileptiform discharges, and pathological high frequency oscillations, as a part of the presurgical assessment of children with refractory focal epilepsy, where electroencephalography is not contributive. MEG can also map the eloquent cortex before surgical resection. MEG also provides insights into the physiopathology of both generalized and focal epilepsy. On-scalp recordings based on cryogenic-free sensors have demonstrated their use in the field of childhood focal epilepsy and should become a reference technique for diagnosing epilepsy in the paediatric population. WHAT THIS PAPER ADDS: Magnetoencephalography (MEG) contributes to the diagnosis and understanding of paediatric epilepsy. On-scalp MEG recordings demonstrate some advantages over cryogenic MEG.
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Affiliation(s)
- Odile Feys
- Department of Neurology, Université libre de Bruxelles, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Bruxelles, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles, Université libre de Bruxelles, ULB Neuroscience Institute, Bruxelles, Belgium
| | - Xavier De Tiège
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles, Université libre de Bruxelles, ULB Neuroscience Institute, Bruxelles, Belgium
- Department of Translational Neuroimaging, Université libre de Bruxelles, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Bruxelles, Belgium
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Geller AS, Teale P, Kronberg E, Ebersole JS. Magnetoencephalography for Epilepsy Presurgical Evaluation. Curr Neurol Neurosci Rep 2024; 24:35-46. [PMID: 38148387 DOI: 10.1007/s11910-023-01328-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE OF THE REVIEW Magnetoencephalography (MEG) is a functional neuroimaging technique that records neurophysiology data with millisecond temporal resolution and localizes it with subcentimeter accuracy. Its capability to provide high resolution in both of these domains makes it a powerful tool both in basic neuroscience as well as clinical applications. In neurology, it has proven useful in its ability to record and localize epileptiform activity. Epilepsy workup typically begins with scalp electroencephalography (EEG), but in many situations, EEG-based localization of the epileptogenic zone is inadequate. The complementary sensitivity of MEG can be crucial in such cases, and MEG has been adopted at many centers as an important resource in building a surgical hypothesis. In this paper, we review recent work evaluating the extent of MEG influence of presurgical evaluations, novel analyses of MEG data employed in surgical workup, and new MEG instrumentation that will likely affect the field of clinical MEG. RECENT FINDINGS MEG consistently contributes to presurgical evaluation and these contributions often change the plan for epilepsy surgery. Extensive work has been done to develop new analytic methods for localizing the source of epileptiform activity with MEG. Systems using optically pumped magnetometry (OPM) have been successfully deployed to record and localize epileptiform activity. MEG remains an important noninvasive tool for epilepsy presurgical evaluation. Continued improvements in analytic methodology will likely increase the diagnostic yield of the test. Novel instrumentation with OPM may contribute to this as well, and may increase accessibility of MEG by decreasing cost.
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Affiliation(s)
- Aaron S Geller
- Department of Neurology, CU Anschutz Medical School, Aurora, CO, USA.
| | - Peter Teale
- Department of Neurology, CU Anschutz Medical School, Aurora, CO, USA
| | - Eugene Kronberg
- Department of Neurology, CU Anschutz Medical School, Aurora, CO, USA
| | - John S Ebersole
- Department of Neurology, Atlantic Neuroscience Institute, Summit, NJ, USA
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Poghosyan V, Algethami H, Alshahrani A, Asiri S, Aldosari MM. Association Between Magnetoencephalography-Localized Epileptogenic Zone, Surgical Resection Volume, and Postsurgical Seizure Outcome. J Clin Neurophysiol 2024:00004691-990000000-00118. [PMID: 38194636 DOI: 10.1097/wnp.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
PURPOSE Surgical resection of magnetoencephalography (MEG) dipole clusters, reconstructed from interictal epileptiform discharges, is associated with favorable seizure outcomes. However, the relation of MEG cluster resection to the surgical resection volume is not known nor is it clear whether this association is direct and causal, or it may be mediated by the resection volume or other predictive factors. This study aims to clarify these open questions and assess the diagnostic accuracy of MEG in our center. METHODS We performed a retrospective cohort study of 68 patients with drug-resistant epilepsy who underwent MEG followed by resective epilepsy surgery and had at least 12 months of postsurgical follow-up. RESULTS Good seizure outcomes were associated with monofocal localization (χ2 = 6.94, P = 0.001; diagnostic odds ratio = 10.2) and complete resection of MEG clusters (χ2 = 22.1, P < 0.001; diagnostic odds ratio = 42.5). Resection volumes in patients with and without removal of MEG clusters were not significantly different (t = 0.18, P = 0.86; removed: M = 20,118 mm3, SD = 10,257; not removed: M = 19,566 mm3, SD = 10,703). Logistic regression showed that removal of MEG clusters predicts seizure-free outcome independent of the resection volume and other prognostic factors (P < 0.001). CONCLUSIONS Complete resection of MEG clusters leads to favorable seizure outcomes without affecting the volume of surgical resection and independent of other prognostic factors. MEG can localize the epileptogenic zone with high accuracy. MEG interictal epileptiform discharges mapping should be used whenever feasible to improve postsurgical seizure outcomes.
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Affiliation(s)
- Vahe Poghosyan
- Department of Neurophysiology, National Neuroscience Institute, King Fahad Medical City, Riyadh, K.S.A.; and
| | - Hanin Algethami
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, K.S.A
| | - Ashwaq Alshahrani
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, K.S.A
| | - Safiyyah Asiri
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, K.S.A
| | - Mubarak M Aldosari
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, K.S.A
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Vogrin SJ, Plummer C. EEG Source Imaging-Clinical Considerations for EEG Acquisition and Signal Processing for Improved Temporo-Spatial Resolution. J Clin Neurophysiol 2024; 41:8-18. [PMID: 38181383 DOI: 10.1097/wnp.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
SUMMARY EEG source imaging (ESI) has gained traction in recent years as a useful clinical tool for the noninvasive surgical work-up of patients with drug-resistant focal epilepsy. Despite its proven benefits for the temporo-spatial modeling of spike and seizure sources, ESI remains widely underused in clinical practice. This partly relates to a lack of clarity around an optimal approach to the acquisition and processing of scalp EEG data for the purpose of ESI. Here, we describe some of the practical considerations for the clinical application of ESI. We focus on patient preparation, the impact of electrode number and distribution across the scalp, the benefit of averaging raw data for signal analysis, and the relevance of modeling different phases of the interictal discharge as it evolves from take-off to peak. We emphasize the importance of recording high signal-to-noise ratio data for reliable source analysis. We argue that the accuracy of modeling cortical sources can be improved using higher electrode counts that include an inferior temporal array, by averaging interictal waveforms rather than limiting ESI to single spike analysis, and by careful interrogation of earlier phase components of these waveforms. No amount of postacquisition signal processing or source modeling sophistication, however, can make up for suboptimally recorded scalp EEG data in a poorly prepared patient.
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Affiliation(s)
- Simon J Vogrin
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Neurosciences, St Vincent's Hospital, Melbourne, Victoria, Australia; and
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Chris Plummer
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Neurosciences, St Vincent's Hospital, Melbourne, Victoria, Australia; and
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Chericoni A, Ricci L, Ntolkeras G, Billardello R, Stone SSD, Madsen JR, Papadelis C, Grant PE, Pearl PL, Taffoni F, Rotenberg A, Tamilia E. Sleep Spindle Generation Before and After Epilepsy Surgery: A Source Imaging Study in Children with Drug-Resistant Epilepsy. Brain Topogr 2024; 37:88-101. [PMID: 37737957 DOI: 10.1007/s10548-023-01007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Literature lacks studies investigating the cortical generation of sleep spindles in drug-resistant epilepsy (DRE) and how they evolve after resection of the epileptogenic zone (EZ). Here, we examined sleep EEGs of children with focal DRE who became seizure-free after focal epilepsy surgery, and aimed to investigate the changes in the spindle generation before and after the surgery using low-density scalp EEG and electrical source imaging (ESI). METHODS We analyzed N2-sleep EEGs from 19 children with DRE before and after surgery. We identified slow (8-12 Hz) and fast spindles (13-16 Hz), computed their spectral features and cortical generators through ESI and computed their distance from the EZ and irritative zone (IZ). We performed two-way ANOVA testing the effect of spindle type (slow vs. fast) and surgical phase (pre-surgery vs. post-surgery) on each feature. RESULTS Power, frequency and cortical activation of slow spindles increased after surgery (p < 0.005), while this was not seen for fast spindles. Before surgery, the cortical generators of slow spindles were closer to the EZ (57.3 vs. 66.2 mm, p = 0.007) and IZ (41.3 vs. 55.5 mm, p = 0.02) than fast spindle generators. CONCLUSIONS Our data indicate alterations in the EEG slow spindles after resective epilepsy surgery. Fast spindle generation on the contrary did not change after surgery. Although the study is limited by its retrospective nature, lack of healthy controls, and reduced cortical spatial sampling, our findings suggest a spatial relationship between the slow spindles and the epileptogenic generators.
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Affiliation(s)
- Assia Chericoni
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Lorenzo Ricci
- Department of Medicine and Surgery, Research Unit of Neurology, Neurobiology, Neurophysiology, University Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Georgios Ntolkeras
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roberto Billardello
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Advanced Robotics and Human-Centred Technologies - CREO Lab, Campus Bio-Medico di Roma, Rome, Italy
| | - Scellig S D Stone
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Joseph R Madsen
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook children's Health Care System, Boston, TX, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - P Ellen Grant
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fabrizio Taffoni
- Advanced Robotics and Human-Centred Technologies - CREO Lab, Campus Bio-Medico di Roma, Rome, Italy
| | - Alexander Rotenberg
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleonora Tamilia
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Sathyanarayana A, El Atrache R, Jackson M, Cantley S, Reece L, Ufongene C, Loddenkemper T, Mandl KD, Bosl WJ. Measuring Real-Time Medication Effects From Electroencephalography. J Clin Neurophysiol 2024; 41:72-82. [PMID: 35583401 PMCID: PMC9669285 DOI: 10.1097/wnp.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Evaluating the effects of antiseizure medication (ASM) on patients with epilepsy remains a slow and challenging process. Quantifiable noninvasive markers that are measurable in real-time and provide objective and useful information could guide clinical decision-making. We examined whether the effect of ASM on patients with epilepsy can be quantitatively measured in real-time from EEGs. METHODS This retrospective analysis was conducted on 67 patients in the long-term monitoring unit at Boston Children's Hospital. Two 30-second EEG segments were selected from each patient premedication and postmedication weaning for analysis. Nonlinear measures including entropy and recurrence quantitative analysis values were computed for each segment and compared before and after medication weaning. RESULTS Our study found that ASM effects on the brain were measurable by nonlinear recurrence quantitative analysis on EEGs. Highly significant differences ( P < 1e-11) were found in several nonlinear measures within the seizure zone in response to antiseizure medication. Moreover, the size of the medication effect correlated with a patient's seizure frequency, seizure localization, number of medications, and reported seizure frequency reduction on medication. CONCLUSIONS Our findings show the promise of digital biomarkers to measure medication effects and epileptogenicity.
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Affiliation(s)
- Aarti Sathyanarayana
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, U.S.A.;
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, U.S.A.;
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, U.S.A.;
| | - Rima El Atrache
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Michele Jackson
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Sarah Cantley
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Latania Reece
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Claire Ufongene
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Tobias Loddenkemper
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, U.S.A.;
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Kenneth D. Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, U.S.A.;
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, U.S.A.;
| | - William J. Bosl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, U.S.A.;
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, U.S.A.;
- Department of Health Professions, University of San Francisco, San Francisco, California, U.S.A
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Mohammed AH, Cabrerizo M, Pinzon A, Yaylali I, Jayakar P, Adjouadi M. Graph neural networks in EEG spike detection. Artif Intell Med 2023; 145:102663. [PMID: 37925203 DOI: 10.1016/j.artmed.2023.102663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 06/06/2023] [Accepted: 09/14/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This study develops new machine learning architectures that are more adept at detecting interictal epileptiform discharges (IEDs) in scalp EEG. A comparison of results using the average precision (AP) metric is made with the proposed models on two datasets obtained from Baptist Hospital of Miami and Temple University Hospital. METHODS Applying graph neural networks (GNNs) on functional connectivity (FC) maps of different frequency sub-bands to yield a novel architecture we call FC-GNN. Attention mechanism is applied on a complete graph to let the neural network select its important edges, hence bypassing the extraction of features, a model we refer to as CA-GNN. RESULTS On the Baptist Hospital dataset, the results were as follows: Vanilla Self-Attention →0.9029±0.0431, Hierarchical Attention →0.8546±0.0587, Vanilla Visual Geometry Group (VGG) →0.92±0.0618, Satelight →0.9219±0.046, FC-GNN →0.9731±0.0187, and CA-GNN →0.9788±0.0125. In the same order, the results on the Temple University Hospital dataset are 0.9692, 0.9113, 0.97, 0.9575, 0.963, and 0.9879. CONCLUSION Based on the good results they yield, GNNs prove to have a strong potential in detecting epileptogenic activity. SIGNIFICANCE This study opens the door for the discovery of the powerful role played by GNNs in capturing IEDs, which is an essential step for identifying the epileptogenic networks of the affected brain and hence improving the prospects for more accurate 3D source localization.
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Affiliation(s)
- Ahmed Hossam Mohammed
- Department of Electrical and Computer Engineering, Florida International University, 10555 W Flagler St, Miami, 33174, FL, USA.
| | - Mercedes Cabrerizo
- Department of Electrical and Computer Engineering, Florida International University, 10555 W Flagler St, Miami, 33174, FL, USA
| | - Alberto Pinzon
- Epilepsy Center, Baptist Hospital of Miami, 9090 SW 87th Ct Suite201, Miami, 33176, FL, USA
| | - Ilker Yaylali
- Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, 97239, OR, USA
| | - Prasanna Jayakar
- Brain Institute, Nicklaus Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA
| | - Malek Adjouadi
- Department of Electrical and Computer Engineering, Florida International University, 10555 W Flagler St, Miami, 33174, FL, USA
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Kalina A, Jezdik P, Fabera P, Marusic P, Hammer J. Electrical Source Imaging of Somatosensory Evoked Potentials from Intracranial EEG Signals. Brain Topogr 2023; 36:835-853. [PMID: 37642729 DOI: 10.1007/s10548-023-00994-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
Stereoelectroencephalography (SEEG) records electrical brain activity with intracerebral electrodes. However, it has an inherently limited spatial coverage. Electrical source imaging (ESI) infers the position of the neural generators from the recorded electric potentials, and thus, could overcome this spatial undersampling problem. Here, we aimed to quantify the accuracy of SEEG ESI under clinical conditions. We measured the somatosensory evoked potential (SEP) in SEEG and in high-density EEG (HD-EEG) in 20 epilepsy surgery patients. To localize the source of the SEP, we employed standardized low resolution brain electromagnetic tomography (sLORETA) and equivalent current dipole (ECD) algorithms. Both sLORETA and ECD converged to similar solutions. Reflecting the large differences in the SEEG implantations, the localization error also varied in a wide range from 0.4 to 10 cm. The SEEG ESI localization error was linearly correlated with the distance from the putative neural source to the most activated contact. We show that it is possible to obtain reliable source reconstructions from SEEG under realistic clinical conditions, provided that the high signal fidelity recording contacts are sufficiently close to the source of the brain activity.
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Affiliation(s)
- Adam Kalina
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital (Full Member of the ERN EpiCARE), V Uvalu 84, 150 06, Prague 5, Czechia.
| | - Petr Jezdik
- Department of Measurement, Faculty of Electrical Engineering, Czech Technical University in Prague, Technicka 2, 166 27, Prague 6, Czechia
| | - Petr Fabera
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital (Full Member of the ERN EpiCARE), V Uvalu 84, 150 06, Prague 5, Czechia
| | - Petr Marusic
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital (Full Member of the ERN EpiCARE), V Uvalu 84, 150 06, Prague 5, Czechia
| | - Jiri Hammer
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital (Full Member of the ERN EpiCARE), V Uvalu 84, 150 06, Prague 5, Czechia.
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11
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Abarrategui B, Mariani V, Rizzi M, Berta L, Scarpa P, Zauli FM, Squarza S, Banfi P, d’Orio P, Cardinale F, Del Vecchio M, Caruana F, Avanzini P, Sartori I. Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report. Front Hum Neurosci 2023; 17:1254779. [PMID: 37900727 PMCID: PMC10600519 DOI: 10.3389/fnhum.2023.1254779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/15/2023] [Indexed: 10/31/2023] Open
Abstract
Language lateralization in patients with focal epilepsy frequently diverges from the left-lateralized pattern that prevails in healthy right-handed people, but the mechanistic explanations are still a matter of debate. Here, we debate the complex interaction between focal epilepsy, language lateralization, and functional neuroimaging techniques by introducing the case of a right-handed patient with unaware focal seizures preceded by aphasia, in whom video-EEG and PET examination suggested the presence of focal cortical dysplasia in the right superior temporal gyrus, despite a normal structural MRI. The functional MRI for language was inconclusive, and the neuropsychological evaluation showed mild deficits in language functions. A bilateral stereo-EEG was proposed confirming the right superior temporal gyrus origin of seizures, revealing how ictal aphasia emerged only once seizures propagated to the left superior temporal gyrus and confirming, by cortical mapping, the left lateralization of the posterior language region. Stereo-EEG-guided radiofrequency thermocoagulations of the (right) focal cortical dysplasia not only reduced seizure frequency but led to the normalization of the neuropsychological assessment and the "restoring" of a classical left-lateralized functional MRI pattern of language. This representative case demonstrates that epileptiform activity in the superior temporal gyrus can interfere with the functioning of the contralateral homologous cortex and its associated network. In the case of presurgical evaluation in patients with epilepsy, this interference effect must be carefully taken into consideration. The multimodal language lateralization assessment reported for this patient further suggests the sensitivity of different explorations to this interference effect. Finally, the neuropsychological and functional MRI changes after thermocoagulations provide unique cues on the network pathophysiology of focal cortical dysplasia and the role of diverse techniques in indexing language lateralization in complex scenarios.
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Affiliation(s)
- Belén Abarrategui
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Neurology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Valeria Mariani
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Neurology and Stroke Unit, ASST Santi Paolo e Carlo, Presidio San Carlo Borromeo, Milan, Italy
| | - Michele Rizzi
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Berta
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Pina Scarpa
- Cognitive Neuropsychology Centre, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Flavia Maria Zauli
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Philosophy “P. Martinetti”, Università degli Studi di Milano, Milan, Italy
| | - Silvia Squarza
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paola Banfi
- Neurology and Stroke Unit, ASST Sette Laghi Ospedale di Circolo, Varese, Italy
| | - Piergiorgio d’Orio
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Unit of Neuroscience, Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Italy
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Francesco Cardinale
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Unit of Neuroscience, Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Italy
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Maria Del Vecchio
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Fausto Caruana
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Pietro Avanzini
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Ivana Sartori
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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12
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Matarrese MAG, Loppini A, Fabbri L, Tamilia E, Perry MS, Madsen JR, Bolton J, Stone SSD, Pearl PL, Filippi S, Papadelis C. Spike propagation mapping reveals effective connectivity and predicts surgical outcome in epilepsy. Brain 2023; 146:3898-3912. [PMID: 37018068 PMCID: PMC10473571 DOI: 10.1093/brain/awad118] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 04/06/2023] Open
Abstract
Neurosurgical intervention is the best available treatment for selected patients with drug resistant epilepsy. For these patients, surgical planning requires biomarkers that delineate the epileptogenic zone, the brain area that is indispensable for the generation of seizures. Interictal spikes recorded with electrophysiological techniques are considered key biomarkers of epilepsy. Yet, they lack specificity, mostly because they propagate across brain areas forming networks. Understanding the relationship between interictal spike propagation and functional connections among the involved brain areas may help develop novel biomarkers that can delineate the epileptogenic zone with high precision. Here, we reveal the relationship between spike propagation and effective connectivity among onset and areas of spread and assess the prognostic value of resecting these areas. We analysed intracranial EEG data from 43 children with drug resistant epilepsy who underwent invasive monitoring for neurosurgical planning. Using electric source imaging, we mapped spike propagation in the source domain and identified three zones: onset, early-spread and late-spread. For each zone, we calculated the overlap and distance from surgical resection. We then estimated a virtual sensor for each zone and the direction of information flow among them via Granger causality. Finally, we compared the prognostic value of resecting these zones, the clinically-defined seizure onset zone and the spike onset on intracranial EEG channels by estimating their overlap with resection. We observed a spike propagation in source space for 37 patients with a median duration of 95 ms (interquartile range: 34-206), a spatial displacement of 14 cm (7.5-22 cm) and a velocity of 0.5 m/s (0.3-0.8 m/s). In patients with good surgical outcome (25 patients, Engel I), the onset had higher overlap with resection [96% (40-100%)] than early-spread [86% (34-100%), P = 0.01] and late-spread [59% (12-100%), P = 0.002], and it was also closer to resection than late-spread [5 mm versus 9 mm, P = 0.007]. We found an information flow from onset to early-spread in 66% of patients with good outcomes, and from early-spread to onset in 50% of patients with poor outcome. Finally, resection of spike onset, but not area of spike spread or the seizure onset zone, predicted outcome with positive predictive value of 79% and negative predictive value of 56% (P = 0.04). Spatiotemporal mapping of spike propagation reveals information flow from onset to areas of spread in epilepsy brain. Surgical resection of the spike onset disrupts the epileptogenic network and may render patients with drug resistant epilepsy seizure-free without having to wait for a seizure to occur during intracranial monitoring.
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Affiliation(s)
- Margherita A G Matarrese
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
- Laboratory of Nonlinear Physics and Mathematical Modeling, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX, USA
| | - Alessandro Loppini
- Laboratory of Nonlinear Physics and Mathematical Modeling, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Lorenzo Fabbri
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX, USA
| | - Eleonora Tamilia
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey Bolton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Scellig S D Stone
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Simonetta Filippi
- Laboratory of Nonlinear Physics and Mathematical Modeling, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Christos Papadelis
- Jane and John Justin Institute for Mind Health Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
- Department of Bioengineering, The University of Texas at Arlington, Arlington, TX, USA
- School of Medicine, Texas Christian University, Fort Worth, TX, USA
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13
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Chikara RK, Jahromi S, Tamilia E, Madsen JR, Stufflebeam SM, Pearl PL, Papadelis C. Electromagnetic source imaging predicts surgical outcome in children with focal cortical dysplasia. Clin Neurophysiol 2023; 153:88-101. [PMID: 37473485 PMCID: PMC10528204 DOI: 10.1016/j.clinph.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/25/2023] [Accepted: 06/15/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of electromagnetic source imaging (EMSI) in localizing spikes and predict surgical outcome in children with drug resistant epilepsy (DRE) due to focal cortical dysplasia (FCD). METHODS We retrospectively analyzed magnetoencephalography (MEG) and high-density (HD-EEG) data from 23 children with FCD-associated DRE who underwent intracranial EEG and surgery. We localized spikes using equivalent current dipole (ECD) fitting, dipole clustering, and dynamical statistical parametric mapping (dSPM) on EMSI, electric source imaging (ESI), and magnetic source imaging (MSI). We calculated the distance from the seizure onset zone (DSOZ) and resection (DRES). We estimated receiver operating characteristic (ROC) curves with Youden's index (J) to predict outcome. RESULTS EMSI presented shorter DSOZ (15.18 ± 9.06 mm) and DRES (8.56 ± 6.24 mm) compared to ESI (DSOZ: 25.04 ± 16.20 mm, p < 0.009; DRES: 18.88 ± 17.30 mm, p < 0.03) and MSI (DSOZ: 23.37 ± 8.98 mm, p < 0.03; DRES: 15.51 ± 10.11 mm, p < 0.02) for clustering in patients with good outcome. Clustering showed shorter DSOZ and DRES compared to ECD fitting and dSPM (p < 0.05). EMSI had higher performance as outcome predictor (J = 70.63%) compared to ESI (J = 41.27%) and MSI (J = 33.33%) for clustering. CONCLUSIONS EMSI provides superior localization and improved predictive performance than individual modalities. SIGNIFICANCE EMSI can help the surgical planning and facilitate the localization of epileptogenic foci.
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Affiliation(s)
- Rupesh Kumar Chikara
- Jane and John Justin Institute for Mind Health, Neuroscience Research, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Saeed Jahromi
- Jane and John Justin Institute for Mind Health, Neuroscience Research, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Eleonora Tamilia
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steve M Stufflebeam
- Athinoula Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christos Papadelis
- Jane and John Justin Institute for Mind Health, Neuroscience Research, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA; School of Medicine, Texas Christian University, Fort Worth, TX, USA.
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14
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Miron G, Baag T, Götz K, Holtkamp M, Vorderwülbecke BJ. Integration of interictal EEG source localization in presurgical epilepsy evaluation - A single-center prospective study. Epilepsia Open 2023; 8:877-887. [PMID: 37170682 PMCID: PMC10472400 DOI: 10.1002/epi4.12754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE To investigate cost in working hours for initial integration of interictal EEG source localization (ESL) into clinical practice of a tertiary epilepsy center, and to examine concordance of results obtained with three different ESL pipelines. METHODS This prospective study covered the first year of using ESL in the Epilepsy-Center Berlin-Brandenburg. Patients aged ≥14 years with drug-resistant focal epilepsy referred for noninvasive presurgical evaluation were included. Interictal ESL was based on low-density EEG and individual head models. Source maxima were obtained from two freely available software packages and one commercial provider. One physician and computer scientist documented their working hours for setting up and processing ESL. Additionally, a survey was conducted among epilepsy centers in Germany to assess the current role of ESL in presurgical evaluation. RESULTS Of 40 patients included, 22 (55%) had enough interictal spikes for ESL. The physician's working times decreased from median 4.7 hours [interquartile range 3.9-6.4] in the first third of cases to 2.0 hours [1.9-2.4] in the remaining two thirds; P < 0.01. In addition, computer scientist and physician spent a total of 35.5 and 33.0 working hours on setting up the digital infrastructure, and on training and testing. Sublobar agreement between all three pipelines was 20%, mean measurement of agreement (kappa) 0.13. Finally, the survey revealed that 53% of epilepsy centers in Germany currently use ESL for presurgical evaluation. SIGNIFICANCE This study provides information regarding expected effort and costs for integration of ESL into an epilepsy surgery program. Low result agreement across different ESL pipelines calls for further standardization.
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Affiliation(s)
- Gadi Miron
- Epilepsy‐Center Berlin‐BrandenburgInstitute for Diagnostics of EpilepsyBerlinGermany
- Department of Neurology, Epilepsy‐Center Berlin‐BrandenburgCharité – Universitätsmedizin BerlinBerlinGermany
| | - Thomas Baag
- Epilepsy‐Center Berlin‐BrandenburgInstitute for Diagnostics of EpilepsyBerlinGermany
| | - Kara Götz
- Epilepsy‐Center Berlin‐BrandenburgInstitute for Diagnostics of EpilepsyBerlinGermany
- Department of Neurology, Epilepsy‐Center Berlin‐BrandenburgCharité – Universitätsmedizin BerlinBerlinGermany
| | - Martin Holtkamp
- Epilepsy‐Center Berlin‐BrandenburgInstitute for Diagnostics of EpilepsyBerlinGermany
- Department of Neurology, Epilepsy‐Center Berlin‐BrandenburgCharité – Universitätsmedizin BerlinBerlinGermany
| | - Bernd J. Vorderwülbecke
- Epilepsy‐Center Berlin‐BrandenburgInstitute for Diagnostics of EpilepsyBerlinGermany
- Department of Neurology, Epilepsy‐Center Berlin‐BrandenburgCharité – Universitätsmedizin BerlinBerlinGermany
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15
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Xu F, Xu Y, Wang Y, Niu K, Li Y, Wang P, Li Y, Sun J, Chen Q, Wang X. Language-related brain areas in childhood epilepsy with centrotemporal spikes studied with MEG. Clin Neurophysiol 2023; 152:11-21. [PMID: 37257319 DOI: 10.1016/j.clinph.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Children with self-limited epilepsy with centrotemporal spikes (SeLECTS) typically indicate cognitive impairment with widespread speech impairment. We explored how epilepsy affects language-related brain areas and areas in their vicinity. METHODS Twenty-two children with SeLECTS and declined verbal comprehension (DVC), 21 with SeLECTS and normal verbal comprehension (NVC), and 23 healthy controls (HCs) underwent high-sampling magnetoencephalography recordings. According to a previous study, 24 language-related regions of interest were selected bilaterally, and the relative spectral power was estimated using a minimum norm estimate. RESULTS The highest mean power spectral density was observed in the delta band for the DVC group, in the theta band for the NVC group, and in the alpha band for HCs within language-specific brain regions. The distinctions between the DVC and NVC groups in the delta and theta frequency bands were primarily concentrated in the right linguistic brain area. CONCLUSIONS Children with SeLECTS may have developmental problems in language-related brain areas, with different developmental levels observed in the DVC, NVC, and HC groups. The DVC group could have inferior speech comprehension due to a more significant number of seizures and more left-sided spike locations. SIGNIFICANCE Children having SeLECTS showed impaired brain maturation, leading to associated language impairment.
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Affiliation(s)
- Fengyuan Xu
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Xu
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yingfan Wang
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Niu
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yihan Li
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Pengfei Wang
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yanzhang Li
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jintao Sun
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qiqi Chen
- Country MEG Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoshan Wang
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
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16
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Corona L, Tamilia E, Perry MS, Madsen JR, Bolton J, Stone SSD, Stufflebeam SM, Pearl PL, Papadelis C. Non-invasive mapping of epileptogenic networks predicts surgical outcome. Brain 2023; 146:1916-1931. [PMID: 36789500 PMCID: PMC10151194 DOI: 10.1093/brain/awac477] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/03/2022] [Accepted: 11/30/2022] [Indexed: 02/16/2023] Open
Abstract
Epilepsy is increasingly considered a disorder of brain networks. Studying these networks with functional connectivity can help identify hubs that facilitate the spread of epileptiform activity. Surgical resection of these hubs may lead patients who suffer from drug-resistant epilepsy to seizure freedom. Here, we aim to map non-invasively epileptogenic networks, through the virtual implantation of sensors estimated with electric and magnetic source imaging, in patients with drug-resistant epilepsy. We hypothesize that highly connected hubs identified non-invasively with source imaging can predict the epileptogenic zone and the surgical outcome better than spikes localized with conventional source localization methods (dipoles). We retrospectively analysed simultaneous high-density electroencephalography (EEG) and magnetoencephalography data recorded from 37 children and young adults with drug-resistant epilepsy who underwent neurosurgery. Using source imaging, we estimated virtual sensors at locations where intracranial EEG contacts were placed. On data with and without spikes, we computed undirected functional connectivity between sensors/contacts using amplitude envelope correlation and phase locking value for physiologically relevant frequency bands. From each functional connectivity matrix, we generated an undirected network containing the strongest connections within sensors/contacts using the minimum spanning tree. For each sensor/contact, we computed graph centrality measures. We compared functional connectivity and their derived graph centrality of sensors/contacts inside resection for good (n = 22, ILAE I) and poor (n = 15, ILAE II-VI) outcome patients, tested their ability to predict the epileptogenic zone in good-outcome patients, examined the association between highly connected hubs removal and surgical outcome and performed leave-one-out cross-validation to support their prognostic value. We also compared the predictive values of functional connectivity with those of dipoles. Finally, we tested the reliability of virtual sensor measures via Spearman's correlation with intracranial EEG at population- and patient-level. We observed higher functional connectivity inside than outside resection (P < 0.05, Wilcoxon signed-rank test) for good-outcome patients, on data with and without spikes across different bands for intracranial EEG and electric/magnetic source imaging and few differences for poor-outcome patients. These functional connectivity measures were predictive of both the epileptogenic zone and outcome (positive and negative predictive values ≥55%, validated using leave-one-out cross-validation) outperforming dipoles on spikes. Significant correlations were found between source imaging and intracranial EEG measures (0.4 ≤ rho ≤ 0.9, P < 0.05). Our findings suggest that virtual implantation of sensors through source imaging can non-invasively identify highly connected hubs in patients with drug-resistant epilepsy, even in the absence of frank epileptiform activity. Surgical resection of these hubs predicts outcome better than dipoles.
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Affiliation(s)
- Ludovica Corona
- Jane and John Justin Institute for Mind Health, Cook Children's Health Care System, Fort Worth, TX 76104, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX 76010, USA
| | - Eleonora Tamilia
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health, Cook Children's Health Care System, Fort Worth, TX 76104, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jeffrey Bolton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Scellig S D Stone
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Steve M Stufflebeam
- Athinoula Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Christos Papadelis
- Jane and John Justin Institute for Mind Health, Cook Children's Health Care System, Fort Worth, TX 76104, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX 76010, USA
- School of Medicine, Texas Christian University, Fort Worth, TX 76129, USA
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17
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Unnwongse K, Rampp S, Wehner T, Kowoll A, Parpaley Y, von Lehe M, Lanfer B, Rusiniak M, Wolters C, Wellmer J. Validating EEG source imaging using intracranial electrical stimulation. Brain Commun 2023; 5:fcad023. [PMID: 36824389 PMCID: PMC9942548 DOI: 10.1093/braincomms/fcad023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 08/31/2022] [Accepted: 02/06/2023] [Indexed: 02/08/2023] Open
Abstract
Electrical source imaging is used in presurgical epilepsy evaluation and in cognitive neurosciences to localize neuronal sources of brain potentials recorded on EEG. This study evaluates the spatial accuracy of electrical source imaging for known sources, using electrical stimulation potentials recorded on simultaneous stereo-EEG and 37-electrode scalp EEG, and identifies factors determining the localization error. In 11 patients undergoing simultaneous stereo-EEG and 37-electrode scalp EEG recordings, sequential series of 99-110 biphasic pulses (2 ms pulse width) were applied by bipolar electrical stimulation on adjacent contacts of implanted stereo-EEG electrodes. The scalp EEG correlates of stimulation potentials were recorded with a sampling rate of 30 kHz. Electrical source imaging of averaged stimulation potentials was calculated utilizing a dipole source model of peak stimulation potentials based on individual four-compartment finite element method head models with various skull conductivities (range from 0.0413 to 0.001 S/m). Fitted dipoles with a goodness of fit of ≥80% were included in the analysis. The localization error was calculated using the Euclidean distance between the estimated dipoles and the centre point of adjacent stimulating contacts. A total of 3619 stimulation locations, respectively, dipole localizations, were included in the evaluation. Mean localization errors ranged from 10.3 to 26 mm, depending on source depth and selected skull conductivity. The mean localization error increased with an increase in source depth (r(3617) = [0.19], P = 0.000) and decreased with an increase in skull conductivity (r(3617) = [-0.26], P = 0.000). High skull conductivities (0.0413-0.0118 S/m) yielded significantly lower localization errors for all source depths. For superficial sources (<20 mm from the inner skull), all skull conductivities yielded insignificantly different localization errors. However, for deeper sources, in particular >40 mm, high skull conductivities of 0.0413 and 0.0206 S/m yielded significantly lower localization errors. In relation to stimulation locations, the majority of estimated dipoles moved outward-forward-downward to inward-forward-downward with a decrease in source depth and an increase in skull conductivity. Multivariate analysis revealed that an increase in source depth, number of skull holes and white matter volume, while a decrease in skull conductivity independently led to higher localization error. This evaluation of electrical source imaging accuracy using artificial patterns with a high signal-to-noise ratio supports its application in presurgical epilepsy evaluation and cognitive neurosciences. In our artificial potential model, optimizing the selected skull conductivity minimized the localization error. Future studies should examine if this accounts for true neural signals.
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Affiliation(s)
- Kanjana Unnwongse
- Correspondence to: Kanjana Unnwongse, MD Ruhr Epileptologie, Neurologische Klinik Universitätsklinikum Knappschaftskrankenhaus Bochum In der Schornau 23-25, 44892 Bochum, Germany E-mail:
| | | | - Tim Wehner
- Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, 44892 Bochum, Germany
| | - Annika Kowoll
- Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, 44892 Bochum, Germany
| | - Yaroslav Parpaley
- Department of Neurosurgery, University Hospital Knappschaftskrankenhaus, Ruhr-University, 44892 Bochum, Germany
| | - Marec von Lehe
- Department of Neurosurgery, University Hospital Knappschaftskrankenhaus, Ruhr-University, 44892 Bochum, Germany
| | - Benjamin Lanfer
- Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, 44892 Bochum, Germany
| | | | - Carsten Wolters
- Institute for Biomagnetism und Biosignalanalysis, University of Münster, 48149 Münster, Germany,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, 48149 Münster, Germany
| | - Jörg Wellmer
- Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, 44892 Bochum, Germany
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18
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Pedersen M, Abbott DF, Jackson GD. Wearable OPM-MEG: A changing landscape for epilepsy. Epilepsia 2022; 63:2745-2753. [PMID: 35841260 PMCID: PMC9805039 DOI: 10.1111/epi.17368] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 01/09/2023]
Abstract
Magnetoencephalography with optically pumped magnometers (OPM-MEG) is an emerging and novel, cost-effective wearable system that can simultaneously record neuronal activity with high temporal resolution ("when" neuronal activity occurs) and spatial resolution ("where" neuronal activity occurs). This paper will first outline recent methodological advances in OPM-MEG compared to conventional superconducting quantum interference device (SQUID)-MEG before discussing how OPM-MEG can become a valuable and noninvasive clinical support tool in epilepsy surgery evaluation. Although OPM-MEG and SQUID-MEG share similar data features, OPM-MEG is a wearable design that fits children and adults, and it is also robust to head motion within a magnetically shielded room. This means that OPM-MEG can potentially extend the application of MEG into the neurobiology of severe childhood epilepsies with intellectual disabilities (e.g., epileptic encephalopathies) without sedation. It is worth noting that most OPM-MEG sensors are heated, which may become an issue with large OPM sensor arrays (OPM-MEG currently has fewer sensors than SQUID-MEG). Future implementation of triaxial sensors may alleviate the need for large OPM sensor arrays. OPM-MEG designs allowing both awake and sleep recording are essential for potential long-term epilepsy monitoring.
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Affiliation(s)
- Mangor Pedersen
- Department of Psychology and NeuroscienceAuckland University of TechnologyAucklandNew Zealand
| | - David F. Abbott
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia,Department of Medicine, Austin Health and Florey Department of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Graeme D. Jackson
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia,Department of Medicine, Austin Health and Florey Department of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
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19
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Mattioli P, Cleeren E, Hadady L, Cossu A, Cloppenborg T, Arnaldi D, Beniczky S. Electric Source Imaging in Presurgical Evaluation of Epilepsy: An Inter-Analyser Agreement Study. Diagnostics (Basel) 2022; 12:diagnostics12102303. [PMID: 36291992 PMCID: PMC9601236 DOI: 10.3390/diagnostics12102303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Electric source imaging (ESI) estimates the cortical generator of the electroencephalography (EEG) signals recorded with scalp electrodes. ESI has gained increasing interest for the presurgical evaluation of patients with drug-resistant focal epilepsy. In spite of a standardised analysis pipeline, several aspects tailored to the individual patient involve subjective decisions of the expert performing the analysis, such as the selection of the analysed signals (interictal epileptiform discharges and seizures, identification of the onset epoch and time-point of the analysis). Our goal was to investigate the inter-analyser agreement of ESI in presurgical evaluations of epilepsy, using the same software and analysis pipeline. Six experts, of whom five had no previous experience in ESI, independently performed interictal and ictal ESI of 25 consecutive patients (17 temporal, 8 extratemporal) who underwent presurgical evaluation. The overall agreement among experts for the ESI methods was substantial (AC1 = 0.65; 95% CI: 0.59–0.71), and there was no significant difference between the methods. Our results suggest that using a standardised analysis pipeline, newly trained experts reach similar ESI solutions, calling for more standardisation in this emerging clinical application in neuroimaging.
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Affiliation(s)
- Pietro Mattioli
- Department of Neuroscience (DINOGMI), University of Genoa, 16132 Genoa, Italy
- Danish Epilepsy Center, 4293 Dianalund, Denmark
| | - Evy Cleeren
- Danish Epilepsy Center, 4293 Dianalund, Denmark
- Department of Neurology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Levente Hadady
- Danish Epilepsy Center, 4293 Dianalund, Denmark
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, 6720 Szeged, Hungary
| | - Alberto Cossu
- Danish Epilepsy Center, 4293 Dianalund, Denmark
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Thomas Cloppenborg
- Department of Epileptology, Krankenhaus Mara, Medical School, Bielefeld University, 33615 Bielefeld, Germany
| | - Dario Arnaldi
- Department of Neuroscience (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS San Martino Hospital, 16132 Genoa, Italy
| | - Sándor Beniczky
- Danish Epilepsy Center, 4293 Dianalund, Denmark
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, 6720 Szeged, Hungary
- Department of Clinical Neurophysiology, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
- Correspondence: ; Tel.: +45-26-981536
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20
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Ntolkeras G, Tamilia E, AlHilani M, Bolton J, Ellen Grant P, Prabhu SP, Madsen JR, Stufflebeam SM, Pearl PL, Papadelis C. Presurgical accuracy of dipole clustering in MRI-negative pediatric patients with epilepsy: Validation against intracranial EEG and resection. Clin Neurophysiol 2022; 141:126-138. [PMID: 33875376 PMCID: PMC8803140 DOI: 10.1016/j.clinph.2021.01.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the utility of interictal magnetic and electric source imaging (MSI and ESI) using dipole clustering in magnetic resonance imaging (MRI)-negative patients with drug resistant epilepsy (DRE). METHODS We localized spikes in low-density (LD-EEG) and high-density (HD-EEG) electroencephalography as well as magnetoencephalography (MEG) recordings using dipoles from 11 pediatric patients. We computed each dipole's level of clustering and used it to discriminate between clustered and scattered dipoles. For each dipole, we computed the distance from seizure onset zone (SOZ) and irritative zone (IZ) defined by intracranial EEG. Finally, we assessed whether dipoles proximity to resection was predictive of outcome. RESULTS LD-EEG had lower clusterness compared to HD-EEG and MEG (p < 0.05). For all modalities, clustered dipoles showed higher proximity to SOZ and IZ than scattered (p < 0.001). Resection percentage was higher in optimal vs. suboptimal outcome patients (p < 0.001); their proximity to resection was correlated to outcome (p < 0.001). No difference in resection percentage was seen for scattered dipoles between groups. CONCLUSION MSI and ESI dipole clustering helps to localize the SOZ and IZ and facilitate the prognostic assessment of MRI-negative patients with DRE. SIGNIFICANCE Assessing the MSI and ESI clustering allows recognizing epileptogenic areas whose removal is associated with optimal outcome.
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Affiliation(s)
- Georgios Ntolkeras
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleonora Tamilia
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michel AlHilani
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; The Hillingdon Hospital NHS Foundation Trust, London, United Kingdom
| | - Jeffrey Bolton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Division of Neuroradiology, Department of Radiology, Boston Children's Hospital, Harvard Medical School, MA, USA
| | - Sanjay P Prabhu
- Division of Neuroradiology, Department of Radiology, Boston Children's Hospital, Harvard Medical School, MA, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Stufflebeam
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christos Papadelis
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA.
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21
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Hu Y, Zhang H, Adilijiang A, Zhou J, Guan Y, Qi X, Wang M, Wang J, Wang X, Liu C, Luan G. Seizure outcomes and prognostic factors in patients with gangliogliomas associated with epilepsy. Front Surg 2022; 9:946201. [PMID: 36034348 PMCID: PMC9403059 DOI: 10.3389/fsurg.2022.946201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Ganglioglioma (GG) patients often present with seizures. Although most patients can be seizure-free after tumor resection, some still experience seizures. The present study aimed to analyze a group of GGs patients associated with epilepsy and evaluate the seizure outcomes and prognostic factors. Methods This retrospective study involved clinical data collected from medical records of patients diagnosed with GG pathologically and underwent surgical resection in Sanbo Brain Hospital, Capital Medical University. The seizure outcomes were evaluated based on the International League Against Epilepsy (ILAE) seizure outcome classification. The prognostic factors were identified according to univariate and multivariate analysis. Results A total of 222 patients were included, with a mean age at surgery of 19.19 ± 10.93 years. All patients were followed up at least for one year with a mean follow-up duration of 6.28 ± 3.17 years. At the final follow-up, 174 (78.4%) patients achieved ILAE Class 1 or 2. Univariate and multivariate analyses revealed that the short duration of seizures and gross total resection were significant positive factors for seizure-free. Bilateral interictal or ictal epileptiform discharges in preoperative video-electroencephalogram (VEEG) were related to poor seizure outcomes. Conclusion Surgical resection is an effective treatment for patients with epilepsy associated with GGs. The analysis of predictive factors could effectively guide clinical practice and evaluate the prognosis of epilepsy with GG.
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Affiliation(s)
- Yue Hu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Huawei Zhang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | | | - Jian Zhou
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Xueling Qi
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiongfei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Changqing Liu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Correspondence: Guoming Luan Changqing Liu
| | - Guoming Luan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Correspondence: Guoming Luan Changqing Liu
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22
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Ricci L, Matarrese M, Peters JM, Tamilia E, Madsen JR, Pearl PL, Papadelis C. Virtual implantation using conventional scalp EEG delineates seizure onset and predicts surgical outcome in children with epilepsy. Clin Neurophysiol 2022; 139:49-57. [PMID: 35526353 PMCID: PMC10026594 DOI: 10.1016/j.clinph.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Delineation of the seizure onset zone (SOZ) is required in children with drug resistant epilepsy (DRE) undergoing neurosurgery. Intracranial EEG (icEEG) serves as gold standard but has limitations. Here, we examine the utility of virtual implantation with electrical source imaging (ESI) on ictal scalp EEG for mapping the SOZ and predict surgical outcome. METHODS We retrospectively analyzed EEG data from 35 children with DRE who underwent surgery and dichotomized into seizure-free (SF) and non-seizure-free (NSF). We estimated virtual sensors (VSs) at brain locations that matched icEEG implantation and compared ictal patterns at VSs vs icEEG. We calculated the agreement between VSs SOZ and clinically defined SOZ and built receiver operating characteristic (ROC) curves to test whether it predicted outcome. RESULTS Twenty-one patients were SF after surgery. Moderate agreement between virtual and icEEG patterns was observed (kappa = 0.45, p < 0.001). Virtual SOZ agreement with clinically defined SOZ was higher in SF vs NSF patients (66.6% vs 41.6%, p = 0.01). Anatomical concordance of virtual SOZ with clinically defined SOZ predicted outcome (AUC = 0.73; 95% CI: 0.57-0.89; sensitivity = 66.7%; specificity = 78.6%; accuracy = 71.4%). CONCLUSIONS Virtual implantation on ictal scalp EEG can approximate the SOZ and predict outcome. SIGNIFICANCE SOZ mapping with VSs may contribute to tailoring icEEG implantation and predict outcome.
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Affiliation(s)
- Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Margherita Matarrese
- Unit of Non-Linear Physics and Mathematical Modelling, Engineering Department, University Campus Bio-Medico of Rome, Rome, Italy; Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Jurriaan M Peters
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleonora Tamilia
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA; School of Medicine, Texas Christian University, Fort Worth, TX, USA.
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23
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Papadelis C, Ricci L, Matarrese MAG, Peters JM, Tamilia E, Madsen J, Pearl PL. Reply to "Added value of high-resolution electrical source imaging of ictal activity in children with structural focal epilepsy". Clin Neurophysiol 2022; 140:254-255. [PMID: 35728995 DOI: 10.1016/j.clinph.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, 1500 Cooper St., Fort Worth, TX 76104, USA.
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Via Álvaro del Portillo, 21, Rome 128, Italy.
| | - Margherita A G Matarrese
- Laboratory of Nonlinear Physics and Mathematical Modeling, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, Rome 128, Italy.
| | - Jurriaan M Peters
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Eleonora Tamilia
- Department of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, 401 Park Drive, BCH3146, Boston, MA 02115, USA.
| | - Joseph Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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24
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Feys O, Corvilain P, Aeby A, Sculier C, Holmes N, Brookes M, Goldman S, Wens V, De Tiège X. On-Scalp Optically Pumped Magnetometers versus Cryogenic Magnetoencephalography for Diagnostic Evaluation of Epilepsy in School-aged Children. Radiology 2022; 304:429-434. [PMID: 35503013 DOI: 10.1148/radiol.212453] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Magnetoencephalography (MEG) is an established method used to detect and localize focal interictal epileptiform discharges (IEDs). Current MEG systems house hundreds of cryogenic sensors in a rigid, one-size-fits-all helmet, which results in several limitations, particularly in children. Purpose To determine if on-scalp MEG based on optically pumped magnetometers (OPMs) alleviates the main limitations of cryogenic MEG. Materials and Methods In this prospective single-center study conducted in a tertiary university teaching hospital, participants underwent cryogenic (102 magnetometers, 204 planar gradiometers) and on-scalp (32 OPMs) MEG. The two modalities for the detection and localization of IEDs were compared. The t test was used to compare IED amplitude and signal-to-noise ratio (SNR). Distributed source modeling was performed on OPM-based and cryogenic MEG data. Results Five children (median age, 9.4 years [range, 5-11 years]; four girls) with self-limited idiopathic (n = 3) or refractory (n = 2) focal epilepsy were included. IEDs were identified in all five children with comparable sensor topographies for both MEG devices. IED amplitudes were 2.3 (7.2 of 3.1) to 4.6 (3.2 of 0.7) times higher (P < .001) with on-scalp MEG, and the SNR was 27% (16.7 of 13.2) to 60% (12.8 of 8.0) higher (P value range: .001-.009) with on-scalp MEG in all but one participant (P = .93), whose head movements created pronounced motion artifacts. The neural source of averaged IEDs was located at approximately 5 mm (n = 3) or higher (8.3 mm, n = 1; 15.6 mm, n = 1) between on-scalp and cryogenic MEG. Conclusion Despite the limited number of sensors and scalp coverage, on-scalp magnetoencephalography (MEG) based on optically pumped magnetometers helped detect interictal epileptiform discharges in school-aged children with epilepsy with a higher amplitude, higher signal-to-noise ratio, and similar localization value compared with conventional cryogenic MEG. Online supplemental material is available for this article. © RSNA, 2022 See also the editorial by Widjaja in this issue.
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Affiliation(s)
- Odile Feys
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Pierre Corvilain
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Alec Aeby
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Claudine Sculier
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Niall Holmes
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Matthew Brookes
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Serge Goldman
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Vincent Wens
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Xavier De Tiège
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
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25
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Billardello R, Ntolkeras G, Chericoni A, Madsen JR, Papadelis C, Pearl PL, Grant PE, Taffoni F, Tamilia E. Novel User-Friendly Application for MRI Segmentation of Brain Resection following Epilepsy Surgery. Diagnostics (Basel) 2022; 12:diagnostics12041017. [PMID: 35454065 PMCID: PMC9032020 DOI: 10.3390/diagnostics12041017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
Delineation of resected brain cavities on magnetic resonance images (MRIs) of epilepsy surgery patients is essential for neuroimaging/neurophysiology studies investigating biomarkers of the epileptogenic zone. The gold standard to delineate the resection on MRI remains manual slice-by-slice tracing by experts. Here, we proposed and validated a semiautomated MRI segmentation pipeline, generating an accurate model of the resection and its anatomical labeling, and developed a graphical user interface (GUI) for user-friendly usage. We retrieved pre- and postoperative MRIs from 35 patients who had focal epilepsy surgery, implemented a region-growing algorithm to delineate the resection on postoperative MRIs and tested its performance while varying different tuning parameters. Similarity between our output and hand-drawn gold standards was evaluated via dice similarity coefficient (DSC; range: 0-1). Additionally, the best segmentation pipeline was trained to provide an automated anatomical report of the resection (based on presurgical brain atlas). We found that the best-performing set of parameters presented DSC of 0.83 (0.72-0.85), high robustness to seed-selection variability and anatomical accuracy of 90% to the clinical postoperative MRI report. We presented a novel user-friendly open-source GUI that implements a semiautomated segmentation pipeline specifically optimized to generate resection models and their anatomical reports from epilepsy surgery patients, while minimizing user interaction.
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Affiliation(s)
- Roberto Billardello
- Fetal Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Newborn Medicine Division, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA; (G.N.); (A.C.); (P.E.G.)
- Advanced Robotics and Human-Centered Technologies-CREO Lab, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
- Correspondence: (R.B.); (E.T.)
| | - Georgios Ntolkeras
- Fetal Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Newborn Medicine Division, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA; (G.N.); (A.C.); (P.E.G.)
- Baystate Children’s Hospital, Springfield, MA 01199, USA
| | - Assia Chericoni
- Fetal Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Newborn Medicine Division, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA; (G.N.); (A.C.); (P.E.G.)
- Advanced Robotics and Human-Centered Technologies-CREO Lab, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Joseph R. Madsen
- Epilepsy Surgery Program, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX 76104, USA;
| | - Phillip L. Pearl
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Patricia Ellen Grant
- Fetal Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Newborn Medicine Division, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA; (G.N.); (A.C.); (P.E.G.)
| | - Fabrizio Taffoni
- Advanced Robotics and Human-Centered Technologies-CREO Lab, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Eleonora Tamilia
- Fetal Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Newborn Medicine Division, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA; (G.N.); (A.C.); (P.E.G.)
- Correspondence: (R.B.); (E.T.)
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Fujimoto A, Matsumaru Y, Masuda Y, Marushima A, Hosoo H, Araki K, Ishikawa E. Endovascular Electroencephalogram Records Simultaneous Subdural Electrode-Detectable, Scalp Electrode-Undetectable Interictal Epileptiform Discharges. Brain Sci 2022; 12:brainsci12030309. [PMID: 35326265 PMCID: PMC8946704 DOI: 10.3390/brainsci12030309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: We hypothesized that an endovascular electroencephalogram (eEEG) can detect subdural electrode (SDE)-detectable, scalp EEG-undetectable epileptiform discharges. The purpose of this study is, therefore, to measure SDE-detectable, scalp EEG-undetectable epileptiform discharges by an eEEG on a pig. Methods: A pig under general anesthesia was utilized to measure an artificially generated epileptic field by an eEEG that was able to be detected by an SDE, but not a scalp EEG as a primary outcome. We also compared the phase lag of each epileptiform discharge that was detected by the eEEG and SDE as a secondary outcome. Results: The eEEG electrode detected 113 (97%) epileptiform discharges (97% sensitivity). Epileptiform discharges that were localized within the three contacts (contacts two, three and four), but not spread to other parts, were detected by the eEEG with a 92% sensitivity. The latency between peaks of the eEEG and right SDE earliest epileptiform discharge ranged from 0 to 48 ms (mean, 13.3 ms; median, 11 ms; standard deviation, 9.0 ms). Conclusion: In a pig, an eEEG could detect epileptiform discharges that an SDE could detect, but that a scalp EEG could not.
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Affiliation(s)
- Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka 988-056, Japan;
- School of Rehabilitation Sciences, Seirei Christopher University, Shizuoka 988-056, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
- E.P. Medical Inc., 403 Nihonbashi-Life-Science Building, 2-3-11, Honcho, Nihonbashi, Chuo-ku, Tokyo 103-0023, Japan
- Correspondence: ; Tel.: +81-29-853-3900; Fax: +81-29-853-3214
| | - Yosuke Masuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Kota Araki
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba 305-8575, Japan; (Y.M.); (A.M.); (H.H.); (K.A.); (E.I.)
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Papadelis C, Conrad SE, Song Y, Shandley S, Hansen D, Bosemani M, Malik S, Keator C, Perry MS. Case Report: Laser Ablation Guided by State of the Art Source Imaging Ends an Adolescent's 16-Year Quest for Seizure Freedom. Front Hum Neurosci 2022; 16:826139. [PMID: 35145387 PMCID: PMC8821813 DOI: 10.3389/fnhum.2022.826139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 01/14/2023] Open
Abstract
Epilepsy surgery is the most effective therapeutic approach for children with drug resistant epilepsy (DRE). Recent advances in neurosurgery, such as the Laser Interstitial Thermal Therapy (LITT), improved the safety and non-invasiveness of this method. Electric and magnetic source imaging (ESI/MSI) plays critical role in the delineation of the epileptogenic focus during the presurgical evaluation of children with DRE. Yet, they are currently underutilized even in tertiary epilepsy centers. Here, we present a case of an adolescent who suffered from DRE for 16 years and underwent surgery at Cook Children's Medical Center (CCMC). The patient was previously evaluated in a level 4 epilepsy center and treated with multiple antiseizure medications for several years. Presurgical evaluation at CCMC included long-term video electroencephalography (EEG), magnetoencephalography (MEG) with simultaneous conventional EEG (19 channels) and high-density EEG (256 channels) in two consecutive sessions, MRI, and fluorodeoxyglucose - positron emission tomography (FDG-PET). Video long-term EEG captured nine focal-onset clinical seizures with a maximal evolution over the right frontal/frontal midline areas. MRI was initially interpreted as non-lesional. FDG-PET revealed a small region of hypometabolism at the anterior right superior temporal gyrus. ESI and MSI performed with dipole clustering showed a tight cluster of dipoles in the right anterior insula. The patient underwent intracranial EEG which indicated the right anterior insular as seizure onset zone. Eventually LITT rendered the patient seizure free (Engel 1; 12 months after surgery). Retrospective analysis of ESI and MSI clustered dipoles found a mean distance of dipoles from the ablated volume ranging from 10 to 25 mm. Our findings highlight the importance of recent technological advances in the presurgical evaluation and surgical treatment of children with DRE, and the underutilization of epilepsy surgery in children with DRE.
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Affiliation(s)
- Christos Papadelis
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
- School of Medicine, Texas Christian University, University of North Texas Health Science Center, Fort Worth, TX, United States
- *Correspondence: Christos Papadelis orcid.org/0000-0001-6125-9217
| | - Shannon E. Conrad
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Yanlong Song
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
| | - Sabrina Shandley
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Daniel Hansen
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Madhan Bosemani
- Department of Radiology, Cook Children's Medical Center, Fort Worth, TX, United States
| | - Saleem Malik
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Cynthia Keator
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - M. Scott Perry
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States
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Thurairajah A, Freibauer A, RamachandranNair R, Whitney R, Jain P, Donner E, Widjaja E, Jones KC. Low density electrical source imaging of the ictal onset zone in the surgical evaluation of children with epilepsy. Epilepsy Res 2021; 178:106810. [PMID: 34784573 DOI: 10.1016/j.eplepsyres.2021.106810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/18/2021] [Accepted: 11/02/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the utility of Low Density (LD) Electrical Source Imaging (ESI) to model the ictal onset zone (IOZ) for the surgical work up of children with medically refractory epilepsy. METHODS This was a retrospective review of 12 patients from a district and regional pediatric epilepsy center, who underwent focal resections between 2014 and 2019. ESI was generated using the Curry 8 software, incorporating T1 Magnetic Resonance Imaging (MRI) scans and scalp electroencephalogram (EEG) recordings. Concordance of the ictal LD-ESI localizations to the epileptogenic zone was assessed by comparing the location of the ictal LD-ESI to the focal resection margins on neuroimaging and noting the post-operative outcomes at one year. Localizations determined by ictal LD-ESI were also compared to interictal LD-ESI, positron emission tomography (FDG-PET) and interictal magnetoencephalography (MEG). RESULTS Ictal ESI correctly localized the ictal onset zone in 4/6 patients, with all four being seizure free at one year. Similarly, interictal ESI localized the irritative zone in 7/9 patients with focal resections, with 6/7 being seizure free at one year. Additionally, we observed ictal ESI to be concordant to interictal ESI in 5/6 patients. Ictal ESI and interictal ESI were concordant to interictal MEG in 3/6 patients. Ictal ESI was concordant with FDG-PET in 6/7 cases. CONCLUSION IOZ source localization through LD-ESI is a promising complementary method of assessing the epileptogenic focus in children. These findings may support the inclusion of ictal LD-ESI within the pre-surgical evaluation of children to supplement current diagnostic tools.
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Affiliation(s)
- Arun Thurairajah
- The Division of Neurology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Alexander Freibauer
- The Division of Neurology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Rajesh RamachandranNair
- The Division of Neurology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Robyn Whitney
- The Division of Neurology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Puneet Jain
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Donner
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elysa Widjaja
- The Division of Neuroimaging, Department of Diagnostic Imaging, The Hospital for Sick Children Toronto ON, Canada
| | - Kevin C Jones
- The Division of Neurology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada.
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29
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Matarrese MAG, Loppini A, Jahromi S, Tamilia E, Fabbri L, Madsen JR, Pearl PL, Filippi S, Papadelis C. Electric Source Imaging on Intracranial EEG Localizes Spatiotemporal Propagation of Interictal Spikes in Children with Epilepsy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:2668-2671. [PMID: 34891801 PMCID: PMC8928574 DOI: 10.1109/embc46164.2021.9630246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Interictal epileptiform discharges (IEDs) serve as sensitive but not specific biomarkers of epilepsy that can delineate the epileptogenic zone (EZ) in patients with drug resistant epilepsy (DRE) undergoing surgery. Intracranial EEG (icEEG) studies have shown that IEDs propagate in time across large areas of the brain. The onset of this propagation is regarded as a more specific biomarker of epilepsy than areas of spread. Yet, the limited spatial resolution of icEEG does not allow to identify the onset of this activity with high precision. Here, we propose a new method of mapping the spatiotemporal propagation of IEDs (and identify its onset) by using Electrical Source Imaging (ESI) on icEEG bypassing the spatial limitations of icEEG. We validated our method on icEEG recordings from 8 children with DRE who underwent surgery with good outcome (Engel score =1). On each icEEG channel, we detected IEDs and identified the propagation onset using an automated algorithm. We localized the propagation of IEDs with dynamic Statistical Parametric Mapping (dSPM) using a time-sliding window approach. We defined two brain regions: the ESI-onset and ESI-spread zone. We estimated the overlap of these regions with resection volume (in percentage), which served as the gold-standard of the EZ. We also estimated the mean distance of these regions from resection and clinically defined seizure onset zone (SOZ). We observed spatio-temporal propagation of IEDs in all patients across several channels (98 [85-102]) with a mean duration of 155 ms [96-186 ms]. A higher overlap with resection was seen for the ESI-onset zone compared to spread (73.3 % [ 47.4-100 %], 36.5 % [20.3-59.9 %], p = 0.008). The distance of the ESI-onset from resection was shorter compared to the ESI-spread zone (4.3 mm [3.4-5.5 mm], 7.4 mm [6.0-20.6 mm], p = 0.008) and the same trend was observed for the distance from the SOZ (11.9 mm [7.2-15.1 mm], 20.6 mm [15.4-27.2 mm], p = 0.02). These findings show that our method can map the spatiotemporal propagation of IEDs and de-lineate its onset, which is a reliable and focal biomarker of the EZ in children with DRE.Clinical Relevance - ESI on icEEG recordings of children with DRE can localize the spikes propagation phenomenon and help in the delineation of the EZ.
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30
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Papadelis C, Perry MS. Localizing the Epileptogenic Zone with Novel Biomarkers. Semin Pediatr Neurol 2021; 39:100919. [PMID: 34620466 PMCID: PMC8501232 DOI: 10.1016/j.spen.2021.100919] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 01/01/2023]
Abstract
Several noninvasive methods, such as high-density EEG or magnetoencephalography, are currently used to delineate the epileptogenic zone (EZ) during the presurgical evaluation of patients with drug resistant epilepsy (DRE). Yet, none of these methods can reliably identify the EZ by their own. In most cases a multimodal approach is needed. Challenging cases often require the implantation of intracranial electrodes, either through stereo-taxic EEG or electro-corticography. Recently, a growing body of literature introduces novel biomarkers of epilepsy that can be used for analyzing both invasive as well as noninvasive electrophysiological data. Some of these biomarkers are able to delineate the EZ with high precision, augment the presurgical evaluation, and predict the surgical outcome of patients with DRE undergoing surgery. However, the use of these epilepsy biomarkers in clinical practice is limited. Here, we summarize and discuss the latest technological advances in the presurgical neurophysiological evaluation of children with DRE with emphasis on electric and magnetic source imaging, high frequency oscillations, and functional connectivity.
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Affiliation(s)
- Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX; School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX; Department of Bioengineering, University of Texas at Arlington, Arlington, TX; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - M Scott Perry
- Jane and John Justin Neurosciences Center, Cook Children’s Health Care System, Fort Worth, TX, USA
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Jeong H, Ntolkeras G, Grant PE, Bonmassar G. Numerical simulation of the radiofrequency safety of 128-channel hd-EEG nets on a 29-month-old whole-body model in a 3 Tesla MRI. IEEE TRANSACTIONS ON ELECTROMAGNETIC COMPATIBILITY 2021; 63:1748-1756. [PMID: 34675444 PMCID: PMC8522907 DOI: 10.1109/temc.2021.3097732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This study investigates the radiofrequency (RF) induced heating in a pediatric whole-body voxel model with a high-density electroencephalogram (hd-EEG) net during magnetic resonance imaging (MRI) at 3 Tesla. A total of three cases were studied: no net (NoNet), a resistive hd-EEG (NeoNet), and a copper (CuNet) net. The maximum values of specific absorption rate averaged over 10g-mass (10gSAR) in the head were calculated with the NeoNet was 12.51 W/kg and in the case of the NoNet was 12.40 W/kg. In contrast, the CuNet case was 17.04 W/Kg. Temperature simulations were conducted to determine the RF-induced heating without and with hd-EEG nets (NeoNet and CuNet) during an MRI scan using an age-corrected and thermoregulated perfusion for the child model. The results showed that the maximum temperature estimated in the child's head was 38.38 °C for the NoNet, 38.43 °C for the NeoNet, and 43.05 °C for the CuNet. In the case of NeoNet, the maximum temperature estimated in the child's head remained compliant with IEC 60601 for the MRI RF safety limit. However, the case of CuNet estimated to exceed the RF safety limit, which may require an appropriate cooling period or a hardware design to suppress the RF-induced heating.
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Affiliation(s)
- Hongbae Jeong
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Med-ical School, Charlestown, MA 02129 USA
| | - Georgios Ntolkeras
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - P Ellen Grant
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Giorgio Bonmassar
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Med-ical School, Charlestown, MA 02129 USA
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Abstract
BACKGROUND A large number of patients have epilepsy that is intractable and adversely affects a child's lifelong experience with addition societal burden that is disabling and expensive. The last two decades have seen a major explosion of new antiseizure medication options. Despite these advances, children with epilepsy continue to have intractable seizures. An option that has been long available but little used is epilepsy surgery to control intractable epilepsy. METHODS This article is a review of the literature as well as published opinions. RESULTS Epilepsy surgery in pediatrics is an underused modality to effectively treat children with epilepsy. Adverse effects of medication should be weighed against risks of surgery as well as risks of nonefficacy. CONCLUSIONS We discuss an approach to selecting the appropriate pediatric patient for consideration, a detailed evaluation including necessary evaluation, and the creation of an algorithm to approach patients with both generalized and focal epilepsy. We then discuss surgical options available including outcome data. New modalities are also addressed including high-frequency ultrasound and co-registration techniques including magnetic resonance imaging-guided laser therapy.
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Zhang K, Sun J, Sun Y, Niu K, Wang P, Wu C, Chen Q, Wang X. Pretreatment Source Location and Functional Connectivity Network Correlated With Therapy Response in Childhood Absence Epilepsy: A Magnetoencephalography Study. Front Neurol 2021; 12:692126. [PMID: 34413824 PMCID: PMC8368437 DOI: 10.3389/fneur.2021.692126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: This study aims to investigate the differences between antiepileptic drug (AED) responders and nonresponders among patients with childhood absence epilepsy (CAE) using magnetoencephalography (MEG) and to additionally evaluate whether the neuromagnetic signals of the brain neurons were correlated with the response to therapy. Methods: Twenty-four drug-naïve patients were subjected to MEG under six frequency bandwidths during ictal periods. The source location and functional connectivity were analyzed using accumulated source imaging and correlation analysis, respectively. All patients were treated with appropriate AED, at least 1 year after their MEG recordings, their outcome was assessed, and they were consequently divided into responders and nonresponders. Results: The source location of the nonresponders was mainly in the frontal cortex at a frequency range of 8–12 and 30–80 Hz, especially 8–12 Hz, while the source location of the nonresponders was mostly in the medial frontal cortex, which was chosen as the region of interest. The nonresponders showed strong positive local frontal connections and deficient anterior and posterior connections at 80–250 Hz. Conclusion: The frontal cortex and especially the medial frontal cortex at α band might be relevant to AED-nonresponsive CAE patients. The local frontal positive epileptic network at 80–250 Hz in our study might further reveal underlying cerebral abnormalities even before treatment in CAE patients, which could cause them to be nonresponsive to AED. One single mechanism cannot explain AED resistance; the nonresponders may represent a subgroup of CAE who is refractory to several antiepileptic drugs.
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Affiliation(s)
- Ke Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yulei Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Kai Niu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Pengfei Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Caiyun Wu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Qiqi Chen
- MEG Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
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Saute RL, Peixoto-Santos JE, Velasco TR, Leite JP. Improving surgical outcome with electric source imaging and high field magnetic resonance imaging. Seizure 2021; 90:145-154. [PMID: 33608134 DOI: 10.1016/j.seizure.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
While most patients with focal epilepsy present with clear structural abnormalities on standard, 1.5 or 3 T MRI, some patients are MRI-negative. For those, quantitative MRI techniques, such as volumetry, voxel-based morphometry, and relaxation time measurements can aid in finding the epileptogenic focus. High-field MRI, just recently approved for clinical use by the FDA, increases the resolution and, in several publications, was shown to improve the detection of focal cortical dysplasias and mild cortical malformations. For those cases without any tissue abnormality in neuroimaging, even at 7 T, scalp EEG alone is insufficient to delimitate the epileptogenic zone. They may benefit from the use of high-density EEG, in which the increased number of electrodes helps improve spatial sampling. The spatial resolution of even low-density EEG can benefit from electric source imaging techniques, which map the source of the recorded abnormal activity, such as interictal epileptiform discharges, focal slowing, and ictal rhythm. These EEG techniques help localize the irritative, functional deficit, and seizure-onset zone, to better estimate the epileptogenic zone. Combining those technologies allows several drug-resistant cases to be submitted to surgery, increasing the odds of seizure freedom and providing a must needed hope for patients with epilepsy.
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Affiliation(s)
- Ricardo Lutzky Saute
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Brazil
| | - Jose Eduardo Peixoto-Santos
- Discipline of Neuroscience, Department of Neurology and Neurosurgery, Paulista School of Medicine, Unifesp, Brazil
| | - Tonicarlo R Velasco
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Brazil
| | - Joao Pereira Leite
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Brazil.
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Changes in the Functional Brain Network of Children Undergoing Repeated Epilepsy Surgery: An EEG Source Connectivity Study. Diagnostics (Basel) 2021; 11:diagnostics11071234. [PMID: 34359317 PMCID: PMC8306224 DOI: 10.3390/diagnostics11071234] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
About 30% of children with drug-resistant epilepsy (DRE) continue to have seizures after epilepsy surgery. Since epilepsy is increasingly conceptualized as a network disorder, understanding how brain regions interact may be critical for planning re-operation in these patients. We aimed to estimate functional brain connectivity using scalp EEG and its evolution over time in patients who had repeated surgery (RS-group, n = 9) and patients who had one successful surgery (seizure-free, SF-group, n = 12). We analyzed EEGs without epileptiform activity at varying time points (before and after each surgery). We estimated functional connectivity between cortical regions and their relative centrality within the network. We compared the pre- and post-surgical centrality of all the non-resected (untouched) regions (far or adjacent to resection) for each group (using the Wilcoxon signed rank test). In alpha, theta, and beta frequency bands, the post-surgical centrality of the untouched cortical regions increased in the SF group (p < 0.001) whereas they decreased (p < 0.05) or did not change (p > 0.05) in the RS group after failed surgeries; when re-operation was successful, the post-surgical centrality of far regions increased (p < 0.05). Our data suggest that removal of the epileptogenic focus in children with DRE leads to a gain in the network centrality of the untouched areas. In contrast, unaltered or decreased connectivity is seen when seizures persist after surgery.
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Xu N, Shan W, Qi J, Wu J, Wang Q. Presurgical Evaluation of Epilepsy Using Resting-State MEG Functional Connectivity. Front Hum Neurosci 2021; 15:649074. [PMID: 34276321 PMCID: PMC8283278 DOI: 10.3389/fnhum.2021.649074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022] Open
Abstract
Epilepsy is caused by abnormal electrical discharges (clinically identified by electrophysiological recording) in a specific part of the brain [originating in only one part of the brain, namely, the epileptogenic zone (EZ)]. Epilepsy is now defined as an archetypical hyperexcited neural network disorder. It can be investigated through the network analysis of interictal discharges, ictal discharges, and resting-state functional connectivity. Currently, there is an increasing interest in embedding resting-state connectivity analysis into the preoperative evaluation of epilepsy. Among the various neuroimaging technologies employed to achieve brain functional networks, magnetoencephalography (MEG) with the excellent temporal resolution is an ideal tool for estimating the resting-state connectivity between brain regions, which can reveal network abnormalities in epilepsy. What value does MEG resting-state functional connectivity offer for epileptic presurgical evaluation? Regarding this topic, this paper introduced the origin of MEG and the workflow of constructing source-space functional connectivity based on MEG signals. Resting-state functional connectivity abnormalities correlate with epileptogenic networks, which are defined by the brain regions involved in the production and propagation of epileptic activities. This paper reviewed the evidence of altered epileptic connectivity based on low- or high-frequency oscillations (HFOs) and the evidence of the advantage of using simultaneous MEG and intracranial electroencephalography (iEEG) recordings. More importantly, this review highlighted that MEG-based resting-state functional connectivity has the potential to predict postsurgical outcomes. In conclusion, resting-state MEG functional connectivity has made a substantial progress toward serving as a candidate biomarker included in epileptic presurgical evaluations.
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Affiliation(s)
- Na Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Shan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Qi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianping Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Neurological Diseases, Beijing, China
- Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neuromodulation, Beijing, China
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Tamilia E, Matarrese MAG, Ntolkeras G, Grant PE, Madsen JR, Stufflebeam SM, Pearl PL, Papadelis C. Noninvasive Mapping of Ripple Onset Predicts Outcome in Epilepsy Surgery. Ann Neurol 2021; 89:911-925. [PMID: 33710676 PMCID: PMC8229023 DOI: 10.1002/ana.26066] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Intracranial electroencephalographic (icEEG) studies show that interictal ripples propagate across the brain of children with medically refractory epilepsy (MRE), and the onset of this propagation (ripple onset zone [ROZ]) estimates the epileptogenic zone. It is still unknown whether we can map this propagation noninvasively. The goal of this study is to map ripples (ripple zone [RZ]) and their propagation onset (ROZ) using high-density EEG (HD-EEG) and magnetoencephalography (MEG), and to estimate their prognostic value in pediatric epilepsy surgery. METHODS We retrospectively analyzed simultaneous HD-EEG and MEG data from 28 children with MRE who underwent icEEG and epilepsy surgery. Using electric and magnetic source imaging, we estimated virtual sensors (VSs) at brain locations that matched the icEEG implantation. We detected ripples on VSs, defined the virtual RZ and virtual ROZ, and estimated their distance from icEEG. We assessed the predictive value of resecting virtual RZ and virtual ROZ for postsurgical outcome. Interictal spike localization on HD-EEG and MEG was also performed and compared with ripples. RESULTS We mapped ripple propagation in all patients with HD-EEG and in 27 (96%) patients with MEG. The distance from icEEG did not differ between HD-EEG and MEG when mapping the RZ (26-27mm, p = 0.6) or ROZ (22-24mm, p = 0.4). Resecting the virtual ROZ, but not virtual RZ or the sources of spikes, was associated with good outcome for HD-EEG (p = 0.016) and MEG (p = 0.047). INTERPRETATION HD-EEG and MEG can map interictal ripples and their propagation onset (virtual ROZ). Noninvasively mapping the ripple onset may augment epilepsy surgery planning and improve surgical outcome of children with MRE. ANN NEUROL 2021;89:911-925.
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Affiliation(s)
- Eleonora Tamilia
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMA
- Fetal‐Neonatal Neuroimaging and Developmental Science CenterBoston Children's Hospital, Harvard Medical SchoolBostonMA
| | - Margherita A. G. Matarrese
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMA
- Laboratory of Nonlinear Physics and Mathematical Modeling, Department of EngineeringUniversity Bio‐Medico Campus of RomeRomeItaly
| | - Georgios Ntolkeras
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMA
- Fetal‐Neonatal Neuroimaging and Developmental Science CenterBoston Children's Hospital, Harvard Medical SchoolBostonMA
| | - P. Ellen Grant
- Fetal‐Neonatal Neuroimaging and Developmental Science CenterBoston Children's Hospital, Harvard Medical SchoolBostonMA
| | - Joseph R. Madsen
- Epilepsy Surgery Program, Department of NeurosurgeryBoston Children's Hospital, Harvard Medical SchoolBostonMA
| | - Steve M. Stufflebeam
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Phillip L. Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of NeurologyBoston Children's Hospital, Harvard Medical SchoolBostonMA
| | - Christos Papadelis
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMA
- Jane and John Justin Neurosciences CenterCook Children's Health Care SystemFort WorthTX
- School of Medicine, Texas Christian University and University of North Texas Health Science CenterFort WorthTX
- Department of BioengineeringUniversity of Texas at ArlingtonArlingtonTX
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Ricci L, Tamilia E, Alhilani M, Alter A, Scott Perry Μ, Madsen JR, Peters JM, Pearl PL, Papadelis C. Source imaging of seizure onset predicts surgical outcome in pediatric epilepsy. Clin Neurophysiol 2021; 132:1622-1635. [PMID: 34034087 PMCID: PMC8202024 DOI: 10.1016/j.clinph.2021.03.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/08/2021] [Accepted: 03/04/2021] [Indexed: 12/20/2022]
Abstract
Objective: To assess whether ictal electric source imaging (ESI) on low-density scalp EEG can approximate the seizure onset zone (SOZ) location and predict surgical outcome in children with refractory epilepsy undergoing surgery. Methods: We examined 35 children with refractory epilepsy. We dichotomized surgical outcome into seizure- and non-seizure-free. We identified ictal onsets recorded with scalp and intracranial EEG and localized them using equivalent current dipoles and standardized low-resolution magnetic tomography (sLORETA). We estimated the localization accuracy of scalp EEG as distance of scalp dipoles from intracranial dipoles. We also calculated the distances of scalp dipoles from resection, as well as their resection percentage and compared between seizure-free and non-seizure-free patients. We built receiver operating characteristic curves to test whether resection percentage predicted outcome. Results: Resection distance was lower in seizure-free patients for both dipoles (p = 0.006) and sLORETA (p = 0.04). Resection percentage predicted outcome with a sensitivity of 57.1% (95% CI, 34–78.2%), a specificity of 85.7% (95% CI, 57.2–98.2%) and an accuracy of 68.6% (95% CI, 50.7–83.5%) (p = 0.01). Conclusion: Ictal ESI performed on low-density scalp EEG can delineate the SOZ and predict outcome. Significance: Such an application may increase the number of children who are referred for epilepsy surgery and improve their outcome.
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Affiliation(s)
- Lorenzo Ricci
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Eleonora Tamilia
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michel Alhilani
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; The Hillingdon Hospital NHS Foundation Trust, London, UK
| | - Aliza Alter
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Μ Scott Perry
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jurriaan M Peters
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christos Papadelis
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA.
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Otsubo H, Ogawa H, Pang E, Wong SM, Ibrahim GM, Widjaja E. A review of magnetoencephalography use in pediatric epilepsy: an update on best practice. Expert Rev Neurother 2021; 21:1225-1240. [PMID: 33780318 DOI: 10.1080/14737175.2021.1910024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Magnetoencephalography (MEG) is a noninvasive technique that is used for presurgical evaluation of children with drug-resistant epilepsy (DRE).Areas covered: The contributions of MEG for localizing the epileptogenic zone are discussed, in particular in extra-temporal lobe epilepsy and focal cortical dysplasia, which are common in children, as well as in difficult to localize epilepsy such as operculo-insular epilepsy. Further, the authors review current evidence on MEG for mapping eloquent cortex, its performance, application in clinical practice, and potential challenges.Expert opinion: MEG could change the clinical management of children with DRE by directing placement of intracranial electrodes thereby enhancing their yield. With improved identification of a circumscribed epileptogenic zone, MEG could render more patients as suitable candidates for epilepsy surgery and increase utilization of surgery.
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Affiliation(s)
- Hiroshi Otsubo
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
| | - Hiroshi Ogawa
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
| | - Elizabeth Pang
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada.,Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Canada
| | - Simeon M Wong
- Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada.,Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
| | - Elysa Widjaja
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada.,Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Canada.,Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
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40
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Huang Q, Zhou J, Wang X, Li T, Wang M, Wang J, Teng P, Qi X, Zhu M, Luan G, Zhai F. Predictors and Long-term Outcome of Resective Epilepsy Surgery in Patients with Tuberous Sclerosis Complex: A Single-centre Retrospective Cohort Study. Seizure 2021; 88:45-52. [PMID: 33812307 DOI: 10.1016/j.seizure.2021.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify prognostic factors and long-term seizure outcomes for patients with tuberous sclerosis complex (TSC) who underwent resective treatment for epilepsy. METHODS We enrolled 81 patients with TSC who had undergone resective epilepsy surgery at Sanbo Brain Hospital, Capital Medical University, between April 2004 and June 2019. We estimated cumulative probability of remaining seizure-free and plotted survival curves. Variables were compared using Mann-Whitney U, Pearson's correlation, continuity correction, and Fisher's exact chi-square tests. Prognostic predictors were analysed using log-rank (Mantel-Cox) tests and Cox regression models. RESULTS At the last follow-up, 48 (59.3%) patients were classified as International League Against Epilepsy Class 1 (including 14 patients who had seizures <3 times postoperatively on the same or different day and were seizure-free at all other times). The estimated cumulative probability of remaining seizure-free postoperatively was 69.0% (95% confidence interval [CI] 58.8-79.2%), 61.9% (95% CI 51.1-72.7%), and 55.0% (95% CI 42.8-67.2%) at 2, 5, and 10 years, respectively. The mean time of remaining seizure-free was 7.24 ± 0.634 years (95% CI 6.00-8.49); en bloc resection was an essential positive predictor of postoperative seizure freedom, as was age at seizure onset, regional interictal video-electroencephalography pattern, and temporal lobe surgery. The longer the seizure-free time, the less likely a relapse. Patients who postoperatively experienced seizures remained likely to recover. CONCLUSIONS We demonstrated the efficacy of surgical treatment for patients with TSC and intractable epilepsy. Detailed perioperative tests are a reliable predictor of postoperative seizure freedom.
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Affiliation(s)
- Qi Huang
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China.
| | - Jian Zhou
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
| | - Xiongfei Wang
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
| | - Tianfu Li
- Department of Brian Institute, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China; Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
| | - Mengyang Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
| | - Jing Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
| | - Pengfei Teng
- Department of Magnetoencephalography, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
| | - Xueling Qi
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
| | - Mingwang Zhu
- Department of Radiology, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
| | - Guoming Luan
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
| | - Feng Zhai
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China.
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Urriola J, Bollmann S, Tremayne F, Burianová H, Marstaller L, Reutens D. Functional connectivity of the irritative zone identified by electrical source imaging, and EEG-correlated fMRI analyses. NEUROIMAGE-CLINICAL 2020; 28:102440. [PMID: 33002859 PMCID: PMC7527619 DOI: 10.1016/j.nicl.2020.102440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/02/2020] [Accepted: 09/15/2020] [Indexed: 11/06/2022]
Abstract
The irritative zone differs on Electrical Source Imaging (ESI) and EEG-fMRI. Findings differ in functional connectivity and show low temporal correlation. ESI and EEG-fMRI reveal distinct aspects of the irritative zone. The differences may reflect differences in temporal resolution of the techniques.
Objective The irritative zone - the area generating epileptic spikes - can be studied non-invasively during the interictal period using Electrical Source Imaging (ESI) and simultaneous electroencephalography-functional magnetic resonance imaging (EEG-fMRI). Although the techniques yield results which may overlap spatially, differences in spatial localization of the irritative zone within the same patient are consistently observed. To investigate this discrepancy, we used Blood Oxygenation Level Dependent (BOLD) functional connectivity measures to examine the underlying relationship between ESI and EEG-fMRI findings. Methods Fifteen patients (age 20–54), who underwent presurgical epilepsy investigation, were scanned using a single-session resting-state EEG-fMRI protocol. Structural MRI was used to obtain the electrode localisation of a high-density 64-channel EEG cap. Electrical generators of interictal epileptiform discharges were obtained using a distributed local autoregressive average (LAURA) algorithm as implemented in Cartool EEG software. BOLD activations were obtained using both spike-related and voltage-map EEG-fMRI analysis. The global maxima of each method were used to investigate the temporal relationship of BOLD time courses and to assess the spatial similarity using the Dice similarity index between functional connectivity maps. Results ESI, voltage-map and spike-related EEG-fMRI methods identified peaks in 15 (100%), 13 (67%) and 8 (53%) of the 15 patients, respectively. For all methods, maxima were localised within the same lobe, but differed in sub-lobar localisation, with a median distance of 22.8 mm between the highest peak for each method. The functional connectivity analysis showed that the temporal correlation between maxima only explained 38% of the variance between the time course of the BOLD response at the maxima. The mean Dice similarity index between seed-voxel functional connectivity maps showed poor spatial agreement. Significance Non-invasive methods for the localisation of the irritative zone have distinct spatial and temporal sensitivity to different aspects of the local cortical network involved in the generation of interictal epileptiform discharges.
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Affiliation(s)
- Javier Urriola
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Steffen Bollmann
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia; ARC Training Centre for Innovation in Biomedical Imaging Technology, The University of Queensland, Brisbane, Australia
| | - Fred Tremayne
- Department of Neurology, Royal Brisbane and Women's Hospital, Australia
| | - Hana Burianová
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia; Department of Psychology, Bournemouth University, Bournemouth, United Kingdom
| | - Lars Marstaller
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia; Department of Psychology, Bournemouth University, Bournemouth, United Kingdom
| | - David Reutens
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia; ARC Training Centre for Innovation in Biomedical Imaging Technology, The University of Queensland, Brisbane, Australia.
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Khosropanah P, Ho ETW, Lim KS, Fong SL, Thuy Le MA, Narayanan V. EEG Source Imaging (ESI) utility in clinical practice. BIOMED ENG-BIOMED TE 2020; 65:/j/bmte.ahead-of-print/bmt-2019-0128/bmt-2019-0128.xml. [PMID: 32623371 DOI: 10.1515/bmt-2019-0128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 02/21/2020] [Indexed: 11/15/2022]
Abstract
Epilepsy surgery is an important treatment modality for medically refractory focal epilepsy. The outcome of surgery usually depends on the localization accuracy of the epileptogenic zone (EZ) during pre-surgical evaluation. Good localization can be achieved with various electrophysiological and neuroimaging approaches. However, each approach has its own merits and limitations. Electroencephalography (EEG) Source Imaging (ESI) is an emerging model-based computational technique to localize cortical sources of electrical activity within the brain volume, three-dimensionally. ESI based pre-surgical evaluation gives an overall clinical yield of 73-91%, depending on choice of head model, inverse solution and EEG electrode density. It is a cost effective, non-invasive method which provides valuable additional information in presurgical evaluation due to its high localizing value specifically in MRI-negative cases, extra or basal temporal lobe epilepsy, multifocal lesions such as tuberous sclerosis or cases with multiple hypotheses. Unfortunately, less than 1% of surgical centers in developing countries use this method as a part of pre-surgical evaluation. This review promotes ESI as a useful clinical tool especially for patients with lesion-negative MRI to determine EZ cost-effectively with high accuracy under the optimized conditions.
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Affiliation(s)
- Pegah Khosropanah
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Eric Tatt-Wei Ho
- Center for Intelligent Signal & Imaging Research, Universiti Teknologi PETRONAS, Seri Iskandar, Malaysia
- Department of Electrical & Electronics Engineering, Universiti Teknologi PETRONAS, Seri Iskandar, Malaysia
| | - Kheng-Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Si-Lei Fong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Minh-An Thuy Le
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Neurology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Vairavan Narayanan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Sun J, Gao Y, Miao A, Yu C, Tang L, Huang S, Wu C, Shi Q, Zhang T, Li Y, Sun Y, Wang X. Multifrequency Dynamics of Cortical Neuromagnetic Activity Underlying Seizure Termination in Absence Epilepsy. Front Hum Neurosci 2020; 14:221. [PMID: 32670039 PMCID: PMC7332835 DOI: 10.3389/fnhum.2020.00221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/15/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose This study aimed to investigate the spectral and spatial signatures of neuromagnetic activity underlying the termination of absence seizures. Methods Magnetoencephalography (MEG) data were recorded from 18 drug-naive patients with childhood absence epilepsy (CAE). Accumulated source imaging (ASI) was used to analyze MEG data at the source level in seven frequency ranges: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–30 Hz), gamma (30–80 Hz), ripple (80–250 Hz), and fast ripple (250–500 Hz). Result In the 1–4, 4–8, and 8–12 Hz ranges, the magnetic source during seizure termination appeared to be consistent over the ictal period and was mainly localized in the frontal cortex (FC) and parieto-occipito-temporal junction (POT). In the 12–30 and 30–80 Hz ranges, a significant reduction in source activity was observed in the frontal lobe during seizure termination as well as a decrease in peak source strength. The ictal peak source strength in the 1–4 Hz range was negatively correlated with the ictal duration of the seizure, whereas in the 30–80 Hz range, it was positively correlated with the course of epilepsy. Conclusion The termination of absence seizures is associated with a dynamic neuromagnetic process. Frequency-dependent changes in the FC were observed during seizure termination, which may be involved in the process of neural network interaction. Neuromagnetic activity in different frequency bands may play different roles in the pathophysiological mechanism during absence seizures.
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Affiliation(s)
- Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yuan Gao
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Ailiang Miao
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Chuanyong Yu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Lu Tang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Shuyang Huang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Caiyun Wu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Qi Shi
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Tingting Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yulei Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
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Pellegrino G, Xu M, Alkuwaiti A, Porras-Bettancourt M, Abbas G, Lina JM, Grova C, Kobayashi E. Effects of Independent Component Analysis on Magnetoencephalography Source Localization in Pre-surgical Frontal Lobe Epilepsy Patients. Front Neurol 2020; 11:479. [PMID: 32582009 PMCID: PMC7280485 DOI: 10.3389/fneur.2020.00479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/01/2020] [Indexed: 01/18/2023] Open
Abstract
Objective: Magnetoencephalography source imaging (MSI) of interictal epileptiform discharges (IED) is a useful presurgical tool in the evaluation of drug-resistant frontal lobe epilepsy (FLE) patients. Yet, failures in MSI can arise related to artifacts and to interference of background activity. Independent component analysis (ICA) is a popular denoising procedure but its clinical application remains challenging, as the selection of multiple independent components (IC) is controversial, operator dependent, and time consuming. We evaluated whether selecting only one IC of interest based on its similarity with the average IED field improves MSI in FLE. Methods: MSI was performed with the equivalent current dipole (ECD) technique and two distributed magnetic source imaging (dMSI) approaches: minimum norm estimate (MNE) and coherent Maximum Entropy on the Mean (cMEM). MSI accuracy was evaluated under three conditions: (1) ICA of continuous data (Cont_ICA), (2) ICA at the time of IED (IED_ICA), and (3) without ICA (No_ICA). Localization performance was quantitatively measured as actual distance of the source maximum in relation to the focus (Dmin), and spatial dispersion (SD) for dMSI. Results: After ICA, ECD Dmin did not change significantly (p > 0.200). For both dMSI techniques, ICA application worsened the source localization accuracy. We observed a worsening of both MNE Dmin (p < 0.05, consistently) and MNE SD (p < 0.001, consistently) for both ICA approaches. A similar behaviour was observed for cMEM, for which, however, Cont_ICA seemed less detrimental. Conclusion: We demonstrated that a simplified ICA approach selecting one IC of interest in combination with distributed magnetic source imaging can be detrimental. More complex approaches may provide better results but would be rather difficult to apply in real-world clinical setting. In a broader perspective, caution should be taken in applying ICA for source localization of interictal activity. To ensure optimal and useful results, effort should focus on acquiring good quality data, minimizing artifacts, and determining optimal candidacy for MEG, rather than counting on data cleaning techniques.
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Affiliation(s)
- Giovanni Pellegrino
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Min Xu
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Abdulla Alkuwaiti
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Manuel Porras-Bettancourt
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Ghada Abbas
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Jean-Marc Lina
- Multimodal Functional Imaging Laboratory, Biomedical Engineering Department, McGill University, Montreal, QC, Canada.,Département de Génie Électrique, École de Technologie Supérieure, Montreal, QC, Canada.,Centre de Recherches Mathematiques, Univeristé de Montréal, Montreal, QC, Canada
| | - Christophe Grova
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Multimodal Functional Imaging Laboratory, Biomedical Engineering Department, McGill University, Montreal, QC, Canada.,Département de Génie Électrique, École de Technologie Supérieure, Montreal, QC, Canada.,Physics Department and PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Eliane Kobayashi
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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Mégevand P, Seeck M. Electric source imaging for presurgical epilepsy evaluation: current status and future prospects. Expert Rev Med Devices 2020; 17:405-412. [DOI: 10.1080/17434440.2020.1748008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Pierre Mégevand
- Epilepsy Unit, Neurology Division, Clinical Neuroscience Department, Geneva University Hospitals, Genève, Switzerland
- Basic Neuroscience Department, Faculty of Medicine, University of Geneva, Genève, Switzerland
| | - Margitta Seeck
- Epilepsy Unit, Neurology Division, Clinical Neuroscience Department, Geneva University Hospitals, Genève, Switzerland
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Abstract
Magnetoencephalography (MEG) is a noninvasive neuroimaging technique that measures the electromagnetic fields generated by the human brain. This article highlights the benefits that pediatric MEG has to offer to clinical practice and pediatric research, particularly for infants and young children; reviews the existing literature on adult MEG systems for pediatric use; briefly describes the few pediatric MEG systems currently extant; and draws attention to future directions of research, with focus on the clinical use of MEG for patients with drug-resistant epilepsy.
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Ishizaki T, Maesawa S, Nakatsubo D, Yamamoto H, Takai S, Shibata M, Kato S, Natsume J, Hoshiyama M, Wakabayashi T. Distributed source analysis of magnetoencephalography using a volume head model combined with statistical methods improves focus diagnosis in epilepsy surgery. Sci Rep 2020; 10:5263. [PMID: 32210314 PMCID: PMC7093400 DOI: 10.1038/s41598-020-62098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/06/2020] [Indexed: 11/29/2022] Open
Abstract
Deep-seated epileptic focus estimation using magnetoencephalography is challenging because of its low signal-to-noise ratio and the ambiguity of current sources estimated by interictal epileptiform discharge (IED). We developed a distributed source (DS) analysis method using a volume head model as the source space of the forward model and standardized low-resolution brain electromagnetic tomography combined with statistical methods (permutation tests between IEDs and baselines and false discovery rate between voxels to reduce variation). We aimed to evaluate the efficacy of the combined DS (cDS) analysis in surgical cases. In total, 19 surgical cases with adult and pediatric focal epilepsy were evaluated. Both cDS and equivalent current dipole (ECD) analyses were performed in all cases. The concordance rates of the two methods with surgically identified epileptic foci were calculated and compared with surgical outcomes. Concordance rates from the cDS analysis were significantly higher than those from the ECD analysis (68.4% vs. 26.3%), especially in cases with deep-seated lesions, such as in the interhemispheric, fronto-temporal base, and mesial temporal structures (81.8% vs. 9.1%). Furthermore, the concordance rate correlated well with surgical outcomes. In conclusion, cDS analysis has better diagnostic performance in focal epilepsy, especially with deep-seated epileptic focus, and potentially leads to good surgical outcomes.
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Affiliation(s)
- Tomotaka Ishizaki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Satoshi Maesawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
| | - Daisuke Nakatsubo
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
| | - Hiroyuki Yamamoto
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan.,Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sou Takai
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masashi Shibata
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sachiko Kato
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Jun Natsume
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan.,Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Minoru Hoshiyama
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Dirodi M, Tamilia E, Grant PE, Madsen JR, Stufflebeam SM, Pearl PL, Papadelis C. Noninvasive Localization of High-Frequency Oscillations in Children with Epilepsy: Validation against Intracranial Gold-Standard. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1555-1558. [PMID: 31946191 DOI: 10.1109/embc.2019.8857793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Patients with medically refractory epilepsy (MRE) need surgical resection of the epileptogenic zone (EZ) to gain seizure-freedom. High-frequency oscillations (HFOs, > 80 Hz) are promising biomarkers of the EZ that are typically localized using intracranial electroencephalography (icEEG). The goal of this study was to localize the cortical generators of HFOs non-invasively using high-density (HD) EEG and magnetoencephalography (MEG) and validate the localization against the gold-standard given by the icEEGdefined HFO-zone. METHODS We analyzed simultaneous HDEEG and MEG data from six children with MRE who underwent icEEG and surgery. We detected interictal HFOs (80-160 Hz) on HD-EEG and MEG separately, using an inhouse automatic detector followed by visual human review, and distinguished between HFOs with and without spikes. We localized the cortical generators of each HFO on HD-EEG or MEG using the wavelet Maximum Entropy on the Mean (wMEM). For the HFOs localized in the brain area covered by icEEG, we estimated the localization error (Eloc) with respect to the gold-standard, and classified them as either concordant (Eloc≤15mm) or not. RESULTS We found that: (i) HD-EEG presented a higher rate of HFOs than MEG (1 vs 0.5 HFOs/min, p=0.031); (ii) HFOs without spikes were more likely to be localized outside the brain regions of interest (i.e. covered by icEEG) than HFOs with spikes; and (iii) both HD-EEG and MEG showed high precision to the gold-standard (92% and 96%). CONCLUSION We reported quantitative evidence that HDEEG and MEG can localize the HFO cortical generators with high precision to the icEEG gold-standard in children with MRE, suggesting that they may possibly limit the need for icEEG prior to surgery. We also showed that HFOs with spikes on HD-EEG/MEG are more likely to be epileptogenic than those independent from spikes, which may represent physiological events from normal brain.
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Tamilia E, Dirodi M, Alhilani M, Grant PE, Madsen JR, Stufflebeam SM, Pearl PL, Papadelis C. Scalp ripples as prognostic biomarkers of epileptogenicity in pediatric surgery. Ann Clin Transl Neurol 2020; 7:329-342. [PMID: 32096612 PMCID: PMC7086004 DOI: 10.1002/acn3.50994] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To assess the ability of high‐density Electroencephalography (HD‐EEG) and magnetoencephalography (MEG) to localize interictal ripples, distinguish between ripples co‐occurring with spikes (ripples‐on‐spike) and independent from spikes (ripples‐alone), and evaluate their localizing value as biomarkers of epileptogenicity in children with medically refractory epilepsy. Methods We retrospectively studied 20 children who underwent epilepsy surgery. We identified ripples on HD‐EEG and MEG data, localized their generators, and compared them with intracranial EEG (icEEG) ripples. When ripples and spikes co‐occurred, we performed source imaging distinctly on the data above 80 Hz (to localize ripples) and below 70 Hz (to localize spikes). We assessed whether missed resection of ripple sources predicted poor outcome, separately for ripples‐on‐spikes and ripples‐alone. Similarly, predictive value of spikes was calculated. Results We observed scalp ripples in 16 patients (10 good outcome). Ripple sources were highly concordant to the icEEG ripples (HD‐EEG concordance: 79%; MEG: 83%). When ripples and spikes co‐occurred, their sources were spatially distinct in 83‐84% of the cases. Removing the sources of ripples‐on‐spikes predicted good outcome with 90% accuracy for HD‐EEG (P = 0.008) and 86% for MEG (P = 0.044). Conversely, removing ripples‐alone did not predict outcome. Resection of spike sources (generated at the same time as ripples) predicted good outcome for HD‐EEG (P = 0.036; accuracy = 87%), while did not reach significance for MEG (P = 0.1; accuracy = 80%). Interpretation HD‐EEG and MEG localize interictal ripples with high precision in children with refractory epilepsy. Scalp ripples‐on‐spikes are prognostic, noninvasive biomarkers of epileptogenicity, since removing their cortical generators predicts good outcome. Conversely, scalp ripples‐alone are most likely generated by non‐epileptogenic areas.
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Affiliation(s)
- Eleonora Tamilia
- Laboratory of Children’s Brain DynamicsDivision of Newborn MedicineDepartment of MedicineBoston Children's HospitalHarvard Medical SchoolBostonMassachusetts
- Fetal‐Neonatal Neuroimaging and Developmental Science CenterDivision of Newborn MedicineDepartment of MedicineBoston Children’s HospitalHarvard Medical SchoolBostonMassachusetts
| | - Matilde Dirodi
- G. Tec Medical Engineering GmbHGuger Technologies OGGrazAustria
| | - Michel Alhilani
- Laboratory of Children’s Brain DynamicsDivision of Newborn MedicineDepartment of MedicineBoston Children's HospitalHarvard Medical SchoolBostonMassachusetts
- Fetal‐Neonatal Neuroimaging and Developmental Science CenterDivision of Newborn MedicineDepartment of MedicineBoston Children’s HospitalHarvard Medical SchoolBostonMassachusetts
| | - P. Ellen Grant
- Fetal‐Neonatal Neuroimaging and Developmental Science CenterDivision of Newborn MedicineDepartment of MedicineBoston Children’s HospitalHarvard Medical SchoolBostonMassachusetts
| | - Joseph R. Madsen
- Division of Epilepsy SurgeryDepartment of NeurosurgeryBoston Children’s HospitalHarvard Medical SchoolBostonMassachusetts
| | - Steven M. Stufflebeam
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalHarvard Medical SchoolBostonMassachusetts
| | - Phillip L. Pearl
- Division of Epilepsy and Clinical NeurophysiologyDepartment of NeurologyBoston Children’s HospitalHarvard Medical SchoolBostonMassachusetts
| | - Christos Papadelis
- Laboratory of Children’s Brain DynamicsDivision of Newborn MedicineDepartment of MedicineBoston Children's HospitalHarvard Medical SchoolBostonMassachusetts
- Jane and John Justin Neurosciences CenterCook Children's Health Care SystemFort WorthTexas
- School of MedicineTexas Christian University and University of North Texas Health Science CenterFort WorthTexas
- Department of BioengineeringUniversity of Texas at ArlingtonArlingtonTexas
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50
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Alhilani M, Tamilia E, Ricci L, Ricci L, Grant PE, Madsen JR, Pearl PL, Papadelis C. Ictal and interictal source imaging on intracranial EEG predicts epilepsy surgery outcome in children with focal cortical dysplasia. Clin Neurophysiol 2020; 131:734-743. [PMID: 32007920 DOI: 10.1016/j.clinph.2019.12.408] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/12/2019] [Accepted: 12/04/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To localize the seizure onset zone (SOZ) and irritative zone (IZ) using electric source imaging (ESI) on intracranial EEG (iEEG) and assess their clinical value in predicting epilepsy surgery outcome in children with focal cortical dysplasia (FCD). METHODS We analyzed iEEG data from 25 children with FCD-associated medically refractory epilepsy (MRE) who underwent surgery. We performed ESI on ictal onset to localize SOZ (ESI-SOZ) and on interictal discharges to localize IZ (ESI-IZ). We tested whether resection of ESI-SOZ and ESI-IZ predicted good surgical outcome (Engel 1). We further compared the prediction performance of ESI-SOZ and ESI-IZ to those of SOZ and IZ defined using conventional methods, i.e. by identifying iEEG-contacts showing ictal onsets (conventional-SOZ) or being the most interictally active (conventional-IZ). RESULTS The proximity of ESI-SOZ (p = 0.043, odds-ratio = 3.9) and ESI-IZ (p = 0.011, odds-ratio = 7.04) to resection has higher effect on patients' outcome than proximity of conventional-SOZ (p = 0.17, odds-ratio = 1.7) and conventional-IZ (p = 0.038, odds-ratio = 2.6). Resection of ESI-SOZ and ESI-IZ presented higher discriminative power in predicting outcome (68% and 60%) than conventional-SOZ and conventional-IZ (48% and 53%). CONCLUSIONS Localizing SOZ and IZ via ESI on iEEG offers higher predictive value compared to conventional-iEEG interpretation. SIGNIFICANCE iEEG-ESI may help surgical planning and facilitate prognostic assessment of children with FCD-associated MRE.
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Affiliation(s)
- Michel Alhilani
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; The Hillingdon Hospital NHS Foundation Trust, London, UK
| | - Eleonora Tamilia
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorenzo Ricci
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Laura Ricci
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christos Papadelis
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA.
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