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Stoyell SM, Wilmskoetter J, Dobrota MA, Chinappen DM, Bonilha L, Mintz M, Brinkmann BH, Herman ST, Peters JM, Vulliemoz S, Seeck M, Hämäläinen MS, Chu CJ. High-Density EEG in Current Clinical Practice and Opportunities for the Future. J Clin Neurophysiol 2021; 38:112-123. [PMID: 33661787 PMCID: PMC8083969 DOI: 10.1097/wnp.0000000000000807] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
SUMMARY High-density EEG (HD-EEG) recordings use a higher spatial sampling of scalp electrodes than a standard 10-20 low-density EEG montage. Although several studies have demonstrated improved localization of the epileptogenic cortex using HD-EEG, widespread implementation is impeded by cost, setup and interpretation time, and lack of specific or sufficient procedural billing codes. Despite these barriers, HD-EEG has been in use at several institutions for years. These centers have noted utility in a variety of clinical scenarios where increased spatial resolution from HD-EEG has been required, justifying the extra time and cost. We share select scenarios from several centers, using different recording techniques and software, where HD-EEG provided information above and beyond the standard low-density EEG. We include seven cases where HD-EEG contributed directly to current clinical care of epilepsy patients and highlight two novel techniques which suggest potential opportunities to improve future clinical care. Cases illustrate how HD-EEG allows clinicians to: case 1-lateralize falsely generalized interictal epileptiform discharges; case 2-improve localization of falsely generalized epileptic spasms; cases 3 and 4-improve localization of interictal epileptiform discharges in anatomic regions below the circumferential limit of standard low-density EEG coverage; case 5-improve noninvasive localization of the seizure onset zone in lesional epilepsy; cases 6 and 7-improve localization of the seizure onset zone to guide invasive investigation near eloquent cortex; case 8-identify epileptic fast oscillations; and case 9-map language cortex. Together, these nine cases illustrate that using both visual analysis and advanced techniques, HD-EEG can play an important role in clinical management.
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Affiliation(s)
- Sally M Stoyell
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Janina Wilmskoetter
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Mary-Ann Dobrota
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | | | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Mark Mintz
- The Center for Neurological and Neurodevelopmental Health, Voorhees, New Jersey, U.S.A
| | | | - Susan T Herman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Jurriaan M Peters
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Matti S Hämäläinen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
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Dense array EEG estimated the epileptic focus in a patient with epilepsy secondary to tuberous sclerosis complex. Brain Dev 2019; 41:116-120. [PMID: 30077508 DOI: 10.1016/j.braindev.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/09/2018] [Accepted: 07/18/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Tuberous sclerosis complex (TSC) is a leading cause of epilepsy, with seizures affecting almost 80-90% of children. We used the concordance between magnetic resonance imaging (MRI) and dense array electroencephalography (dEEG) findings to detect epileptic focus in a patient with TSC. METHODS A 9-year-old boy with TSC exhibited daily choking spells. As we could not detect the seizure onset area with conventional scalp electroencephalogram (EEG) and long-term video monitoring, we performed dEEG and captured his regular seizures. RESULTS dEEG estimated that the clinical seizure activities from the right frontal region. This patient underwent focus removal, tuberectomy of the right frontal lobe, and removal of a subependymal giant cell astrocytoma. He has been seizure free for 7 years and 10 months. CONCLUSION dEEG was useful for estimation of the placement of intracranial electrodes in a patient with TSC. This method may be useful for pre-surgical evaluation of epilepsy treatment.
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Fisher R, Zhou J, Fogarty A, Joshi A, Markert M, Deutsch GK, Velez M. Repetitive transcranial magnetic stimulation directed to a seizure focus localized by high-density EEG: A case report. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:47-53. [PMID: 29984172 PMCID: PMC6031434 DOI: 10.1016/j.ebcr.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/07/2018] [Accepted: 03/19/2018] [Indexed: 12/29/2022]
Abstract
We demonstrate feasibility of using high-density EEG to map a neocortical seizure focus in conjunction with delivery of magnetic therapy. Our patient had refractory seizures affecting the left leg. A five-day course of placebo stimulation followed a month later by active rTMS was directed to the mapped seizure dipole. Active rTMS resulted in reduced EEG spiking, and shortening of seizure duration compared to placebo. Seizure frequency, however, improved similarly in both placebo and active treatment stages. rTMS-evoked EEG potentials demonstrated that a negative peak at 40 ms - believed to represent GABAergic inhibition - was enhanced by stimulation.
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Affiliation(s)
- Robert Fisher
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Jing Zhou
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Adam Fogarty
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Aditya Joshi
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Matthew Markert
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Gayle K Deutsch
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Mariel Velez
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
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Feng R, Hu J, Wu J, Lang L, Ma C, Sun B, Gu X, Pan L. Accurate source imaging based on high resolution scalp electroencephalography and individualized finite difference head models in epilepsy pre-surgical workup. Seizure 2018; 59:126-131. [DOI: 10.1016/j.seizure.2018.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/12/2018] [Accepted: 05/15/2018] [Indexed: 10/16/2022] Open
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Complex patterns of spatially extended generators of epileptic activity: Comparison of source localization methods cMEM and 4-ExSo-MUSIC on high resolution EEG and MEG data. Neuroimage 2016; 143:175-195. [DOI: 10.1016/j.neuroimage.2016.08.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 11/23/2022] Open
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High density EEG-what do we have to lose? Clin Neurophysiol 2014; 126:433-4. [PMID: 25113273 DOI: 10.1016/j.clinph.2014.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 11/22/2022]
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Pittau F, Grouiller F, Spinelli L, Seeck M, Michel CM, Vulliemoz S. The role of functional neuroimaging in pre-surgical epilepsy evaluation. Front Neurol 2014. [PMID: 24715886 DOI: 10.3389/fneur.2014.00031.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The prevalence of epilepsy is about 1% and one-third of cases do not respond to medical treatment. In an eligible subset of patients with drug-resistant epilepsy, surgical resection of the epileptogenic zone is the only treatment that can possibly cure the disease. Non-invasive techniques provide information for the localization of the epileptic focus in the majority of cases, whereas in others invasive procedures are required. In the last years, non-invasive neuroimaging techniques, such as simultaneous recording of functional magnetic resonance imaging and electroencephalogram (EEG-fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), electric and magnetic source imaging (MSI, ESI), spectroscopy (MRS), have proved their usefulness in defining the epileptic focus. The combination of these functional techniques can yield complementary information and their concordance is crucial for guiding clinical decision, namely the planning of invasive EEG recordings or respective surgery. The aim of this review is to present these non-invasive neuroimaging techniques, their potential combination, and their role in the pre-surgical evaluation of patients with pharmaco-resistant epilepsy.
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Affiliation(s)
- Francesca Pittau
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Frédéric Grouiller
- Department of Radiology and Medical Informatics, University Hospital of Geneva , Geneva , Switzerland
| | - Laurent Spinelli
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Margitta Seeck
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Christoph M Michel
- Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, University of Geneva , Geneva , Switzerland
| | - Serge Vulliemoz
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
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Pittau F, Grouiller F, Spinelli L, Seeck M, Michel CM, Vulliemoz S. The role of functional neuroimaging in pre-surgical epilepsy evaluation. Front Neurol 2014; 5:31. [PMID: 24715886 PMCID: PMC3970017 DOI: 10.3389/fneur.2014.00031] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 03/06/2014] [Indexed: 12/25/2022] Open
Abstract
The prevalence of epilepsy is about 1% and one-third of cases do not respond to medical treatment. In an eligible subset of patients with drug-resistant epilepsy, surgical resection of the epileptogenic zone is the only treatment that can possibly cure the disease. Non-invasive techniques provide information for the localization of the epileptic focus in the majority of cases, whereas in others invasive procedures are required. In the last years, non-invasive neuroimaging techniques, such as simultaneous recording of functional magnetic resonance imaging and electroencephalogram (EEG-fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), electric and magnetic source imaging (MSI, ESI), spectroscopy (MRS), have proved their usefulness in defining the epileptic focus. The combination of these functional techniques can yield complementary information and their concordance is crucial for guiding clinical decision, namely the planning of invasive EEG recordings or respective surgery. The aim of this review is to present these non-invasive neuroimaging techniques, their potential combination, and their role in the pre-surgical evaluation of patients with pharmaco-resistant epilepsy.
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Affiliation(s)
- Francesca Pittau
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Frédéric Grouiller
- Department of Radiology and Medical Informatics, University Hospital of Geneva , Geneva , Switzerland
| | - Laurent Spinelli
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Margitta Seeck
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Christoph M Michel
- Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, University of Geneva , Geneva , Switzerland
| | - Serge Vulliemoz
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
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Song J, Tucker DM, Gilbert T, Hou J, Mattson C, Luu P, Holmes MD. Methods for examining electrophysiological coherence in epileptic networks. Front Neurol 2013; 4:55. [PMID: 23720650 PMCID: PMC3654376 DOI: 10.3389/fneur.2013.00055] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 04/30/2013] [Indexed: 11/13/2022] Open
Abstract
Epilepsy may reflect a focal abnormality of cerebral tissue, but the generation of seizures typically involves propagation of abnormal activity through cerebral networks. We examined epileptiform discharges (spikes) with dense array electroencephalography (dEEG) in five patients to search for the possible engagement of pathological networks. Source analysis was conducted with individual electrical head models for each patient, including sensor position measurement for registration with MRI with geodesic photogrammetry; tissue segmentation and skull conductivity modeling with an atlas skull warped to each patient's MRI; cortical surface extraction and tessellation into 1 cm(2) equivalent dipole patches; inverse source estimation with either minimum norm or cortical surface Laplacian constraints; and spectral coherence computed among equivalent dipoles aggregated within Brodmann areas with 1 Hz resolution from 1 to 70 Hz. These analyses revealed characteristic source coherence patterns in each patient during the pre-spike, spike, and post-spike intervals. For one patient with both spikes and seizure onset localized to a single temporal lobe, we observed a cluster of apparently abnormal coherences over the involved temporal lobe. For the other patients, there were apparently characteristic coherence patterns associated with the discharges, and in some cases these appeared to reflect abnormal temporal lobe synchronization, but the coherence patterns for these patients were not easily related to an unequivocal epileptogenic zone. In contrast, simple localization of the site of onset of the spike discharge, and/or the site of onset of the seizure, with non-invasive 256 dEEG was useful in predicting the characteristic site of seizure onset for those cases that were verified by intracranial EEG and/or by surgical outcome.
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Yamazaki M, Tucker DM, Terrill M, Fujimoto A, Yamamoto T. Dense array EEG source estimation in neocortical epilepsy. Front Neurol 2013; 4:42. [PMID: 23717298 PMCID: PMC3652005 DOI: 10.3389/fneur.2013.00042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 04/15/2013] [Indexed: 11/13/2022] Open
Abstract
RATIONALE Dense array EEG (dEEG) evenly covers the whole head surface with over 100 channels contributing to more accurate electrical source imaging due to the higher spatial and temporal resolution. Several studies have shown the clinical utility of dEEG in presurgical clinical evaluation of epilepsy. However validation studies measuring the accuracy of dEEG source imaging are still needed. This can be achieved through simultaneously recording both scalp dEEG with intracranial electrodes (icEEG), which is considered as the true measure of cortical activity at the source. The purpose of this study is to evaluate the accuracy of 256-channel dEEG electrical source estimation for interictal spikes. METHODS Four patients with medically refractory neocortical epilepsy, all surgical candidates, underwent subdural electrode implantation to determine ictal onset and define functional areas. One patient showed a lesion on the magnetic resonance imaging in the right parietal lobe. The patient underwent simultaneous recording of interictal spikes by both scalp 256-channelsvdEEG and icEEG. The dEEG was used to non-invasively estimate the source of the interictal spikes detected by the 256-channel dEEG array, which was then compared to the activity measured directly at the source by the icEEG. RESULTS From the four patients, a total of 287 interictal spikes were measured with the icEEG. One hundred fifty-five of the 287 spikes (54%) were visually detected by the dEEG upon examination of the 256 channel head surface array. The spike amplitudes detected by the 256-channel dEEG correlated with icEEG spike amplitudes (p < 0.01). All spikes detected in dEEG were localized to the same lobe correctly. CONCLUSION Our study demonstrates that 256-channel dEEG can reliably detect interictal spikes and localize them with reasonable accuracy. Two hundred fifty-six-channel dEEG may be clinically useful in the presurgical workup for epilepsy and also reduce the need for invasive EEG evaluation.
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Affiliation(s)
- Madoka Yamazaki
- Department of Health Science, Daito Bunka UniversitySaitama, Japan
- Comprehensive Epilepsy Center, Seirei Hamamatsu General HospitalShizuoka, Japan
| | - Don M. Tucker
- Department of Psychology, University of OregonEugene, OR, USA
- Electrical Geodesics, Inc.Eugene, OR, USA
| | | | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General HospitalShizuoka, Japan
| | - Takamichi Yamamoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General HospitalShizuoka, Japan
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Yamazaki M, Tucker DM, Fujimoto A, Yamazoe T, Okanishi T, Yokota T, Enoki H, Yamamoto T. Comparison of dense array EEG with simultaneous intracranial EEG for Interictal spike detection and localization. Epilepsy Res 2012; 98:166-73. [DOI: 10.1016/j.eplepsyres.2011.09.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/24/2011] [Accepted: 09/16/2011] [Indexed: 11/16/2022]
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Vulliemoz S, Lemieux L, Daunizeau J, Michel CM, Duncan JS. The combination of EEG Source Imaging and EEG-correlated functional MRI to map epileptic networks. Epilepsia 2010; 51:491-505. [PMID: 19817805 DOI: 10.1111/j.1528-1167.2009.02342.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Serge Vulliemoz
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom.
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Brodbeck V, Spinelli L, Lascano AM, Pollo C, Schaller K, Vargas MI, Wissmeyer M, Michel CM, Seeck M. Electrical source imaging for presurgical focus localization in epilepsy patients with normal MRI. Epilepsia 2010; 51:583-91. [PMID: 20196796 DOI: 10.1111/j.1528-1167.2010.02521.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Patients with magnetic resonance (MR)-negative focal epilepsy (MRN-E) have less favorable surgical outcomes (between 40% and 70%) compared to those in whom an MRI lesion guides the site of surgical intervention (60-90%). Patients with extratemporal MRN-E have the worst outcome (around 50% chance of seizure freedom). We studied whether electroencephalography (EEG) source imaging (ESI) of interictal epileptic activity can contribute to the identification of the epileptic focus in patients with normal MRI. METHODS We carried out ESI in 10 operated patients with nonlesional MRI and a postsurgical follow-up of at least 1 year. Five of the 10 patients had extratemporal lobe epilepsy. Evaluation comprised surface and intracranial EEG monitoring of ictal and interictal events, structural MRI, [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET), ictal and interictal perfusion single photon emission computed tomography (SPECT) scans. Eight of the 10 patients also underwent intracranial monitoring. RESULTS ESI correctly localized the epileptic focus within the resection margins in 8 of 10 patients, 9 of whom experienced favorable postsurgical outcomes. DISCUSSION The results highlight the diagnostic value of ESI and encourage broadening its application to patients with MRN-E. If the surface EEG contains fairly localized spikes, ESI contributes to the presurgical decision process.
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Affiliation(s)
- Verena Brodbeck
- Functional Brain Mapping Laboratory, 4 Rue Gabrielle-Perret-Gentil, Geneva, Switzerland.
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Abstract
Digital EEG analysis provides significantly more information to the clinical electroencephalographer (EEGer) for scalp as well as for intracranial monitoring than is currently being routinely utilized. When modern data analysis software is used, interictal spikes contain considerably more information than had previously been ascribed to them. To optimize the diagnostic value of the EEG, sleep recordings after sleep deprivation is valuable because focal spikes, unless abundant, are relatively rare in the waking state. Recording time should also be sufficiently long to allow spikes to emerge. Spikes are always pathologic and can be associated with impaired cerebral perfusion, metabolic changes and concomitant behavioral changes. They can also be separated into simple and complex forms which may allow prognostic statements. The simplest way to accomplish this is by placing a cursor on the peak of the spike and see whether or not other channels show latency differences. More precise methods are: comparisons of voltage maps with current source density maps, principal component analysis and distinctions between stationary versus moving dipoles. Averaging of spikes is valuable but care must be taken that only those spikes which have the same distribution are averaged, and when the average is obtained only from the spike peak, propagation may already have occurred. It has been recommended that the midpoint of the ascending negative phase be used as the point for averaging. In intracranial recordings the frequencies above the gamma range should also be assessed. Their small electrical field allows a differentiation between locally generated events from those which are volume conducted and can thereby more accurately reflect the epileptogenic zone(s). High frequency activity can also be recorded from foramen ovale electrodes which enhances their diagnostic utility. It is emphasized that for centers which perform pre-surgical evaluations the software supplied by instrument manufacturers is inadequate and needs to be supplemented by additional commercially available programs. Furthermore, archived data should be used for retrospective investigations and follow-up studies of patients who have undergone either excisions, resections, or multiple subpial transections to evaluate the success rates by taking into account all the properties of interictal and ictal recordings which are mentioned in this article.
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Affiliation(s)
- E Rodin
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA.
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