Thalamic epileptic spikes disrupt sleep spindles in patients with epileptic encephalopathy

In severe epileptic encephalopathies, epileptic activity contributes to progressive cognitive dysfunction. Epileptic encephalopathies share the trait of spike-wave activation during non-rapid eye movement sleep (EE-SWAS), a sleep stage dominated by sleep spindles, brain oscillations known to coordinate offline memory consolidation. Epileptic activity has been proposed to hijack the circuits driving these thalamocortical oscillations, thereby contributing to cognitive impairment. Using a unique dataset of simultaneous human thalamic and cortical recordings in subjects with and without EE-SWAS, we provide evidence for epileptic spike interference of thalamic sleep spindle production in patients with EE-SWAS. First, we show that epileptic spikes and sleep spindles are both predicted by slow oscillations during stage two sleep (N2), but at different phases of the slow oscillation. Next, we demonstrate that sleep activated cortical epileptic spikes propagate to the thalamus (thalamic spike rate increases after a cortical spike, p≈0). We then show that epileptic spikes in the thalamus increase the thalamic spindle refractory period (p≈0). Finally, we show that in three patients with EE-SWAS, there is a downregulation of sleep spindles for 30 seconds after each thalamic spike (p<0.01). These direct human thalamocortical observations support a proposed mechanism for epileptiform activity to impact cognitive function, wherein epileptic spikes inhibit thalamic sleep spindles in epileptic encephalopathy with spike and wave activation during sleep.

Different Methods to Estimate the Phase of Neural Rhythms Agree But Only During Times of Low Uncertainty

Rhythms are a common feature of brain activity. Across different types of rhythms, the phase has been proposed to have functional consequences, thus requiring its accurate specification from noisy data. Phase is conventionally specified using techniques that presume a frequency band-limited rhythm. However, in practice, observed brain rhythms are typically nonsinusoidal and amplitude modulated. How these features impact methods to estimate phase remains unclear. To address this, we consider three phase estimation methods, each with different underlying assumptions about the rhythm. We apply these methods to rhythms simulated with different generative mechanisms and demonstrate inconsistency in phase estimates across the different methods. We propose two improvements to the practice of phase estimation: (1) estimating confidence in the phase estimate, and (2) examining the consistency of phase estimates between two (or more) methods.

Different methods to estimate the phase of neural rhythms agree, but only during times of low uncertainty

Rhythms are a common feature of brain activity. Across different types of rhythms, the phase has been proposed to have functional consequences, thus requiring its accurate specification from noisy data. Phase is conventionally specified using techniques that presume a frequency band-limited rhythm. However, in practice, observed brain rhythms are typically non-sinusoidal and amplitude modulated. How these features impact methods to estimate phase remains unclear. To address this, we consider three phase estimation methods, each with different underlying assumptions about the rhythm. We apply these methods to rhythms simulated with different generative mechanisms and demonstrate inconsistency in phase estimates across the different methods. We propose two improvements to the practice of phase estimation: (1) estimating confidence in the phase estimate, and (2) examining the consistency of phase estimates between two (or more) methods.

Structural Connectome constrained Graphical Lasso for MEG Partial Coherence

Structural connectivity provides the backbone for communication between neural populations. Since axonal transmission occurs on a millisecond time scale, measures of M/EEG functional connectivity sensitive to phase synchronization, such as coherence, are expected to reflect structural connectivity. We develop a model of MEG functional connectivity whose edges are constrained by the structural connectome. The edge strengths are defined by partial coherence, a measure of conditional dependence. We build a new method - the adaptive graphical lasso (AGL) - to fit the partial coherence to perform inference on the hypothesis that the structural connectome is reflected in MEG functional connectivity. In simulations, we demonstrate that the structural connectivity’s influence on the partial coherence can be inferred using the AGL. Further, we show that fitting the partial coherence is superior to alternative methods at recovering the structural connectome even after the source localization estimates required to map MEG from sensors to the cortex. Finally, we show how partial coherence can be used to explore how distinct parts of the structural connectome contribute to MEG functional connectivity in different frequency bands. Partial coherence offers better estimates of the strength of direct functional connections and consequently a potentially better estimate of network structure.

Sensory stimulation-based protection from impending stroke following MCA occlusion is correlated with desynchronization of widespread spontaneous local field potentials

In a rat model of ischemic stroke by permanent occlusion of the medial cerebral artery (pMCAo), we have demonstrated using continuous recordings by microelectrode array at the depth of the ischemic territory that there is an immediate wide-spread increase in spontaneous local field potential synchrony following pMCAo that was correlated with ischemic stroke damage, but such increase was not seen in control sham-surgery rats. We further found that the underpinning source of the synchrony increase is intermittent bursts of low multi-frequency oscillations. Here we show that such increase in spontaneous LFP synchrony after pMCAo can be reduced to pre-pMCAo baseline level by delivering early (immediately after pMCAo) protective sensory stimulation that reduced the underpinning bursts. However, the delivery of a late (3 h after pMCAo) destructive sensory stimulation had no influence on the elevated LFP synchrony and its underpinning bursts. Histology confirmed both protection for the early stimulation group and an infarct for the late stimulation group. These findings highlight the unexpected importance of spontaneous LFP and its synchrony as a predictive correlate of cerebral protection or stroke infarct during the hyperacute state following pMCAo and the potential clinical relevance of stimulation to reduce EEG synchrony in acute stroke.

Coherent neural oscillations inform early stroke motor recovery

Neural oscillations may contain important information pertaining to stroke rehabilitation. This study examined the predictive performance of electroencephalography‐derived neural oscillations following stroke using a data‐driven approach. Individuals with stroke admitted to an inpatient rehabilitation facility completed a resting‐state electroencephalography recording and structural neuroimaging around the time of admission and motor testing at admission and discharge. Using a lasso regression model with cross‐validation, we determined the extent of motor recovery (admission to discharge change in Functional Independence Measurement motor subscale score) prediction from electroencephalography, baseline motor status, and corticospinal tract injury. In 27 participants, coherence in a 1–30 Hz band between leads overlying ipsilesional primary motor cortex and 16 leads over bilateral hemispheres predicted 61.8% of the variance in motor recovery. High beta (20–30 Hz) and alpha (8–12 Hz) frequencies contributed most to the model demonstrating both positive and negative associations with motor recovery, including high beta leads in supplementary motor areas and ipsilesional ventral premotor and parietal regions and alpha leads overlying contralesional temporal–parietal and ipsilesional parietal regions. Electroencephalography power, baseline motor status, and corticospinal tract injury did not significantly predict motor recovery during hospitalization (R² = 0–6.2%). Findings underscore the relevance of oscillatory synchronization in early stroke rehabilitation while highlighting contributions from beta and alpha frequency bands and frontal, parietal, and temporal–parietal regions overlooked by traditional hypothesis‐driven prediction models.

A state space modeling approach to real-time phase estimation

Brain rhythms have been proposed to facilitate brain function, with an especially important role attributed to the phase of low-frequency rhythms. Understanding the role of phase in neural function requires interventions that perturb neural activity at a target phase, necessitating estimation of phase in real-time. Current methods for real-time phase estimation rely on bandpass filtering, which assumes narrowband signals and couples the signal and noise in the phase estimate, adding noise to the phase and impairing detections of relationships between phase and behavior. To address this, we propose a state space phase estimator for real-time tracking of phase. By tracking the analytic signal as a latent state, this framework avoids the requirement of bandpass filtering, separately models the signal and the noise, accounts for rhythmic confounds, and provides credible intervals for the phase estimate. We demonstrate in simulations that the state space phase estimator outperforms current state-of-the-art real-time methods in the contexts of common confounds such as broadband rhythms, phase resets, and co-occurring rhythms. Finally, we show applications of this approach to in vivo data. The method is available as a ready-to-use plug-in for the Open Ephys acquisition system, making it widely available for use in experiments.

Damage to the structural connectome reflected in resting-state fMRI functional connectivity

The relationship between structural and functional connectivity has been mostly examined in intact brains. Fewer studies have examined how differences in structure as a result of injury alters function. In this study we analyzed the relationship of structure to function across patients with stroke among whom infarcts caused heterogenous structural damage. We estimated relationships between distinct brain regions of interest (ROIs) from functional MRI in two pipelines. In one analysis pipeline, we measured functional connectivity by using correlation and partial correlation between 114 cortical ROIs. We found fMRI-BOLD partial correlation was altered at more edges as a function of the structural connectome (SC) damage, relative to the correlation. In a second analysis pipeline, we limited our analysis to fMRI correlations between pairs of voxels for which we possess SC information. We found that voxel-level functional connectivity showed the effect of structural damage that we could not see when examining correlations between ROIs. Further, the effects of structural damage on functional connectivity are consistent with a model of functional connectivity, diffusion, which expects functional connectivity to result from activity spreading over multiple edge anatomical paths.

Rapid development of strong, persistent, spatiotemporally extensive cortical synchrony and underlying oscillations following acute MCA focal ischemia

Stroke is a leading cause of death and the leading cause of long-term disability, but its electrophysiological basis is poorly understood. Characterizing acute ischemic neuronal activity dynamics is important for understanding the temporal and spatial development of ischemic pathophysiology and determining neuronal activity signatures of ischemia. Using a 32-microelectrode array spanning the depth of cortex, electrophysiological recordings generated for the first time a continuous spatiotemporal profile of local field potentials (LFP) and multi-unit activity (MUA) before (baseline) and directly after (0-5 h) distal, permanent MCA occlusion (pMCAo) in a rat model. Although evoked activity persisted for hours after pMCAo with minor differences from baseline, spatiotemporal analyses of spontaneous activity revealed that LFP became spatially and temporally synchronized regardless of cortical depth within minutes after pMCAo and extended over large parts of cortex. Such enhanced post-ischemic synchrony was found to be driven by increased bursts of low multi-frequency oscillations and continued throughout the acute ischemic period whereas synchrony measures minimally changed over the same recording period in surgical sham controls. EEG recordings of a similar frequency range have been applied to successfully predict stroke damage and recovery, suggesting clear clinical relevance for our rat model.

Low-Frequency Oscillations Are a Biomarker of Injury and Recovery After Stroke

Background and Purpose- Low-frequency oscillations reflect brain injury but also contribute to normal behaviors. We examined hypotheses relating electroencephalography measures, including low-frequency oscillations, to injury and motor recovery poststroke. Methods- Patients with stroke completed structural neuroimaging, a resting-state electroencephalography recording and clinical testing. A subset admitted to an inpatient rehabilitation facility also underwent serial electroencephalography recordings. The relationship that electroencephalography measures (power and coherence with leads overlying ipsilesional primary motor cortex [iM1]) had with injury and motor status was assessed, focusing on delta (1-3 Hz) and high-beta (20-30 Hz) bands. Results- Across all patients (n=62), larger infarct volume was related to higher delta band power in bilateral hemispheres and to higher delta band coherence between iM1 and bilateral regions. In chronic stroke, higher delta power bilaterally correlated with better motor status. In subacute stroke, higher delta coherence between iM1 and bilateral areas correlated with poorer motor status. These coherence findings were confirmed in serial recordings from 18 patients in an inpatient rehabilitation facility. Here, interhemispheric coherence between leads overlying iM1 and contralesional M1 was elevated at inpatient rehabilitation facility admission compared with healthy controls (n=22), declining to control levels over time. Decreases in interhemispheric coherence between iM1 and contralesional M1 correlated with better motor recovery. Conclusions- Delta band coherence with iM1 related to greater injury and poorer motor status subacutely, while delta band power related to greater injury and better motor status chronically. Low-frequency oscillations reflect both injury and recovery after stroke and may be useful biomarkers in stroke recovery and rehabilitation.

Abstract TMP42: Coherent Neural Oscillations Inform Early Stroke Motor Recovery

Introduction: Neural oscillations may contain valuable information for stroke rehabilitation. The objective of this study was to examine the predictive performance of neural oscillations in early stroke motor recovery using dense array electroencephalography (EEG). Since past work theorizes that neural oscillations underlie behavior, we hypothesized that coherent oscillations with ipsilesional primary motor cortex (M1) across a 1-30 Hz band would significantly predict early motor recovery post-stroke.

Methods: Individuals with stroke admitted to an inpatient rehabilitation facility (IRF) completed a three-minute resting EEG recording and structural MRI around the time of IRF admission and motor testing (Functional Independence Measurement motor subscale (FIM-motor)) at IRF admission and discharge. We examined how well FIM-Motor change was predicted using EEG power and coherence with ipsilesional M1 across delta (1-3 Hz), theta (4-7 Hz), alpha (8-12 Hz), low beta (13-19 Hz), and high beta (20-30 Hz) frequency bands, along with corticospinal tract (CST) injury, in a lasso regression with K-fold cross-validation for deviance estimation.

Results: Twenty-seven subjects (20 males, 58.3±14.6 years, 8-17 days post-stroke) with predominantly mild-moderate motor impairment participated. EEG ipsilesional M1 coherence with 16 leads overlying both hemispheres predicted 61.8% of FIM-motor change from IRF admission to discharge, with higher frequencies (alpha, high beta) positively relating to motor recovery. Lower frequencies overlying contralesional parietal (theta) and frontal (delta) regions inversely and positively related to motor recovery respectively. Coherence outperformed EEG power and CST injury measurements. Ipsilesional M1 coherence also predicted 55.2% of the variance in residuals derived from a predictive model containing only CST injury, suggesting that EEG coherence and CST injury contain unique information for motor recovery prediction.

Conclusions: Early after stroke, coherence of neural oscillations with ipsilesional M1 across the entire brain through a wide frequency spectrum is best at predicting functional gains from inpatient rehabilitation and may be feasible as a bedside biomarker of motor recovery.

Abstract TP314: EEG Has High Precision for Diagnosing Stroke Hours After Onset

Background: Improvements are needed in prehospital diagnosis of stroke. The electroencephalogram (EEG) changes immediately after brain ischemia, and advances in EEG technology enable rapid acquisition in the acute care setting. We hypothesized that EEG data increase the accuracy with which patients are correctly classified as having acute stroke or not, and so performed a study in the Emergency Department (ED) as an initial step towards evaluating prehospital utility of EEG.

Methods: Patients with suspected stroke in a comprehensive stroke center ED underwent a 3 min EEG using a wireless, dry-electrode system; data were analyzed offline. A model was developed to classify patients as stroke/TIA vs non-stroke using a training set of 60 randomly selected patients. The model was then tested in an independent validation cohort of 40 new patients. EEG variables were selected using Lasso regression. Four models were examined, the first three using logistic regression: [1] clinical data only; [2] EEG data only; [3] combined clinical and EEG data; [4] a deep learning neural network model using clinical and EEG data.

Results: Of the 100 ED patients (mean age 64.5 ± 15.7), 63 were ultimately discharged with a diagnosis of stroke (43 ischemic, 7 hemorrhagic) or TIA (13). Median time from last known well (LKW) to EEG was 9.4 hours; from ED arrival to EEG, 3.7 hours. Median time to prepare/place EEG leads then initiate recording was 9 min, shortened during the study (p<0.0001), and was as brief as 36 seconds. To classify patients as stroke/TIA vs non-stroke: [1] The clinical data (including LKW and Rapid Arterial Occlusion Evaluation score) model had AUC=62.3. [2] The EEG data (Lasso selected 4 frontocentral leads, in higher frequencies) model had AUC=78.2. [3] The clinical+EEG data model had AUC=80.3. [4] The deep learning neural network model yielded AUC=87.8.

Conclusions: The data support the feasibility of using a dry lead EEG system to rapidly acquire EEG in the acute stroke ED setting and suggest utility to improve prehospital stroke diagnosis once acquisition and analysis approaches are appropriately streamlined. EEG captures a signal that is diagnostically useful, independent from clinical measures, and improves the precision with which acute stroke can be diagnosed.

Abstract WP181: Linking Post-Stroke Injury, Neural Function, and Motor Behavior With EEG

Introduction: Elucidating the relationship between stroke-induced injury and changes in neural function may potentiate rehabilitation and treatment development. This study examined post-stroke associations between functional electroencephalography (EEG) measures, structural injury, and motor behavior.

Hypothesis: Greater injury extent and motor impairment correspond to increasing delta band (1-3Hz) and decreasing high beta band (20-30Hz) EEG measures in a time-dependent manner.

Methods: Subjects with stroke completed a 3-minute resting-state EEG recording, an MRI, and motor testing (Fugl-Meyer, FM). EEG power and ipsilesional primary motor cortex (M1) coherence (connectivity) were computed from dense-array EEG (194 leads). Global (lesion volume) and motor-specific (%CST injury) injury were measured on MRI. Associations between EEG measures and injury/behavior were significant if ≥10% of leads demonstrated significance (p≤0.05).

Results: Sixty individuals (mean age 56.6 years, 11.9 months post-stroke) were stratified into subacute (n=24) and chronic (n=36) groups. For EEG power, larger delta band power correlated strongly with increasing lesion volume early after stroke, and this association expanded (21 to 82 leads) in chronic stroke to bilateral premotor, M1, and temporal-parietal regions. This delta power expansion strongly correlated with greater FM scores. For EEG coherence, larger delta band ipsilesional M1 coherence with leads overlying bilateral fronto-temporal-parietal regions strongly correlated with both greater lesion volume (64 leads) and CST injury (52 leads) early after stroke. These associations were reduced in chronic stroke but still strongly correlated with greater FM scores. Beta band power and coherence measurements showed negative and positive correlations with lesion volume, respectively, but did not relate to motor behavior.

Conclusions: Low-frequency band EEG power and coherence measures predominantly capture global injury arising from stroke. The expansion of delta power and the reduction of delta coherence from subacute to chronic stroke are adaptive responses indicative of lower motor impairment, and these measures may prove valuable in monitoring stroke rehabilitation.