1
|
Zawar I, Shreshtha B, Benech D, Burgess RC, Bulacio J, Knight EMP. Electrographic Features of Epilepsy With Eyelid Myoclonia With Photoparoxysmal Responses. J Clin Neurophysiol 2024; 41:83-92. [PMID: 35394968 DOI: 10.1097/wnp.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Epilepsy with eyelid myoclonia (EMA) is characterized by eyelid myoclonia, eyelid closure sensitivity, and photosensitivity. EEG may manifest with frontal-predominant (FPEDs) or occipital-predominant epileptiform discharges (OPEDs). Data on clinical and electrographic features of these two subtypes are lacking. The purpose of our research was to look at baseline electroclinical features of EMA subtypes and to study electrographic findings of patients with EMA during intermittent photic stimulation (IPS). METHODS We retrospectively identified all patients who had photoparoxysmal responses on EEGs performed at Cleveland clinic between January 01, 2012, and December 31, 2019. Patients who met diagnostic criteria for EMA were studied further. RESULTS Of the 249 patients with photoparoxysmal responses, 70 (28.1%) had EMA (62 [88.6%] female; the mean age of epilepsy onset: 7.0 ± 7.9 years). Patients with EMA had either FPEDs or OPEDs. Eleven patients with EMA (15.7%) had seizures (4 absence, 5 myoclonic and 2 bilateral tonic-clonic) during IPS. Patients with OPEDs were more likely to have drug-resistant epilepsy; occipital focal IEDs and other focal IEDs (other than frontal/occipital) on baseline EEG; and generalized IEDs with occipital predominance, generalized IEDs with no predominance, or focal IEDs during IPS. Predictors of seizure occurrence during photic stimulation included the presence of focal occipital IEDs on baseline EEG, generalized IEDs with frontal predominance during IPS, and photoparoxysmal response outlasting the stimulus. CONCLUSIONS Our study provides evidence that EMA has two distinct subtypes, which differ in clinical characteristics, baseline EEG, and EEG during photic stimulation. We highlight diagnostic and prognostic implications of these findings. Our study also details EEG characteristics of patients with EMA during IPS.
Collapse
Affiliation(s)
- Ifrah Zawar
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
- Department of Neurology, University of Virginia School of Medicine, Virginia, U.S.A
| | - Bijina Shreshtha
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Daniela Benech
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Richard C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Juan Bulacio
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| | - Elia M Pestana Knight
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.; and
| |
Collapse
|
2
|
Bagić AI, Bowyer SM, Burgess RC, Funke ME, Lowden A, Mohamed IS, Wilson T, Zhang W, Zillgitt AJ, Tenney JR. Role of optically pumped magnetometers in presurgical epilepsy evaluation: Commentary of the American Clinical Magnetoencephalography Society. Epilepsia 2023; 64:3155-3159. [PMID: 37728519 DOI: 10.1111/epi.17770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
One of the major challenges of modern epileptology is the underutilization of epilepsy surgery for treatment of patients with focal, medication resistant epilepsy (MRE). Aggravating this distressing failure to deliver optimum care to these patients is the underuse of proven localizing tools, such as magnetoencephalography (MEG), a clinically validated, non-invasive, neurophysiological method used to directly measure and localize brain activity. A sizable mass of published evidence indicates that MEG can improve identification of surgical candidates and guide pre-surgical planning, increasing the yield of SEEG and improving operative outcomes. However, despite at least 10 common, evidence supported, clinical scenarios in MRE patients where MEG can offer non-redundant information and improve the pre-surgical evaluation, it is regularly used by only a minority of USA epilepsy centers. The current state of the art in MEG sensors employs SQUIDs, which require cooling with liquid helium to achieve superconductivity. This sensor technology has undergone significant generational improvement since whole head MEG scanners were introduced around in 1990s, but still has limitations. Further advances in sensor technology which may make ME G more easily accessible and affordable have been eagerly awaited, and development of new techniques should be encouraged. Of late, optically pumped magnetometers (OPMs) have received considerable attention, even prompting some potential acquisitions of new MEG systems to be put on hold, based on a hope that OPMs will usher in a new generation of MEG equipment and procedures. The development of any new clinical test used to guide intracranial EEG monitoring and/or surgical planning must address several specific issues. The goal of this commentary is to recognize the current state of OPM technology and to suggest a framework for it to advance in the clinical realm where it can eventually be deemed clinically valuable to physicians and patients. The American Clinical MEG Society (ACMEGS) strongly supports more advanced and less expensive technology and looks forward to continuing work with researchers to develop new sensors and clinical devices which will improve the experience and outcome for patients, and perhaps extend the role of MEG. However, currently, there are no OPM devices ready for practical clinical use. Based on the engineering obstacles and the clinical tradeoffs to be resolved, the assessment of experts suggests that there will most likely be another decade relying solely on "frozen SQUIDs" in the clinical MEG field.
Collapse
Affiliation(s)
- Anto I Bagić
- University of Pittsburgh Comprehensive Epilepsy Center, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Susan M Bowyer
- MEG Laboratory, Henry Ford Hospital, Wayne State University, Detroit, Michigan, USA
| | - Richard C Burgess
- Magnetoencephalography Laboratory, Cleveland Clinic Epilepsy Center, Cleveland, Ohio, USA
| | - Michael E Funke
- Department of Pediatrics, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Andrea Lowden
- Division of Pediatric Neurology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ismail S Mohamed
- Department of Pediatrics, University of Alabama, Birmingham, Alabama, USA
| | - Tony Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Wenbo Zhang
- Minnesota Epilepsy Group, Roseville, Minnesota, USA
| | - Andrew J Zillgitt
- Corewell Health William Beaumont University Hospital, Royal Oak, Minnesota, USA
| | - Jeffrey R Tenney
- MEG Center, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
3
|
Katagiri M, Wang ZI, Hirfanoglu T, Aldosari MM, Aung T, Wang S, Kobayashi K, Bulacio J, Bingaman W, Najm IM, Alexopoulos AV, Burgess RC. Clinical significance of ictal magnetoencephalography in patients undergoing epilepsy surgery. Clin Neurophysiol 2023; 145:108-118. [PMID: 36443170 DOI: 10.1016/j.clinph.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The significance of ictal magnetoencephalography (MEG) is not well appreciated. We evaluated the relationships between ictal MEG, MRI, intracranial electroencephalography (ICEEG), surgery and postoperative seizure outcome. METHODS A total of 45 patients (46 cases) with ictal MEG who underwent epilepsy surgery was included. We examined the localization of each modality, surgical resection area and seizure freedom after surgery. RESULTS Twenty-one (45.7%) out of 46 cases were seizure-free at more than 6 months follow-up. Median duration of postoperative follow-up was 16.5 months. The patients in whom ictal, interictal single equivalent current dipole (SECD) and MRI lesion localization were completely included in the resection had a higher chance of being seizure-free significantly (p < 0.05). Concordance between ictal and interictal SECD localizations was significantly associated with seizure-freedom. Concordance between MRI lesion and ictal SECD, concordance between ictal ICEEG and ictal and interictal SECD, as well as concordance between ictal ICEEG and MRI lesion were significantly associated with seizure freedom. CONCLUSIONS Ictal MEG can contribute useful information for delineating the resection area in epilepsy surgery. SIGNIFICANCE Resection should include ictal, interictal SECDs and MRI lesion localization, when feasible. Concordant ictal and interictal SECDs on MEG can be a favorable predictor of seizure freedom.
Collapse
Affiliation(s)
- Masaya Katagiri
- Epilepsy Center, Cleveland Clinic, OH, USA; Department of Neurosurgery, Graduate School of Medicine, Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Tugba Hirfanoglu
- Epilepsy Center, Cleveland Clinic, OH, USA; Department of Pediatric Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Mubarak M Aldosari
- Epilepsy Center, Cleveland Clinic, OH, USA; Epilepsy Program, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Thandar Aung
- Epilepsy Center, Cleveland Clinic, OH, USA; Comprehensive Epilepsy Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shan Wang
- Epilepsy Center, Cleveland Clinic, OH, USA; Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Katsuya Kobayashi
- Epilepsy Center, Cleveland Clinic, OH, USA; Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | | | | |
Collapse
|
4
|
Coan AC, Cavalcante CM, Burgess RC. Utility of Functional MRI and Magnetoencephalography in the Diagnosis of Infantile Spasms and Hypsarrhythmia. J Clin Neurophysiol 2022; 39:544-551. [PMID: 35323155 DOI: 10.1097/wnp.0000000000000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY Neuroimaging and neurophysiology techniques can add a significant contribution to the comprehension of infantile spasms (IS) and hypsarrhythmia. Functional MRI and magnetoencephalography (MEG) are two noninvasive tools that can be used in young children with IS. In the past two decades, interesting data about IS have emerged from functional MRI and MEG studies. Regarding their clinical utility, MEG has supported the concept that epileptic spasms can have a focal origin. Moreover, MEG might contribute to the localization of the epileptogenic zone in children with IS under investigation for epilepsy surgery. Functional MRI data have contributed to improve the knowledge about the physiopathology of IS and hypsarrhythmia. It has demonstrated abnormal brainstem involvement during the high-amplitude slow waves of hypsarrhythmia and cortical involvement during the epileptiform discharges. Since the feasibility of these techniques has been demonstrated in infants, it is possible that, in the future, larger functional MRI and MEG studies might contribute to the treatment and the definition of the long-term prognosis of children with IS.
Collapse
Affiliation(s)
- Ana Carolina Coan
- Department of Neurology, Child Neurology Unit, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), at UNICAMP, Campinas, SP, Brazil; and
| | - Charlington M Cavalcante
- Department of Neurology, Child Neurology Unit, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), at UNICAMP, Campinas, SP, Brazil; and
| | - Richard C Burgess
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| |
Collapse
|
5
|
Jin L, Choi JY, Bulacio J, Alexopoulos AV, Burgess RC, Murakami H, Bingaman W, Najm I, Wang ZI. Multimodal Image Integration for Epilepsy Presurgical Evaluation: A Clinical Workflow. Front Neurol 2021; 12:709400. [PMID: 34421808 PMCID: PMC8372749 DOI: 10.3389/fneur.2021.709400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/25/2021] [Indexed: 12/02/2022] Open
Abstract
Multimodal image integration (MMII) is a promising tool to help delineate the epileptogenic zone (EZ) in patients with medically intractable focal epilepsies undergoing presurgical evaluation. We report here the detailed methodology of MMII and an overview of the utility of MMII at the Cleveland Clinic Epilepsy Center from 2014 to 2018, exemplified by illustrative cases. The image integration was performed using the Curry platform (Compumedics Neuroscan™, Charlotte, NC, USA), including all available diagnostic modalities such as Magnetic resonance imaging (MRI), Positron Emission Tomography (PET), single-photon emission computed tomography (SPECT) and Magnetoencephalography (MEG), with additional capability of trajectory planning for intracranial EEG (ICEEG), particularly stereo-EEG (SEEG), as well as surgical resection planning. In the 5-year time span, 467 patients underwent MMII; of them, 98 patients (21%) had a history of prior neurosurgery and recurring seizures. Of the 467 patients, 425 patients underwent ICEEG implantation with further CT co-registration to identify the electrode locations. A total of 351 patients eventually underwent surgery after MMII, including 197 patients (56%) with non-lesional MRI and 223 patients (64%) with extra-temporal lobe epilepsy. Among 269 patients with 1-year post-operative follow up, 134 patients (50%) had remained completely seizure-free. The most common histopathological finding is focal cortical dysplasia. Our study illustrates the usefulness of MMII to enhance SEEG electrode trajectory planning, assist non-invasive/invasive data interpretation, plan resection strategy, and re-evaluate surgical failures. Information presented by MMII is essential to the understanding of the anatomo-functional-electro-clinical correlations in individual cases, which leads to the ultimate success of presurgical evaluation of patients with medically intractable focal epilepsies.
Collapse
Affiliation(s)
- Liri Jin
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China.,Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States
| | - Joon Yul Choi
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States
| | - Juan Bulacio
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States
| | | | | | | | - William Bingaman
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States
| | | |
Collapse
|
6
|
Bagić AI, Funke ME, Kirsch HE, Tenney JR, Zillgitt AJ, Burgess RC. The 10 Common Evidence-Supported Indications for MEG in Epilepsy Surgery: An Illustrated Compendium. J Clin Neurophysiol 2021; 37:483-497. [PMID: 33165222 DOI: 10.1097/wnp.0000000000000726] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Unfamiliarity with the indications for and benefits of magnetoencephalography (MEG) persists, even in the epilepsy community, and hinders its acceptance to clinical practice, despite the evidence. The wide treatment gap for patients with drug-resistant epilepsy and immense underutilization of epilepsy surgery had similar effects. Thus, educating referring physicians (epileptologists, neurologists, and neurosurgeons) both about the value of epilepsy surgery and about the potential benefits of MEG can achieve synergy and greatly improve the process of selecting surgical candidates. As a practical step toward a comprehensive educational process to benefit potential MEG users, current MEG referrers, and newcomers to MEG, the authors have elected to provide an illustrated guide to 10 everyday situations where MEG can help in the evaluation of people with drug-resistant epilepsy. They are as follows: (1) lacking or imprecise hypothesis regarding a seizure onset; (2) negative MRI with a mesial temporal onset suspected; (3) multiple lesions on MRI; (4) large lesion on MRI; (5) diagnostic or therapeutic reoperation; (6) ambiguous EEG findings suggestive of "bilateral" or "generalized" pattern; (7) intrasylvian onset suspected; (8) interhemispheric onset suspected; (9) insular onset suspected; and (10) negative (i.e., spikeless) EEG. Only their practical implementation and furtherance of personal and collective education will lead to the potentially impactful synergy of the two-MEG and epilepsy surgery. Thus, while fulfilling our mission as physicians, we must not forget that ignoring the wealth of evidence about the vast underutilization of epilepsy surgery - and about the usefulness and value of MEG in selecting surgical candidates - is far from benign neglect.
Collapse
Affiliation(s)
- Anto I Bagić
- University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), Department of Neurology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, U.S.A
| | - Michael E Funke
- MEG Center, McGovern Medical School, UT Houston, Houston, Texas, U.S.A
| | - Heidi E Kirsch
- UCSF Biomagnetic Imaging Laboratory, UCSF, San Francisco, California, U.S.A
| | - Jeffrey R Tenney
- MEG Center, Cincinnati Children's Hospital Medical Center , Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Andrew J Zillgitt
- Department of Neurology, Beaumont Health Adult Comprehensive Epilepsy Center, Neurosicence Center, Royal Oak, Michigan, U.S.A.; and
| | - Richard C Burgess
- Magnetoencephalography Laboratory, Cleveland Clinic Epilepsy Center, Cleveland, Ohio, U.S.A
| |
Collapse
|
7
|
Abstract
Normal variants, although not occurring frequently, may appear similar to epileptic activity. Misinterpretation may lead to false diagnoses. In the context of presurgical evaluation, normal variants may lead to mislocalizations with severe impact on the viability and success of surgical therapy. While the different variants are well known in EEG, little has been published in regard to their appearance in magnetoencephalography. Furthermore, there are some magnetoencephalography normal variants that have no counterparts in EEG. This article reviews benign epileptiform variants and provides examples in EEG and magnetoencephalography. In addition, the potential of oscillatory configurations in different frequency bands to appear as epileptic activity is discussed.
Collapse
Affiliation(s)
- Stefan Rampp
- Department of Neurosurgery, University Hospital, Erlangen, Germany.,Department of Neurosurgery, University Hospital, Halle (Saale), Germany
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University School of Medicine, Sendai, Japan
| | - Sumiya Shibata
- Department of Neurosurgery and Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Xingtong Wu
- Department of Neurosurgery, University Hospital, Erlangen, Germany.,Department of Neurology, West China Hospital, Sichuan University, Sichuan, China; and
| | - Karl Rössler
- Department of Neurosurgery, University Hospital, Erlangen, Germany
| | | | | |
Collapse
|
8
|
Abstract
Magnetoencephalography is the noninvasive measurement of miniscule magnetic fields produced by brain electrical currents, and is used most fruitfully to evaluate epilepsy patients. While other modalities infer brain function indirectly by measuring changes in blood flow, metabolism, and oxygenation, magnetoencephalography measures neuronal and synaptic function directly with submillisecond temporal resolution. The brain's magnetic field is recorded by neuromagnetometers surrounding the head in a helmet-shaped sensor array. Because magnetic signals are not distorted by anatomy, magnetoencephalography allows for a more accurate measurement and localization of brain activities than electroencephalography. Magnetoencephalography has become an indispensable part of the armamentarium at epilepsy centers.
Collapse
Affiliation(s)
- Richard C Burgess
- Epilepsy Center, Neurological Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
9
|
Alkawadri R, Burgess RC, Kakisaka Y, Mosher JC, Alexopoulos AV. Assessment of the Utility of Ictal Magnetoencephalography in the Localization of the Epileptic Seizure Onset Zone. JAMA Neurol 2019; 75:1264-1272. [PMID: 29889930 DOI: 10.1001/jamaneurol.2018.1430] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Literature on ictal magnetoencephalography (MEG) in clinical practice and the relationship to other modalities is limited because of the brevity of routine studies. Objective To investigate the utility and reliability of ictal MEG in the localization of the epileptogenic zone. Design, Setting, and Participants A retrospective medical record review and prospective analysis of a novel ictal rhythm analysis method was conducted at a tertiary epilepsy center with a wide base of referrals for epilepsy surgery evaluation and included consecutive cases of patients who experienced epileptic seizures during routine MEG studies from March 2008 to February 2012. A total of 377 studies screened. Data were analyzed from November 2011 to October 2015. Main Outcomes and Measures Presurgical workup and interictal and ictal MEG data were reviewed. The localizing value of using extended-source localization of a narrow band identified visually at onset was analyzed. Results Of the 44 included patients, the mean (SD) age at the time of recording was 19.3 (14.9) years, and 25 (57%) were male. The mean duration of recording was 51.2 minutes. Seizures were provoked by known triggers in 3 patients and were spontaneous otherwise. Twenty-five patients (57%) had 1 seizure, 6 (14%) had 2, and 13 (30%) had 3 or more. Magnetoencephalography single equivalent current dipole analysis was possible in 29 patients (66%), of whom 8 (28%) had no clear interictal discharges. Sublobar concordance between ictal and interictal dipoles was seen in 18 of 21 patients (86%). Three patients (7%) showed clear ictal MEG patterns without electroencephalography changes. Ictal MEG dipoles correlated with the lobe of onset in 7 of 8 patients (88%) who underwent intracranial electroencephalography evaluations. Reasons for failure to identify ictal dipoles included diffuse or poor dipolar ictal patterns, no MEG changes, and movement artifact. Resection of areas containing a minimum-norm estimate of a narrow band at onset, not single equivalent current dipole, was associated with sustained seizure freedom. Conclusions and Significance Ictal MEG data can provide reliable localization, including in cases that are difficult to localize by other modalities. These findings support the use of extended-source localization for seizures recorded during MEG.
Collapse
Affiliation(s)
- Rafeed Alkawadri
- The Epilepsy Center at Cleveland Clinic Foundation, Cleveland, Ohio.,Yale Comprehensive Epilepsy Center, School of Medicine, Yale University, New Haven, Connecticut.,Yale Human Brain Mapping Program, School of Medicine, Yale University, New Haven, Connecticut
| | | | - Yosuke Kakisaka
- The Epilepsy Center at Cleveland Clinic Foundation, Cleveland, Ohio.,The Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - John C Mosher
- The Epilepsy Center at Cleveland Clinic Foundation, Cleveland, Ohio
| | | |
Collapse
|
10
|
Abstract
This scientific commentary refers to ‘Magnetoencephalography for epileptic focus localization in a series of 1000 cases’, by Rampp et al. (doi:10.1093/brain/awz231).
Collapse
Affiliation(s)
- Richard C Burgess
- Director, Magnetoencephalography Laboratory, Cleveland Clinic Epilepsy Center, Cleveland, Ohio, USA
| |
Collapse
|
11
|
Wang S, Tang Y, Aung T, Chen C, Katagiri M, Jones SE, Prayson RA, Krishnan B, Gonzalez-Martinez JA, Burgess RC, Najm IM, Alexopoulos AV, Wang S, Ding M, Wang ZI. Multimodal noninvasive evaluation in MRI-negative operculoinsular epilepsy. J Neurosurg 2019; 132:1334-1344. [PMID: 30978689 DOI: 10.3171/2018.12.jns182746] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/26/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Presurgical evaluation of patients with operculoinsular epilepsy and negative MRI presents major challenges. Here the authors examined the yield of noninvasive modalities such as voxel-based morphometric MRI postprocessing, FDG-PET, subtraction ictal SPECT coregistered to MRI (SISCOM), and magnetoencephalography (MEG) in a cohort of patients with operculoinsular epilepsy and negative MRI. METHODS Twenty-two MRI-negative patients were included who had focal ictal onset from the operculoinsular cortex on intracranial EEG, and underwent focal resection limited to the operculoinsular cortex. MRI postprocessing was applied to presurgical T1-weighted volumetric MRI using a morphometric analysis program (MAP). Individual and combined localization yields of MAP, FDG-PET, MEG, and SISCOM were compared with the ictal onset location on intracranial EEG. Seizure outcomes were reported at 1 year and 2 years (when available) using the Engel classification. RESULTS Ten patients (45.5%, 10/22) had operculoinsular abnormalities on MAP; 5 (23.8%, 5/21) had operculoinsular hypometabolism on FDG-PET; 4 (26.7%, 4/15) had operculoinsular hyperperfusion on SISCOM; and 6 (30.0%, 6/20) had an MEG cluster (3 tight, 3 loose) within the operculoinsular cortex. The highest yield of a 2-test combination was 59.1%, seen with MAP and SISCOM, followed by 54.5% with MAP and FDG-PET, and also 54.5% with MAP and MEG. The highest yield of a 3-test combination was 68.2%, seen with MAP, MEG, and SISCOM. The yield of the 4-test combination remained at 68.2%. When all other tests were negative or nonlocalizing, unique information was provided by MAP in 5, MEG in 1, SISCOM in 2, and FDG-PET in none of the patients. One-year follow-up was available in all patients, and showed 11 Engel class IA, 4 class IB, 4 class II, and 3 class III/IV. Two-year follow-up was available in 19 patients, and showed 9 class IA, 3 class IB, 1 class ID, 3 class II, and 3 class III/IV. CONCLUSIONS This study highlights the individual and combined values of multiple noninvasive modalities for the evaluation of nonlesional operculoinsular epilepsy. The 3-test combination of MAP, MEG, and SISCOM represented structural, interictal, and ictal localization information, and constituted the highest yield. MAP showed the highest yield of unique information when other tests were negative or nonlocalizing.
Collapse
Affiliation(s)
- Shan Wang
- 1Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,2Department of Neurology, West China Hospital of Sichuan University, Chengdu, China; and
| | - Yingying Tang
- 2Department of Neurology, West China Hospital of Sichuan University, Chengdu, China; and.,3Epilepsy Center
| | | | - Cong Chen
- 1Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | | | | | | | | | | | | | | | | - Shuang Wang
- 1Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ding
- 1Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | |
Collapse
|
12
|
Abstract
Clinical neurophysiologic signals cover a broad range of frequencies. Filters help to emphasize waveforms that are of clinical or research interest and to mold their frequency characteristics to suit the purpose of the investigation. Some frequency content is obvious and well known, such as the alpha rhythm (8-11Hz) or spindles (12-14Hz) in the EEG. Other frequencies are not initially discriminable from background activity and require filtering in order to examine them, such as high-frequency oscillations (80-500Hz) in EEG and brainstem auditory evoked potentials (100-3000Hz). Often used to mitigate the effects of background noise or artifact, filters can be used specifically to attenuate unwanted frequencies, such as mains interference (50 or 60Hz) and electrode offset potential (<0.1Hz). For digital instrumentation, an antialiasing filter (below Nyquist) is always needed prior to sampling by the analog-to-digital converter. Once the signals are in the digital realm, sophisticated filtering operations can be carried out post hoc; but in order not to be misled, the neurophysiologist must always bear in mind the effect of filtering on the physiological waveform.
Collapse
Affiliation(s)
- Richard C Burgess
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, United States.
| |
Collapse
|
13
|
Abstract
Magnetoencephalography (MEG) is the noninvasive measurement of the miniscule magnetic fields produced by electrical currents flowing in the brain-the same neuroelectric activity that produces the EEG. MEG is one of several diagnostic tests employed in the evaluation of patients with epilepsy, but without the need to expose the patient to any potentially harmful agents. MEG is especially important in those being considered for epilepsy surgery, in whom accurate localization of the epileptic focus is paramount. While other modalities infer brain function indirectly by measuring changes in blood flow, metabolism, oxygenation, etc., MEG, as well as EEG, measures neuronal and synaptic function directly and, like EEG, MEG enjoys submillisecond temporal resolution. The measurement of magnetic fields provides information not only about the amplitude of the current but also its orientation. MEG picks up the magnetic field from neuromagnetometers surrounding the head in a helmet-shaped array of sensors. Clinical whole-head systems currently have 200-300 magnetic sensors, thereby offering very high resolution. The magnetic signals are not distorted by anatomy, because magnetic susceptibility is the same for all tissues, including the skull. Hence, MEG allows for a more accurate measurement and localization of brain activities than does EEG. Because one of its primary strengths is the ability to precisely localize electromagnetic activity within brain areas, MEG results are always coregistered to the patient's MRI. When combined in this way with structural imaging, it has been called magnetic source imaging (MSI), but MEG is properly understood as a clinical neurophysiologic diagnostic test. Signal processing and clinical interpretation in magnetoencephalography require sophisticated noise reduction and computerized mathematical modeling. Technological advances in these areas have brought MEG to the point where it is now part of routine clinical practice. MEG has become an indispensable part of the armamentarium at epilepsy centers where MEG laboratories are located, especially when patients are MRI-negative or where results of other structural and functional tests are not entirely concordant.
Collapse
Affiliation(s)
- Richard C Burgess
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, United States.
| |
Collapse
|
14
|
Abstract
Since the purpose of clinical neurophysiology testing is to record the electrical activity of the nervous system, and often to electrically stimulate the peripheral or central nervous system (for evoked potentials, nerve conduction studies, etc.), these tests by their very nature demand an excellent electrical connection to the patient. This direct electrical connection by definition puts the patient at increased risk of electrical shock. When patients suffer from other nonneurological disorders that also require equipment to be attached to or inserted into their body, the additional and more direct electrical pathways to the heart make them even more vulnerable, especially when undergoing monitoring in the operating room or intensive care unit. Although we depend on the hospital's construction and utilities to follow appropriate regulations (the National Electrical Code in the United States) and on the vendors to sell only safe equipment (approved by the Food and Drug Administration in the United States), there may exist combinations of equipment and connections that put the patient at risk of injurious or fatal electrical shock. Regular testing and safe practices, informed by a scientific understanding of the risks, are the responsibilities of the healthcare providers in order to protect the patient from harm from electricity.
Collapse
Affiliation(s)
- Richard C Burgess
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, United States.
| |
Collapse
|
15
|
Murakami H, Wang ZI, Marashly A, Krishnan B, Prayson RA, Kakisaka Y, Mosher JC, Bulacio J, Gonzalez-Martinez JA, Bingaman WE, Najm IM, Burgess RC, Alexopoulos AV. Correlating magnetoencephalography to stereo-electroencephalography in patients undergoing epilepsy surgery. Brain 2018; 139:2935-2947. [PMID: 27567464 DOI: 10.1093/brain/aww215] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/06/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hiroatsu Murakami
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.,Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Zhong I Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmad Marashly
- Department of Child Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Balu Krishnan
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Richard A Prayson
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University School of Medicine, Sendai, Japan
| | - John C Mosher
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Juan Bulacio
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Imad M Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | | | | |
Collapse
|
16
|
Gopalakrishnan R, Burgess RC, Malone DA, Lempka SF, Gale JT, Floden DP, Baker KB, Machado AG. Deep brain stimulation of the ventral striatal area for poststroke pain syndrome: a magnetoencephalography study. J Neurophysiol 2018; 119:2118-2128. [PMID: 29384450 DOI: 10.1152/jn.00830.2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Poststroke pain syndrome (PSPS) is an often intractable disorder characterized by hemiparesis associated with unrelenting chronic pain. Although traditional analgesics have largely failed, integrative approaches targeting affective-cognitive spheres have started to show promise. Recently, we demonstrated that deep brain stimulation (DBS) of the ventral striatal area significantly improved the affective sphere of pain in patients with PSPS. In the present study, we examined whether electrophysiological correlates of pain anticipation were modulated by DBS that could serve as signatures of treatment effects. We recorded event-related fields (ERFs) of pain anticipation using magnetoencephalography (MEG) in 10 patients with PSPS preoperatively and postoperatively in DBS OFF and ON states. Simple visual cues evoked anticipation as patients awaited a painful (PS) or nonpainful stimulus (NPS) to the nonaffected or affected extremity. Preoperatively, ERFs showed no difference between PS and NPS anticipation to the affected extremity, possibly due to loss of salience in a network saturated by pain experience. DBS significantly modulated the early N1, consistent with improvements in affective networks involving restoration of salience and discrimination capacity. Additionally, DBS suppressed the posterior P2 (aberrant anticipatory anxiety) while enhancing the anterior N1 (cognitive and emotional regulation) in responders. DBS-induced changes in ERFs could potentially serve as signatures for clinical outcomes. NEW & NOTEWORTHY We examined the electrophysiological correlates of pain affect in poststroke pain patients who underwent deep brain stimulation (DBS) targeting the ventral striatal area under a randomized, controlled trial. DBS significantly modulated early event-related components, particularly N1 and P2, measured with magnetoencephalography during a pain anticipatory task, compared with baseline and the DBS-OFF condition, pointing to possible mechanisms of action. DBS-induced changes in event-related fields could potentially serve as biomarkers for clinical outcomes.
Collapse
Affiliation(s)
- Raghavan Gopalakrishnan
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic , Cleveland, Ohio
| | - Richard C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic , Cleveland, Ohio
| | - Donald A Malone
- Center for Behavioral Health, Neurological Institute, Cleveland Clinic , Cleveland, Ohio
| | - Scott F Lempka
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic , Cleveland, Ohio.,Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center , Cleveland, Ohio
| | - John T Gale
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic , Cleveland, Ohio.,Department of Neuroscience, Lerner Research Institute, Cleveland Clinic , Cleveland, Ohio
| | - Darlene P Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic , Cleveland, Ohio
| | - Kenneth B Baker
- Department of Neuroscience, Lerner Research Institute, Cleveland Clinic , Cleveland, Ohio
| | - Andre G Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic , Cleveland, Ohio.,Department of Neurosurgery, Neurological Institute, Cleveland Clinic , Cleveland, Ohio
| |
Collapse
|
17
|
Shukla G, Kazutaka J, Gupta A, Mosher J, Jones S, Alexopoulos A, Burgess RC. Magnetoencephalographic Identification of Epileptic Focus in Children With Generalized Electroencephalographic (EEG) Features but Focal Imaging Abnormalities. J Child Neurol 2017; 32:981-995. [PMID: 28828916 DOI: 10.1177/0883073817724903] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Children with generalized seizures are often excluded as epilepsy surgery candidates. This prospective study was conducted to evaluate the utility of magnetoencephalography (MEG) to refine the location of the "irritative zone" in children with single lesions on magnetic resonance imaging (MRI) but with generalized ictal electroencephalographic (EEG) findings. METHODS Patients admitted with refractory epilepsy with imaging studies showing focal or hemispheric abnormalities but scalp video EEG showing generalized or multiregional epileptiform abnormalities were included. Patients were encouraged into natural sleep, and simultaneous whole-head MEG/EEG was recorded. Source localization of epileptic spikes on MEG was carried out while blinded to other results. Acceptable dipoles were classified into 3 groups: focal, hemispheric clusters, and single focal cluster with additional widespread dipoles. RESULTS Nine patients (4 female, 5 males; ages 10 months to 15 years) were included. Two had focal features on clinical semiology, whereas all had generalized or multiregional interictal and ictal EEG. Etiologies included tuberous sclerosis complex (2), postencephalitic sequelae (1), focal cortical dysplasia (1), and unknown (2). Five patients had clear focal lesions on brain MRI whereas the other 2 had focal positron emission tomography (PET) abnormalities. An average of 38 spikes were accepted (average goodness of fit = 85.3%). A single tight cluster of dipoles was identified in 5 patients, 1 had dipoles with propagation from left occipital to right temporal. One patient had 2 distinct dipole clusters. MEG demonstrated focal findings 9 times more often than the simultaneously recorded scalp EEG, and 3 times more often than the associated multiday video EEG recordings. CONCLUSION This study shows that neurophysiologic evidence of focal epileptiform abnormalities in patients with focal brain lesions and generalized EEG findings can be strengthened using MEG. Further feasibility of surgical candidacy should be evaluated in these patients.
Collapse
Affiliation(s)
- Garima Shukla
- 1 Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA.,2 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Jin Kazutaka
- 1 Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA.,3 Department of Epileptology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Ajay Gupta
- 1 Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Mosher
- 1 Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Jones
- 1 Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | |
Collapse
|
18
|
Bagić AI, Burgess RC. Guidelines for the clinical use in epilepsy surgery evaluation of magnetoencephalography and electroencephalography for source localization. Epilepsia 2016; 57:1941-1942. [DOI: 10.1111/epi.13583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anto I. Bagić
- University of Pittsburgh Medical School; Pittsburgh Pennsylvania U.S.A
| | | |
Collapse
|
19
|
Wang ZI, Krishnan B, Shattuck DW, Leahy RM, Moosa ANV, Wyllie E, Burgess RC, Al-Sharif NB, Joshi AA, Alexopoulos AV, Mosher JC, Udayasankar U, Jones SE. Automated MRI Volumetric Analysis in Patients with Rasmussen Syndrome. AJNR Am J Neuroradiol 2016; 37:2348-2355. [PMID: 27609620 DOI: 10.3174/ajnr.a4914] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Rasmussen syndrome, also known as Rasmussen encephalitis, is typically associated with volume loss of the affected hemisphere of the brain. Our aim was to apply automated quantitative volumetric MR imaging analyses to patients diagnosed with Rasmussen encephalitis, to determine the predictive value of lobar volumetric measures and to assess regional atrophy differences as well as monitor disease progression by using these measures. MATERIALS AND METHODS Nineteen patients (42 scans) with diagnosed Rasmussen encephalitis were studied. We used 2 control groups: one with 42 age- and sex-matched healthy subjects and the other with 42 epileptic patients without Rasmussen encephalitis with the same disease duration as patients with Rasmussen encephalitis. Volumetric analysis was performed on T1-weighted images by using BrainSuite. Ratios of volumes from the affected hemisphere divided by those from the unaffected hemisphere were used as input to a logistic regression classifier, which was trained to discriminate patients from controls. Using the classifier, we compared the predictive accuracy of all the volumetric measures. These ratios were used to further assess regional atrophy differences and correlate with epilepsy duration. RESULTS Interhemispheric and frontal lobe ratios had the best prediction accuracy for separating patients with Rasmussen encephalitis from healthy controls and patient controls without Rasmussen encephalitis. The insula showed significantly more atrophy compared with all the other cortical regions. Patients with longitudinal scans showed progressive volume loss in the affected hemisphere. Atrophy of the frontal lobe and insula correlated significantly with epilepsy duration. CONCLUSIONS Automated quantitative volumetric analysis provides accurate separation of patients with Rasmussen encephalitis from healthy controls and epileptic patients without Rasmussen encephalitis, and thus may assist the diagnosis of Rasmussen encephalitis. Volumetric analysis could also be included as part of follow-up for patients with Rasmussen encephalitis to assess disease progression.
Collapse
Affiliation(s)
- Z I Wang
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - B Krishnan
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - D W Shattuck
- Ahmanson-Lovelace Brain Mapping Center (D.W.S., N.B.A.-S.), Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - R M Leahy
- Signal and Image Processing Institute (A.A.J., R.M.L.), University of Southern California, Los Angeles, California
| | - A N V Moosa
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - E Wyllie
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - R C Burgess
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - N B Al-Sharif
- Ahmanson-Lovelace Brain Mapping Center (D.W.S., N.B.A.-S.), Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - A A Joshi
- Signal and Image Processing Institute (A.A.J., R.M.L.), University of Southern California, Los Angeles, California
| | - A V Alexopoulos
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - J C Mosher
- From the Epilepsy Center (Z.I.W., B.K., A.N.V.M., E.W., R.C.B., A.V.A., J.C.M.)
| | - U Udayasankar
- Department of Radiology (U.U.), University of Arizona College of Medicine, Tucson, Arizona
| | | | - S E Jones
- Imaging Institute (S.E.J.), Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
20
|
Enatsu R, Gonzalez-Martinez J, Bulacio J, Mosher JC, Burgess RC, Najm I, Nair DR. Connectivity of the frontal and anterior insular network: a cortico-cortical evoked potential study. J Neurosurg 2016; 125:90-101. [DOI: 10.3171/2015.6.jns15622] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The frontal and insular fiber network in humans remains largely unknown. This study investigated the connectivity of the frontal and anterior insular network in humans using cortico-cortical evoked potential (CCEP).
METHODS
This retrospective analysis included 18 patients with medically intractable focal epilepsy who underwent stereoelectroencephalography and CCEP. Alternating 1-Hz electrical stimuli were delivered to parts of the frontal lobe and anterior insula (prefrontal cortex [PFC], ventrolateral and dorsolateral premotor area [vPM and dPM, respectively], presupplementary motor area [pre-SMA], SMA, frontal operculum, and anterior insula). A total of 40–60 stimuli were averaged in each trial to obtain CCEP responses. The distribution of CCEP was evaluated by calculating the root mean square of CCEP responses.
RESULTS
Stimulation of the PFC elicited prominent CCEP responses in the medial PFC and PMs over the ipsilateral hemisphere. Stimulation of the vPM and dPM induced CCEP responses in the ipsilateral frontoparietal areas. Stimulation of the pre-SMA induced CCEP responses in the ipsilateral medial and lateral frontal areas and contralateral pre-SMA, whereas stimulation of the SMA induced CCEP responses in the bilateral frontoparietal areas. Stimulation of the frontal operculum induced CCEP responses in the ipsilateral insula and temporal operculum. CCEPs were observed in the ipsilateral medial, lateral frontal, and frontotemporal operculum in the anterior insular stimulation. Stimulation of the vPM and SMA led to the network in the dominant hemisphere being more developed.
CONCLUSIONS
Various regions within the frontal lobe and anterior insula were linked to specific ipsilateral and contralateral regions, which may reflect distinct functional roles.
Collapse
Affiliation(s)
- Rei Enatsu
- 1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; and
- 2Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | | | - Juan Bulacio
- 1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - John C. Mosher
- 1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Richard C. Burgess
- 1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Imad Najm
- 1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Dileep R. Nair
- 1Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; and
| |
Collapse
|
21
|
El Tahry R, Wang ZI, Kakisaka Y, Murakami H, Shibata S, Krishnan B, Kotagal P, Alexopoulos A, Burgess RC. A single tight MEG cluster may only represent a fragment of type I FCD. Clin Neurophysiol 2016; 127:2570-2. [DOI: 10.1016/j.clinph.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/25/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022]
|
22
|
Gopalakrishnan R, Burgess RC, Lempka SF, Gale JT, Floden DP, Machado AG. Pain anticipatory phenomena in patients with central poststroke pain: a magnetoencephalography study. J Neurophysiol 2016; 116:1387-95. [PMID: 27358316 DOI: 10.1152/jn.00215.2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/24/2016] [Indexed: 11/22/2022] Open
Abstract
Central poststroke pain (CPSP) is characterized by hemianesthesia associated with unrelenting chronic pain. The final pain experience stems from interactions between sensory, affective, and cognitive components of chronic pain. Hence, managing CPSP will require integrated approaches aimed not only at the sensory but also the affective-cognitive spheres. A better understanding of the brain's processing of pain anticipation is critical for the development of novel therapeutic approaches that target affective-cognitive networks and alleviate pain-related disability. We used magnetoencephalography (MEG) to characterize the neural substrates of pain anticipation in patients suffering from intractable CPSP. Simple visual cues evoked anticipation while patients awaited impending painful (PS), nonpainful (NPS), or no stimulus (NOS) to their nonaffected and affected extremities. MEG responses were studied at gradiometer level using event-related fields analysis and time-frequency oscillatory analysis upon source localization. On the nonaffected side, significantly greater responses were recorded during PS. PS (vs. NPS and NOS) exhibited significant parietal and frontal cortical activations in the beta and gamma bands, respectively, whereas NPS (vs. NOS) displayed greater activation in the orbitofrontal cortex. On the affected extremity, PS (vs. NPS) did not show significantly greater responses. These data suggest that anticipatory phenomena can modulate neural activity when painful stimuli are applied to the nonaffected extremity but not the affected extremity in CPSP patients. This dichotomy may stem from the chronic effects of pain on neural networks leading to habituation or saturation. Future clinically effective therapies will likely be associated with partial normalization of the neurophysiological correlates of pain anticipation.
Collapse
Affiliation(s)
- Raghavan Gopalakrishnan
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Richard C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott F Lempka
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; and
| | - John T Gale
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Darlene P Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andre G Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
23
|
Gopalakrishnan R, Burgess RC, Plow EB, Floden DP, Machado AG. Early event related fields during visually evoked pain anticipation. Clin Neurophysiol 2015; 127:1855-63. [PMID: 26733321 DOI: 10.1016/j.clinph.2015.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/02/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Pain experience is not only a function of somatosensory inputs. Rather, it is strongly influenced by cognitive and affective pathways. Pain anticipatory phenomena, an important limitation to rehabilitative efforts in the chronic state, are processed by associative and limbic networks, along with primary sensory cortices. Characterization of neurophysiological correlates of pain anticipation, particularly during very early stages of neural processing is critical for development of therapeutic interventions. METHODS Here, we utilized magnetoencephalography to study early event-related fields (ERFs) in healthy subjects exposed to a 3 s visual countdown task that preceded a painful stimulus, a non-painful stimulus or no stimulus. RESULTS We found that the first countdown cue, but not the last cue, evoked critical ERFs signaling anticipation, attention and alertness to the noxious stimuli. Further, we found that P2 and N2 components were significantly different in response to first-cues that signaled incoming painful stimuli when compared to non-painful or no stimuli. CONCLUSIONS The findings indicate that early ERFs are relevant neural substrates of pain anticipatory phenomena and could be potentially serve as biomarkers. SIGNIFICANCE These measures could assist in the development of neurostimulation approaches aimed at curbing the negative effects of pain anticipation during rehabilitation.
Collapse
Affiliation(s)
- Raghavan Gopalakrishnan
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Richard C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Ela B Plow
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Darlene P Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Andre G Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| |
Collapse
|
24
|
Gopalakrishnan R, Burgess RC, Plow EB, Floden DP, Machado AG. A magnetoencephalography study of multi-modal processing of pain anticipation in primary sensory cortices. Neuroscience 2015. [PMID: 26210576 DOI: 10.1016/j.neuroscience.2015.07.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pain anticipation plays a critical role in pain chronification and results in disability due to pain avoidance. It is important to understand how different sensory modalities (auditory, visual or tactile) may influence pain anticipation as different strategies could be applied to mitigate anticipatory phenomena and chronification. In this study, using a countdown paradigm, we evaluated with magnetoencephalography the neural networks associated with pain anticipation elicited by different sensory modalities in normal volunteers. When encountered with well-established cues that signaled pain, visual and somatosensory cortices engaged the pain neuromatrix areas early during the countdown process, whereas the auditory cortex displayed delayed processing. In addition, during pain anticipation, the visual cortex displayed independent processing capabilities after learning the contextual meaning of cues from associative and limbic areas. Interestingly, cross-modal activation was also evident and strong when visual and tactile cues signaled upcoming pain. Dorsolateral prefrontal cortex and mid-cingulate cortex showed significant activity during pain anticipation regardless of modality. Our results show pain anticipation is processed with great time efficiency by a highly specialized and hierarchical network. The highest degree of higher-order processing is modulated by context (pain) rather than content (modality) and rests within the associative limbic regions, corroborating their intrinsic role in chronification.
Collapse
Affiliation(s)
- R Gopalakrishnan
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - R C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - E B Plow
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - D P Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - A G Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|
25
|
Wang ZI, Jones SE, Jaisani Z, Najm IM, Prayson RA, Burgess RC, Krishnan B, Ristic A, Wong CH, Bingaman W, Gonzalez-Martinez JA, Alexopoulos AV. Voxel-based morphometric magnetic resonance imaging (MRI) postprocessing in MRI-negative epilepsies. Ann Neurol 2015; 77:1060-75. [PMID: 25807928 DOI: 10.1002/ana.24407] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/02/2015] [Accepted: 03/15/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the presurgical workup of magnetic resonance imaging (MRI)-negative (MRI(-) or "nonlesional") pharmacoresistant focal epilepsy (PFE) patients, discovering a previously undetected lesion can drastically change the evaluation and likely improve surgical outcome. Our study utilizes a voxel-based MRI postprocessing technique, implemented in a morphometric analysis program (MAP), to facilitate detection of subtle abnormalities in a consecutive cohort of MRI(-) surgical candidates. METHODS Included in this retrospective study was a consecutive cohort of 150 MRI(-) surgical patients. MAP was performed on T1-weighted MRI, with comparison to a scanner-specific normal database. Review and analysis of MAP were performed blinded to patients' clinical information. The pertinence of MAP(+) areas was confirmed by surgical outcome and pathology. RESULTS MAP showed a 43% positive rate, sensitivity of 0.9, and specificity of 0.67. Overall, patients with the MAP(+) region completely resected had the best seizure outcomes, followed by the MAP(-) patients, and patients who had no/partial resection of the MAP(+) region had the worst outcome (p < 0.001). Subgroup analysis revealed that visually identified subtle findings are more likely correct if also MAP(+) . False-positive rate in 52 normal controls was 2%. Surgical pathology of the resected MAP(+) areas contained mainly non-balloon-cell focal cortical dysplasia (FCD). Multiple MAP(+) regions were present in 7% of patients. INTERPRETATION MAP can be a practical and valuable tool to: (1) guide the search for subtle MRI abnormalities and (2) confirm visually identified questionable abnormalities in patients with PFE due to suspected FCD. A MAP(+) region, when concordant with the patient's electroclinical presentation, should provide a legitimate target for surgical exploration.
Collapse
Affiliation(s)
- Z Irene Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, OH
| | - Stephen E Jones
- Department of Diagnostic Radiology, Mellen Imaging Center, Cleveland Clinic, Cleveland, OH
| | | | - Imad M Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, OH
| | | | | | | | - Aleksandar Ristic
- Clinic of Neurology, Epilepsy Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Chong H Wong
- Department of Neurology, Westmead Hospital, Sydney, Australia
| | | | | | | |
Collapse
|
26
|
Almubarak S, Alexopoulos A, Von-Podewils F, Wang ZI, Kakisaka Y, Mosher JC, Bulacio J, González-Martínez J, Bingaman W, Burgess RC. The correlation of magnetoencephalography to intracranial EEG in localizing the epileptogenic zone: A study of the surgical resection outcome. Epilepsy Res 2014; 108:1581-90. [DOI: 10.1016/j.eplepsyres.2014.08.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/20/2014] [Accepted: 08/21/2014] [Indexed: 11/27/2022]
|
27
|
Wang ZI, Alexopoulos AV, Jones SE, Najm IM, Ristic A, Wong C, Prayson R, Schneider F, Kakisaka Y, Wang S, Bingaman W, Gonzalez-Martinez JA, Burgess RC. Linking MRI postprocessing with magnetic source imaging in MRI-negative epilepsy. Ann Neurol 2014; 75:759-70. [PMID: 24777960 DOI: 10.1002/ana.24169] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE MRI-negative (MRI-) pharmacoresistant focal epilepsy (PFE) patients are most challenging for epilepsy surgical management. This study utilizes a voxel-based MRI postprocessing technique, implemented using a morphometric analysis program (MAP), aiming to facilitate detection of subtle focal cortical dysplasia (FCD) in MRI- patients. Furthermore, the study examines the concordance between MAP-identified regions and localization from magnetic source imaging (MSI). METHODS Included in this retrospective study were 25 MRI- surgical patients. MAP was performed on T1-weighted MRI, with comparison to a normal database. The pertinence of MAP+ areas was confirmed by MSI, surgical outcome and pathology. Analyses of MAP and MSI were performed blindly from patients' clinical information and independently from each other. RESULTS The detection rate of subtle changes by MAP was 48% (12/25). Once MAP+ areas were resected, patients were more likely to be seizure-free (p=0.02). There were no false positives in the 25 age-matched normal controls. Seven patients had a concordant MSI correlate. Patients in whom a concordant area was identified by both MAP and MSI had a significantly higher chance of achieving a seizure-free outcome following complete resection of this area (p=0.008). In the 9 resected MAP+ areas, pathology revealed FCD type IA in 7 and type IIB in 2. INTERPRETATION MAP shows promise in identifying subtle FCD abnormalities and increasing the diagnostic yield of conventional MRI visual analysis in presurgical evaluation of PFE. Concordant MRI postprocessing and MSI analyses may lead to the noninvasive identification of a structurally and electrically abnormal subtle lesion that can be surgically targeted.
Collapse
Affiliation(s)
- Zhong I Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, OH
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Machado AG, Gopalakrishnan R, Plow EB, Burgess RC, Mosher JC. A magnetoencephalography study of visual processing of pain anticipation. J Neurophysiol 2014; 112:276-86. [PMID: 24790165 DOI: 10.1152/jn.00193.2014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Anticipating pain is important for avoiding injury; however, in chronic pain patients, anticipatory behavior can become maladaptive, leading to sensitization and limiting function. Knowledge of networks involved in pain anticipation and conditioning over time could help devise novel, better-targeted therapies. With the use of magnetoencephalography, we evaluated in 10 healthy subjects the neural processing of pain anticipation. Anticipatory cortical activity elicited by consecutive visual cues that signified imminent painful stimulus was compared with cues signifying nonpainful and no stimulus. We found that the neural processing of visually evoked pain anticipation involves the primary visual cortex along with cingulate and frontal regions. Visual cortex could quickly and independently encode and discriminate between visual cues associated with pain anticipation and no pain during preconscious phases following object presentation. When evaluating the effect of task repetition on participating cortical areas, we found that activity of prefrontal and cingulate regions was mostly prominent early on when subjects were still naive to a cue's contextual meaning. Visual cortical activity was significant throughout later phases. Although visual cortex may precisely and time efficiently decode cues anticipating pain or no pain, prefrontal areas establish the context associated with each cue. These findings have important implications toward processes involved in pain anticipation and maladaptive pain conditioning.
Collapse
Affiliation(s)
- Andre G Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Raghavan Gopalakrishnan
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Richard C Burgess
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - John C Mosher
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
29
|
Kakisaka Y, Jehi L, Alkawadri R, Wang ZI, Enatsu R, Mosher JC, Dubarry AS, Alexopoulos AV, Burgess RC. Cephalic aura after frontal lobe resection. J Clin Neurosci 2014; 21:1450-2. [PMID: 24613491 DOI: 10.1016/j.jocn.2013.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 11/10/2013] [Indexed: 10/25/2022]
Abstract
A cephalic aura is a common sensory aura typically seen in frontal lobe epilepsy. The generation mechanism of cephalic aura is not fully understood. It is hypothesized that to generate a cephalic aura extensive cortical areas need to be excited. We report a patient who started to have cephalic aura after right frontal lobe resection. Magnetoencephalography (MEG) showed interictal spike and ictal change during cephalic aura, both of which were distributed in the right frontal region, and the latter involved much more widespread areas than the former on MEG sensors. The peculiar seizure onset pattern may indicate that surgical modification of the epileptic network was related to the appearance of cephalic aura. We hypothesize that generation of cephalic aura may be associated with more extensive cortical involvement of epileptic activity than that of interictal activity, in at least a subset of cases.
Collapse
Affiliation(s)
- Yosuke Kakisaka
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.
| | - Lara Jehi
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rafeed Alkawadri
- The Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
| | - Zhong I Wang
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rei Enatsu
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - John C Mosher
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Anne-Sophie Dubarry
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Andreas V Alexopoulos
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Richard C Burgess
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| |
Collapse
|
30
|
Wang ZI, Alexopoulos AV, Jones SE, Najm IM, Ristic A, Wong C, Prayson R, Schneider F, Kakisaka Y, Wang S, Bingaman W, Gonzalez-Martinez JA, Burgess RC. Linking MRI post-processing with Magnetic source imaging in MRI-negative epilepsy. Ann Neurol 2014. [DOI: 10.1002/ana.24097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- ZI Wang
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - AV Alexopoulos
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - SE Jones
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - IM Najm
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - A Ristic
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - C Wong
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - R Prayson
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - F Schneider
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - Y Kakisaka
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - S Wang
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - W Bingaman
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - JA Gonzalez-Martinez
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| | - RC Burgess
- Cleveland Clinic Epilepsy Center; 9500 Euclid Avenue, Desk S-51 Cleveland OH 44195
| |
Collapse
|
31
|
Antony AR, Alexopoulos AV, González-Martínez JA, Mosher JC, Jehi L, Burgess RC, So NK, Galán RF. Functional connectivity estimated from intracranial EEG predicts surgical outcome in intractable temporal lobe epilepsy. PLoS One 2013; 8:e77916. [PMID: 24205027 PMCID: PMC3813548 DOI: 10.1371/journal.pone.0077916] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/15/2013] [Indexed: 11/18/2022] Open
Abstract
This project aimed to determine if a correlation-based measure of functional connectivity can identify epileptogenic zones from intracranial EEG signals, as well as to investigate the prognostic significance of such a measure on seizure outcome following temporal lobe lobectomy. To this end, we retrospectively analyzed 23 adult patients with intractable temporal lobe epilepsy (TLE) who underwent an invasive stereo-EEG (SEEG) evaluation between January 2009 year and January 2012. A follow-up of at least one year was required. The primary outcome measure was complete seizure-freedom at last follow-up. Functional connectivity between two areas in the temporal lobe that were sampled by two SEEG electrode contacts was defined as Pearson's correlation coefficient of interictal activity between those areas. SEEG signals were filtered between 5 and 50 Hz prior to computing this correlation. The mean and standard deviation of the off diagonal elements in the connectivity matrix were also calculated. Analysis of the mean and standard deviation of the functional connections for each patient reveals that 90% of the patients who had weak and homogenous connections were seizure free one year after temporal lobectomy, whereas 85% of the patients who had stronger and more heterogeneous connections within the temporal lobe had recurrence of seizures. This suggests that temporal lobectomy is ineffective in preventing seizure recurrence for patients in whom the temporal lobe is characterized by weakly connected, homogenous networks. This pilot study shows promising potential of a simple measure of functional brain connectivity to identify epileptogenicity and predict the outcome of epilepsy surgery.
Collapse
Affiliation(s)
- Arun R. Antony
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, United States of America
| | | | | | - John C. Mosher
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Richard C. Burgess
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Norman K. So
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Roberto F. Galán
- Department of Neurosciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail:
| |
Collapse
|
32
|
Enatsu R, Matsumoto R, Piao Z, O'Connor T, Horning K, Burgess RC, Bulacio J, Bingaman W, Nair DR. Cortical negative motor network in comparison with sensorimotor network: A cortico-cortical evoked potential study. Cortex 2013; 49:2080-96. [DOI: 10.1016/j.cortex.2012.08.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 08/13/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
|
33
|
Gopalakrishnan R, Machado AG, Burgess RC, Mosher JC. The use of contact heat evoked potential stimulator (CHEPS) in magnetoencephalography for pain research. J Neurosci Methods 2013; 220:55-63. [PMID: 23994044 DOI: 10.1016/j.jneumeth.2013.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/13/2013] [Accepted: 08/15/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Contact heat evoked potentials (CHEP) is a thermal stimulus modality used in pain research. We examine a commercial CHEP stimulator (CHEPS) that is designed to work in an fMRI environment, but poorly understood in the MEG environment. The CHEPS attains target temperatures rapidly using sophisticated control signals that unfortunately induce artifacts in the MEG. In this paper, we summarize our experiences using the CHEPS in MEG to study pain using an experimental paradigm, and propose a novel method for managing its artifact. NEW METHOD We introduce a novel damped sinusoid modeling (DSM) technique to remove the CHEPS artifact based on estimates of the underlying sinusoids and damping factors. We show comparisons to signal space projection (SSP) and temporal signal space separation (tSSS) methods. RESULTS The CHEPS artifact is highly dynamic, yet deterministic, switching rapidly from one frequency to another, with different spatial components. The galvanic connection between the subject and the CHEPS probe alters its performance, making pre-characterization difficult. COMPARISON WITH EXISTING METHODS SSP methods failed to remove the artifact completely. TSSS performed better than SSP; however, tSSS requires the use of a multipolar head model that decreases the dimensionality and possibly the information content of the data. In contrast, DSM offers a strictly temporal modeling approach in which the artifact is estimated as a sum of damped sinusoids which is subtracted from the data. CONCLUSION Though the CHEPS increases the noise floor and introduces artifacts to the data, we believe the device can be successfully used in MEG if appropriate artifact removal techniques are followed.
Collapse
|
34
|
Vadera S, Jehi L, Burgess RC, Shea K, Alexopoulos AV, Mosher J, Gonzalez-Martinez J, Bingaman W. Correlation between magnetoencephalography-based “clusterectomy” and postoperative seizure freedom. Neurosurg Focus 2013; 34:E9. [DOI: 10.3171/2013.4.focus1357] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
During the presurgical evaluation of patients with medically intractable focal epilepsy, a variety of noninvasive studies are performed to localize the hypothetical epileptogenic zone and guide the resection. Magnetoencephalography (MEG) is becoming increasingly used in the clinical realm for this purpose. No investigators have previously reported on coregisteration of MEG clusters with postoperative resection cavities to evaluate whether complete “clusterectomy” (resection of the area associated with MEG clusters) was performed or to compare these findings with postoperative seizure-free outcomes.
Methods
The authors retrospectively reviewed the charts and imaging studies of 65 patients undergoing MEG followed by resective epilepsy surgery from 2009 until 2012 at the Cleveland Clinic. Preoperative MEG studies were fused with postoperative MRI studies to evaluate whether clusters were within the resected area. These data were then correlated with postoperative seizure freedom.
Results
Sixty-five patients were included in this study. The average duration of follow-up was 13.9 months, the mean age at surgery was 23.1 years, and the mean duration of epilepsy was 13.7 years. In 30 patients, the main cluster was located completely within the resection cavity, in 28 it was completely outside the resection cavity, and in 7 it was partially within the resection cavity. Seventy-four percent of patients were seizure free at 12 months after surgery, and this rate decreased to 60% at 24 months. Improved likelihood of seizure freedom was seen with complete clusterectomy in patients with localization outside the temporal lobe (extra–temporal lobe epilepsy) (p = 0.04).
Conclusions
In patients with preoperative MEG studies that show clusters in surgically accessible areas outside the temporal lobe, we suggest aggressive resection to improve the chances for seizure freedom. When the cluster is found within the temporal lobe, further diagnostic testing may be required to better localize the epileptogenic zone.
Collapse
Affiliation(s)
| | - Lara Jehi
- 2Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Katherine Shea
- 2Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - John Mosher
- 2Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | |
Collapse
|
35
|
Alkawadri R, Krishnan B, Kakisaka Y, Nair D, Mosher JC, Burgess RC, Alexopoulos AV. Localization of the ictal onset zone with MEG using minimum norm estimate of a narrow band at seizure onset versus standard single current dipole modeling. Clin Neurophysiol 2013; 124:1915-8. [PMID: 23642832 DOI: 10.1016/j.clinph.2013.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 10/26/2022]
|
36
|
Wang ZI, Alexopoulos AV, Nair D, Krishnan B, Mosher JC, Burgess RC, Kakisaka Y. Feasibility of magnetoencephalography recording in an epilepsy patient with implanted responsive cortical stimulation device. Clin Neurophysiol 2013; 124:1705-6. [PMID: 23474057 DOI: 10.1016/j.clinph.2013.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/24/2013] [Accepted: 01/31/2013] [Indexed: 11/15/2022]
|
37
|
Fogarasi A, Loddenkemper T, Mellado C, Tuxhorn I, Evers G, Sarco D, Burgess RC, Halász P, Barsis P, Gyorsok Z, Gyimesi C, Kóbor J, Siegler Z, Janszky J, Jakus R, Rásonyi G, Ebner A, Woermann FG, Sahin M. Sturge-Weber syndrome: clinical and radiological correlates in 86 patients. Ideggyogy Sz 2013; 66:53-57. [PMID: 23607230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUNDS AND PURPOSE To correlate the extent of the leptomeningeal angiomatosis with clinical features in Sturge-Weber syndrome (SWS). METHODS The study group consisted of 86 consecutive patients aged two months to 56 (mean 7.9 +/- 10.3) years with SWS and epilepsy. Clinical and MRI data were analyzed. RESULTS Based on the extent of leptomeningeal angiomatosis, patients were divided into two subgroups: 43 patients had hemispheric angiomatosis and atrophy, whereas, another 43 had focal involvement. Nine of the 43 hemispherial patients (10%) showed bilateral involvement: all of these bilateral cases demonstrated dominance in a single side with hemispheric leptomeningeal angiomatosis and contralateral focal extension. Hemispheric and focal subgroups were clinically different. Patients with hemispheric SWS were younger at the age of epilepsy onset (p < 0.001) and age at MRI examination (p < 0.05). Neither gender, lateralization, duration of epilepsy, appearance of secondarily generalized seizures, nor seizure frequency revealed a significant difference between subgroups. CONCLUSION Bilateral involvement is frequent and occurs in cases with a hemisperic involvement on one side. The age of epilepsy onset is related to the extent of leptomeningeal angiomatosis. Patients with hemispheric form of SWS presented with earlier age of seizure onset. Focal pial angiomatoses do not tend to progress (a longer duration is not associated with more frequent hemispheric involvement). Other variables including seizure frequency and secondary generalized tonic-clonic seizures are not associated with the extent of angiomatosis.
Collapse
Affiliation(s)
- András Fogarasi
- Epilepsy Center, Bethesda Children's Hospital, Budapest, Hungary.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Enatsu R, Kubota Y, Kakisaka Y, Bulacio J, Piao Z, O’Connor T, Horning K, Mosher J, Burgess RC, Bingaman W, Nair DR. Reorganization of posterior language area in temporal lobe epilepsy: A cortico-cortical evoked potential study. Epilepsy Res 2013; 103:73-82. [DOI: 10.1016/j.eplepsyres.2012.07.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 06/15/2012] [Accepted: 07/03/2012] [Indexed: 11/25/2022]
|
39
|
Kakisaka Y, Gupta A, Enatsu R, I. Wang Z, V. Alexopoulos A, C. Mosher J, Dubarry AS, Hino-Fukuyo N, Burgess RC. Magnetoencephalography Reveals a Unique Neurophysiological Profile of Focal-Onset Epileptic Spasms. TOHOKU J EXP MED 2013; 229:147-51. [DOI: 10.1620/tjem.229.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yosuke Kakisaka
- Department of Pediatrics, Tohoku University School of Medicine
- Epilepsy Center, Neurological Institute Cleveland Clinic Foundation
| | - Ajay Gupta
- Epilepsy Center, Neurological Institute Cleveland Clinic Foundation
| | - Rei Enatsu
- Epilepsy Center, Neurological Institute Cleveland Clinic Foundation
| | - Zhong I. Wang
- Epilepsy Center, Neurological Institute Cleveland Clinic Foundation
| | | | - John C. Mosher
- Epilepsy Center, Neurological Institute Cleveland Clinic Foundation
| | | | | | | |
Collapse
|
40
|
Kakisaka Y, Gupta A, Enatsu R, I. Wang Z, V. Alexopoulos A, C. Mosher J, Dubarry AS, Hino-Fukuyo N, C. Burgess R. Magnetoencephalography Reveals a Unique Neurophysiological Profile of Focal-Onset Epileptic Spasms. TOHOKU J EXP MED 2013. [DOI: 10.1620/tjem.229.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yosuke Kakisaka
- Epilepsy Center, Neurological Institute Cleveland Clinic Foundation
- Department of Pediatrics, Tohoku University School of Medicine
| | - Ajay Gupta
- Epilepsy Center, Neurological Institute Cleveland Clinic Foundation
| | - Rei Enatsu
- Epilepsy Center, Neurological Institute Cleveland Clinic Foundation
| | - Zhong I. Wang
- Epilepsy Center, Neurological Institute Cleveland Clinic Foundation
| | | | - John C. Mosher
- Epilepsy Center, Neurological Institute Cleveland Clinic Foundation
| | | | | | | |
Collapse
|
41
|
Schneider F, Irene Wang Z, Alexopoulos AV, Almubarak S, Kakisaka Y, Jin K, Nair D, Mosher JC, Najm IM, Burgess RC. Magnetic source imaging and ictal SPECT in MRI-negative neocortical epilepsies: Additional value and comparison with intracranial EEG. Epilepsia 2012; 54:359-69. [DOI: 10.1111/epi.12004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
42
|
Wang ZI, Jin K, Kakisaka Y, Burgess RC, Gonzalez-Martinez JA, Wang S, Ito S, Mosher JC, Hantus S, Alexopoulos AV. Interconnections in superior temporal cortex revealed by musicogenic seizure propagation. J Neurol 2012; 259:2251-4. [PMID: 23010942 DOI: 10.1007/s00415-012-6556-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/11/2012] [Accepted: 05/14/2012] [Indexed: 11/25/2022]
|
43
|
Kakisaka Y, Mosher JC, Wang ZI, Jin K, Dubarry AS, Alexopoulos AV, Burgess RC. Utility of temporally-extended signal space separation algorithm for magnetic noise from vagal nerve stimulators. Clin Neurophysiol 2012; 124:1277-82. [PMID: 22727713 DOI: 10.1016/j.clinph.2012.03.082] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/18/2012] [Accepted: 03/10/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the utility of a temporally-extended signal space separation algorithm (tSSS) for patients with vagal nerve stimulator (VNS). METHODS We evaluated median nerve somatosensory evoked responses (SER) of magnetoencephalography (MEG) in 27 VNS patients (48 sides) with/without tSSS processing. We classified SER dipoles as 'acceptable' if: (A) the location of the dipole was in the expected location in the central sulcus, and (B) the goodness of fit value (GOF) was greater than 80%. We evaluated (1) the number of sides which produced acceptable dipoles in each dataset (i.e. with/without tSSS processing), and in cases where the both data produced reliable dipoles, (2) compared their GOFs and the 95% confidence volumes (CV) (mm(3)). Statistical differences in the GOF and CV between with/without tSSS conditions were determined by paired t test. RESULTS Only 11 (23%) responses had reliable dipoles without tSSS processing, while all 48 (100%) had acceptable dipoles under tSSS processing. Additionally, the latter group had significantly higher GOF (increased by 7% on average) and lower CV (mean decrease of 200 mm(3)) than the former (p<0.01). CONCLUSIONS Processing with tSSS quantitatively improves dipole fitting of known sources in VNS patients. SIGNIFICANCE This algorithm permits satisfactory MEG testing in the relatively commonly encountered epilepsy patient with VNS.
Collapse
Affiliation(s)
- Yosuke Kakisaka
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
| | | | | | | | | | | | | |
Collapse
|
44
|
Schneider F, Alexopoulos AV, Wang Z, Almubarak S, Kakisaka Y, Jin K, Nair D, Mosher JC, Najm IM, Burgess RC. Magnetic source imaging in non-lesional neocortical epilepsy: additional value and comparison with ICEEG. Epilepsy Behav 2012; 24:234-40. [PMID: 22542998 DOI: 10.1016/j.yebeh.2012.03.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 03/19/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the utility of magnetic source imaging (MSI) for localizing the epileptogenic zone (EZ) and predicting epilepsy surgery outcome in non-lesional neocortical focal epilepsy (NLNE) patients. METHODS Data from 18 consecutive patients with NLNE who underwent presurgical evaluation including intracranial electroencephalography (ICEEG) and MSI were studied. Follow-up after epilepsy surgery was ≥24 months. Intracranial electroencephalography and MSI results were classified using a sublobar classification. RESULTS Sublobar ICEEG focus was completely resected in 15 patients; seizure-free rate was 60%. Eight patients showed sublobar-concordant ICEEG/MSI results and complete resection of both regions; seizure-free rate was 87.5%. Seizure-free rate in cases not matching these criteria was only 30% (p=0.013). CONCLUSIONS Magnetoencephalography is a useful tool to localize the EZ and determine the site of surgical resection in NLNE patients. When sublobar concordance with ICEEG is observed, MSI increases the predictive value for a seizure-free epilepsy surgery outcome in these patients.
Collapse
Affiliation(s)
- Felix Schneider
- Cleveland Clinic Epilepsy Center, Neurological Institute, 9500 Euclid Avenue, Desk S-51, Cleveland, OH 44195, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Kakisaka Y, Iwasaki M, Alexopoulos AV, Enatsu R, Jin K, Wang ZI, Mosher JC, Dubarry AS, Nair DR, Burgess RC. Magnetoencephalography in fronto-parietal opercular epilepsy. Epilepsy Res 2012; 102:71-7. [PMID: 22658720 DOI: 10.1016/j.eplepsyres.2012.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/03/2012] [Accepted: 05/06/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To clarify the clinical and neurophysiological profiles of fronto-parietal opercular epilepsy in which epileptic spikes are detected with magnetoencephalography (MEG) but not with scalp electroencephalography (EEG). METHODS Four patients presented with epileptic spikes localized to the fronto-parietal opercular cortex, which were only appreciated following MEG recordings. RESULTS In all cases, seizure semiology suggested early activation of the operculum and lower peri-rolandic cortex consistent with the somatotopic organization of this region, i.e. tingling sensation involving the throat and hemi-face or contralateral upper limb, and spasms of the neck and throat. MEG spikes were localized in the fronto-parietal operculum. Three of the four patients underwent invasive electrocorticography and/or stereo-EEG recordings, and spikes were confirmed to arise from the estimated area of MEG dipole localization. Two patients remained seizure-free for over 1 year after resection of the epileptogenic region; the other patient declined resective surgery due to proximity to the language cortex. CONCLUSION This study demonstrates the usefulness of MEG in localizing spikes arising from within the fronto-parietal opercular regions, and implies that MEG may provide localizing information in patients with symptoms suggestive of opercular epilepsy, even if scalp EEG recordings fail to disclose any epileptogenic activities.
Collapse
Affiliation(s)
- Yosuke Kakisaka
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Kakisaka Y, Wang ZI, Mosher JC, Dubarry AS, Alexopoulos AV, Enatsu R, Kotagal P, Burgess RC. Clinical evidence for the utility of movement compensation algorithm in magnetoencephalography: successful localization during focal seizure. Epilepsy Res 2012; 101:191-6. [PMID: 22503605 DOI: 10.1016/j.eplepsyres.2012.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 03/11/2012] [Accepted: 03/18/2012] [Indexed: 11/30/2022]
Abstract
A movement compensation (MC) algorithm may help to evaluate seizure focus in magnetoencephalography despite patient movement. We report a boy whose ictal MEG focus was localized to the same sublobar region before and after head turning when MC was applied, but which was erroneously localized to a different area without MC. This study provides the first clinical evidence for utility of MC in magnetoencephalography for localizing focal seizures.
Collapse
Affiliation(s)
- Yosuke Kakisaka
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Wang ZI, Jones SE, Ristic AJ, Wong C, Kakisaka Y, Jin K, Schneider F, Gonzalez-Martinez JA, Mosher JC, Nair D, Burgess RC, Najm IM, Alexopoulos AV. Voxel-based morphometric MRI post-processing in MRI-negative focal cortical dysplasia followed by simultaneously recorded MEG and stereo-EEG. Epilepsy Res 2012; 100:188-93. [PMID: 22391138 DOI: 10.1016/j.eplepsyres.2012.02.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/07/2012] [Accepted: 02/12/2012] [Indexed: 11/28/2022]
Abstract
We aim to report on the usefulness of a voxel-based morphometric MRI post-processing technique in detecting subtle epileptogenic structural lesions. The MRI post-processing technique was implemented in a morphometric analysis program (MAP), in a 30-year-old male with pharmacoresistant focal epilepsy and negative MRI. MAP gray-white matter junction file facilitated the identification of a suspicious structural lesion in the right frontal opercular area. The electrophysiological data by simultaneously recorded stereo-EEG and MEG confirmed the epileptogenicity of the underlying subtle structural abnormality. The patient underwent a limited right frontal opercular resection, which completely included the area detected by MAP. Surgical pathology revealed focal cortical dysplasia (FCD) type IIb. Postoperatively the patient has been seizure-free for 2 years. This study demonstrates that MAP has promise in increasing the diagnostic yield of MRI reading in challenging patients with "non-lesional" MRIs. The clinical relevance and epileptogenicity of MAP abnormalities in patients with epilepsy have not been investigated systematically; therefore it is important to confirm their pertinence by performing electrophysiological recordings. When confirmed to be epileptogenic, such MAP abnormalities may reflect an underlying subtle cortical dysplasia whose complete resection can lead to seizure-free outcome.
Collapse
Affiliation(s)
- Z I Wang
- Epilepsy Center, Neurological Institute, Cleveland Clinic Foundation, United States.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Wang ZI, Jin K, Kakisaka Y, Mosher JC, Bingaman WE, Kotagal P, Burgess RC, Najm IM, Alexopoulos AV. Imag(in)ing seizure propagation: MEG-guided interpretation of epileptic activity from a deep source. Hum Brain Mapp 2012; 33:2797-801. [PMID: 22328363 DOI: 10.1002/hbm.21401] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 04/08/2011] [Accepted: 06/09/2011] [Indexed: 11/08/2022] Open
Abstract
Identification and accurate localization of seizure foci is vital in patients with medically-intractable focal epilepsy, who may be candidates for potentially curative resective epilepsy surgery. We present a patient with difficult-to-control seizures associated with an occult focal cortical dysplasia residing within the deeper left parietal operculum and underlying posterior insula, which was not detected by conventional MRI analysis. Propagated activities from this deeper generator produced misleading EEG patterns both on surface and subdural electrode recordings suggesting initial activation of the perirolandic and mesial frontal regions. However, careful spatio-temporal analysis of stereotyped interictal activities recorded during MEG, using sequential dipole modeling, revealed a consistent pattern of epileptic propagation originating from the deeper source and propagating within few milliseconds to the dorsal convexity. In this instance, careful dissection of noninvasive investigations (interictal MEG along with ictal SPECT findings) allowed clinicians to dismiss the inaccurate and misleading findings of the traditional "gold-standard" intracranial EEG. In fact, this multimodal noninvasive approach uncovered a subtle dysplastic lesion, resection of which rendered the patient seizure-free. This case highlights the potential benefits of dynamic analysis of interictal MEG in the appropriate clinical context. Pathways of interictal spike propagation may help elucidate essential neural networks underlying focal epilepsy.
Collapse
Affiliation(s)
- Zhong I Wang
- Cleveland Clinic Epilepsy Center, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Kakisaka Y, Wang ZI, Mosher JC, Nair DR, Alexopoulos AV, Burgess RC. Magnetoencephalography's higher sensitivity to epileptic spikes may elucidate the profile of electroencephalographically negative epileptic seizures. Epilepsy Behav 2012; 23:171-3. [PMID: 22227034 PMCID: PMC4003487 DOI: 10.1016/j.yebeh.2011.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 08/31/2011] [Accepted: 09/03/2011] [Indexed: 11/28/2022]
Abstract
Video electroencephalography (EEG) plays an important role in judging whether a clinical spell is an epileptic seizure or paroxysmal event, but its interpretation is not always straightforward. If clinical events without EEG correlates are strongly suggestive of seizures, we usually regard these spells as epileptic seizures. However, the electric/magnetic physiological profile of EEG-negative epileptic seizures remains unknown. We describe a 19-year-old man known to have epileptic seizures, in which both magnetoencephalography (MEG)-unique and EEG/MEG spikes were seen. Both types of spikes originated from the same source, but the EEG/MEG spikes were of significantly higher magnitude than the MEG-unique spikes. Therefore, some epileptic seizures, even though generated identically to the MEG-positive seizures, could be EEG-negative because of their smaller magnitude.
Collapse
Affiliation(s)
- Yosuke Kakisaka
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA,Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Zhong I. Wang
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
| | - John C. Mosher
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
| | - Dileep R. Nair
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
| | - Andreas V. Alexopoulos
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
| | - Richard C. Burgess
- Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|
50
|
Kakisaka Y, Gupta A, Wang ZI, Dubarry AS, Alexopoulos AV, Mosher JC, Burgess RC. Different cortical involvement pattern of generalized and localized spasms: a magnetoencephalography study. Epilepsy Behav 2011; 22:599-601. [PMID: 21944062 PMCID: PMC3994169 DOI: 10.1016/j.yebeh.2011.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 08/10/2011] [Accepted: 08/11/2011] [Indexed: 11/26/2022]
Abstract
We report successful magnetoencephalography (MEG) recording in a child who had generalized epileptic spasms (ESs) as well as ESs involving the legs only during the recording. MEG source localization results demonstrated that (1) the interictal epileptiform discharges and both types of ESs had the same origin, that is, the right parietal region, and (2) the two types of ESs had different cortical spread patterns, that is, epileptic involvement localized to the right parietal region in spasms of the legs and rapid diffuse involvement in generalized spasms. In this case, MEG provided new insight into the mechanisms underlying the two types of ESs: both types were generated from the same focus, and in generalized ESs, abnormal excitation spread to cortical areas diffusely.
Collapse
Affiliation(s)
- Yosuke Kakisaka
- Epilepsy Center, Department of Neurology The Cleveland Clinic, Cleveland, OH 44195, USA,Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Ajay Gupta
- Epilepsy Center, Department of Neurology The Cleveland Clinic, Cleveland, OH 44195, USA
| | - Zhong I. Wang
- Epilepsy Center, Department of Neurology The Cleveland Clinic, Cleveland, OH 44195, USA
| | - Anne-Sophie Dubarry
- Epilepsy Center, Department of Neurology The Cleveland Clinic, Cleveland, OH 44195, USA
| | | | - John C. Mosher
- Epilepsy Center, Department of Neurology The Cleveland Clinic, Cleveland, OH 44195, USA
| | - Richard C. Burgess
- Epilepsy Center, Department of Neurology The Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|