Comparison of source localization of interictal epileptic spike potentials in patients estimated by the dipole tracing method with the focus directly recorded by the depth electrodes

Critical roles for breathing in the genesis and modulation of emotional states

Breathing can be classified into metabolic and behavioral categories. Metabolic breathing and voluntary behavioral breathing are controlled in the brainstem and in the cerebral motor cortex, respectively. This chapter places special emphasis on the reciprocal influences between breathing and emotional processes. As is the case with neural control of breathing, emotions are generated by multiple control networks, located primarily in the forebrain. For several decades, a respiratory rhythm generator has been investigated in the limbic system. The amygdala receives respiratory-related input from the piriform cortex. Excitatory recurrent branches are located in the piriform cortex and have tight reciprocal synaptic connections, which produce periodic oscillations, similar to those recorded in the hippocampus during slow-wave sleep. The relationship between olfactory breathing rhythm and emotion is seen as the gateway to interpreting the relationship between breathing and emotion. In this chapter, we describe roles of breathing in the genesis of emotion, neural structures common to breathing and emotion, and mutual importance of breathing and emotion. We also describe the central roles of conscious awareness and voluntary control of breathing, as effective methods for stabilizing attention and the contents in the stream of consciousness. Voluntary control of breathing is seen as an essential practice for achieving emotional well-being.

Do Spike Domain Analysis Interictally Correlate With the Ictal Patterns in Temporal Lobe Epilepsy?

PURPOSE

To study if one can conceptualize the scalp ictal onset pattern through analysis of interictal spike domain analysis in temporal lobe epilepsy (TLE).

METHODS

Seventy-four patients with unilateral mesial temporal sclerosis (MTS) were categorized into "type A" interictal epileptiform discharges (IEDs) with negativity over infero-lateral scalp electrodes over temporal region and contralateral central region showing positivity; all IEDs other than type A were categorized as type B. The ictal electrographic patterns was termed "focal" when confined to side of MTS, was "regional" when lateralized to the ipsilateral hemisphere; "diffuse" if nonlateralized/localized; and ictal onset contralateral to MTS termed as "discordant."

RESULTS

A total of 377 seizures and 5,476 spikes were studied. These were divided into four types: (1) type A IEDs ipsilateral to MTS (44 patients), (2) type A IEDs bitemporally (16 patients), (3) type A IEDs contralaterally (7 patients) and type B IEDs ipsilaterally, and (4) bilateral type B IEDs (7 patients). The ictal pattern was either focal or regional in 51 of 60 patients (85%) with type A IEDs; it was "diffuse" in 9 patients (15%). Diffuse ictal onset was seen in 12 of 14 (86%) with either ipsilateral/bitemporal type B IEDs. Ictal onset on the opposite hemisphere was noted in 2 (14%).

CONCLUSIONS

Type A IEDs signify a focal ictal onset and type B IEDs suggest a diffuse ictal onset in patients with MTS on one side.

SIGNIFICANCE

Interictal spike domain analysis helps predicting ictal patterns in temporal lobe epilepsy.

Effects of Left Amygdala Lesions on Respiration, Skin Conductance, Heart Rate, Anxiety, and Activity of the Right Amygdala During Anticipation of Negative Stimulus

The present study reports the effects of lesions in the left amygdala on anxiety, respiration, skin conductance, heart rate, and electrical potentials in the right amygdala in two patients. Trait and anticipatory-state anxiety were measured before and after left amygdala resection to control medically intractable epilepsy in the patients. Lesions in the left amygdala resulted in decreases of trait and state anxiety, respiratory rate, and activity in the right amygdala in both patients; one patient also showed notable decreases in skin conductance and heart rate. The study also reports that activities in the right amygdala before the lesion were not observed after the lesion. We suggest that the activity of the right amygdala is dominantly activated in anxiety and anxiety-related physiological responses but needs excitatory inputs from the left amygdala.

Arousal electrical stimuli evoke sudomotor activity related to P300, and skin vasoconstrictor activity related to N140 in humans

OBJECTIVE

Arousal stimuli evoke bursts of skin sympathetic nerve activity (SSNA). SSNA usually contains sudomotor and vasoconstrictor neural spikes. The aim of this study was to elucidate which components of event-related potentials (ERPs) are related to sudomotor and vasoconstrictor responses comprising arousal SSNA bursts.

METHODS

We recorded SSNA from the tibial nerve by microneurography, with corresponding sympathetic skin response (SSR), sympathetic flow response (SFR), and ERPs in 10 healthy subjects. Electrical stimulation of the median nerve was used to induce arousal responses. ERPs were classified by the occurrence of SSR and SFR.

RESULTS

SSNA bursts followed by SSR were associated with larger P300 than SSNA bursts followed by no SSR. For N140, no difference in the amplitude was found between SSNA bursts with and without SSR. SSNA bursts followed by SFR were associated with larger N140 than SSNA bursts followed by no SFR. However, there were no differences in the amplitude of P300 between SSNA bursts with and without SFR.

CONCLUSIONS

Sudomotor and skin vasoconstrictor responses to arousal stimuli were differently associated with distinct ERP components.

SIGNIFICANCE

The possibility that sudomotor and skin vasoconstrictor activities comprising arousal SSNA reflect different stages of the cognitive process is suggested.

Respiratory response toward olfactory stimuli might be an index for odor-induced emotion and recognition

Olfaction is a unique sensory modality. Odor molecules reach olfactory receptors by inspiration, and odor information projects directly to limbic structures not through the thalamus. Odor stimuli thus induce respiratory changes, and simultaneously induce emotion and memory recognition via stimulation of olfactory-related limbic structures. We review the relations between respiration and olfaction, and between brain rhythm and respiration from our studies in normal subjects and in patients with Parkinson's disease who had been reported to have olfactory impairment.

Expiration: the moment we experience retronasal olfaction in flavor

Respiration is essential for smell perception. Previously we found that 8-12-Hz cortical rhythms were phase-locked to inspiration onset during the presentation of odor stimuli; this is referred to as inspiration phase-locked alpha band oscillation (I-alpha). Generators of I-alpha estimated with a dipole fitting model were found in the piriform, the entorhinal cortex (ENT), the amygdala (AMG), the hippocampus (HI) and the orbitofrontal cortex (OFC). Such olfactory perception is said to occur via the orthonasal olfaction route. Another route is the retronasal olfaction route. In this study, we investigated the link between respiration phase and retronasal olfactory perception. Electroencephalograph (EEG) and respiratory flows (separately measured with mouth and nose) were simultaneously recorded during stimulation of subjects' tongues with liquids of chocolate, sucrose and water. The percentage of subjects correctly identifying the chocolate taste was higher when subjects were asked to breathe through the nose than when they were breathing through the mouth. In the averaged EEGs triggered by the onset of expiration measured from the flow through the nose, a 8-12-Hz oscillation was observed. Generators of this potential were found in the left ENT, HI, AMG and OFC in the order of milliseconds after expiration onset. Perception of retronasal olfaction is dependent on expiration, and combining retronasal olfactory information with gustatory information and somatosensation enable us to identify flavors when drinking and feeding.

Advances in spike localization with EEG dipole modeling

EEG interpretation by visual inspection of waveforms, using the assumption that activity at a given electrode is a representation of only the activity of the cortex immediately beneath it, has been the traditional form of EEG analysis since its inception. The relatively recent advent of digital EEG has allowed more advanced analysis of EEG data and has shown that the simple visual inspection described above is a simplistic form of analysis. This is especially true when one is attempting to localize an epileptogenic focus using EEG spikes or seizure onset data. Spatiotemporal analysis of scalp voltage fields has allowed for improved localization of likely cerebral origins of such waveforms. Equivalent dipole source modeling is one such technique and, although not perfect, provides improved characterization of spike and seizure sources as compared to previous methods when properly interpreted. The use of other modern techniques, such as 3D MRI reconstructions and realistic head models, can further improve accuracy of dipole localization and allow for the synthesis of EEG and imaging data, which may be invaluable, especially in cases of pre-surgical epilepsy evaluation.

Typical dipole locations can be estimated using averaged somatosensory-evoked potentials and a standard brain model

It is reasonable to hypothesize that dipoles estimated from grand averaged event-related potentials based on summed-up data obtained from multiple subjects and standard head models could correspond to typical brain regions associated to a particular event. Six healthy subjects were enrolled in a study to test this hypothesis. We estimated dipoles from somatosensory-evoked potentials (SEP) elicited by electrical stimulation to the left median nerve. We also created individual three-layered (scalp, skull, and brain) head models from each subject's magnetic resonance imaging scan, and dipoles were estimated from the individual averaged SEP with each individual head model. We then estimated dipoles using grand averaged SEP across all subjects on the standard head model created from the Montreal Neurological Institute (MNI) standard coordinate system brain template to compare the estimated dipoles located on our own head model and those on the MNI. The dipoles in the post-central gyrus were estimated from negative potentials at 20 ms from the grand averaged data incorporated with the MNI head model, corresponding to a typical location related to SEP stimulation. The results suggest the validity of estimating the dipole location from the grand averaged potential of all subjects with the MNI model if we focus on typical regions related to the task.

Breathing rhythms and emotions

Respiration is primarily regulated for metabolic and homeostatic purposes in the brainstem. However, breathing can also change in response to changes in emotions, such as sadness, happiness, anxiety or fear. Final respiratory output is influenced by a complex interaction between the brainstem and higher centres, including the limbic system and cortical structures. Respiration is important in maintaining physiological homeostasis and co-exists with emotions. In this review, we focus on the relationship between respiration and emotions by discussing previous animal and human studies, including studies of olfactory function in relation to respiration and the piriform-amygdala in relation to respiration. In particular, we discuss oscillations of piriform-amygdala complex activity and respiratory rhythm.

Clinical Application of Dipole Models in the Localization of Epileptiform Activity

SUMMARY

Routine clinical interpretation of EEG using visual inspection of traces is a time-honored, but simplistic, form of analysis. This is particularly true in attempts to localize an epileptogenic focus by means of EEG spike or seizure waveforms. Improved understanding of the cortical substrates of these potentials has allowed us to identify their likely cerebral origins through spatio-temporal analysis of scalp voltage fields. Equivalent dipole modeling is one such technique. Although an imperfect representation of spike or seizure sources, proper interpretation of dipole models can lead to a far better characterization of their localization and propagation. Modern techniques of 3-D MRI reconstruction and realistic head models have both improved localization accuracy and provided a means of displaying results in an image of the individual's brain.

Impairment of odor recognition in Parkinson's disease caused by weak activations of the orbitofrontal cortex

Olfactory dysfunction and abnormalities of olfactory brain structures are found in patients with Parkinson's disease (PD), and a number of studies have reported that olfactory dysfunction is caused by abnormalities of the central olfactory systems. We previously analyzed electroencephalograms (EEGs) and respiration simultaneously in normal subjects while testing for detection and recognition of odors. We identified changes in respiration pattern in response to odor stimuli and found inspiratory phase-locked alpha oscillations (I-alpha). The genesis of I-alpha were identified in olfactory-related areas including the entorhinal cortex, hippocampus, amygdale and orbitofrontal cortex with an EEG dipole tracing method. In the present study, we used the same protocol in PD patients and compared results of PD with those of age-matched controls. All PD patients detected odor, but 5 out of 10 showed impaired odor recognition. Changes in breathing pattern associated with emotional changes during exposure to odor stimuli were not observed in PD patients. I-alpha waveforms were not observed; however, positive waves followed by negative waves were identified approximately 100ms after inspiration onset. Dipoles of this component were localized in the entorhinal cortex for odor detection in all patients and in the entorhinal cortex and middle temporal gyrus for PD patients who could discriminate odors. Odor recognition in PD could be subserved by a different neural circuit from that of normal subjects, done through the temporal association cortex as a subsystem for recognizing the odor; however, the system may not be associated with the odor-induced emotions.

Inspiratory phase-locked alpha oscillation in human olfaction: source generators estimated by a dipole tracing method

Olfactory perception and related emotions are largely dependent on inspiration. We acquired simultaneous respiration and electroencephalographic recordings during pleasant odour and unpleasant odour stimulation. We sought to identify changes in respiratory pattern, inspiratory-related potentials and location of dipoles estimated from the potentials. Electroencephalographic recording was triggered by inspiration onset. Respiratory frequency decreased at pleasant odour recognition, and it increased at unpleasant odour detection and recognition. O2 consumption records showed that these changes were not due to metabolic demand. During olfactory stimulation, inspiratory phase-locked alpha oscillation (I-alpha) was found in the averaged potential triggered by inspiration onset. I-alpha was observed at both pleasant odour and unpleasant odour detection and recognition, but it was not seen in the inspiration-triggered potentials of normal air breathing. Electroencephalographic dipole tracing identified the location of dipoles from the I-alpha in the limbic area and the cortex; the entorhinal cortex, hippocampus, amygdala, premotor area and centroposterior orbitofrontal cortex subserve odour detection, and the rostromedial orbitofrontal cortex subserves odour recognition. We suggest that the I-alpha in our study originated from the olfactory cortex in the forebrain and was phase-locked to inspiration.

The amygdala of patients with Parkinson’s disease is silent in response to fearful facial expressions

We previously found that patients with Parkinson's disease (PD) were impaired with respect to recognition of fear and disgust in facial expressions. To investigate the neural mechanisms that underlie this impairment, we recorded visual event-related potentials (ERPs) in response to the viewing of fearful facial expressions. Ten normal elderly volunteers and nine patients with PD were studied. Fearful, surprised, and neutral facial expressions were presented randomly for 500 ms each, with a probability of 0.1, 0.1, and 0.8, respectively. The locations of the components of the ERPs were analyzed using a scalp-skull-brain/dipole tracing method. The ERPs elicited in response to the facial stimuli consisted of a negative peak (N1), two positive peaks, and a subsequent slow negative shift. For N1, the equivalent current dipoles were concentrated in the fusiform gyrus, right superior temporal gyrus, parahippocampal gyrus, cingulate cortex, and cerebellum, in normal subjects. In response to the fearful stimulus, dipoles were also generated from the amygdala in seven out of 10 normal subjects. In contrast, in patients with PD, N1 was centered bilaterally in the angular gyrus and supramarginal gyrus, and there was no neuronal activity in the amygdala. After N1, dipoles moved toward the frontal region in normal subjects, whereas they remained in the parietal lobes in patients with PD. These results suggest that neither the amygdala nor the temporal visual-associated cortices are involved in responding to fearful expressions in patients with PD. Corticostriatal connections may be variably affected by a lack of dopamine or by pathological changes in the amygdala. Thus, somatosensory recruitment may overcome the mild cognitive emotional deficits that are present in patients with PD owing to a dysfunction of the amygdala.

High-resolution source imaging in mesiotemporal lobe epilepsy: a comparison between MEG and simultaneous EEG

Magnetic source imaging is claimed to have a high accuracy in epileptic focus localization and may be a guide for epilepsy surgery. Non-lesional mesiotemporal lobe epilepsy (MTLE), the most common form of epilepsy operated on, has different etiologies, which may affect the choice of surgical approach. The authors compared whole-head magnetoencephalography (MEG) with high-resolution EEG for source identification in MTLE. Nineteen patients with unilateral, nonlesional MTLE underwent a simultaneous 151-channel CTF MEG (CTF Systems, Inc., Port Coquitlam, British Columbia, Canada) and 64-channel EEG recordings with sleep induction. Three independent observers selected spikes from the EEG and MEG recordings separately. Only when there was interobserver agreement (kappa>0.4) on the presence of spikes in recordings were consensus spikes averaged. EEG and MEG equivalent current dipoles (ECD) were then integrated in the head model of the patient reconstructed from MRI. The results were compared with intraoperative electrocorticography findings. Spikes were detected in 32% of MEGs and 42% of EEGs. No patient showed MEG spikes only. Equivalent current dipole modeling correctly localized the source to the temporal lobe in four out of five MEG and three out of eight EEG recordings. MEG localized sources were more superficial and EEG localized sources were deeper. Unfortunately, basal temporal lobe areas were only partially covered by the sensor helmet of the MEG setup. Best correlation between EEG or MEG findings and electrocorticography findings was between horizontal EEG dipole orientation and prominent neocortical spiking; these patients also had a less favorable prognosis. Magnetic source imaging is currently unlikely to alter the surgical management of MTLE. The yield of spikes is too low, and ECD modeling shows only partial correlation with electrocorticography findings. Moreover, the whole-head MEG helmet provides insufficient coverage of the temporal lobe.