EEG-Linked functional magnetic resonance imaging in epilepsy and cognitive neurophysiology

Interictal Electroencephalography and Functional Magnetic Resonance Imaging Reveals Involvement of Mesial Anterior Frontal Structures in Patients With Hyperkinetic Semiology Type I

PURPOSE

This work investigates the presence of common anatomic regions associated with interictal activity in patients with hyperkinetic seizures type I by means of concurrent electroencephalography and functional magnetic resonance imaging.

METHODS

Six patients with hyperkinetic seizures type I were evaluated with video-EEG and electroencephalography and functional magnetic resonance imaging in the context of their presurgical evaluation. Statistical Parametric Mapping was used to perform a correlation study between the occurrence of interictal spikes on EEG and suprathreshold blood oxygen level-dependent changes in the whole-brain volume.

RESULTS

In all patients, Statistical Parametric Mapping revealed suprathreshold blood oxygen level-dependent clusters in the mesial anterior frontal areas, including the rostral mesial superior frontal gyrus and the anterior cingulate, associated with the patients' typical interictal activity.

CONCLUSIONS

The electroencephalography and functional magnetic resonance imaging findings contribute to our understanding of hyperkinetic seizures type I semiology generation and can inform stereo-EEG targeting for surgical planning in refractory cases.

Hyperglycemic hemianopia: A case report

BACKGROUND

Nonketotic hyperglycemia (NKH) is characterized by hyperglycemia with little or no ketoacidosis. Diverse neurological symptoms have been described in NKH patients, including choreoathetosis, hemiballismus, seizures, and coma in severe cases. Homonymous hemianopia, with or without occipital seizures, caused by hyperglycemia is less readily recognized.

CASE SUMMARY

We describe a 54-year-old man with NKH, who reported seeing round, colored flickering lights with right homonymous hemianopia. Cranial magnetic resonance imaging demonstrated abnormalities in the left occipital lobe, with decreased T2 signal of the white matter, restricted diffusion, and corresponding low signal intensity in the apparent diffusion coefficient map. He responded to rehydration and a low-dose insulin regimen, with improvements of his visual field defect.

CONCLUSION

Patients with NKH may present focal neurologic signs. Hyperglycemia should be taken into consideration when making an etiologic diagnosis of homonymous hemianopia.

Reference-free removal of EEG-fMRI ballistocardiogram artifacts with harmonic regression

Combining electroencephalogram (EEG) recording and functional magnetic resonance imaging (fMRI) offers the potential for imaging brain activity with high spatial and temporal resolution. This potential remains limited by the significant ballistocardiogram (BCG) artifacts induced in the EEG by cardiac pulsation-related head movement within the magnetic field. We model the BCG artifact using a harmonic basis, pose the artifact removal problem as a local harmonic regression analysis, and develop an efficient maximum likelihood algorithm to estimate and remove BCG artifacts. Our analysis paradigm accounts for time-frequency overlap between the BCG artifacts and neurophysiologic EEG signals, and tracks the spatiotemporal variations in both the artifact and the signal. We evaluate performance on: simulated oscillatory and evoked responses constructed with realistic artifacts; actual anesthesia-induced oscillatory recordings; and actual visual evoked potential recordings. In each case, the local harmonic regression analysis effectively removes the BCG artifacts, and recovers the neurophysiologic EEG signals. We further show that our algorithm outperforms commonly used reference-based and component analysis techniques, particularly in low SNR conditions, the presence of significant time-frequency overlap between the artifact and the signal, and/or large spatiotemporal variations in the BCG. Because our algorithm does not require reference signals and has low computational complexity, it offers a practical tool for removing BCG artifacts from EEG data recorded in combination with fMRI.

Simultaneous EEG-fMRI in Human Epilepsy

Electroencephalography (EEG) has been used to study and characterize epilepsy for decades, but has a limited ability to localize epileptiform activity to a specific brain region. With recent technological advances, high-quality EEG can now be recorded during functional magnetic resonance imaging (fMRI), which characterizes brain activity through local changes in blood oxygenation. By combining these techniques, the specific timing of interictal events can be identified on the EEG at millisecond resolution and spatially localized with fMRI at millimeter resolution. As a result, simultaneous EEG-fMRI provides the opportunity to better investigate the spatiotemporal mechanisms of the generation of epileptiform activity in the brain. This article discusses the technical considerations and their solutions for recording simultaneous EEG-fMRI and the results of studies to date. It also addresses the application of EEG-fMRI to epilepsy in humans, including clinical applications and ongoing challenges.

EEG and MEG: relevance to neuroscience

To understand dynamic cognitive processes, the high time resolution of EEG/MEG is invaluable. EEG/MEG signals can play an important role in providing measures of functional and effective connectivity in the brain. After a brief description of the foundations and basic methodological aspects of EEG/MEG signals, the relevance of the signals to obtain novel insights into the neuronal mechanisms underlying cognitive processes is surveyed, with emphasis on neuronal oscillations (ultra-slow, theta, alpha, beta, gamma, and HFOs) and combinations of oscillations. Three main functional roles of brain oscillations are put in evidence: (1) coding specific information, (2) setting and modulating brain attentional states, and (3) assuring the communication between neuronal populations such that specific dynamic workspaces may be created. The latter form the material core of cognitive functions.

Localization of focal epileptic discharges using functional connectivity magnetic resonance imaging

OBJECT

In patients with medically refractory epilepsy the accurate localization of the seizure onset zone is critical for successful surgical treatment. The object of this study was to investigate whether the degree of coupling of spontaneous brain activity as measured with functional connectivity MR imaging (fcMR imaging) can accurately identify and localize epileptic discharges.

METHODS

The authors studied 6 patients who underwent fcMR imaging presurgical mapping and subsequently underwent invasive electroencephalography.

RESULTS

Focal regions of statistically significant increases in connectivity were identified in 5 patients when compared with an ad hoc normative sample of 300 controls. The foci identified by fcMR imaging overlapped the epileptogenic areas identified by invasive encephalography in all 5 patients.

CONCLUSIONS

These results suggest that fcMR imaging may provide an effective high-spatial resolution and noninvasive method of localizing epileptic discharges in patients with refractory epilepsy.

An open-source hardware and software system for acquisition and real-time processing of electrophysiology during high field MRI

Simultaneous recording of electrophysiology and functional magnetic resonance imaging (fMRI) is a technique of growing importance in neuroscience. Rapidly evolving clinical and scientific requirements have created a need for hardware and software that can be customized for specific applications. Hardware may require customization to enable a variety of recording types (e.g., electroencephalogram, local field potentials, or multi-unit activity) while meeting the stringent and costly requirements of MRI safety and compatibility. Real-time signal processing tools are an enabling technology for studies of learning, attention, sleep, epilepsy, neurofeedback, and neuropharmacology, yet real-time signal processing tools are difficult to develop. We describe an open-source system for simultaneous electrophysiology and fMRI featuring low-noise (<0.6microV p-p input noise), electromagnetic compatibility for MRI (tested up to 7T), and user-programmable real-time signal processing. The hardware distribution provides the complete specifications required to build an MRI-compatible electrophysiological data acquisition system, including circuit schematics, print circuit board (PCB) layouts, Gerber files for PCB fabrication and robotic assembly, a bill of materials with part numbers, data sheets, and vendor information, and test procedures. The software facilitates rapid implementation of real-time signal processing algorithms. This system has been used in human EEG/fMRI studies at 3 and 7T examining the auditory system, visual system, sleep physiology, and anesthesia, as well as in intracranial electrophysiological studies of the non-human primate visual system during 3T fMRI, and in human hyperbaric physiology studies at depths of up to 300 feet below sea level.

Medial temporal fMRI activation reflects memory lateralization and memory performance in patients with epilepsy

Memory difficulties are a frequent cognitive complaint of patients with chronic epilepsy. Previous studies have suggested that the presence of a seizure focus causes reorganization of brain mechanisms underlying memory function. Here we examine whether seizure onset in the left hemisphere and onset in the right hemisphere have different effects on memory lateralization and whether longer duration of epilepsy is associated with increased lateralization of memory functions to the unaffected hemisphere. We hypothesized that hemisphere of onset and duration of epilepsy would influence plasticity of memory mechanisms, similar to the plasticity observed for language mechanisms. Healthy controls (HC, N = 10) and patients with epilepsy (N = 23, 11 with a left- and 12 with a right-hemisphere focus) performed a scene-encoding fMRI task at 4 T. Active voxels (relative to scrambled image viewing) were identified for each participant. Memory laterality indices (LIs) were calculated in three regions of interest (ROIs) designed on the basis of HC group data: a functional ROI, an anatomical-hippocampal ROI, and an anatomical-medial temporal ROI encompassing hippocampus and parahippocampal gyrus. In healthy controls, LIs were suggestive of slight left lateralization of encoding memory for pictures. Patients with right hemisphere epilepsy showed a nonsignificant increase in degree of left lateralization. In contrast, patients with left hemispheric epilepsy showed right-lateralized activation, differing significantly from controls and from patients with right hemispheric epilepsy. Neuropsychological measures of memory (WMS-III Story Recall) across epilepsy patients predicted LIs in the anatomical ROIs: higher scores were associated with more left-lateralized medial temporal fMRI activation. Neither age of onset nor duration of epilepsy was significantly related to LI. These results indicate that focal epilepsy may influence the functional neuroanatomy of memory function.

EEG/(f)MRI measurements at 7 Tesla using a new EEG cap (“InkCap”)

We aimed at improving the signal-to-noise ratio (SNR) of electroencephalography (EEG) during magnetic resonance imaging (MRI) by introducing a new EEG cap ("InkCap") based on conductive ink technology. The InkCap was tested with temperature measurements on an electrically conductive phantom head and during structural and functional MRI (fMRI) recordings in 11 healthy human volunteers at 7 T. Combined EEG/fMRI measurements were conducted to study the interaction between the two modalities. The EEG recordings with the InkCap demonstrated up to a five-fold average decrease in signal variance during echo-planar imaging, with respect to a cap made of standard carbon fiber leads. During concurrent EEG/fMRI measurements in human volunteers, alpha oscillations were clearly detected at 7 T. Minimal artifacts were present in the T2* and high-resolution structural MR images of the brain parenchyma. Our results show that the InkCap technology considerably improves the quality of both EEG and (f)MRI during concurrent measurements even at 7 T.

Attentional modulation in the detection of irrelevant deviance: a simultaneous ERP/fMRI study

Little is known about the neural mechanisms that control attentional modulation of deviance detection in the auditory modality. In this study, we manipulated the difficulty of a primary task to test the relation between task difficulty and the detection of infrequent, task-irrelevant deviant (D) tones (1,300 Hz) presented among repetitive standard (S) tones (1,000 Hz). Simultaneous functional magnetic resonance imaging (fMRI)/event-related potentials (ERPs) were recorded from 21 subjects performing a two-alternative forced-choice duration discrimination task (short and long tones of equal probability). The duration of the short tone was always 50 msec. The duration of the long tone was 100 msec in the easy task and 60 msec in the difficult task. As expected, response accuracy decreased and response time (RT) increased in the difficult compared with the easy task. Performance was also poorer for D than for S tones, indicating distraction by task-irrelevant frequency information on trials involving D tones. In the difficult task, an amplitude increase was observed in the difference waves for N1 and P3a, ERP components associated with increased attention to deviant sounds. The mismatch negativity (MMN) response, associated with passive deviant detection, was larger in the easy task, demonstrating the susceptibility of this component to attentional manipulations. The fMRI contrast D > S in the difficult task revealed activation on the right superior temporal gyrus (STG) and extending ventrally into the superior temporal sulcus, suggesting this region's involvement in involuntary attention shifting toward unattended, infrequent sounds. Conversely, passive deviance detection, as reflected by the MMN, was associated with more dorsal activation on the STG. These results are consistent with the view that the dorsal STG region is responsive to mismatches between the memory trace of the standard and the incoming deviant sound, whereas the ventral STG region is activated by involuntary shifts of attention to task-irrelevant auditory features.

Using voxel-specific hemodynamic response function in EEG-fMRI data analysis

Most existing analytical techniques for EEG-fMRI data need specific assumptions about the hemodynamic response function (HRF). These assumptions may not be appropriate when the HRF varies from subject to subject or from region to region. In this article, we introduce a deconvolution method for EEG-fMRI activation detection, which can be implemented with voxel-specific HRFs. A comparison of performance is made between three fixed HRFs and the deconvolution method under the framework of the general linear model. The main results are as follows: (1) the volume of detected regions from the deconvolved HRFs is larger. (2) In some subjects, the deconvolution technique can find areas of activation that have not been detected with the three fixed HRFs at our threshold of significance. (3) Deconvolution obtained higher adjusted coefficients of multiple determination compared to those obtained with the three fixed HRFs. The results suggest that the fixed HRF methods may not be the most appropriate for the analysis of epileptic activity with EEG-fMRI, and the deconvolution method may be a better choice.

Hemodynamic correlates of epileptiform discharges: An EEG-fMRI study of 63 patients with focal epilepsy

Using continuous EEG-correlated fMRI, we investigated the Blood Oxygen Level Dependent (BOLD) signal correlates of interictal epileptic discharges (IEDs) in 63 consecutively recruited patients with focal epilepsy. Semi-automated spike detection and advanced modeling strategies are introduced to account for different EEG event types, and to minimize false activations from uncontrolled motion. We show that: (1) significant hemodynamic correlates were detectable in over 68% of patients in whom discharges were captured and were highly, but not entirely, concordant with site(s) of presumed seizure generation where known; (2) deactivations were less concordant and may non-specifically reflect the consequential or downstream effects of IEDs on brain activity; (3) a striking pattern of retrosplenial deactivation was observed in 7 cases mainly with focal discharges; (4) the basic hemodynamic response to IEDs is physiological; (5) incorporating information about different types of IEDs, their durations and saturation effects resulted in more powerful models for the detection of fMRI correlates; (6) focal activations were more likely when there was good electroclinical localization, frequent stereotyped spikes, less head motion and less background EEG abnormality, but were also seen in patients in whom the electroclinical focus localization was uncertain. These findings provide important new information on the optimal use and interpretation of EEG-fMRI in focal epilepsy and suggest a possible role for EEG-fMRI in providing new targets for invasive EEG monitoring.

Visual evoked potentials may be recorded simultaneously with fMRI scanning: A validation study

Integrating electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) data may help to optimize anatomical and temporal resolution in the investigation of cortical function. Successful removal of fMRI scanning artifacts from continuous EEG in simultaneous recordings has been reported. We assessed the feasibility of recording reliable visual evoked potentials (VEPs) during fMRI scanning using available artifact removing procedures. EEG during administration of visual stimuli was recorded using MRI-compatible 32-channel equipment in nine normal subjects (mean age, 23.9 +/- 2.5 years), with and without fMRI acquisition. fMRI scanning and cardioballistographic artifacts were removed after subtraction of averaged artifact waveforms. Consistency between VEPs waveforms and of P1 and N1 peak latencies and amplitudes in the two conditions was assessed. Good correlation was found between VEP waveforms (Pearson's correlation coefficient: r(P) between 0.76-0.94 across subjects; P < 0.0001) and between latency or amplitude of P1 and N1 peaks (latencies: r = 0.7, P < 0.035; amplitudes: r > 0.65, P < 0.05; Spearman rank correlation coefficient) in the two recording conditions. No significant differences were found between P1 and N1 parameters in the two conditions (Wilcoxon signed rank test). Consistent VEP waveforms, latencies, and amplitudes with and without fMRI scanning indicate that reliable VEPs may be obtained simultaneously with fMRI recording. This possibility might be helpful by shortening recording times and reducing variability from learning, habituation, and fatigue phenomena from separate recordings for the integration of event-related EEG and fMRI data.

Simultaneous 3-T fMRI and high-density recording of human auditory evoked potentials

We acquired simultaneous high-field (3 T) functional magnetic resonance imaging (fMRI) and high-density (64- and 128-channel) EEG using a sparse sampling technique to measure auditory cortical activity generated by right ear stimulus presentation. Using dipole source localization, we showed that the anatomical location of the grand mean equivalent dipole of auditory evoked potentials (AEPs) and the center of gravity of fMRI activity were in good agreement in the horizontal plane. However, the grand mean equivalent dipole was located significantly superior in the cortex compared to fMRI activity. Interhemispheric asymmetry was exhibited by fMRI, whereas neither the AEP dipole moments nor the mean global field power (MGFP) of the AEPs showed significant asymmetry. Increasing the number of recording electrodes from 64 to 128 improved the accuracy of the equivalent dipole source localization but decreased the signal-to-noise ratio (SNR) of MR images. This suggests that 64 electrodes may be optimal for use in simultaneous recording of EEG and fMRI.

Ballistocardiogram artifact reduction in the simultaneous acquisition of auditory ERPS and fMRI

Electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) are now being combined to analyze brain function. Confounding the EEG signal acquired in the MR environment is a ballistocardiogram artifact (BA), which is predominantly caused by cardiac-related body movement. The objective of this study was to develop and evaluate a method for reducing these MR-induced artifacts to retrieve small auditory event-related potentials (ERPs) from EEG recorded during fMRI. An algorithm for BA reduction was developed that relies on timing information obtained from simultaneous electrocardiogram (ECG) recordings and subsequent creation of an adaptive BA template. The BA template is formed by median-filtering 10 consecutive BA events in the EEG signal. The continuously updated template is then subtracted from each BA in the EEG. The auditory ERPs are obtained through signal averaging of the remaining EEG signal. Experimental and simulated ERP data were estimated to assess effectiveness of the BA reduction. Simulation showed that the algorithm reduced BA without significantly altering the morphology of a signal periodically inserted in the EEG. Auditory ERP data, obtained in a 1.5-T scanner during a passive auditory oddball paradigm and processed with the BA reduction algorithm, were comparable to data recorded in a mock scanner outside the magnetic field with the same experimental paradigm. It is concluded that through adequate reduction of the BA, relatively small auditory ERPs can be acquired in the MR environment.

Overview of artifact reduction and removal in evoked potential and event-related potential recordings

Artifact in one form or another needs to be contended with in all EEG and EP studies. Various methods have been employed to avoid, eliminate, or minimize artifact. This article has described the methods that have been available for some time and newer methods and their advantages. It is the authors' hope that through the use of these methods the accuracy of all EP and ERP measurements will be improved and promote the validity and general acceptance of EP and ERP recordings. Genuine and valuable data are contained in EPs and ERPs. The challenge is to extract relatively small voltage signals often occurring within a higher voltage background of artifact. The computing power required to perform the artifact removal/reduction procedures now is available with basic laptop and desktop computers, as are the software programs that provide the artifact removal/reduction capabilities. It may be of interest for a prudent researcher to integrate the currently available artifact rejection methods before subjecting the ERP and EP data for further analysis and subsequent publication.

Functional coupling of simultaneous electrical and metabolic activity in the human brain

The relationships between brain electrical and metabolic activity are being uncovered currently in animal models using invasive methods; however, in the human brain this relationship remains not well understood. In particular, the relationship between noninvasive measurements of electrical activity and metabolism remains largely undefined. To understand better these relations, cerebral activity was measured simultaneously with electroencephalography (EEG) and positron emission tomography using [(18)f]-fluoro-2-deoxy-D-glucose (PET-FDG) in 12 normal human subjects during rest. Intracerebral distributions of current density were estimated, yielding tomographic maps for seven standard EEG frequency bands. The PET and EEG data were registered to the same space and voxel dimensions, and correlational maps were created on a voxel-by-voxel basis across all subjects. For each band, significant positive and negative correlations were found that are generally consistent with extant understanding of EEG band power function. With increasing EEG frequency, there was an increase in the number of positively correlated voxels, whereas the lower alpha band (8.5-10.0 Hz) was associated with the highest number of negative correlations. This work presents a method for comparing EEG signals with other more traditionally tomographic functional imaging data on a 3-D basis. This method will be useful in the future when it is applied to functional imaging methods with faster time resolution, such as short half-life PET blood flow tracers and functional magnetic resonance imaging.

Mapping of spikes, slow waves, and motor tasks in a patient with malformation of cortical development using simultaneous EEG and fMRI

We report on the simultaneous and continuous acquisition of EEG and functional MRI data in a patient with a left hemiparesis and focal epilepsy secondary to malformation of cortical development in the right hemisphere. EEG-triggered fMRI localization was previously demonstrated in this patient. In the experiments reported here, 322 spikes maximum at electrode C4 and 126 focal slow waves were identified offline. A hierarchy of models was explored in order to assess the relative contributions of each type of EEG event. Modeling the BOLD response to C4 spikes alone showed an area of activation within the large malformation, adjacent to the area of infolding cortex. However, also modeling slow-waves gave rise to a broader and stronger activation, suggesting that the generators overlap. Motor mapping of the right hand showed activation in the left sensorimotor cortex; left-hand tapping led to a more diffuse area of activation, displaced superiorly into the superior frontal gyrus, and a small area of activation within the lesion. In conclusion, continuous EEG-fMRI is useful to compare the functional mapping of epileptiform activity and eloquent cortices in individual patients.

EEG quality during simultaneous functional MRI of interictal epileptiform discharges

This article concerns the evaluation of the quality of interictal epileptiform EEG discharges recorded throughout simultaneous echo planar imaging (EPI). BOLD (blood oxygen level dependent) functional MRI (fMRI) images were acquired continuously on a patient with intractable epilepsy. EEG was sampled simultaneously, during and after imaging, with removal of pulse and imaging artifacts by subtraction of channel-specific running averages. Contiguous EEG epochs recorded with and without fMRI (fMRI+ve vs. fMRI-ve) were next randomized and presented to two blinded observers. Epileptiform discharges were identified retrospectively, and comparison was made in terms of the number of identified events, their amplitude, and spatiotemporal distribution. A spectral analysis was also performed on the EEG. In the randomized comparison of EEG segments, 80 (fMRI+ve) vs. 69 (fMRI-ve) discharges were noted with good interobserver agreement (69%). There were no significant differences in amplitude or spatio-temporal distribution. Comparison of the events detected and measured by two expert observers demonstrated that the Interictal Epileptiform Discharge (IED) characteristics were indistinguishable with and without scanning. We review briefly the existing literature on EEG recording quality for combined EEG/fMRI.

The BOLD response and the gamma oscillations respond differently than evoked potentials: an interleaved EEG-fMRI study

BACKGROUND

The integration of EEG and fMRI is attractive because of their complementary precision regarding time and space. But the relationship between the indirect hemodynamic fMRI signal and the more direct EEG signal is uncertain. Event-related EEG responses can be analyzed in two different ways, reflecting two different kinds of brain activity: evoked, i.e. phase-locked to the stimulus, such as evoked potentials, or induced, i.e. non phase-locked to the stimulus such as event-related oscillations. In order to determine which kind of EEG activity was more closely related with fMRI, EEG and fMRI signals were acquired together, while subjects were presented with two kinds of rare events intermingled with frequent distractors. Target events had to be signaled by pressing a button and Novel events had to be ignored.

RESULTS

Both Targets and Novels triggered a P300, of larger amplitude in the Novel condition. On the opposite, the fMRI BOLD response was stronger in the Target condition. EEG event-related oscillations in the gamma band (32-38 Hz) reacted in a way similar to the BOLD response.

CONCLUSIONS

The reasons for such opposite differential reactivity between oscillations / fMRI on the one hand, and evoked potentials on the other, are discussed in the paper. Those results provide further arguments for a closer relationship between fast oscillations and the BOLD signal, than between evoked potentials and the BOLD signal.

Studying spontaneous EEG activity with fMRI

The multifaceted technological challenge of acquiring simultaneous EEG-correlated fMRI data has now been met and the potential exists for mapping electrophysiological activity with unprecedented spatio-temporal resolution. Work has already begun on studying a host of spontaneous EEG phenomena ranging from alpha rhythm and sleep patterns to epileptiform discharges and seizures, with far reaching clinical implications. However, the transformation of EEG data into linear models suitable for voxel-based statistical hypothesis testing is central to the endeavour. This in turn is predicated upon a number of assumptions regarding the manner in which the generators of EEG phenomena may engender changes in the blood oxygen level dependent (BOLD) signal. Furthermore, important limitations are posed by a set of considerations quite unique to 'paradigmless fMRI'. Here, these issues are assembled and explored to provide an overview of progress made and unresolved questions, with an emphasis on applications in epilepsy.

Mapping of the neuronal networks of human cortical brain functions

OBJECTIVE

The principles and methodology of event-related fMRI, electromagnetic source imaging and intracranial evoked potentials will be described along with some examples of the mapping of the neuronal networks of human cortical brain functions with the use of these techniques.

INTRODUCTION

Functional brain mapping using PET or fMRI has provided clues on the functioning brain and notably on the functional neuroanatomy of cognitive functions. These mapping possibilities can be used to delineate in an individual patient the brain areas subserving a cerebral function that might be compromised by a surgery in a nearby location, or to target a functional neurosurgical procedure.

BACKGROUND

Brain functions and notably "higher brain functions" are served by a complex network of interrelating brain regions. Deeper insights into the functioning of a neuronal network can be gained by adding dynamic, i.e. temporal, information to the functional maps. This will demonstrate the orchestration of the activation of the different brain areas constituting the network, which gives clues to the information processing and therefore to the functioning of the different modules of the network. In order to track the flow of information and the sequential activation of the different brain regions constituting the network, brain activity has to be recorded at the speed of transfer of activation from one neuronal population to the other. The temporal resolution needed to achieve this is not in the range of traditional subtractive or comparative PET or fMRI techniques.

NEW DEVELOPMENTS

Novel fMRI methods that record haemodynamic signal changes after single events (event-related fMRI) are now able to determine sequential neural processing by distinguishing the relative onset-time of activity between different areas. The temporal resolution of event-related (ER) fMRI is sufficient to detect changes of mental activity within the order of several hundreds of milliseconds. This allows the exploration of a broad range of cognitive functions. Nevertheless, this technique is currently not rapid enough to observe the transient coordinations and oscillations of neuronal activities occurring across certain cortical areas during the performance of cognitive tasks. The temporal resolution needed for that is within the order of tens or a few milliseconds and is only accessible by EEG or MEG that allow true real-time measurements of the neuronal activity elicited by a stimulus. Surface recordings of multichannel EEG or MEG combined with novel electromagnetic source localisation algorithms allow a relatively precise estimation of the activated areas. A more direct localisation of electric activity is achieved by intracranial recordings in patients having implanted electrodes for diagnostic reasons. In these cases, a high temporal and spatial resolution is achieved but with a limited sampling of brain regions.

CONCLUSION

Although the temporal resolution of ER fMRI is due to improve, the temporal measures provided by EEG, MEG or intracranial event-related potentials (ERPs) are absolute, which remains a unique feature of these techniques. Therefore, ER fMRI and electromagnetic source imaging are complementary. The maps obtained with ER fMRI may be refined by electromagnetic ERPs that provide further insights into the temporal coordination or orchestration between the cortical areas already detected by ER fMRI and constituting a neuronal network, and ER fMRI can be used to precisely locate the areas coarsely situated and delineated by electromagnetic source imaging. Thus, the combination of ER fMRI and electromagnetic ERPs is essential in order to produce a mapping method with a millimetre spatial resolution and a millisecond temporal resolution. Future applications should combine these techniques to localise precisely and non-invasively relevant sensory, motor and cognitive processes in order to adequately tailor any brain surgery.

Brain activation using triggered event-related fMRI

EEG-triggered fMRI provides a method for localizing the sources of brain electrical activity, such as epileptic discharges. Extending single-image acquisitions, following an event on the EEG, into triggered image series acquisitions may allow BOLD time courses to be obtained, such as those observed in event-related (ER) fMRI experiments. However, in contrast to the standard ER-fMRI, triggered image series are greatly affected by magnetization non-steady-state effects. The purpose of this paper is to show that the BOLD responses can be recovered using subtraction between two triggered image series having different functional contrasts. In order to evaluate this technique, a comparison with standard ER-fMRI using motor cortex activation task was made in 5 volunteers. We conclude that this can be a useful technique for studying brain activation associated with irregularly appearing stimuli.

Localizing significance of temporal intermittent rhythmic delta activity (TIRDA) in drug-resistant focal epilepsy

OBJECTIVE

Temporal intermittent rhythmic delta activity (TIRDA) is an EEG pattern characterized by sinusoidal trains of activity, ranging from 1 to 3.5 Hz, and well localized over the temporal regions. It is considered to be an indicator of temporal lobe epilepsy (TLE), but full agreement between different authors has still not been reached. The aim of this study was therefore to assess the role of TIRDA in localizing the epileptogenic zone, which was estimated using anatomo-electro-clinical correlations obtained from non-invasive pre-surgical investigations, in a large group of patients affected by drug-resistant partial epilepsy.

METHODS

The occurrence of TIRDA was investigated using a prolonged Video-EEG recording of 129 patients affected by drug-resistant partial epilepsy that underwent a non-invasive pre-surgical protocol. Patients were divided into 3 groups: TLE only, extratemporal epilepsy, and multilobar epilepsy including temporal lobe. According to the epileptogenic zone identified using anatomo-clinical-radiological correlations, 3 different subgroups of TLE were identified: mesial, lateral, and mesio-lateral. Statistical analysis was performed in order to evaluate the relationship between TIRDA and the epileptogenic zone, and neuroradiological, neuropathological, EEG interictal and ictal findings.

RESULTS

The pattern of TIRDA was observed in 52 out of the 129 (40.3%) patients studied. Significant correlations were found between TIRDA and: (i) mesial and mesio-lateral TLE; (ii) mesial temporal sclerosis; (iii) interictal epileptiform discharge localized over the anterior temporal regions; and (iv) 5-9 Hz temporal ictal discharge.

CONCLUSIONS

Our research shows that TIRDA plays a role in localizing the epileptogenic zone, suggesting that this pattern might be considered as an EEG marker of an epileptogenesis that involves the mesial structures of the temporal lobe. However, further studies investigating the relationship between intracranial EEG monitoring and simultaneous scalp EEG recording are needed in order to confirm our findings and improve our understanding of the significance of TIRDA.

Simultaneous EEG-Correlated Ictal fMRI

The ability to continuously acquire simultaneous EEG and fMRI data during seizures presents a formidable challenge both clinically and technically. Published ictal fMRI reports have so far been unable to benefit from simultaneous electrographic recordings and remain largely assumptive. Unique findings from a Continuous EEG-correlated fMRI experiment are presented in which a focal subclinical seizure was captured in its entirety. For the first time dynamic and biphasic Blood Oxygen Level Dependent (BOLD) signal changes are shown using statistical parametric mapping time-locked to the ictal EEG activity localizing seizure generation and propagation sites, with millimeter resolution, to electroclinically concordant gray matter structures. Though presently of limited clinical applicability, a new avenue is opened for further research.

Role of functional magnetic resonance imaging in the evaluation of patients with malformations caused by cortical development

As functional MR imaging (fMRI) continues to offer unparalleled advantages in probing neural activity, diagnostic applications continue to flourish. The evaluation of malformations caused by abnormalities of cortical development is an area in which fMRI has an emerging role and potential to provide new insights into epileptogenesis through multimodal integration with electroencephalagraphy. The clinical impact, however, is just beginning to be felt as new data emerge.

Rapid self-paced event-related functional MRI: feasibility and implications of stimulus- versus response-locked timing

Many cognitive paradigms require self-paced responses or examine events that occur at unpredictable times. To explore whether functional MRI (fMRI) can accommodate such paradigms, a method allowing rapid, unpredictable trial pacing was developed and tested on 17 subjects using activation of the motor network as a model. Trial onset was determined solely by the subjects' self-paced responses and trials occurred, on average, less than 2 s apart. The hemodynamic response was estimated both in relation to stimulus onset (stimulus-locked) and in relation to behavioral response time (response-locked). Results yielded robust activation maps and hemodynamic response estimates. Specifically, significant activation in motor cortex, supplementary motor area (SMA), and cerebellum was observed both at the group and at the individual-subject level, confirming predicted patterns of brain activity. Moreover, the self-paced design resulted in even temporal sampling of the hemodynamic response across the image acquisition, allowing estimation of response parameters. Stimulus-locked analysis demonstrated strong correlation between hemodynamic- and behavioral-response timing both within and across subjects. Conversely, response-locked analysis showed minimal correlation with behavioral timing, suggesting effective resynchronization of the timing parameters. These results demonstrate fMRI procedures that can accommodate rapid, arbitrarily timed events and, in doing so, provide precise temporal estimates of the hemodynamic response.

Influence of EEG electrodes on the BOLD fMRI signal

Measurement of the EEG during fMRI scanning can give rise to image distortions due to magnetic susceptibility, eddy currents or chemical shift artifacts caused by certain types of EEG electrodes, cream, leads, or amplifiers. Two different creams were tested using MRS and T2* measurements, and we found that the one with higher water content was superior. This study introduces an index that quantifies the influence of EEG equipment on the BOLD fMRI signal. This index can also be used more generally to measure the changes in the fMRI signal due to the presence of any type of device inside (or outside) of the field of view (e.g., with fMRI and diffuse optical tomography, infrared imaging, transcranial magnetic stimulation, ultrasound imaging, etc.). Quantitative noise measurements are hampered by the normal variability of functional activation within the same subject and by the different slice profiles obtained when inserting a subject multiple times inside a MR imaging system. Our measurements account for these problems by using a matched filtering of cortical surface maps of functional activations. The results demonstrate that the BOLD signal is not influenced by the presence of EEG electrodes when using a properly constructed MRI compatible recording cap.

Functional MRI with simultaneous EEG recording: feasibility and application to motor and visual activation

The possibility of combining the high spatial resolution of functional magnetic resonance imaging (fMRI) with the high temporal resolution of electroencephalography (EEG) may provide a new tool in cognitive neurophysiology, as well as in clinical applications such as epilepsy. However, the simultaneous recording of EEG and fMRI raises important practical problems: 1) the patients' safety, in particular the risk of skin burns due to electrodes heating; 2) the impairment of the EEG recording by the static magnetic field, as well as by RF and magnetic field gradients used during MRI; and 3) the quality of MR images, which may be affected by the presence of conductors and electronic devices in the MRI bore. Here we present our experiences on 19 normal volunteers who underwent combined fMRI and 16-channel EEG examination. Consistent with previous reports, safety could be assured when performing EEG recordings during fMRI acquisition. Electrophysiological signals recorded with surface EEG were similar inside and outside the 1.5 T magnet. Furthermore, fMRI using motor or visual tasks revealed similar areas of activation when performed with and without 16-channel EEG recording. J. Magn. Reson. Imaging 2001;13:943-948.

Spatiotemporal Brain Imaging of Visual-Evoked Activity Using Interleaved EEG and fMRI Recordings

Combined analysis of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) has the potential to provide higher spatiotemporal resolution than either method alone. In some situations, in which the activity of interest cannot be reliably reproduced (e.g., epilepsy, learning, sleep states), accurate combined analysis requires simultaneous acquisition of EEG and fMRI. Simultaneous measurements ensure that the EEG and fMRI recordings reflect the exact same brain activity state. We took advantage of the spatial filtering properties of the bipolar montage to allow recording of very short (125--250 ms) visual-evoked potentials (VEPs) during fMRI. These EEG and fMRI measurements are of sufficient quality to allow source localization of the cortical generators. In addition, our source localization approach provides a combined EEG/fMRI analysis that does not require any manual selection of fMRI activations or placement of source dipoles. The source of the VEP was found to be located in the occipital cortex. Separate analysis of EEG and fMRI data demonstrated good spatial overlap of the observed activated sites. As expected, the combined EEG/fMRI analysis provided better spatiotemporal resolution than either approach alone. The resulting spatiotemporal movie allows for the millisecond-to-millisecond display of changes in cortical activity caused by visual stimulation. These data reveal two peaks in activity corresponding to the N75 and the P100 components. This type of simultaneous acquisition and analysis allows for the accurate characterization of the location and timing of neurophysiological activity in the human brain.

Current trends in electroencephalography

Several recent articles re-emphasize the value of clinical electrophysiology: in localizing epileptogenesis, predicting effectiveness of epilepsy surgery, and disclosing a mechanism of benign Rolandic epilepsy of childhood.A review of the role of EEG in the diagnosis of epilepsy indicated that epileptiform activity will appear in 50% of initial awake recordings of adults with epilepsy and in 85% of subjects undergoing two recordings. This contrasts with the appearance of spikes in only 4 of 1000 normal persons. Several studies focused on the value of electroencephalography in extratemporal epilepsy: 62% of patients with neocortical epilepsy had at least one localizing ictal EEG; occipital and temporal neocortical seizures were localized in a greater proportion than frontal or parietal attacks. Interictal spikes, if unifocal, always arose from the epileptogenic region in a study of their seizure localizing value. Such congruence augured for better seizure control by focal resection in two studies reviewed herein. Studies indicating the value of interictal temporal lobe spikes and scalp-recorded seizures in lateralising a temporal seizure focus are reviewed. One study found EEG to be slightly more reliable for lateralization of temporal epileptogenesis than MRI. In patients with benign Rolandic seizures, enhanced motor evoked potentials (MEPs) were obtained from transcranial magnetic stimulation when this was applied 50-80 msec after electrical stimulation of the thumb whereas this interval inhibited the MEP in normal subjects. This suggests that afferent cutaneous input abnormally and synchronously activates a large population of sensory neurons; such activation is subsequently transmitted to the motor cortex to produce the focal spikes in this condition.Finally, advances in non-invasive technology have redefined and limited the need for invasive monitoring in children with intractable seizure disorders.