Current trends in electroencephalography

Automatic Recognition of High-Density Epileptic EEG Using Support Vector Machine and Gradient-Boosting Decision Tree

Background: Epilepsy (Ep) is a chronic neural disease. The diagnosis of epilepsy depends on detailed seizure history and scalp electroencephalogram (EEG) examinations. The automatic recognition of epileptic EEG is an artificial intelligence application developed from machine learning (ML). Purpose: This study compares the classification effects of two kinds of classifiers by controlling the EEG data source and characteristic values. Method: All EEG data were collected by GSN HydroCel 256 leads and high-density EEG from Xiangya Third Hospital. This study used time-domain features (mean, kurtosis and skewness processed by empirical mode decomposition (EMD) and three IMFs), a frequency-domain feature (power spectrum density, PSD) and a non-linear feature (Shannon entropy). Support vector machine (SVM) and gradient-boosting decision tree (GBDT) classifiers were used to recognize epileptic EEG. Result: The result of the SVM classifier showed an accuracy of 72.00%, precision of 73.98%, and an F1_score of 82.28%. Meanwhile, the result of the GBDT classifier showed a sensitivity of 98.57%, precision of 89.13%, F1_score of 93.40%, and an AUC of 0.9119. Conclusion: The comparison of GBDT and SVM by controlling the variables of the feature values and parameters of a classifier is presented. GBDT obtained the better classification accuracy (90.00%) and F1_score (93.40%).

Transient Cognitive Impairment in Epilepsy

Impairments of the dialog between excitation and inhibition (E/I) is commonly associated to neuropsychiatric disorders like autism, bipolar disorders and epilepsy. Moderate levels of hyperexcitability can lead to mild alterations of the EEG and are often associated with cognitive deficits even in the absence of overt seizures. Indeed, various testing paradigms have shown degraded performances in presence of acute or chronic non-ictal epileptiform activity. Evidences from both animal models and the clinics suggest that anomalous activity can cause cognitive deficits by transiently disrupting cortical processing, independently from the underlying etiology of the disease. Here, we will review our understanding of the influence of an abnormal EEG activity on brain computation in the context of the available clinical data and in genetic or pharmacological animal models.

Transitory effect of spike and spike-and-wave discharges on EEG power in children

BACKGROUND

Spikes and spike-and-wave discharges on the EEG of children are a strong biomarker of epilepsy. There is increasing evidence that these EEG abnormalities also impair brain function and result in transitory cognitive impairment. Studies in animal models have shown that EEG spikes alters single cell firing and that such impairment in firing may extend beyond the duration of the spike-and-wave discharge. Whether interictal epileptiform discharges have lasting effects on EEG activity in humans is not known.

METHODS AND RESULTS

The EEGs of 60 consecutive children with focal or interictal spike-and-wave discharges were evaluated using power spectral analysis to determine if there were any changes in power spectra from before to after the interictal abnormalities. Neither focal spike-and-wave nor generalized spike-and-wave discharges had any effect on the EEG frequency or spectral power following the discharge.

CONCLUSION

While interictal EEG discharges temporarily alter neural activity during the duration of the spike-and-wave discharge, there is no evidence that alterations of spectral power continue beyond the duration of the interictal discharge. The effects of interictal activity on EEG rhythms therefore appear to be quite transient and confined to the duration of the interictal discharge.

Ontogenetic influence on rat susceptibility to lindane seizure after pretreatment with phencyclidine

The aim of the study was to determine the effects of early postnatal PCP treatment on the sensitivity of pubertal and adult rats to lindane proepileptogenic effects. Rat pups were treated with NaCl (0.9%) or PCP (10 mg/kg) at postnatal days 2, 6, 9 and 12. One control (NaCl-35) and one experimental (PCP-35) group have received lindane (4 mg/kg) at postnatal day 35, while others received lindane at postnatal day 65 (NaCl-65 and PCP-65). One week prior to lindane treatment three gold-plated EEG electrodes were implanted. Pubertal rats had significantly shorter latency time. After lindane, a prompt increase in power spectral density seen in PCP-treated groups vs. control was evident earlier in PCP-65 rats. The theta waves were significantly increased in PCP-35 and alpha rhythm in PCP-65 rats, when compared with corresponding controls. Postnatal PCP treatment increases the synchronization of brain electrical activity, thus contributing to the increased susceptibility to lindane.

Spontaneous EEG-Functional MRI in Mesial Temporal Lobe Epilepsy: Implications for the Neural Correlates of Consciousness

The combination of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) has been shown to have great potential for providing a greater understanding of normal and diseased states in both human and animal studies. Simultaneous EEG-fMRI is particularly well suited for the study of epilepsy in that it may reveal the neurobiology of ictal and interictal epileptiform discharges and noninvasively localize epileptogenic foci. Spontaneous, coherent fluctuations of neuronal activity and the coupled hemodynamic responses have also been shown to provide diagnostic markers of disease, extending our understanding of intrinsically structured ongoing brain activity. Following a short summary of the hardware and software development of simultaneous EEG-fMRI, this paper reviews a unified framework of integrating neuronal and hemodynamic processes during epileptic seizures and discusses the role and impact of spontaneous activity in the mesial temporal lobe epilepsies with particular emphasis on the neural and physiological correlates of consciousness.

Comparison of three methods for localizing interictal epileptiform discharges with magnetoencephalography

PURPOSE

To compare three methods of localizing the source of epileptiform activity recorded with magnetoencephalography: equivalent current dipole, minimum current estimate, and dynamic statistical parametric mapping (dSPM), and to evaluate the solutions by comparison with clinical symptoms and other electrophysiological and neuroradiological findings.

METHODS

Fourteen children of 3 to 15 years were studied. Magnetoencephalography was collected with a whole-head 204-channel helmet-shaped sensor array. We calculated equivalent current dipoles and made minimum current estimate and dSPM movies to estimate the cortical distribution of interictal epileptiform discharges in these patients.

RESULTS

The results for four patients with localization-related epilepsy and one patient with Landau-Kleffner Syndrome were consistent among all the three analysis methods. In the rest of the patients, minimum current estimate and dSPM suggested multifocal or widespread activity; in these patients, the equivalent current dipole results were so scattered that interpretation of the results was not possible. For 9 patients with localization-related epilepsy and generalized epilepsy, the epileptiform discharges were wide spread or only slow waves, but dSPM suggested a possible propagation path of the interictal epileptiform discharges.

CONCLUSION

Minimum current estimate and dSPM could identify the propagation of epileptiform activity with high temporal resolution. The results of dSPM were more stable because the solutions were less sensitive to background brain activity.

Interictal spikes in developing rats cause long-standing cognitive deficits

Frequent interictal spikes are a common finding in the electroencephalograms of children with epileptic encephalopathies. While it is well recognized that interictal spikes are a biological marker of seizures and can lead to transitory cognitive impairment, whether interictal spikes can result in long-standing adverse effects on learning and memory in children is not known. Here we investigated the consequences of interictal spikes in rat pups without seizures on long-term learning and memory. Rat pups were given a low dose of flurothyl for 4h for 10 days during continuous electroencephalographic monitoring. Rats developed interictal spikes without seizures while age-matched controls under similar testing conditions had few interictal spikes. When rats were tested as adults, there was impairment in reference memory in the probe test of the Morris water maze, reference memory impairment in the four-trial radial-arm water maze and impaired long-term potentiation. Early-life interictal spikes resulted in impaired new cell formation and decreased cell counts in the hippocampus but did not cause an increase in apoptosis. This study, for the first time demonstrates that interictal spikes in rat pups without seizures can result in long-standing spatial cognitive impairment. Our findings suggest that suppressing IIS may be as important as treating seizures during brain development.

Heterogeneous neuronal firing patterns during interictal epileptiform discharges in the human cortex

Epileptic cortex is characterized by paroxysmal electrical discharges. Analysis of these interictal discharges typically manifests as spike-wave complexes on electroencephalography, and plays a critical role in diagnosing and treating epilepsy. Despite their fundamental importance, little is known about the neurophysiological mechanisms generating these events in human focal epilepsy. Using three different systems of microelectrodes, we recorded local field potentials and single-unit action potentials during interictal discharges in patients with medically intractable focal epilepsy undergoing diagnostic workup for localization of seizure foci. We studied 336 single units in 20 patients. Ten different cortical areas and the hippocampus, including regions both inside and outside the seizure focus, were sampled. In three of these patients, high density microelectrode arrays simultaneously recorded between 43 and 166 single units from a small (4 mm x 4 mm) patch of cortex. We examined how the firing rates of individual neurons changed during interictal discharges by determining whether the firing rate during the event was the same, above or below a median baseline firing rate estimated from interictal discharge-free periods (Kruskal-Wallis one-way analysis, P<0.05). Only 48% of the recorded units showed such a modulation in firing rate within 500 ms of the discharge. Units modulated during the discharge exhibited significantly higher baseline firing and bursting rates than unmodulated units. As expected, many units (27% of the modulated population) showed an increase in firing rate during the fast segment of the discharge (+ or - 35 ms from the peak of the discharge), while 50% showed a decrease during the slow wave. Notably, in direct contrast to predictions based on models of a pure paroxysmal depolarizing shift, 7.7% of modulated units recorded in or near the seizure focus showed a decrease in activity well ahead (0-300 ms) of the discharge onset, while 12.2% of units increased in activity in this period. No such pre-discharge changes were seen in regions well outside the seizure focus. In many recordings there was also a decrease in broadband field potential activity during this same pre-discharge period. The different patterns of interictal discharge-modulated firing were classified into more than 15 different categories. This heterogeneity in single unit activity was present within small cortical regions as well as inside and outside the seizure onset zone, suggesting that interictal epileptiform activity in patients with epilepsy is not a simple paroxysm of hypersynchronous excitatory activity, but rather represents an interplay of multiple distinct neuronal types within complex neuronal networks.

Hippocampal interictal spikes disrupt cognition in rats

OBJECTIVE

Cognitive impairment is common in epilepsy, particularly in memory function. Interictal spikes (IISs) are thought to disrupt cognition, but it is difficult to delineate their contribution from general impairments in memory produced by etiology and seizures. We investigated the transient impact of focal IISs on the hippocampus, a structure crucial for learning and memory and yet highly prone to IISs in temporal lobe epilepsy (TLE).

METHODS

Bilateral hippocampal depth electrodes were implanted into 14 Sprague-Dawley rats, followed by intrahippocampal pilocarpine or saline infusion unilaterally. Rats that developed chronic spikes were trained in a hippocampal-dependent operant behavior task, delayed-match-to-sample. Depth-electroencephalogram (EEG) was recorded during 5,562 trials among five rats, and within-subject analyses evaluated the impact of hippocampal spikes on short-term memory operations.

RESULTS

Hippocampal spikes that occurred during memory retrieval strongly impaired performance (p < 0.001). However, spikes that occurred during memory encoding or memory maintenance did not affect performance in those trials. Hippocampal spikes also affected response latency, adding approximately 0.48 seconds to the time taken to respond (p < 0.001).

INTERPRETATION

We found that focal IIS-related interference in cognition extends to structures in the limbic system, which required intrahippocampal recordings. Hippocampal spikes seem most harmful if they occur when hippocampal function is critical, extending human studies showing that cortical spikes are most disruptive during active cortical functioning. The cumulative effects of spikes could therefore impact general cognitive functioning. These results strengthen the argument that suppression of IISs may improve memory and cognitive performance in patients with epilepsy.

Ambulatory electroencephalography (EEG) in children: diagnostic yield and tolerability

Sixty-four children, aged 0-17 years, undergoing ambulatory electroencephalography (EEG) were prospectively recruited during a 12-month period. The diagnostic yield of ambulatory electroencephalography was determined for each of the following groups: group 1: differentiation of seizures from nonepileptic events; group 2: determination of seizure/interictal discharge frequency; and group 3: classification of seizure type or localization. The ambulatory electroencephalography answered the clinical question in 61% of group 1 (27/44) and 100% of groups 2 (16/16) and 3 (4/4). Of 44 cases in Group 1, clinical events were recorded in 61%; the ambulatory electroencephalography result changed the diagnosis from epileptic to nonepileptic or vice versa in 27%. When clinicians suspected that events were epileptic, ambulatory electroencephalography changed the clinical impression in 50%, whereas when events were suspected to be nonepileptic, ambulatory electroencephalography confirmed that impression in 83%.

The Impact of Cerebral Source Area and Synchrony on Recording Scalp Electroencephalography Ictal Patterns

PURPOSE

To determine the cerebral electroencephalography (EEG) substrates of scalp EEG seizure patterns, such as source area and synchrony, and in so doing assess the limitations of scalp seizure recording in the localization of seizure onset zones in patients with temporal lobe epilepsy.

METHODS

We recorded simultaneously 26 channels of scalp EEG with subtemporal supplementary electrodes and 46-98 channels of intracranial EEG in presurgical candidates with temporal lobe epilepsy. We correlated intracranial EEG source area and synchrony at seizure onset with the corresponding scalp EEG. Eighty-six simultaneous intracranial- and scalp-recorded seizures from 23 patients were evaluated.

RESULTS

Thirty-four intracranial ictal discharges (40%) from 9 patients (39%) had sufficient cortical source area (namely > 10 cm(2)) and synchrony at seizure onset to produce a simultaneous or nearly simultaneous focal scalp EEG ictal pattern. Forty-one intracranial ictal discharges (48%) from 10 patients (43%) gradually achieved the necessary source area and synchrony over several seconds to generate a scalp EEG ictal pattern. These scalp rhythms were lateralized, but not localizable as to seizure origin. Eleven intracranial ictal discharges (13%) from 4 patients (17%) recruited the necessary source area, but lacked sufficient synchrony to result in a clearly localized or lateralized scalp ictal pattern.

CONCLUSIONS

Sufficient source area and synchrony are mandatory cerebral EEG requirements for generating scalp-recordable ictal EEG patterns. The dynamic interaction of cortical source area and synchrony at the onset and during a seizure is a primary reason for heterogeneous scalp ictal EEG patterns.

The frequency-amplitude gradient in the sleep EEG of children and its diagnostic significance

OBJECTIVE

1014 EEGs of children in the 3-months to 12-years age group were obtained during sleep with the purpose of assessing the frequency and amplitude gradient (FAG) its absence thought to be an indicator of neurological disorder.

METHOD

FAG findings were divided into present/absent. The neurological findings were classified according to the presence (abnormal neurological finding-ANF) or absence (normal neurological finding-NNF) of neurological disorder. The association and significance between FAG and neurological findings was determined by prevalence ration (PR) and chi-square test (chi2).

RESULTS

FAG showed a characteristic distributions of voltage output during non-REM sleep, stage II, in the 3-months to 5-years age group with NNF. The PR and the chi2 test demonstrated a strong association between FAG absent and ANF.

CONCLUSION

FAG is an age-dependent EEG sleep parameter and absence of FAG in the 3-months to 5-years age group is highly suggestive of neurological disorder.

Do skull base lesions and their surgical treatment cause epileptic seizures?

OBJECTIVES

Few reports exist on the risk of seizures with skull base lesions and their surgical treatment.

PATIENTS AND METHODS

All patients referred for surgery of a skull base lesion at George Washington University Hospital from January 1998 to August 1999 were reviewed. After excluding patients with other risk factors 136 patients were included.

RESULTS

No seizures were reported before or after surgery, but 59 patients (43%) were taking anticonvulsants. Only 17 (12.5%) had EEG. Four of these showed no abnormalities, 2 were abnormal without sharp waves and 11 had sharp waves (an increase compared to the general population). Most sharp waves affected the temporal lobe on the side of surgery. All EEGs were performed less than 4 months after surgery.

CONCLUSION

This study does not indicate that seizures are common in this patient group, but there was an increased amount of epileptiform activity on EEG and many patients were taking AED. A prospective study with systematic patient interviews, pre- and post-surgical EEG and a longer follow up is needed.

Effect of interictal spikes on single-cell firing patterns in the hippocampus

PURPOSE

The interictal EEG spike(s) is the hallmark of the epileptic EEG. While focal interictal spike (IS) have been associated with transitory cognitive impairment, with the type of deficit dependent on where in the cortex the IS arises, the mechanism by which IS result in transitory dysfunction is not known. The purpose of this study was to determine the effect of IS on single-cell firing patterns in freely moving rats with a prior history of seizures.

METHODS

We studied IS in two seizure models; pilocarpine-induced status epilepticus and recurrent flurothyl models. The effect of spontaneous hippocampal spikes on action potentials (APs) of CA1 cells in rats walking in a familiar environment was investigated using 32 extracellular electrodes. We also compared the effect of spikes on two types of hippcampal cells; place cells that discharge rapidly only when the rat's head is in a specific part of the environment, the so-called firing field, and interneurons, which are a main source of inhibition in the hippocampus.

RESULTS

IS were associated with a decreased likelihood of AP compared with IS-free portions of the record. Compared to pre-IS baseline, IS were followed by significant decreases in CA1 APs for periods up to 2 s following the IS in both models. When occurring in flurries, IS were associated with a pronounced decrease in APs. The response to IS was cell-dependent; IS resulted in decreases in AP firing after the IS in interneurons but not place cells.

CONCLUSIONS

This study demonstrates that IS have substantial effects on cellular firing in the hippocampus and that these effects last far longer than the spike and slow wave. Furthermore, the effect of IS on cellular firing was cell specific, affecting interneurons more than place cells. These findings suggest that IS may contribute to seizure-induced cognitive impairment by altering AP firing in a cell-specific manner.

Right parietal activation during delusional state in episodic interictal psychosis of epilepsy: a report of two cases

Magnetoencephalography (MEG) was used to image brain activity associated with delusions in episodic interictal psychosis of epilepsy. Two female patients aged 65 and 68 with temporal lobe epilepsy were studied during and after a delusional state. Topographic images of the excess kurtosis (g2), the statistical index of spikelike activity, were obtained from unaveraged MEG recordings using an analysis called "synthetic aperture magnetometry" (SAM). For both patients, MEG waveforms and excess kurtosis images revealed spiky activity in the right inferior parietal region during the delusional state. A second MEG measurement after delusions were resolved with antipsychotic therapy revealed no excess kurtosis in the right parietal area. Likewise, the sharp waves on MEG recordings disappeared as well. Our results suggest association of the right inferior parietal cortex, including the supramarginal gyrus, with the delusional state of episodic interictal psychosis of epilepsy.

Laminar analysis of human neocortical interictal spike generation and propagation: current source density and multiunit analysis in vivo

Multicontact microelectrodes were chronically implanted in epilepsy patients undergoing subdural grid implantation for seizure localization. Current source density and multiple unit activity of interictal spikes (IISs) were sampled every approximately 150 microm in a line traversing all layers of a cortical column. Our data suggest that interictal epileptiform events in humans are initiated by large postsynaptic depolarizations, consistent with the hypothesis that human IISs correspond to animal paroxysmal depolarization shifts. Furthermore, the cortical layer where the initial depolarization occurs may differ according to whether the IIS is locally generated or propagated from a distant location, and among the propagated IISs, whether the IIS is in the direct path of propagation or on the periphery of that path.

Sleep but not hyperventilation increases the sensitivity of the EEG in patients with temporal lobe epilepsy

PURPOSE

To evaluate the relative impact of 3 and 5 min of hyperventilation (HV) and different sleep stages on the sensitivity of the interictal EEG in focal epilepsy.

METHODS

We examined 20 patients with temporal lobe epilepsy (TLE, 85%) or extratemporal epilepsy during EEG-monitoring. We compared 6 min EEG (12 epochs of 30s) during/after each: (a) waking; (b) 5 or 3 min of HV; (c) sleep stages 1, 2, 3/4 and REM regarding the frequency of epileptiform discharges (ED). The Wilcoxon matched pairs signed rank test was used. The main endpoint was the comparison of 5 min of HV with sleep stage 2.

RESULTS

During sleep stage 2, ED were more frequent than during/after 5 min of HV (P=0.002). Compared to the waking EEG, all NREM-sleep stages activated ED. Sleep stage 2 was associated with the strongest activation. There was no difference between the waking state and REM-sleep. Compared to the waking EEG, neither 3 nor 5 min of HV showed an activation of ED.

CONCLUSION

In patients with TLE, sleep stage 2 shows a significantly higher sensitivity for ED than 5 min of HV. Compared to the waking EEG, HV showed no activating effect on ED. These results suggest that in patients with the clinical diagnosis of TLE (and possibly other focal epilepsies) measures to record sleep stage 2 (such as sleep deprivation) should be increased whereas HV appears to be dispensable in this setting.