Magnetoencephalographic representation of the sensorimotor hand area in cases of intracerebral tumour

Comparing the efficacy of awake and sedated MEG to TMS in mapping hand sensorimotor cortex in a clinical cohort

Non-invasive methods such as Transcranial Magnetic Stimulation (TMS) and magnetoencephalography (MEG) aid in the pre-surgical evaluation of patients with epilepsy or brain tumor to identify sensorimotor cortices. MEG requires sedation in children or patients with developmental delay. However, TMS can be applied to awake patients of all ages with any cognitive abilities. In this study, we compared the efficacy of TMS with MEG (in awake and sedated states) in identifying the hand sensorimotor areas in patients with epilepsy or brain tumors. We identified 153 patients who underwent awake- (n = 98) or sedated-MEG (n = 55), along with awake TMS for hand sensorimotor mapping as part of their pre-surgical evaluation. TMS involved stimulating the precentral gyrus and recording electromyography responses, while MEG identified the somatosensory cortex during median nerve stimulation. Awake-MEG had a success rate of 92.35 % and TMS had 99.49 % (p-value = 0.5517). However, in the sedated-MEG cohort, TMS success rate of 95.61 % was significantly higher compared to MEG's 58.77 % (p-value = 0.0001). Factors affecting mapping success were analyzed. Logistic regression across the entire cohort identified patient sedation as the lone significant predictor, contrary to age, lesion, metal, and number of antiseizure medications (ASMs). A subsequent analysis replaced sedation with anesthetic drug dosage, revealing no significant predictors impacting somatosensory mapping success under sedation. This study yields insights into the utility of TMS and MEG in mapping hand sensorimotor cortices and underscores the importance of considering factors that influence eloquent cortex mapping limitations during sedation.

Localisation of eloquent cortex using magnetoencephalography and its clinical implications

OBJECTIVES

This study aimed to localise the eloquent cortex and measure evoked field (EF) parameters using magnetoencephalography in patients with epilepsy and tumours near the eloquent cortex.

METHODS

A total of 41 patients (26 with drug-refractory epilepsy and 15 with tumours), with a mean age of 33 years, were recruited. Visual evoked field (VEF), auditory evoked field (AEF), sensory evoked field (SSEF), and motor-evoked field (MEF) latencies, amplitudes, and localisation were compared with those of a control population. Subgroup analyses were performed based on lobar involvement. Evoked Field parameters on the affected side were compared with those on the opposite side. The effect of distance from the lesion on nearby and distant evoked fields was evaluated.

RESULTS

AEF and VEF amplitudes and latencies were reduced bilaterally (p < 0.05). Amplitude in the ipsilateral SSEF was reduced by 29.27% and 2.16% in the AEF group compared to the contralateral side (p = 0.02). In patients with temporal lobe lesions, the SSEF amplitude was reduced bilaterally (p < 0.02), and latency was prolonged compared with controls. The MEF amplitude was reduced and latency was prolonged in patients with frontal lobe lesions (p = 0.01). EF displacement was 32%, 57%, 21%, and 16% for AEF, MEF, VEF, and SSEF respectively. Patients in the epilepsy group had distant EF abnormalities.

CONCLUSIONS

EF amplitude was reduced and latency was prolonged in the involved hemisphere. Distant EF amplitudes were more affected than latencies in epilepsy. Amplitude and distance from the lesion had negative correlation for all EF. EF changes indicated eloquent cortical displacement which may not be apparent on MRI.

Retrospective comparison of motor and somatosensory MEG mapping-Considerations for better clinical applications

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MEG is a clinically validated tool for presurgical functional mapping.

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The success rate for MEG somatosensory and motor mapping is not fully known.

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Comprehensive mapping protocols increase the accuracy of sensorimotor mapping.

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Major sources of mapping failures include low SNR, magnetic artifacts, and motion.

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Recommendations for improving mapping success rates in the future are discussed.

While magnetoencephalography (MEG) has proven to be a valuable and reliable tool for presurgical functional mapping of eloquent cortices for at least two decades, widespread use of this technique by clinicians has remained elusive. This modest application may be attributable, at least in part, to misunderstandings regarding the success rate of such mapping procedures, as well as the primary sources contributing to mapping failures. To address this, we conducted a retrospective comparison of sensorimotor functional mapping success rates in 141 patients with epilepsy and 75 tumor patients from the Center for MEG in Omaha, NE. Neurosurgical candidates either completed motor mapping (i.e., finger tapping paradigm), somatosensory mapping (i.e., peripheral stimulation paradigm), or both motor and somatosensory protocols during MEG. All MEG data underwent subsequent time-domain averaging and source localization of left and right primary motor (M1) and somatosensory (S1) cortices was conducted using a single equivalent dipole model. Successful mapping was determined based on dipole goodness of fit metrics ∼ 95%, as well as an accurate and conceivable spatial correspondence to precentral and postcentral gyri for M1 and S1, respectively. Our results suggest that mapping M1 in epilepsy and tumor patients was on average 94.5% successful, when patients only completed motor mapping protocols. In contrast, mapping S1 was successful 45–100% of the time in these patient groups when they only completed somatosensory mapping paradigms. Importantly, Z-tests for independent proportions revealed that the percentage of successful S1 mappings significantly increased to ∼ 94% in epilepsy patients who completed both motor/somatosensory mapping protocols during MEG. Together, these data suggest that ordering more comprehensive mapping procedures (e.g., both motor and somatosensory protocols for a collective sensorimotor network) may substantially increase the accuracy of presurgical functional mapping by providing more extensive data from which to base interpretations. Moreover, clinicians and magnetoencephalographers should be considerate of the major contributors to mapping failures (i.e., low SNR, excessive motion and magnetic artifacts) in order to further increase the percentage of cases achieving successful mapping of eloquent cortices.

Localized N20 Component of Somatosensory Evoked Magnetic Fields in Frontoparietal Brain Tumor Patients Using Noise-Normalized Approaches

PURPOSE

To localize sensorimotor cortical activation in 10 patients with frontoparietal tumors using quantitative magnetoencephalography (MEG) with noise-normalized approaches.

MATERIAL AND METHODS

Somatosensory evoked magnetic fields (SEFs) were elicited in 10 patients with somatosensory tumors and in 10 control participants using electrical stimulation of the median nerve via the right and left wrists. We localized the N20m component of the SEFs using dynamic statistical parametric mapping (dSPM) and standardized low-resolution brain electromagnetic tomography (sLORETA) combined with 3D magnetic resonance imaging (MRI). The obtained coordinates were compared between groups. Finally, we statistically evaluated the N20m parameters across hemispheres using non-parametric statistical tests.

RESULTS

The N20m sources were accurately localized to Brodmann area 3b in all members of the control group and in seven of the patients; however, the sources were shifted in three patients relative to locations outside the primary somatosensory cortex (SI). Compared with the affected (tumor) hemispheres in the patient group, N20m amplitudes and the strengths of the current sources were significantly lower in the unaffected hemispheres and in both hemispheres of the control group. These results were consistent for both dSPM and sLORETA approaches.

CONCLUSION

Tumors in the sensorimotor cortex lead to cortical functional reorganization and an increase in N20m amplitude and current-source strengths. Noise-normalized approaches for MEG analysis that are integrated with MRI show accurate and reliable localization of sensorimotor function.

Fully automated quality assurance and localization of volumetric MEG for single-subject mapping

BACKGROUND

Robust and reproducible source mapping with magnetoencephalography is particularly challenging at the individual level. We evaluated a receiver-operating characteristic reliability (ROC-r) method for automated production of volumetric MEG maps in single-subjects. ROC-r provides quality assurance comparable to that offered by goodness-of-fit (GoF) and confidence volume (CV) for equivalent current dipole (ECD) modeling.

NEW METHOD

ROC-r utilizes within-session reproducibility for quality assurance, latency identification, and thresholding of volumetric source maps. We tested ROC-r on simulated and real MEG with a strongly focal source, using somatosensory evoked fields (SEFs) elicited by bilateral median nerve stimulation (MNS). For quality assurance, the ROC-r reliable fraction (FR) was compared to the ECD GoF and CV. Peak beamformer locations and latencies identified by ROC-r were compared to the ECD for co-localization accuracy.

RESULTS

The predominant component of the SEF response occurred around 35ms, contralateral to the MNS.

COMPARISON WITH EXISTING METHODS

FR and 1/CV were more strongly correlated (mean Pearson's correlation: 0.76; 95% CI 0.60-0.87) than FR and GoF (0.65; 95% CI 0.32-0.85). There was no difference in the latency of the peak GoF (35.0+/-0.6ms), CV (34.8+/-0.7ms) and FR (35.5+/-0.8ms). The ECD fits and ROC-r peaks co-localized to within a mean (median) distance of 8.3+/-5.9mm (6.2mm).

CONCLUSION

ROC-r volumetric mapping co-localized closely with the standard ECD approach. This analysis can be added to any whole-brain MEG source imaging protocol, and is especially useful for single-subject mapping. Additionally, the development of FR as an analogue to GoF or CV for volumetric mapping is a critical improvement for clinical applications.

Altered Rolandic gamma-band activation associated with motor impairment and ictal network desynchronization in childhood epilepsy

Epilepsy is associated with an abnormal expression of neural oscillations and their synchronization across brain regions. Oscillatory brain activation and synchronization also play an important role in cognition, perception and motor control. Childhood epilepsy is associated with a variety of cognitive and motor deficits, but the relationship between altered functional brain responses in various frequency ranges and functional impairment in these children remains poorly understood. We investigated functional magnetoencephalographic (MEG) responses from motor cortex in multiple functionally relevant frequency bands following median nerve stimulation in twelve children with epilepsy, including four children with motor impairments. We demonstrated that children with motor impairments exhibit an excessive gamma-band response from Rolandic cortex, and that the magnitude of this Rolandic gamma response is negatively associated with motor function. Abnormal responses from motor cortex were also associated with ictal desynchronization of oscillations within Rolandic cortex measured using intracranial EEG (iEEG). These results provide the evidence that ictal disruption of motor networks is associated with an altered functional response from motor cortex, which is in turn associated with motor impairment.

Intraoperative confirmation of hand motor area identified preoperatively by magnetoencephalography

BACKGROUND

Presurgical functional mapping using magnetoencephalography (MEG) has been performed for somatosensory, auditory and visual functions; however, the traditional analysis method utilizing dipole source analysis has some inherent limitations when applied to the mapping of cortical motor areas. Recently, a novel source reconstruction algorithm [event-related synthetic aperture magnetometry (erSAM)] has demonstrated success for the localization of motor function in healthy adults. We applied this technique to preoperatively map motor function in a young patient. We then confirmed our mapping with direct cortical stimulation intraoperatively.

METHODS

This is a case report of an 8-year-old girl with right hand and arm weakness and poor right hand motor control secondary to a left peri-rolandic tumor. Preoperatively, whole-head MEG was recorded while the patient performed a self-paced button pressing task. Cortical activity associated with the onset of movement was localized to the right hand precentral gyrus superior and medial to the tumor using erSAM, while sensory function was localized posterior to the tumor on the postcentral gyrus.

RESULTS

Intraoperative direct cortical stimulation of the motor area identified by MEG resulted in electromyographic activation of intrinsic muscles of the contralateral hand exclusively.

CONCLUSIONS

This is the first report of a case where direct cortical stimulation has confirmed a motor cortical location identified by the erSAM method.

MAGNETOENCEPHALOGRAPHIC STUDY OF POSTERIOR TIBIAL NERVE STIMULATION IN PATIENTS WITH INTRACRANIAL LESIONS AROUND THE CENTRAL SULCUS

OBJECTIVE

To study interhemispheric differences of somatosensory evoked field (SEF) characteristics and the spatial distribution of equivalent current dipole sources in patients with unilateral hemispheric lesions around the central sulcus region.

METHODS

In 17 patients with perirolandic lesions, averaged somatosensory responses after posterior tibial nerve stimulation at the ankle were recorded with magnetoencephalography. Dipole source solutions in the affected (AH) and unaffected (UH) hemispheres were analyzed and compared for latency, equivalent current dipole strength, root mean square, and spatial distribution in relation to clinical findings.

RESULTS

Three main SEF components, P45m, N60m, and P75m, were identified in the hemisphere contralateral to the stimulated nerve. Dipole strength for the P45m component was significantly higher in the AH compared with the UH. SEF characteristics in the AH and UH showed no significant differences with respect to component latency or dipole strength of the N60m and P75m components. Interdipole location asymmetries exceeded 1.0 cm in 71% of the patients. Comparison of the posterior tibial nerve evoked responses (P45m and N60m) in patients with motor deficits and patients without deficits showed that these responses are enlarged in the AH when perirolandic lesions are present. Patients with motor deficits also showed an increased response for P45m in the UH.

CONCLUSION

The results of posterior tibial nerve SEFs suggest spatial and functional changes in the somatosensory network as a result of perirolandic lesions with a possible relationship with clinical symptoms. The results can provide further basis for the evaluation of cortical changes in the presence of perirolandic lesions.

Motor field sensitivity for preoperative localization of motor cortex

OBJECT

In this study the role of magnetic source imaging for preoperative motor mapping was evaluated by using a single-dipole localization method to analyze motor field data in 41 patients.

METHODS

Data from affected and unaffected hemispheres were collected in patients performing voluntary finger flexion movements. Somatosensory evoked field (SSEF) data were also obtained using tactile stimulation. Dipole localization using motor field (MF) data was successful in only 49% of patients, whereas localization with movement-evoked field (MEF) data was successful in 66% of patients. When the spatial distribution of MF and MEF dipoles in relation to SSEF dipoles was analyzed, the motor dipoles were not spatially distinct from somatosensory dipoles.

CONCLUSIONS

The findings in this study suggest that single-dipole localization for the analysis of motor data is not sufficiently sensitive and is nonspecific, and thus not clinically useful.