Magnetographic assessment of fetal hiccups and their effect on fetal heart rhythm

Fetal hiccups emerge as early as nine weeks post-conception, being the predominant diaphragmatic movement before 26 weeks of gestation. They are considered as a programmed isometric inspiratory muscle exercise of the fetus in preparation for the post-natal respiratory function, or a manifestation of a reflex circuitry underlying the development of suckling and gasping patterns. The present paper provides the first evidence of non-invasive biomagnetic measurements of the diaphragm spasmodic contractions associated with fetal hiccups. The magnetic field patterns generated by fetal hiccups exhibit well-defined morphological features, consisting of an initial high frequency transient waveform followed by a more prolonged low frequency component. This pattern is consistent across recordings obtained from two fetal subjects, and it is confirmed by signals recorded in a neonatal subject. These results demonstrate that fetal biomagnetometry can provide insights into the electrophysiological mechanisms of diaphragm motor function in the fetus. Additionally, we study the correlation between hiccup events and fetal cardiac rhythm and provide evidence that hiccups may modulate the fetal heart rate during the last trimester of pregnancy.

Comparison of functional magnetic resonance imaging with positron emission tomography and magnetoencephalography to identify the motor cortex in a patient with an arteriovenous malformation

Alterations in gyral contour made it difficult to identify the motor cortex thought to be near an arteriovenous malformation (AVM) in a 24-year-old man considered for stereotactic radiosurgery. Functional imaging in three modalities was performed preoperatively to compare the reliability of localization using functional magnetic resonance imaging (fMRI) on a conventional scanner with positron emission tomography (PET) and magnetoencephalography (MEG). Similar tasks were used for each imaging modality in an attempt to activate and identify the sensory and motor cortex. Data from all three modalities converged for the sensory task, and fMRI and PET data converged for the motor task. The right hemisphere motor strip was localized adjacent and anterior to the AVM. These data were used in planning the radiosurgery isodose configuration to the AVM in order to reduce the irradiation of motor cortex parenchyma. A postoperative fMRI study was also performed using newer techniques to reduce head motion artifact and to improve signal-to-noise ratio. The data confirmed the conclusions derived from the preoperative evaluations. This study demonstrates how conventional MRI scanners can be used for functional studies of use in surgical planning.

Dynamic statistical parametric mapping: combining fMRI and MEG for high-resolution imaging of cortical activity

Functional magnetic resonance imaging (fMRI) can provide maps of brain activation with millimeter spatial resolution but is limited in its temporal resolution to the order of seconds. Here, we describe a technique that combines structural and functional MRI with magnetoencephalography (MEG) to obtain spatiotemporal maps of human brain activity with millisecond temporal resolution. This new technique was used to obtain dynamic statistical parametric maps of cortical activity during semantic processing of visually presented words. An initial wave of activity was found to spread rapidly from occipital visual cortex to temporal, parietal, and frontal areas within 185 ms, with a high degree of temporal overlap between different areas. Repetition effects were observed in many of the same areas following this initial wave of activation, providing evidence for the involvement of feedback mechanisms in repetition priming.

Magnetoencephalographic patterns of epileptiform activity in children with regressive autism spectrum disorders

BACKGROUND

One-third of children diagnosed with autism spectrum disorders (ASDs) are reported to have had normal early development followed by an autistic regression between the ages of 2 and 3 years. This clinical profile partly parallels that seen in Landau-Kleffner syndrome (LKS), an acquired language disorder (aphasia) believed to be caused by epileptiform activity. Given the additional observation that one-third of autistic children experience one or more seizures by adolescence, epileptiform activity may play a causal role in some cases of autism.

OBJECTIVE

To compare and contrast patterns of epileptiform activity in children with autistic regressions versus classic LKS to determine if there is neurobiological overlap between these conditions. It was hypothesized that many children with regressive ASDs would show epileptiform activity in a multifocal pattern that includes the same brain regions implicated in LKS.

DESIGN

Magnetoencephalography (MEG), a noninvasive method for identifying zones of abnormal brain electrophysiology, was used to evaluate patterns of epileptiform activity during stage III sleep in 6 children with classic LKS and 50 children with regressive ASDs with onset between 20 and 36 months of age (16 with autism and 34 with pervasive developmental disorder-not otherwise specified). Whereas 5 of the 6 children with LKS had been previously diagnosed with complex-partial seizures, a clinical seizure disorder had been diagnosed for only 15 of the 50 ASD children. However, all the children in this study had been reported to occasionally demonstrate unusual behaviors (eg, rapid blinking, holding of the hands to the ears, unprovoked crying episodes, and/or brief staring spells) which, if exhibited by a normal child, might be interpreted as indicative of a subclinical epileptiform condition. MEG data were compared with simultaneously recorded electroencephalography (EEG) data, and with data from previous 1-hour and/or 24-hour clinical EEG, when available. Multiple-dipole, spatiotemporal modeling was used to identify sites of origin and propagation for epileptiform transients.

RESULTS

The MEG of all children with LKS showed primary or secondary epileptiform involvement of the left intra/perisylvian region, with all but 1 child showing additional involvement of the right sylvian region. In all cases of LKS, independent epileptiform activity beyond the sylvian region was absent, although propagation of activity to frontal or parietal regions was seen occasionally. MEG identified epileptiform activity in 41 of the 50 (82%) children with ASDs. In contrast, simultaneous EEG revealed epileptiform activity in only 68%. When epileptiform activity was present in the ASDs, the same intra/perisylvian regions seen to be epileptiform in LKS were active in 85% of the cases. Whereas primary activity outside of the sylvian regions was not seen for any of the children with LKS, 75% of the ASD children with epileptiform activity demonstrated additional nonsylvian zones of independent epileptiform activity. Despite the multifocal nature of the epileptiform activity in the ASDs, neurosurgical intervention aimed at control has lead to a reduction of autistic features and improvement in language skills in 12 of 18 cases.

CONCLUSIONS

This study demonstrates that there is a subset of children with ASDs who demonstrate clinically relevant epileptiform activity during slow-wave sleep, and that this activity may be present even in the absence of a clinical seizure disorder. MEG showed significantly greater sensitivity to this epileptiform activity than simultaneous EEG, 1-hour clinical EEG, and 24-hour clinical EEG. The multifocal epileptiform pattern identified by MEG in the ASDs typically includes the same perisylvian brain regions identified as abnormal in LKS. When epileptiform activity is present in the ASDs, therapeutic strategies (antiepileptic drugs, steroids, and even neurosurgery) aimed at its control can lead to a significa

Neuromagnetic assessment of pathophysiologic brain activity induced by minor head trauma

BACKGROUND AND PURPOSE

Patients with mild traumatic brain injury (TBI) often show significant neuropsychological dysfunction despite the absence of abnormalities on traditional neuroradiologic examinations or EEG. Our objective was to determine if magnetic source imaging (MSI), using a combination of MR imaging and magnetoencephalography (MEG), is more sensitive than EEG and MR imaging in providing objective evidence of minor brain injury.

METHODS

Four subject groups were evaluated with MR, MSI, and EEG. Group A consisted of 20 neurologically normal control subjects without histories of head trauma. Group B consisted of 10 subjects with histories of mild head trauma but complete recovery. Group C consisted of 20 subjects with histories of mild head injury and persistent postconcussive symptoms. The 15 subjects included in group D underwent repeat examinations at an interval of 2 to 4 months.

RESULTS

No MR abnormalities were seen in the normal control group or the asymptomatic group, but five (20%) of the patients with persistent postconcussive symptoms had abnormal MR findings. EEG was abnormal for one subject (5%) from the normal control group, one (10%) from the asymptomatic group, and five (20%) from the group with persistent postconcussive symptoms. MSI was abnormal for one subject (5%) from the normal control group, one (10%) from the asymptomatic group, and 13 (65%) from the group with persistent postconcussive symptoms. There was a direct correlation between symptom resolution and MSI findings for the symptomatic head trauma group.

CONCLUSION

MSI indicated brain dysfunction in significantly more patients with postconcussive symptoms than either EEG or MR imaging (P < .01). The presence of excessive abnormal low-frequency magnetic activity provides objective evidence of brain injury in patients with postconcussive syndromes and correlates well with the degree of symptomatic recovery.

Integration of preoperative and intraoperative functional brain mapping in a frameless stereotactic environment for lesions near eloquent cortex. Technical note

The authors present a method of incorporating preoperative noninvasive functional brain mapping data into the frameless stereotactic magnetic resonance (MR) imaging dataset used for image-guided resection of brain lesions located near eloquent cortex. They report the use of functional (f)MR imaging and magnetic source (MS) imaging for preoperative mapping of eloquent cortex in difficult cases of brain tumor resection such as those in which there are large expansive masses or in which reoperations are required and the anatomy is distorted from prior treatments. To correlate methods of preoperative and intraoperative mapping localization directly, the authors have developed techniques of importing preoperative MS and fMR imaging data into an image-guided frameless stereotactic computer workstation. The data appear as a seamless overlay on the same preoperative volumetric MR imaging dataset used for stereotactic guidance during the operation. Intraoperatively identified functional locations mapped by cortical stimulation are recorded as digitally registered points. This approach should prove useful in assessing the accuracy and reliability of various preoperative functional brain mapping techniques.

A study of dipole localization accuracy for MEG and EEG using a human skull phantom

OBJECTIVE

To investigate the accuracy of forward and inverse techniques for EEG and MEG dipole localization.

DESIGN AND METHODS

A human skull phantom was constructed with brain, skull and scalp layers and realistic relative conductivities. Thirty two independent current dipoles were distributed within the 'brain' region and EEG and MEG data collected separately for each dipole. The true dipole locations and orientations and the morphology of the brain, skull and scalp layers were extracted from X-ray CT data. The location of each dipole was estimated from the EEG and MEG data using the R-MUSIC inverse method and forward models based on spherical and realistic head geometries. Additional computer simulations were performed to investigate the factors affecting localization accuracy.

RESULTS

Localization errors using the relatively simpler locally fitted sphere approach are only slightly greater than those using a BEM approach. The average localization error over the 32 dipoles was 7-8 mm for EEG and 3 mm for MEG.

CONCLUSION

The superior performance of MEG over EEG appears to be because the latter is more sensitive to errors in the forward model arising from simplifying assumptions concerning the conductivity of the skull, scalp and brain.

Spontaneous brain magnetic activity in schizophrenia patients treated with aripiprazole

This magnetoencaphalographic (MEG) study was conducted as part of a multicenter clinical trial to study the efficacy of aripiprazole. Participants included 5 DSM-IV schizophrenia subjects and 10 age-matched normal controls. The schizophrenia subjects underwent a second MEG recording after 8 weeks of open-label treatment with aripiprazole. Overall, control subjects showed no abnormal spontaneous magnetic brain activity. At washout, 3 patients showed increased delta and theta activity along with paraxosymal bitemporal slow waves. In 2 of these patients, the slow waves were generated in the superior temporal plane, as determined by dipole modeling. In the third patient, the slow waves appeared to have been generated at multiple regions throughout the temporal and inferior parietal lobes. As a group, schizophrenia patients, when compared with normal controls, demonstrated significant decreases in alpha peak frequency and power. Following treatment, aripiprazole had a significant normalizing effect on delta and theta activity. Patients on aripiprazole continued to demonstrate significant abnormalities in alpha frequency and power.

Spike and slow wave localization by magnetoencephalography

At institutions where MEG is available, it is now considered a standard part of the diagnostic workup of most patients with epilepsy. Available data indicate that interictal MEG can be an effective tool for localization of the epileptic irritative zone, and in some cases it can even indicate the seizure onset site. Both spike and ALFMA examinations are clinically viable because of the availability of large-array systems. The current cost of acquiring MEG technology is high (greater than 2 million dollars), but recent technical developments should soon yield more cost-effective systems. It is anticipated that the increasing applicability of this technology to conditions beyond epilepsy (e.g., head trauma, ischemic disease, dementia, and psychiatric dysfunction) will soon render MEG a critical element in the general armamentarium of diagnostic procedures available to epileptologists, radiologists, neurologists, neurosurgeons, and psychiatrists.

Mapping function in the human brain with magnetoencephalography, anatomical magnetic resonance imaging, and functional magnetic resonance imaging

Integrated analyses of human anatomical and functional measurements offer a powerful paradigm for human brain mapping. Magnetoencephalography (MEG) and EEG provide excellent temporal resolution of neural population dynamics as well as capabilities for source localization. Anatomical magnetic resonance imaging (MRI) provides excellent spatial resolution of head and brain anatomy, whereas functional MRI (fMRI) techniques provide an alternative measure of neural activation based on associated hemodynamic changes. These methodologies constrain and complement each other and can thereby improve our interpretation of functional neural organization. We have developed a number of computational tools and techniques for the visualization, comparison, and integrated analysis of multiple neuroimaging techniques. Construction of geometric anatomical models from volumetric MRI data allows improved models of the head volume conductor and can provide powerful constraints for neural electromagnetic source modeling. These approaches, coupled to enhanced algorithmic strategies for the inverse problem, can significantly enhance the accuracy of source-localization procedures. We have begun to apply these techniques for studies of the functional organization of the human visual system. Such studies have demonstrated multiple, functionally distinct visual areas that can be resolved on the basis of their locations, temporal dynamics, and differential sensitivity to stimulus parameters. Our studies have also produced evidence of internal retinotopic organization in both striate and extrastriate visual areas but have disclosed organizational departures from classical models. Comparative studies of MEG and fMRI suggest a reasonable but imperfect correlation between electrophysiological and hemodynamic responses. We have demonstrated a method for the integrated analysis of fMRI and MEG, and we outline strategies for improvement of these methods. By combining multiple measurement techniques, we can exploit the complementary strengths and transcend the limitations of the individual neuro-imaging methods.

Pediatric magnetic source imaging

Magnetic source imaging has changed the perspective of managing pediatric patients with epilepsy since its introduction into clinical imaging in the pediatric population. Magnetic source imaging can be important in understanding pediatric functional neuroanatomy and for epileptic surgery in children with intractable seizures. The use and efficacy of magnetic source imaging for surgical planning and patient management is demonstrated by case reports presented in this article.

Interhemispheric sharing of visual memory in macaques

(1) In macaques with the optic chiasm transected, and forebrain commissural communication limited to the anterior commissure or the posterior 5 mm of the splenium of the corpus callosum, visual patterns viewed initially by only one eye (hemisphere) are subsequently recognized by the other with normal accuracy. (2) The efficiency of these commissural paths is further indicated by the fact that even when as many as six "target" images are presented for memorization to only one hemisphere, it makes essentially no difference as to accuracy or latency of performance which hemisphere is then required to distinguish "target" from "non-target" images. (3) By electrically tetanizing structures in one or the other temporal lobe at various times in relation to visual input and/or mnemonic testing it could be shown: (a) that a memory trace restricted in its formation to a single hemisphere was available to the other via either forebrain commissure, and (b) that the memory is formed bilaterally despite unilateral input. (4) When the chiasm is split but the commissures are intact, simultaneous presentation of disparate images to each hemisphere severely perturbs performance, suggesting that the callosal system operates continuously to unify visual percepts; but when only the anterior commissure is intact, the two hemispheres accept incongruent images without perturbation. (5) In the fully "split-brain" condition, when one hemisphere cannot access memories held in the other, the accuracy of performance by each hemisphere is nevertheless burdened by the memory load of its neocortically disconnected partner. It can thus be inferred that the brainstem plays a critical, unifying role in this mnemonic process.

Neonatal hypoglycemia: CT and MR findings

A case of neonatal hypoglycemia with extensive occipital cortical loss is presented. Imaging studies revealed a predominance of brain parenchymal loss in the occipital lobes bilaterally with nearly complete absence of cortex in the posterior parietal and occipital regions and generalized thinning of the cortex throughout the brain.

Role of the forebrain commissures in bihemispheric mnemonic integration in macaques

A serial probe recognition task was used to examine the interhemispheric exchange of visual data in macaques. Each block of trials began with the memorization of one to six visual target images. The monkeys then had to determine, in tests that followed immediately, whether probe images were or were not members of the learned target set. Previous work with both humans and macaques has shown that the time required for the evaluation of probes generally increases, while response accuracy decreases, as a function of the number of targets, the "memory load". By testing animals with bisected optic chiasm, it was possible to direct visual information to only one hemisphere at a time, simply by occluding the opposite eye. In this fashion, the quality of intrahemispheric evaluations (in which a monocular probe was a match for a target previously viewed through the same eye) was compared with that of interhemispheric evaluations (in which a probe was a match for a target previously designated through the opposite eye). A key question was whether division of the target list between the hemispheres modified the relationships between reaction time, response accuracy, and memory load. Provided that either the anterior commissure or the splenium of the corpus callosum was intact, interhemispheric processing was only subtly less efficient than intrahemispheric processing. The ability to perform interhemispheric evaluations was selectively and completely disrupted if all forebrain commissural fibers were transected. In this latter split-brain condition, the time required for probe evaluations was, as expected, determined solely by the number of target items memorized by the probed hemisphere. Accuracy, however, was always a function of the total memory load, regardless of the distribution of targets between the hemispheres. This implies, first, that accuracy and latency do not reflect identical mnemonic factors, as frequently held, and second, that in mnemonic processing, the two hemispheres draw upon a unified, shared resource, probably allocated by the intact brainstem.

Cortical organization in adulthood is modified by neonatal infarct: a case study

PURPOSE

To assess anomalous cortical organization of somatosensory function in a 23-year-old man who had had a neonatal infarct involving the left middle cerebral artery.

MATERIALS AND METHODS

The infarct destroyed the primary and secondary somatosensory areas of the subject's left hemisphere but caused only mild perturbation of somatosensation on the right side of his body. With magnetic source imaging, the authors integrated magnetoencephalographic data with magnetic resonance imaging data to create magnetic source localization images that showed the mapping between brain function and structure.

RESULTS

Electrical stimulation of the right median nerve evoked activity in two nontraditional areas: (a) an intact region of the left inferior temporal gyrus and (b) the ipsilateral right medial parietal cortex.

CONCLUSION

These data suggest that bilateral neural reorganization can be induced by unilateral neonatal damage.

Magnetic source imaging: a review of the Magnes system of biomagnetic technologies incorporated

Magnetic source imaging (MSI) is a new, noninvasive technique for defining the relationship between brain function and structure on a patient-to-patient basis. It achieves this by combining detailed neurophysiological data derived from magnetoencephalography with high-quality neuroanatomical data derived via magnetic resonance imaging. By the use of mathematical models, the spatial locations of those neurons that generate neuromagnetic signals of interest are estimated and subsequently marked on spatially aligned magnetic resonance images. There are three prominent types of clinical MSI examinations. These are: 1) functional mapping examinations in which sensory and motor functions are localized; 2) examinations of interictal epileptiform activity; and 3) examinations of abnormal low-frequency magnetic activity, which has been found to be present in a wide range of pathophysiological conditions. Functional mapping provides useful information regarding the relationship between the cortical representation of eloquent function and the location of pathological lesions that may be surgically resectable. This application is of particular utility in cases of intracortical masses that distort and obscure the local neuroanatomy. By defining the primary sites of interictal epileptiform activity, MSI examinations are useful in the surgical planning for the implantation of depth electrodes and the planning of partial lobectomies. Abnormal low-frequency magnetic activity appears to be a neurophysiological correlate of ischemic penumbra associated with stroke, neoplasms, and vascular malformations. Abnormal low-frequency magnetic activity has also been found to be present in several other conditions, including head trauma and psychiatric dysfunction, although the exact pathophysiological mechanisms are presently unclear.(ABSTRACT TRUNCATED AT 250 WORDS)

Neuromagnetic mapping of brain function

Magnetic source imaging, a technique that combines magnetoencephalography (MEG) and magnetic resonance (MR) imaging, was used to localize the somatosensory and auditory cortex in seven healthy subjects. Functional neuromagnetic data were obtained with a 37-channel biomagnetometer. Structural MR imaging data were obtained with a 1.5-T superconducting imager. Coordinates used in defining MEG and MR imaging space were reconciled to produce magnetic source images that displayed the putative locations of somatosensory and auditory activity in relation to brain anatomy. Sources of somatosensory activity were typically localized to the postcentral gyrus; sources of auditory activity were localized to the superior temporal plane. Extension of these results to patients with tumors (or other disorders) that distort normal brain anatomy has the potential to make noninvasive magnetic source imaging examinations clinically useful in guiding neurosurgical interventional procedures.

Forebrain commissures and visual memory: a new approach

The primary purpose of these exploratory experiments was to determine: (1) whether the forebrain commissures can provide full accessibility of the mnemonic store to either hemisphere when the taks involves memory for 'events' (images) rather than, as in essentially all previous tests on split-brain animals, memory for 'rules' (discrimination habits); and (2) whether the anterior commissure (AC) alone is capable of such function. Macaques, with optic chiasm transected to allow limitation of direct visual input to one or the other hemisphere, were trained on tasks requiring recognition of previously viewed photographic slides. For one task, delayed-matching-to-sample (DMTS), the animal was presented with a 'sample' image, and then 0-15s later was required to choose that image in preference to a second image concurrently displayed. On the other task, running recognition (RR), a series of images was presented, some of which were repetitions of images previously seen in that session, and the animal was required to signal its recognition of these repetitions. For either task the initial presentation could be made to one eye and hemisphere, and subsequent recognition required of the other. In such circumstance, if all forebrain commissures were divided, such interhemispheric recognition was no longer possible. For the DMTS task if either the AC or 5 mm of the splenium of the corpus callosum were available, interhemispheric recognition was basically equivalent to that using the same eye and hemisphere. However, interhemispheric accuracy with the RR task, while well above chance levels, was consistently inferior to that achieved intrahemispherically when complex scenes or objects were viewed. This is probably a consequence mostly of the differing visual fields of the two eyes, since interhemispheric accuracy was greatly improved by use of images having approximately identical right and left halves. No consistent hemispheric specialization nor difference in direction of interhemispheric communication was observed despite the use of different types of material and the different mnemonic tasks. It is concluded that the AC in macaques can achieve full and continuously operative neural unification of the mnemonic traces of past experience.

Comparable performance by man and macaque on memory for pictures

Two macaques, shown a series of pictures, recognized 79% and 85% upon re-presentation after 45 other pictures intervened. Human subjects working with the identical pictures (chosen to avoid human linguistic and experiential connotations) averaged 83% correctly recognized. The human false 'recognition' rates were lower than the macaques', hence the average human accuracy was better, but the range of accuracy among the human subjects overlapped that of the macaques.