EEG source imaging.

OBJECTIVE: Electroencephalography (EEG) is an important tool for studying the temporal dynamics of the human brain's large-scale neuronal circuits. However, most EEG applications fail to capitalize on all of the data's available information, particularly that concerning the location of active sources in the brain. Localizing the sources of a given scalp measurement is only achieved by solving the so-called inverse problem. By introducing reasonable a priori constraints, the inverse problem can be solved and the most probable sources in the brain at every moment in time can be accurately localized. METHODS AND RESULTS: Here, we review the different EEG source localization procedures applied during the last two decades. Additionally, we detail the importance of those procedures preceding and following source estimation that are intimately linked to a successful, reliable result. We discuss (1) the number and positioning of electrodes, (2) the varieties of inverse solution models and algorithms, (3) the integration of EEG source estimations with MRI data, (4) the integration of time and frequency in source imaging, and (5) the statistical analysis of inverse solution results. CONCLUSIONS AND SIGNIFICANCE: We show that modern EEG source imaging simultaneously details the temporal and spatial dimensions of brain activity, making it an important and affordable tool to study the properties of cerebral, neural networks in cognitive and clinical neurosciences.     

EEG source imaging in pediatric epilepsy surgery: a new perspective in presurgical workup

PURPOSE: Epilepsy is a relatively frequent disease in children, with considerable impact on cognitive and social life. Successful epilepsy surgery depends on unambiguous focus identification and requires a comprehensive presurgical workup, including several neuroimaging techniques [magnetic resonance imaging, positron emission tomography (PET), and single-photon emission computed tomography (SPECT)]. These may be difficult to apply in younger or developmentally delayed children or both, requiring sedation, and hence, a significant workforce. Modern electric source imaging (ESI) provides accurate epileptic source-localization information in most patients, with minimal patient discomfort or need for cooperation. The purpose of the present study was to determine the usefulness of ESI in pediatric EEG recordings performed with routine electrode arrays. METHODS: Preoperative EEGs recorded from 19 to 29 scalp electrodes were reviewed, and interictal epileptiform activity was analyzed by using a linear source-imaging procedure (depth-weighted minimum norm) in combination with statistical parametric mapping. RESULTS: In 27 (90%) of 30 patients, the ESI correctly localized the epileptogenic region. These numbers compare favorably with the results from other imaging techniques in the same patients (PET, 82%; ictal SPECT, 70%). In extratemporal epilepsy, ESI was correct in all cases, and in temporal lobe epilepsy, in 10 of 13 cases. In two temporal lobe patients showing less-accurate ESI results, 128-electrode data could be analyzed, and in both cases, the 128-electrode ESI was correct. CONCLUSIONS: ESI with standard clinical EEG recordings provides excellent localizing information in pediatric patients, in particular in extratemporal lobe epilepsy. The lower yield in temporal lobe epilepsy seems to be due to undersampling of basal temporal areas with routine scalp recordings.     

Electrical source imaging for presurgical focus localization in epilepsy patients with normal MRI

Purpose: Patients with magnetic resonance (MR)–negative focal epilepsy (MRN‐E) have less favorable surgical outcomes (between 40% and 70%) compared to those in whom an MRI lesion guides the site of surgical intervention (60–90%). Patients with extratemporal MRN‐E have the worst outcome (around 50% chance of seizure freedom). We studied whether electroencephalography (EEG) source imaging (ESI) of interictal epileptic activity can contribute to the identification of the epileptic focus in patients with normal MRI. Methods: We carried out ESI in 10 operated patients with nonlesional MRI and a postsurgical follow‐up of at least 1 year. Five of the 10 patients had extratemporal lobe epilepsy. Evaluation comprised surface and intracranial EEG monitoring of ictal and interictal events, structural MRI, [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG‐PET), ictal and interictal perfusion single photon emission computed tomography (SPECT) scans. Eight of the 10 patients also underwent intracranial monitoring. Results: ESI correctly localized the epileptic focus within the resection margins in 8 of 10 patients, 9 of whom experienced favorable postsurgical outcomes. Discussion: The results highlight the diagnostic value of ESI and encourage broadening its application to patients with MRN‐E. If the surface EEG contains fairly localized spikes, ESI contributes to the presurgical decision process.     

Assessing the localization accuracy and clinical utility of electric and magnetic source imaging in children with epilepsy

ObjectiveTo evaluate the accuracy and clinical utility of conventional 21-channel EEG (conv-EEG), 72-channel high-density EEG (HD-EEG) and 306-channel MEG in localizing interictal epileptiform discharges (IEDs).MethodsTwenty-four children who underwent epilepsy surgery were studied. IEDs on conv-EEG, HD-EEG, MEG and intracranial EEG (iEEG) were localized using equivalent current dipoles and dynamical statistical parametric mapping (dSPM). We compared the localization error (E_Loc) with respect to the ground-truth Irritative Zone (IZ), defined by iEEG sources, between non-invasive modalities and the distance from resection (D_res) between good- (Engel 1) and poor-outcomes. For each patient, we estimated the resection percentage of IED sources and tested whether it predicted outcome.ResultsMEG presented lower E_Loc than HD-EEG and conv-EEG. For all modalities, D_res was shorter in good-outcome than poor-outcome patients, but only the resection percentage of the ground-truth IZ and MEG-IZ predicted surgical outcome.ConclusionsMEG localizes the IZ more accurately than conv-EEG and HD-EEG. MSI may help the presurgical evaluation in terms of patient’s outcome prediction. The promising clinical value of ESI for both conv-EEG and HD-EEG prompts the use of higher-density EEG-systems to possibly achieve MEG performance.SignificanceLocalizing the IZ non-invasively with MSI/ESI facilitates presurgical evaluation and surgical prognosis assessment.     

Clinical significance of nonhabitual seizures during intracranial EEG monitoring

This study sought to determine the frequency and clinical significance of nonhabitual seizures in 101 consecutive patients undergoing presurgical intracranial electroencephalography intracranial (icEEG) recording. We compared clinical data, recording details, and postsurgical outcome in patients with nonhabitual seizures to those without nonhabitual seizures during icEEG. In patients with nonhabitual seizures we compared icEEG recordings of nonhabitual seizures to recordings of habitual seizures. Nonhabitual seizures were recorded in 10% of patients. Those patients had a significantly higher rate of procedure‐related complications compared to patients without nonhabitual seizures. Ultimate seizure outcome did not differ between the groups. Nonhabitual seizures often occurred within the first 3 days of icEEG recording and had larger seizure‐onset zones compared to the patient's habitual seizures. Nonhabitual seizures have no effect on outcome of epilepsy surgery but may serve as important markers of procedure‐related complications during icEEG.     

From EEG source localization to source imaging

A new functional imaging technique, "Focus", has been developed to transform the traditional scalp EEG into an image of source activities. The image is based on multiple spatio-temporal dipole models and consists of gross spatial patterns and source waveforms reflecting the estimated activities of the different brain regions. The application of the 'FOCUS' technique to the EEG in temporal lobe epilepsy revealed the presence of different activities at the basal and lateral aspects of the temporal lobe. The source waveforms showed propagation patterns consistent with subdural recordings which were not recognizable in the scalp EEG.     

Recursive independent component analysis (ICA)-decomposition of ictal EEG to select the best ictal component for EEG source imaging

ObjectiveThis study aimed to present a new ictal component selection technique, named as recursive ICA-decomposition for ictal component selection (RIDICS), for potential application in epileptogenic zone localization.MethodsThe proposed technique decomposes ictal EEG recursively, eliminates a few unwanted components in every recursive cycle, and finally selects the most significant ictal component. Back-projected EEG, regenerated from that component, was used for source estimation. Fifty sets of simulated EEGs and 24 seizures in 8 patients were analyzed. Dipole sources of simulated-EEGs were compared with a known dipole location whereas epileptogenic zones of the seizures were compared with their corresponding sites of successful surgery. The RIDICS technique was compared with a conventional technique.ResultsThe RIDICS technique estimated the dipole sources at an average distance of 12.86 mm from the original dipole location, shorter than the distances obtained using the conventional technique. Epileptogenic zones of the patients, determined by the RIDICS technique, were highly concordant with the sites of surgery with a concordance rate of 83.33%.ConclusionsResults show that the RIDICS technique can be a promising quantitative technique for ictal component selection.SignificanceProperly selected ictal component gives good approximation of epileptogenic zone, which eventually leads to successful epilepsy surgery.     

fMRI functional networks for EEG source imaging

The brain exhibits temporally coherent networks (TCNs) involving numerous cortical and sub‐cortical regions both during the rest state and during the performance of cognitive tasks. TCNs represent the interactions between different brain areas, and understanding such networks may facilitate electroencephalography (EEG) source estimation. We propose a new method for examining TCNs using scalp EEG in conjunction with data obtained by functional magnetic resonance imaging (fMRI). In this approach, termed NEtwork based SOurce Imaging (NESOI), multiple TCNs derived from fMRI with independent component analysis (ICA) are used as the covariance priors of the EEG source reconstruction using Parametric Empirical Bayesian (PEB). In contrast to previous applications of PEB in EEG source imaging with smoothness or sparseness priors, TCNs play a fundamental role among the priors used by NESOI. NESOI achieves an efficient integration of the high temporal resolution EEG and TCN derived from the high spatial resolution fMRI. Using synthetic and real data, we directly compared the performance of NESOI with other distributed source inversion methods, with and without the use of fMRI priors. Our results indicated that NESOI is a potentially useful approach for EEG source imaging. Hum Brain Mapp, 2011. © 2010 Wiley‐Liss, Inc.     

Diagnostic added value of electrical source imaging in presurgical evaluation of patients with epilepsy: A prospective study

ObjectiveTo investigate the diagnostic added value of electrical source imaging (ESI) in presurgical evaluation of patients with drug resistant focal epilepsy.MethodsEighty-two consecutive patients were included. We analyzed both low density (LD) and high density (HD) EEG recordings. LD ESI was done on interictal and ictal signals recorded during long-term video-EEG monitoring (LTM), with standard 25 electrodes and age-matched template head models. HD ESI was done on shorter recordings (90–120 min), with 256 electrodes, using individual head model. The multidisciplinary team made decisions first blinded to ESI (based on all other modalities) and then discussed the results of the ESI. We considered that ESI had diagnostic added value, when it provided non-redundant information that changed the patientś management plan.ResultsESI had diagnostic added value in 28 patients (34%). In most cases (85.7%), these changes were related to planning of the invasive recordings. In nine out of 13 patients, invasive recordings confirmed the localization. Out of eight patients in whom the ESI source was resected, six became seizure-free.ConclusionsESI provides non-redundant information in one third of the patients undergoing presurgical evaluation.SignificanceThis study provides evidence for the diagnostic added value of ESI in presurgical evaluation.     

The value of EEG-fMRI and EEG source analysis in the presurgical setup of children with refractory focal epilepsy

Purpose: In the presurgical evaluation of children and juvenile patients with refractory focal epilepsy, the main challenge is to localize the point of seizure onset as precisely as possible. We compared results of the conventional electroencephalography–functional magnetic resonance imaging (EEG‐fMRI) analysis with those obtained with a newly developed method using voltage maps of average interictal epileptiform discharges (IEDs) recorded during clinical long‐term monitoring and with the results of the electric source imaging (ESI). Methods: Simultaneous EEG‐fMRI was recorded in nine patients (ages 1.5–17.5 years) undergoing presurgical evaluation. The postoperative outcome and resected area were compared with the following: the localizations of blood oxygen–level dependent (BOLD) signal changes associated with IEDs, which were identified by visual inspection changes using SPM5 software (Analysis I); BOLD signal changes related to IED topography, which was characterized using spike‐specific voltage maps of average IED recorded outside the MR scanner during clinical long‐term monitoring (Analysis II); as well as results of EEG source analysis based on the distributed linear local autoregressive average (LAURA) algorithm using the Cartool software by Denis Brunet (Analysis III). Key Findings: All nine patients had postoperative outcome Engel class I–IIb (postoperative time 6–26 months). The analysis I revealed an IED‐related area of activation within the resection area in 3 (33%) of 9 patients, analysis II was able to reliably localize the source of epileptic activity in 4 (44%) of 9 patients, and analysis III rendered results concordant with the postoperative resection site in all nine patients. Conclusions: The localization of seizure onset based on EEG‐fMRI may be a useful adjunct in the preoperative evaluation but also has some deficits that impair the reliability of results. In contrast, EEG source analysis is clearly a more credible method for epileptic focus localization in children with refractory epilepsies. It seems likely that the analysis based on IED topography (Analysis II) may increase sensitivity and reliability of EEG‐fMRI in some patients. However, the benefit from this innovative method in children is rather limited compared with adults.     

EEG and MEG source analysis of single and averaged interictal spikes reveals intrinsic epileptogenicity in focal cortical dysplasia

PURPOSE: Simultaneous interictal EEG and magnetoencephalography (MEG) recordings were used for noninvasive analysis of epileptogenicity in focal cortical dysplasia (FCD). The results of two different approach methods (multiple source analysis of averaged spikes and single dipole peak localization of single spikes) were compared with pre- and postoperative anatomic magnetic resonance imaging (MRI). PATIENTS: We studied nine children and adolescents (age, 3.5-15.9 years) with localization-related epilepsy and FCD diagnosis based on MRI. Five patients underwent epilepsy surgery, two of them after long-term recording with subdural grid electrodes, and one after intraoperative electrocorticography. METHODS: The 122-channel whole-head MEGs and 33-channel EEGs were recorded simultaneously for 25 to 40 min. Interictal spikes were identified visually and used as templates to search for similar spatiotemporal spike patterns throughout the recording. With the BESA program, similar spikes (r > 0.85) were detected, averaged, high-pass filtered (5 Hz) to enhance spike onset, and subjected to multiple spatiotemporal source analysis with a multishell spherical head model. Peak activity from single spikes was modeled by single dipoles for the same subset of spikes. Source localization was visualized by superposition on T1-weighted MRI and compared with the lesion identified in T1- and T2-weighted MRI. In the five cases undergoing epilepsy surgery, the results were correlated with invasive recordings, postoperative MRI, and outcome. RESULTS: In all cases, the analysis of averaged spikes showed a localization of onset- and peak-related sources within the visible lesion for both EEG and MEG. Of the single spikes, 128 (45%; total 284) were localizable at the peak in MEG, and 170 (60%) in EEG. Of these, 91% localized within the lesion with MEG, and 93.5% with EEG. In three of five patients operated on, the resected area included the onset zones of averaged EEG and MEG spike activity. These patients had excellent postoperative outcome, whereas the others did not become seizure free. CONCLUSIONS: Consistent MEG and EEG spike localization in the lesional zone confirmed the hypothesis of intrinsic epileptogenicity in FCD.     

Automatic seizure detection in long-term scalp EEG using an adaptive thresholding technique: A validation study for clinical routine

ObjectiveIn a previous study we proposed a robust method for automatic seizure detection in scalp EEG recordings. The goal of the current study was to validate an improved algorithm in a much larger group of patients in order to show its general applicability in clinical routine.MethodsFor the detection of seizures we developed an algorithm based on Short Time Fourier Transform, calculating the integrated power in the frequency band 2.5–12 Hz for a multi-channel seizure detection montage referenced against the average of Fz-Cz-Pz. For identification of seizures an adaptive thresholding technique was applied. Complete data sets of each patient were used for analyses for a fixed set of parameters.Results159 patients (117 temporal-lobe epilepsies (TLE), 35 extra-temporal lobe epilepsies (ETLE), 7 other) were included with a total of 25,278 h of EEG data, 794 seizures were analyzed. The sensitivity was 87.3% and number of false detections per hour (FpH) was 0.22/h. The sensitivity for TLE patients was 89.9% and FpH = 0.19/h; for ETLE patients sensitivity was 77.4% and FpH = 0.25/h.ConclusionsThe seizure detection algorithm provided high values for sensitivity and selectivity for unselected large EEG data sets without a priori assumptions of seizure patterns.SignificanceThe algorithm is a valuable tool for fast and effective screening of long-term scalp EEG recordings.     

Electromagnetic source imaging using simultaneous scalp EEG and intracranial EEG: An emerging tool for interacting with pathological brain networks

Objective

The goal of this study is to investigate the performance, merits and limitations of source imaging using intracranial EEG (iEEG) recordings and to compare its accuracy to the results of EEG source imaging. Accuracy in this study, is measured both by determining the location and inter-nodal connectivity of underlying brain networks.

EEG dipole source localisation of interictal spikes acquired during routine clinical video-EEG monitoring

OBJECTIVE: We investigated the feasibility of electroencephalography (EEG) dipole source localisation of interictal epileptiform discharges from data acquired during routine clinical inpatient video-EEG monitoring (VEM) and compared a 19-channel 'routine montage' with a 29-channel 'surgical montage' that includes an additional row of 10 inferior temporal electrodes. METHODS: Twenty consecutive patients who had VEM for the presurgical evaluation of medically refractory partial epilepsy were screened. Thirteen of the patients had focal interictal spikes recorded, and in 11 (85%) these were technically satisfactory for source localisation. Fourteen spike foci were analysed as 3 patients had bilateral independent spikes. EEG data was acquired with 29 electrodes including an inferior temporal row (surgical montage). For comparison, the 10 additional electrodes were excluded from analysis (routine montage). Using NEUROSCAN Source 2.0 software, a computed dipole source localisation of averaged spikes was performed utilising a magnetic resonance imaging-based finite element model. Dipole localisation was compared with that of the Comprehensive Epilepsy Program (CEP) evaluation. RESULTS: Using the surgical montage dipole source localisation was consistent with the CEP spike localisation for 13/14 spikes (93%, P<0.005), compared with only 5/14 spikes (36%) using the routine montage. CONCLUSIONS: Data derived from routine clinical inpatient VEM using a routine montage can yield accurate EEG dipole source localisation, but significantly more accurate localisation is obtained using the surgical montage.     

EEG source imaging of anterior temporal lobe spikes: Validity and reliability

ObjectiveTo assess the reliability and validity of EEG source localization of anterior temporal lobe spikes through direct comparison with simultaneously recorded intracranial spike fields.MethodsWe recently showed that classical anterior temporal spikes recorded in mesial temporal lobe epilepsy (MTLE) are non-propagated potentials generated in the anterolateral temporal neocortex (Wennberg et al., 2011). In this study EEG source imaging (ESI) was performed on 64 identical right anterior temporal spikes (and 48 homologous left anterior temporal spikes) in a patient with MTLE investigated with simultaneous depth and subdural intracranial EEG and 27 channel scalp EEG. The effects of different realistic forward models, low frequency filters (LFFs) and spike averaging were assessed in terms of the reliability and physiologic validity of the source solutions.ResultsDipole mapping and distributed source modeling solutions for the grand average of all spikes were accurately localized to the superficial anterolateral temporal neocortex within 1 cm of the intracranially defined spike generator, irrespective of forward model or LFF. ESI of single spikes, however, showed poor reliability (i.e., dissimilar localization results for intracranially identical spikes). Even with an optimal combination of individualized volume conductor and 3 Hz LFF more than one third of single spike source solutions were physiologically invalid. Spike averaging, especially of 8 or more spikes, significantly increased the proportion of valid source solutions.ConclusionsESI of individual anterior temporal spikes was limited by low reliability and a high likelihood of physiologically invalid source solutions. Spike averaging of 8 or more identical spikes prior to ESI, however, reliably produced accurate source solutions localized to the anterolateral temporal neocortex.SignificanceESI performed on averages of identical spikes can provide highly accurate noninvasive source localization of the anterolateral temporal neocortical region responsible for generating classical anterior temporal lobe spikes. The reliability and validity of ESI performed on individual spikes, however, is relatively limited.     

Detection of temporal lobe spikes: Comparing nasopharyngeal, cheek and anterior temporal electrodes to simultaneous subdural recordings

OBJECTIVE: To compare nasopharyngeal (NP), cheek and anterior temporal (AT) electrodes for the detection yield and localization of interictal spikes in temporal lobe epilepsy. METHODS: In patients evaluated for epilepsy surgery with subdural electrocorticography electrodes, we simultaneously recorded NP, cheek and AT electrodes. Two observers identified spikes in EEG traces and marked in which channels they occurred. Interobserver agreement was calculated using Cohen's kappa. For localization, data-sets with high interobserver agreement (kappa-value 0.4) were evaluated. The subdural distribution of NP and AT spikes was mapped. RESULTS: Seven patients were included, six were analyzed for localization. Only 1.5% of spikes recorded by cheek electrodes were not seen on temporal leads, while 25% of NP spikes were not seen on either. Spikes only recorded by NP electrodes had mesiobasal, while AT spikes had lateral temporal distribution. CONCLUSIONS: NP electrodes can increase EEG spike detection rate in temporal lobe epilepsy and are more useful than cheek electrodes. Spikes that are seen only on NP electrodes tend to be mesiobasal temporal lobe spikes. SIGNIFICANCE: Adding NP electrodes to scalp EEG can aid interictal spike detection and source localization, especially in short recordings like MEG-EEG.     

EEG and video-EEG seizure monitoring has limited utility in patients with hypothalamic hamartoma and epilepsy

Purpose: Hypothalamic hamartomas (HHs) are a malformation of the ventral hypothalamus and tuber cinereum, associated with gelastic seizures and epilepsy. We sought to determine the spectrum of electroencephalography (EEG) abnormalities in a large cohort of HH patients. Methods: Data was collected for HH patients undergoing evaluation between 2003 and 2007. Data included seizure history, prior treatment, and results of diagnostic studies. After informed consent, data were entered into a database. Key Findings: We reviewed 133 HH patients. Mean age at time of data analysis was 15.7 years (59.4% male). Most patients had gelastic (77%) and/or complex partial seizures (58%). Records for 102 EEG studies on 73 patients were reviewed. Interictal epileptiform abnormalities were seen in 77%, localizing predominately to the temporal and frontal regions. Records for 104 video‐EEG (VEEG) studies on 65 patients were reviewed. Of 584 gelastic seizures (GS) captured, no ictal EEG change was noted in 438 (75%). Of GS with localizing features, 89% suggested onset from the temporal and/or frontal regions. There were 160 complex partial seizures (CPS). For those with localizing features, 100% localized to the temporal and/or frontal head regions. EEG and VEEG findings correlated with the side of HH attachment. VEEG did not influence outcome. Significance: EEG features in HH patients are diverse. The majority of gelastic seizures fail to demonstrate change in the EEG. The lack of EEG changes with many clinical seizures, and the false localization seen in those events with an ictal change suggest the utility of EEG is limited in the evaluation of these patients.