Hydranencephaly and maximal hydrocephalus: usefulness of electrophysiological studies for their differentiation

The EEG was evaluated in three cases of hydranencephaly and two cases of maximal hydrocephalus, and the visual evoked potential was studied in one case each of hydranencephaly and maximal hydrocephalus. The EEG tracing of hydranencephaly typically showed a flat pattern in most bipolar derivations because of the differential amplification of the same activity from remote generators. However, the EEG of maximal hydrocephalus did not demonstrate a flat pattern in bipolar as well as referential derivation, and the activities were different from various electrodes in referential derivation. The visual evoked potential of maximal hydrocephalus showed a normal pattern, while that of hydranencephaly showed no response. Electrophysiological examinations (such as EEG and visual evoked potential) are useful for differentiation of hydranencephaly and maximal hydrocephalus in cases whose computed tomographic scans do not provide clear differentiation.     

Brain symmetry and topographic analysis of lateralized event-related potentials.

OBJECTIVE: We investigated the influence of symmetry assumptions implicit in the derivation and the use of event-related lateralized potentials (ERLs), such as the lateralized readiness potential (LRP). We describe these assumptions and demonstrate several alternative computational methods. METHODS: Using analytical methods and forward simulations, we computed the error in the ERL topography that results from deviations in symmetry between homologous brain areas. Based on analytical considerations we show that, for source analysis, the ERL derivation provides no benefits compared to a single subtraction of the two (left-lateralized and right-lateralized) conditions underlying the ERL. RESULTS: Relative errors of 10% in the ERL topography are found if the location of an active region in one hemisphere differs by 10 mm from the symmetric location as compared to the other hemisphere A difference of 30 degrees in orientation results in a relative error of the ERL of 40%. Differences in source strength between hemispheres result in an ERL error that is half the size of the relative strength difference. CONCLUSIONS: We estimate that, due to violations of the symmetry assumption underlying the ERL, errors in the ERL topography of 10-40% can be expected. Source analysis does not benefit from the ERL. In topographic mapping and source analysis, the double subtraction of the ERL should be approached with caution and the single subtraction of the ERPs of two lateralized conditions should be first analyzed whenever possible. We suggest that analyses based on the topography of the ERL should only be performed after the assumption of symmetry has been validated.     

Field distribution of antidromically activated digital nerve potentials: model for far-field recording

In 20 median nerves, the shift in mean latency of the referentially recorded antidromic sensory potential was 0.22 to 0.38 msec per 1.5 cm across the palm and only 0.03 to 0.05 msec per 1.5 cm along the third digit. In five radial nerves, referential recording from the tip of the second digit detected a stationary positive potential that was coincident with the entry of the sensory impulse into the nerve terminal near the base of the digit. These findings are consistent with the view that, in far-field recording of a traveling impulse, a time peak could result from an abrupt change in current flow that is based on the geometry of the volume conductor without fixed neural discharges.     

Partial seizures manifesting as apnea only in an adult

PURPOSE: Although several cases of apneic seizures have been reported in neonates, epileptic seizures presenting as apnea only in adults are very rare. We present a case report of a 19-year-old man with viral encephalitis and frequent episodes of apneic seizures. METHODS: Prolonged electroencephalograms (EEGs), respiratory monitorings, and imaging including ictal-interictal subtraction single photon emission computed tomography (SPECT) coregistered with magnetic resonance imaging (MRI) were performed. RESULTS: Ictal EEGs recorded during apneic episodes showed repetitive sharp waves or rhythmic theta activity arising from the left or right independent bitemporal region. Ictal SPECT was performed during one episode of apnea that showed ictal EEG discharges arising from the left posterior temporal area. Ictal-interictal subtraction SPECT coregistered with MRI revealed that the seizures originated from the left, posterior, midlateral temporal cortex. CONCLUSIONS: Previous studies with ictal EEG or brain stimulation suggest that apneic seizures might be mediated through the limbic and associated cortical systems. Our study reports on a very rare case of partial seizures with apnea only in an adult patient and is supported by ictal EEG and ictal-interictal subtraction SPECT coregistered with MRI.     

Comparison of intrinsic optical signals associated with low Mg2+-and 4-aminopyridine-induced seizure-like events reveals characteristic features in adult rat limbic system

PURPOSE: To analyze the intrinsic optical signal change associated with seizure-like events in two frequently used in vitro models-the low-Mg2+ and the 4-aminopyridine (4-AP) models-and to monitor regions of onset and spread patterns of these discharges by using imaging of intrinsic optical signals (IOS). METHODS: Combined hippocampal-entorhinal-cortex slices of adult rats were exposed to two different treatments: lowering extracellular Mg2+ concentrations or application of 100 microM 4-AP. The electrographic features of the discharges were monitored using extracellular microelectrodes. Optical imaging was achieved by infrared transillumination of the slice and analysis of changes in light transmission using a subtraction approach. The electrographic features were compared with the optical changes. Regions of onset and spread patterns were analyzed in relevant anatomic regions of the slice. RESULTS: Both lowering extracellular Mg2+ concentrations and application of 4-AP induced seizure-like events. The relative duration of the intrinsic optical signal change associated with seizure-like events in the low-Mg2+ model was significantly longer compared with that seen with those occurring in the 4-AP model, although duration of field potentials did not differ significantly in the two models. Seizure-like events of the low-Mg2+ model originated predominantly in the entorhinal cortex, with subsequent propagation toward the subiculum and neocortical structures. In contrast, no consistent region of onset or spread patterns were seen in the 4-AP model, indicating that the seizure initiation is not confined to a particular region in this model. CONCLUSIONS: We conclude that different forms of spontaneous epileptiform activity are associated with characteristic optical signal changes and that optical imaging represents an excellent method to assess regions of seizure onset and spread patterns.     

What determines the latency and amplitude of stationary peaks in far-field recordings?

In 20 radial nerves from 10 healthy persons, a referential derivation from the tip of the first or second digit registered two biphasic stationary peaks, PI-NI and PII-NII, following stimulation of the nerve in the forearm. These two peaks occurred slightly before the arrival of the propagating impulse at the wrist and at the base of the digit, respectively. With stepwise reduction of stimulation from a maximal to a threshold intensity, the far-field potential decreased in amplitude linearly with the near-field potential recorded at the junction of the volume conductor. Abduction of the first digit or flexion of the second and third digits altered the waveform and, to a lesser degree, the latency of the far-field peaks. However, these changes appeared in an inconsistent manner, which we were unable to characterize. We conclude that in far-field recording a stationary peak results at the border of the adjoining volume conductors in proportion to the magnitude of the propagating axonal volley approaching the boundary.     

急性幕上大面积脑梗死脑电图波段功率的改变及意义

目的通过连续监测神经重症监护病房(neurological intensive care unit,N-ICU)患者的EEG变化,探讨急性幕上大面积脑梗死脑电图波段功率(band power)的改变及意义。方法急性幕上大面积脑梗死患者20例(梗死组),脑电正常的同期N-ICU患者20例(对照组),采用10～20标准电极安装法,8导参考电极导联进行脑电监护。观察梗死组两侧波段功率的改变,比较梗死组和对照组两侧波段功率差值的不同。结果急性幕上大面积脑梗死双侧大脑半球各波段功率均表现为不对称性,病灶侧δ波的绝对波段功率(absolute band power,ABP)和相对波段功率(relative band power,RBP)较健侧显著增大(t值分别为3.649和5.286,均P0.01),α和β波的RBP均显著减小(t值分别为-4.586和-3.006,均P0.01),θ波的RBP也显著减小(t=-2.243,P0.05)。与对照组比较,梗死组左右半球δ波的ABP差值和各波段的RBP差值均有显著性意义(P0.05)。结论脑缺血时波段功率能早期、定量、直观的反映病情变化,为缺血的发现、病情的评估和疗效的判断提供了一种较好的方法。     

The neural substrates of inferential and referential semantic processing

IntroductionA distinction has been proposed, on theoretical grounds, between referential and inferential semantic abilities. The former account for the relationship of words to the world, the latter for the relationship of words among themselves. The hypothesis of, at least partially, different neurological underpinnings for this distinction has been supported by the presence of double dissociations in neurological patients between tasks that can be considered to tap the cognitive processes involving these two different classes of semantic knowledge, such as, for example, picture naming (referential) and naming to a verbal definition (inferential).MethodsWe report here the results of a functional magnetic resonance experiment, contrasting the pattern of brain activity associated with, respectively, “referential” (picture naming, word-to-picture matching) and “inferential” (naming to definition, word-to-word matching) tasks.ResultsAll tasks activate an extensive set of brain areas involving both hemispheres, corresponding to the “common semantic network”. In addition, left hemispheric temporal areas are selectively engaged by the inferential tasks. Conversely, a specific activation of the right fusiform gyrus is associated with the referential tasks.ConclusionsThese findings suggest that while inferential tasks, as compared with referential tasks, engage additional processing resources subserved by left hemispheric language areas involved in lexical retrieval, referential tasks (as compared with inferential tasks) recruit right hemispheric areas generally associated with nonverbal conceptual and structural object processing. These findings are compatible with the double dissociations reported in neurological patients.     

Basis and use of a true monopolar derivation: the neo-electroencephalography (N.E.E.G.)

A new method of monopolar recording is presented. This true monopolar derivation is based on a computer-reconstituted signals method: use of a reference electrode obtained by interconnecting two electrodes placed one on either side of the neck to form a common pole; detection by Fourier analysis of the various frequencies from 0 to 16 Hz in 1/4 Hz steps; continuous comparison of phase for each activity per 1/4 Hz between the signal PF left - Reference Neck (RC) and O right - Reference Neck (RC) in order to see whether the reference electrode is active or not; automatic subtraction of the value of the reference electrode from the value of all other reference channels if the reference electrode is active. The technique is available for routine purposes. The results are easy to read and provide more precise data as well as new parameters which could prove useful in current clinical practice. The first electroclinical correlations covered frequency, location of potential gradients and phase relations established for 40 adult normal subjects with a reading identified as normal, and for 60 adult pathological subjects with a reading also identified as normal. Clear differences appeared between these two types of supposedly normal readings.     

Tactile‐evoked Rolandic Discharges: A Benign Finding?

PURPOSE: This retrospective study was undertaken to determine if patients having tactile-evoked rolandic discharges were a more "benign" patient population than those with spontaneously occurring nontactile rolandic discharges and to determine whether the presence of tactile-evoked rolandic discharges was a marker for the future development of epilepsy, as previously reported. METHODS: During this 8-year study, 304 patients were seen with rolandic discharges. These patients all had tactile stimulation of their hands and/or feet. They formed two groups: patients with spontaneous rolandic discharges that could not be evoked by tactile stimulation (NT) and patients with spontaneous rolandic discharges that could be enhanced with tactile stimulation (TE). Over a 14-month period, every patient had tactile stimulation of both hands and both feet, resulting in a third group of patients having rolandic discharges seen only with tapping (TO). RESULTS: Tactile-enhanced discharges constituted 38.2% of all rolandic discharges. Patients with TE and TO discharges had a higher incidence of normal development and intelligence, normal neurologic examinations, and a lower incidence of seizures and focal or generalized background abnormalities on their EEGs. Only one patient with normal background and no coexisting epileptiform abnormalities had partial motor seizures with corresponding contralateral central discharges. Only two patients who had no seizures at the time of their first EEG subsequently went on to develop seizures. Neither fit the pattern of the seizure disorder described in the literature. CONCLUSIONS: It is hypothesized that tactile-evoked rolandic discharges are a benign, age-related phenomenon, which do not represent a marker for the future development of epilepsy and are not the interictal electrographic correlate to an already existing seizure disorder.     

Electrophysiological and pharmacological characteristics of two types of spike-wave discharges in WAG/Rij rats

Rats of the WAG/Rij strain are commonly seen as a genetic model for generalised absence epilepsy in man. Interestingly, generalised absence epilepsy shows, in addition to the fully generalised spike-wave discharges, a second type of spike-wave discharge, which lasts for a shorter time, has a lower frequency, and a lower incidence. The originally described distinction between the two types of spike-wave discharges was mainly based on the shape, polarity and duration of the discharges. In the present study other characteristics such as the spatial and temporal distribution of the spike and wave components of the two discharges and frequency spectra were found to differ between the two types. In addition, a reciprocal regulation of the two types of spike-wave discharges by drugs affecting the dopaminergic system (haloperidol and apomorphine) was observed. The results convincingly demonstrate the difference between the two phenomena and warrant the search for neurobiological mechanisms underlying both types of spike-wave discharges.     

Disrupted theory of mind network processing in response to idea of reference evocation in schizophrenia

Park IH, Ku J, Lee H, Kim SY, Kim SI, Yoon KJ, Kim J‐J. Disrupted theory of mind network processing in response to idea of reference evocation in schizophrenia. Objective: This study examined the neural pathophysiology of the theory of mind network by eliciting self‐referential processing during an idea of reference evocating situation in patients with schizophrenia. Method: Functional MRI was conducted on 14 schizophrenic in‐patients with the idea of reference and 15 healthy participants while viewing video vignettes of referential conversations, non‐referential conversations or no conversations between two people, which were filmed at varying distances of 1, 5 or 10 m. Results: The patient group did not show normal patterns of superior temporal sulcus activation to conversational context, and reciprocal deactivation and activation of the ventromedial and dorsomedial prefrontal cortex to referential conversational context. Instead, the patient group showed overall greater ventromedial prefrontal activities across different conversational contexts and inverse correlation between superior temporal sulcus activity and delusional severity. Differential activations of the temporal pole and its posterior extension to varying distances were observed in the control group but not in the patient group. Conclusion: The present study demonstrates that theory of mind‐related responses of the medial prefrontal‐superior temporal network are attenuated during the self‐referential processing in patients with schizophrenia and that these abnormalities may be related to the formation of their referential or persecutory delusion.     

Seizures induced by thinking

A patient with generalized convulsions noted that seizures were reliably precipitated by mental arithmetic. The interictal electroencephalogram revealed only a mild, diffuse, nonspecific disturbance, but bursts of generalized epileptiform activity with no obvious clinical expression accompanied efforts at mental arithmetic with a significantly high incidence. Tasks involving multiplication, division, and manipulation of spatial information were significantly associated with discharges, but few, if any, discharges appeared when addition and subtraction tasks of equivalent difficulty were performed. Tasks involving the retention of numerical information in short-term memory (e.g., immediate repetition of a series of 8 digits) were never associated with paroxysmal EEG activity. It is argued that generalized epilepsy of this kind may be related to focal dysfunction in a manner analogous to the involvement of the occipital lobe in cases of pattern-sensitive epilepsy.     

Cognitive impairment during epileptiform discharges: is it ever justifiable to treat the EEG?

Epileptiform EEG discharges are not confined to people with epilepsy, and their frequency is only weakly related to severity. A fundamental principle of EEG practice is, therefore, to avoid overinterpretation of epileptiform activity. Epileptiform discharges not accompanied by obvious clinical events are generally regarded as subclinical or interictal. However, in many patients sensitive methods of observation, notably continuous psychological testing, show brief episodes of impaired cognitive function during such discharges. This phenomenon of transitory cognitive impairment (TCI) is found in about 50% of patients who show discharges during testing. TCI is not simple inattention. The effects are material and site specific: lateralised discharges are associated with deficits of functions mediated by the hemisphere in which the discharges occur. Conversely, specific tasks can activate or suppress focal discharges over the brain regions that mediate the cognitive activity in question. TCI clearly contributes to the cognitive problems of some people with epilepsy and may cause deficits that pass unrecognised. TCI is demonstrable in many cases of benign partial epilepsy of childhood, a disorder once thought to have no adverse psychological effects. TCI can contribute to abnormalities of psychological test profiles and interferes with daily tasks, such as reading and driving. In children it may be associated with behavioural disorders. An important practical issue is whether TCI materially impairs psychosocial function and, if so, whether drug treatment is desirable or effective. Uncontrolled reports and two preliminary randomised controlled trials of antiepileptic treatment of TCI have suggested that suppression of discharges is associated with significant improvement in psychosocial function.     

Assessment of hairline EEG as a screening tool for nonconvulsive status epilepticus

PURPOSE: Because of the high incidence of nonconvulsive status epilepticus (NCSE), the attraction of a "quick and easy" screening electroencephalogram (EEG) is obvious. Previous studies have shown utility of hairline EEG in diagnosing epilepsy. However, this technique has not been evaluated as a screening tool for NCSE. We wanted to provide proof of principle that a screening hairline EEG has sufficient sensitivity to use as a screening tool for diagnosing NCSE. METHODS: A total of 120, 2- to 3-min EEG samples of normal and various abnormal digital EEG studies were reformatted in three six-channel montages (A, longitudinal bipolar; B, referential to ipsilateral ear; C, referential to contralateral ear) that mimicked a hairline recording and were interpreted by five neurophysiologists. The test data interpretation was compared with the original EEG interpretation. RESULTS: Performance was best with montages A and B; 71% and 70.5% of the samples were interpreted correctly by using these montages. Only 65% of the samples were correctly interpreted by using montage C. With the best montage (A), the sensitivities ranged from 91% for normal EEG to 54% for periodic lateralized epileptiform discharges (PLEDs). The sensitivity for seizures was only 72%. Seizures were frequently misinterpreted as more benign patterns such as normal and diffuse slowing. CONCLUSIONS: EEG data reformatted to resemble a hairline EEG had low sensitivity for detecting seizures. As a result, we do not recommend further pursuit of hairline EEG as a "quick and easy" screening tool for NCSE.     

A general method for remontaging based on a singular value decomposition algorithm.

The authors developed a general mathematic algorithm to convert any montage (referential, bipolar, or Laplacian) to any other by linear transformation. Input and output montages are described by matrices, and singular value decomposition is used to find the linear transformation. An error signal can be calculated from the input data to monitor remontaging validity. This algorithm also identifies output channels that cannot be obtained from the specified input. The authors tested this algorithm using an instrument that retrieves digitally encoded EEG data from videotape and produces signals in referential or bipolar form. They obtained good agreement when they compared referential and Laplacian data derived from bipolar output with the same montages calculated from referential output for the same EEG segment.     

Functional dissociation of ventral frontal and dorsomedial default mode network components during resting state and emotional autobiographical recall

Humans spend a substantial share of their lives mind‐wandering. This spontaneous thinking activity usually comprises autobiographical recall, emotional, and self‐referential components. While neuroimaging studies have demonstrated that a specific brain “default mode network” (DMN) is consistently engaged by the “resting state” of the mind, the relative contribution of key cognitive components to DMN activity is still poorly understood. Here we used fMRI to investigate whether activity in neural components of the DMN can be differentially explained by active recall of relevant emotional autobiographical memories as compared with the resting state. Our study design combined emotional autobiographical memory, neutral memory and resting state conditions, separated by a serial subtraction control task. Shared patterns of activation in the DMN were observed in both emotional autobiographical and resting conditions, when compared with serial subtraction. Directly contrasting autobiographical and resting conditions demonstrated a striking dissociation within the DMN in that emotional autobiographical retrieval led to stronger activation of the dorsomedial core regions (medial prefrontal cortex, posterior cingulate cortex), whereas the resting state condition engaged a ventral frontal network (ventral striatum, subgenual and ventral anterior cingulate cortices) in addition to the IPL. Our results reveal an as yet unreported dissociation within the DMN. Whereas the dorsomedial component can be explained by emotional autobiographical memory, the ventral frontal one is predominantly associated with the resting state proper, possibly underlying fundamental motivational mechanisms engaged during spontaneous unconstrained ideation. Hum Brain Mapp 35:3302–3313, 2014. © 2013 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc. .     

Principles and pitfalls of nerve conduction studies

This report reviews the fundamental principles and the changing concepts of nerve stimulation techniques, and discusses the proper application of these techniques in the differential diagnosis of peripheral nerve disorders. Nerve conduction studies help delineate the extent and distribution of the neural lesion and distinguish two major categories of peripheral nerve disease: demyelination and axonal degeneration. Although the method is based on simple principles, pitfalls abound in practice. Variability in nerve conduction measurement may result from temperature change, variations among nerve segments, and the effects of age. Other sources of error include excessive spread of stimulation current, anomalous innervation, temporal dispersion, and inaccuracy of surface measurement. Unlike a bipolar derivation, which selectively records near-field potentials, a referential recording may give rise to stationary far-field peaks from a moving source. Overlooking this possibility can lead to an incorrect interpretation of findings. Conventional nerve conduction studies deal primarily with measurements of the distal nerve segments in an extremity. More recent techniques are applicable to less accessible anatomical regions, as illustrated by elicitation of the blink reflex, F wave, and H reflex, and the use of the inching technique. Other methods used to assess special aspects of nerve conduction include the ischemic test and studies of slow-conducting fibers.     

Pathophysiology of altered consciousness during seizures: Subtraction SPECT study

BACKGROUND: The mechanisms underlying altered consciousness during seizures are poorly understood. Previous clinicopathologic studies suggest a role for the thalamus and upper brainstem in consciousness mechanisms. OBJECTIVE: To examine blood flow changes associated with altered consciousness during seizures. METHODS: Seventy-one patients with epilepsy who underwent video-EEG monitoring and ictal/interictal SPECT were studied. Patients were divided into three groups depending on their conscious state during seizures: 1) complete impairment of consciousness (CI), 2) no impairment of consciousness (NI), or 3) uncertain impairment of consciousness (UI). The distribution of blood flow changes during these seizures was assessed by subtraction (ictal - interictal) SPECT co-registered to MRI. Conscious state was assessed in relation to secondary ictal hyperperfusion in subcortical regions (i.e., thalamus and upper brainstem). RESULTS: Impairment of consciousness showed a strong association with secondary hyperperfusion in the thalamic/upper brainstem region (p = 0.01), occurring in 92% (45/49) of CI, 69% (9/13) of UI, and 11% (1/9) of NI. CONCLUSIONS: These findings are consistent with a role for the thalamus and upper brainstem in consciousness mechanisms. The authors suggest that the spread of epileptic discharges or a trans-synaptic activation (diaschisis) of these structures is an important mechanism in the alteration of consciousness during seizures. Variance in the results may be due to differences in timing of radioisotope injection, sensitivity of the subtraction SPECT technique, and the ability to clinically assess the conscious state.     

Simple Partial Status Epilepticus Localized by Single-Photon Emission Computed Tomography Subtraction in Chronic Cerebral Paragonimiasis

A patient with chronic cerebral paragonimiasis began to have new motor seizures of the right face manifested by clonic contractions that occurred several hundred times a day, consistent with simple partial status epilepticus. Ictal electroencephalogram discharges started from the left frontal region and then spread to the left hemisphere with left frontal maximum. But clinical seizures were limited to the right face. The frequent partial seizures were controlled by the intravenous infusion of phenytoin. Brain magnetic resonance imaging showed multiple conglomerated round nodules with encephalomalacia in the left temporal and occipital lobes. Applying the technique of ictal-interictal single-photo emission computed tomography subtraction, the authors were able to localize the focal ictal-hyperperfusion on left precentral cortex adjacent to the lesions that correspond to the anatomical distribution of left face motor area.