Post mortem mapping of connectional anatomy for the validation of diffusion MRI.

Diffusion MRI (dMRI) is a unique tool for the study of brain circuitry, as it allows us to image both the macroscopic trajectories and the microstructural properties of axon bundles in vivo. The Human Connectome Project ushered in an era of impressive advances in dMRI acquisition and analysis. As a result of these efforts, the quality of dMRI data that could be acquired in vivo improved substantially, and large collections of such data became widely available. Despite this progress, the main limitation of dMRI remains: it does not image axons directly, but only provides indirect measurements based on the diffusion of water molecules. Thus, it must be validated by methods that allow direct visualization of axons but that can only be performed in post mortem brain tissue. In this review, we discuss methods for validating the various features of connectional anatomy that are extracted from dMRI, both at the macro-scale (trajectories of axon bundles), and at micro-scale (axonal orientations and other microstructural properties). We present a range of validation tools, including anatomic tracer studies, Klingler's dissection, myelin stains, label-free optical imaging techniques, and others. We provide an overview of the basic principles of each technique, its limitations, and what it has taught us so far about the accuracy of different dMRI acquisition and analysis approaches.

Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis.

Invasive motor Cortex Stimulation (iMCS) was introduced in the 1990's for the treatment of chronic neuropathic orofacial pain (CNOP), although its effectiveness remains doubtful. However, CNOP is known to be a heterogeneous group of orofacial pain disorders, which can lead to different responses to iMCS. Therefore, this paper investigated (1) whether the effectiveness of iMCS is significantly different among different CNOP disorders and (2) whether other confounding factors can be impacting iMCS results in CNOP. A systematic review and meta-analysis using a linear mixed-model was performed. Twenty-three papers were included, totaling 140 CNOP patients. Heterogeneity of the studies showed to be 55.8%. A visual analogue scale (VAS) measured median pain relief of 66.5% (ranging from 0-100%) was found. Linear mixed-model analysis showed that patients suffering from trigeminal neuralgia responded significantly more favorable to iMCS than patients suffering from dysfunctional pain syndromes (p = 0.030). Also, patients suffering from CNOP caused by (supra)nuclear lesions responded marginally significantly better to iMCS than patients suffering from CNOP due to trigeminal nerve lesions (p = 0.049). No other confounding factors were elucidated. This meta-analysis showed that patients suffering from trigeminal neuralgia and patients suffering from (supra)nuclear lesions causing CNOP responded significantly more favorable than others on iMCS. No other confounding factors were found relevant.

Localization of slow wave activity in patients with tumor-associated epilepsy.

OBJECTIVE: Brain tumors are frequently accompanied by abnormal low frequency magnetic activity (ALFMA). The prevalence and clinical meaning of ALFMA are not well known, although a relation with epileptic brain tissue has been suggested. We studied the prevalence, characteristics and clinical correlates of ALFMA in 20 patients with brain tumors. METHODS: In 20 patients with clinical seizures due to a supratentorial tumor, MEG was performed, followed by MR imaging. MEG signals were band pass-filtered (1-4 Hz); the sources of this activity were localized and projected onto the MRI of the patient. RESULTS: Peritumoral ALFMA could be detected in 13 of 20 patients. A pattern of ALFMA distribution around the tumor could be recognized. In eight cases ALFMA also appeared to be localized within the tumor. In three cases ALFMA was also detected in peritumoral white matter. CONCLUSIONS: Automatic detection of abnormal delta-activity in patients with a brain tumor and seizures can be performed in a clinical setting. When detected, ALFMA is mostly present in circumscribed regions around the tumor. Presence of ALFMA within the tumor might be an important warning signal for the neurosurgeon that the tumor area comprises functional brain tissue.