Benign rolandic epilepsy -- perhaps not so benign: use of magnetic source imaging as a predictor of outcome.

The purpose of this study was to evaluate children with benign rolandic epilepsy, a childhood epilepsy characterized by centrotemporal/rolandic spike-wave discharges with infrequent partial seizures that may secondarily generalize. Recently, some investigators have questioned whether benign rolandic epilepsy is indeed "benign" or whether long-term cognitive outcome may be adversely affected. We initiated an ongoing study to identify children with benign rolandic epilepsy. The children were evaluated in the Texas Comprehensive Epilepsy Program using outpatient or continuous video-electroencephalographic monitoring, brain magnetic resonance imaging, magnetoencephalography, and neuropsychological testing. Neuropsychological testing revealed fine motor dysfunction, visuomotor integration deficits, dyscalculia, and/or expressive language deficits in all of the 9 patients evaluated, reaffirming that benign rolandic epilepsy is not necessarily a benign disorder. Our study shows a high concordance of motor and cognitive deficits in benign rolandic epilepsy, as others have previously suggested. Furthermore, magnetic source imaging shows a higher resolution of dipole localization compared with conventional electroencephalography, which may ultimately improve prediction of deficits. This reaffirms that magnetoencephalography is a valuable diagnostic tool in the evaluation of children with benign rolandic epilepsy.

Passive language mapping with magnetoencephalography in pediatric patients with epilepsy.

OBJECT: Functional mapping is important for determining surgical candidacy and also in epilepsy surgery planning. However, in young children and uncooperative patients, language mapping has been particularly challenging despite the advances in performing noninvasive functional studies. In this study the authors review a series of children with epilepsy who underwent language mapping with magnetoencephalography (MEG) while sedated or sleeping, to determine receptive language localization for presurgical evaluation. METHODS: The authors undertook a retrospective review of patients who underwent MEG between December 2007 and July 2009, and identified 15 individuals who underwent passive language testing as part of their presurgical evaluation because they were unable to participate in traditional language testing, such as Wada or functional MRI. Factors necessitating passive language testing included age and neurocognitive development. RESULTS: Three of the 15 patients were deemed candidates for epilepsy surgery based on the results from standard preoperative testing, including video electroencephalography, MRI, and passive receptive language testing using MEG technology. The MEG studies were used successfully to localize language in all 3 patients, creating opportunities for seizure freedom through surgery that would not otherwise have been available. All 3 patients then underwent resective epilepsy surgery without experiencing postoperative language deficits. CONCLUSIONS: This case series is the first to look at language mapping during sleep (passive language mapping) in which MEG was used and is the first to evaluate passive language testing in a patient population with intracranial pathological entities. This case series demonstrates that MEG can provide an alternative method for receptive language localization in patients with barriers to more traditional language testing, and in these 3 cases surgery was performed safely based on the results.

Time-locked brain activity associated with emotion: a pilot MEG study.

OBJECTIVE: To examine the time course of brain activation in response to emotionally evocative pictures. METHODS AND PROCEDURES: Regions of the brain involved in the processing of affective stimuli in response to picture sets rated unpleasant, pleasant and affectively neutral, as well as the order of activation of each region, were investigated using magnetoencephalography in 10 normal adult volunteers. RESULTS: Spatiotemporal maps were found consisting of two basic components. The first involving activation in the occipital and basal aspects of the temporal cortex- lasted, on average, 270 ms post-stimulus. The second component involving activation in the mesial temporal lobes (MTL) extended from 270 to 850 ms post-stimulus. After (serial) activating the mesial temporal lobe structures or simultaneous (parallel) to it, activation is also observed in the frontal structures. CONCLUSIONS: The temporal organization in the brain of an emotional stimulus requires the serial and alternating engagement of frontal and posterior cortices. It is suggested that lesions to the brain may disrupt this temporal course, altering the emotional response commonly observed in patients with brain injury.

EEG asymmetry, power, and temperament in children.

Measures of EEG spectral power, lateral asymmetry in the frontal and parietal areas, and social behavior with an examiner were analyzed on 166 children, 10 to 12 years old, who were participating in a longitudinal study of the temperamental contributions to social behavior. Loss of 8- to 13-Hz power (alpha band) on the right, compared with the left, frontal area (right frontal active) was most prevalent among children who were classified as high reactive at 4 months and were highly fearful at 14 and 21 months. Second, greater frontal power in the 14- to 30-Hz band (beta) at rest was correlated with the tendency to be right frontal active. Finally, spontaneous talkativeness with an unfamiliar examiner was associated with right frontal activation and high alpha power for boys, but with right frontal activation and high beta power for girls. Right frontal activation is most characteristic of children who begin life with a temperamental bias favoring high reactivity and who develop a fearful reaction to unfamiliar events in the second year of life.