Reliability of dynamic causal modelling of resting-state magnetoencephalography.

This study assesses the reliability of resting-state dynamic causal modelling (DCM) of magnetoencephalography (MEG) under conductance-based canonical microcircuit models, in terms of both posterior parameter estimates and model evidence. We use resting-state MEG data from two sessions, acquired 2 weeks apart, from a cohort with high between-subject variance arising from Alzheimer's disease. Our focus is not on the effect of disease, but on the reliability of the methods (as within-subject between-session agreement), which is crucial for future studies of disease progression and drug intervention. To assess the reliability of first-level DCMs, we compare model evidence associated with the covariance among subject-specific free energies (i.e., the 'quality' of the models) with versus without interclass correlations. We then used parametric empirical Bayes (PEB) to investigate the differences between the inferred DCM parameter probability distributions at the between subject level. Specifically, we examined the evidence for or against parameter differences (i) within-subject, within-session, and between-epochs; (ii) within-subject between-session; and (iii) within-site between-subjects, accommodating the conditional dependency among parameter estimates. We show that for data acquired close in time, and under similar circumstances, more than 95% of inferred DCM parameters are unlikely to differ, speaking to mutual predictability over sessions. Using PEB, we show a reciprocal relationship between a conventional definition of 'reliability' and the conditional dependency among inferred model parameters. Our analyses confirm the reliability and reproducibility of the conductance-based DCMs for resting-state neurophysiological data. In this respect, the implicit generative modelling is suitable for interventional and longitudinal studies of neurological and psychiatric disorders.

Human sensorimotor resting state beta events and aperiodic activity show good test-retest reliability.

OBJECTIVE: Diseases affecting sensorimotor function impair physical independence. Reliable functional clinical biomarkers allowing early diagnosis or targeting treatment and rehabilitation could reduce this burden. Magnetoencephalography (MEG) non-invasively measures brain rhythms such as the somatomotor 'rolandic' rhythm which shows intermittent high-amplitude beta (14-30 Hz) 'events' that predict behavior across tasks and species and are altered by sensorimotor neurological diseases. METHODS: We assessed test-retest stability, a prerequisite for biomarkers, of spontaneous sensorimotor aperiodic (1/f) signal and beta events in 50 healthy human controls across two MEG sessions using the intraclass correlation coefficient (ICC). Beta events were determined using an amplitude-thresholding approach on a narrow-band filtered amplitude envelope obtained using Morlet wavelet decomposition. RESULTS: Resting sensorimotor characteristics showed good to excellent test-retest stability. Aperiodic component (ICC 0.77-0.88) and beta event amplitude (ICC 0.74-0.82) were very stable, whereas beta event duration was more variable (ICC 0.55-0.7). 2-3 minute recordings were sufficient to obtain stable results. Analysis automatization was successful in 86%. CONCLUSIONS: Sensorimotor beta phenotype is a stable feature of an individual's resting brain activity even for short recordings easily measured in patients. SIGNIFICANCE: Spontaneous sensorimotor beta phenotype has potential as a clinical biomarker of sensorimotor system integrity.

Somatosensory evoked spikes in normal adults detected by magnetoencephalography.

OBJECTIVE: Somatosensory evoked spikes (SESs) have been reported only in children aged under 14 years and are considered as an age-dependent phenomenon. However, we detected SESs in adult patients with epilepsy using magnetoencephalography (MEG). The present study investigated whether MEG can detect SESs in normal adults. METHODS: Spontaneous MEG was recorded during measurement of somatosensory evoked fields (SEFs) for bilateral electrical median nerve stimuli in 30 healthy adults. RESULTS: Bilateral SESs were observed in 10 adults but none in the other 20 subjects. SESs consisted of one or two peaks, and the first peak latency corresponded to that of the second peak (M2) of SEFs. The first SES peak was identical to the M2 in isofield map pattern, as well as location and orientation of the equivalent current dipole (ECD). M2 ECD strength in the 10 subjects with SESs was larger (p <0.0001) than in 20 without SESs. CONCLUSIONS: All-or-nothing detection of bilateral SESs by MEG in normal adults must depend on the signal-to-noise issue of symmetrical SEFs and background brain activity. SIGNIFICANCE: Our results further confirm the higher sensitivity of MEG compared to scalp EEG for the detection of focal cortical sources tangential to the scalp such as SESs.

Reproducibility of Rolandic beta rhythm modulation in MEG and EEG.

The Rolandic beta rhythm, at ∼20 Hz, is generated in the somatosensory and motor cortices and is modulated by motor activity and sensory stimuli, causing a short lasting suppression that is followed by a rebound of the beta rhythm. The rebound reflects inhibitory changes in the primary sensorimotor (SMI) cortex, and thus it has been used as a biomarker to follow the recovery of patients with acute stroke. The longitudinal stability of beta rhythm modulation is a prerequisite for its use in long-term follow-ups. We quantified the reproducibility of beta rhythm modulation in healthy subjects in a 1-year-longitudinal study both for MEG and EEG at T0, 1 month (T1-month, n = 8) and 1 year (T1-year, n = 19). The beta rhythm (13-25 Hz) was modulated by fixed tactile and proprioceptive stimulations of the index fingers. The relative peak strengths of beta suppression and rebound did not differ significantly between the sessions, and intersession reproducibility was good or excellent according to intraclass correlation-coefficient values (0.70-0.96) both in MEG and EEG. Our results indicate that the beta rhythm modulation to tactile and proprioceptive stimulation is well reproducible within 1 year. These results support the use of beta modulation as a biomarker in long-term follow-up studies, e.g., to quantify the functional state of the SMI cortex during rehabilitation and drug interventions in various neurological impairments.NEW & NOTEWORTHY The present study demonstrates that beta rhythm modulation is highly reproducible in a group of healthy subjects within a year. Hence, it can be reliably used as a biomarker in longitudinal follow-up studies in different neurological patient groups to reflect changes in the functional state of the sensorimotor cortex.

Reproducibility of graph measures derived from resting-state MEG functional connectivity metrics in sensor and source spaces.

Prior studies have used graph analysis of resting-state magnetoencephalography (MEG) to characterize abnormal brain networks in neurological disorders. However, a present challenge for researchers is the lack of guidance on which network construction strategies to employ. The reproducibility of graph measures is important for their use as clinical biomarkers. Furthermore, global graph measures should ideally not depend on whether the analysis was performed in the sensor or source space. Therefore, MEG data of the 89 healthy subjects of the Human Connectome Project were used to investigate test-retest reliability and sensor versus source association of global graph measures. Atlas-based beamforming was used for source reconstruction, and functional connectivity (FC) was estimated for both sensor and source signals in six frequency bands using the debiased weighted phase lag index (dwPLI), amplitude envelope correlation (AEC), and leakage-corrected AEC. Reliability was examined over multiple network density levels achieved with proportional weight and orthogonal minimum spanning tree thresholding. At a 100% density, graph measures for most FC metrics and frequency bands had fair to excellent reliability and significant sensor versus source association. The greatest reliability and sensor versus source association was obtained when using amplitude metrics. Reliability was similar between sensor and source spaces when using amplitude metrics but greater for the source than the sensor space in higher frequency bands when using the dwPLI. These results suggest that graph measures are useful biomarkers, particularly for investigating functional networks based on amplitude synchrony.

Spatial sampling of MEG and EEG based on generalized spatial-frequency analysis and optimal design.

In this paper, we analyze spatial sampling of electro- (EEG) and magnetoencephalography (MEG), where the electric or magnetic field is typically sampled on a curved surface such as the scalp. By simulating fields originating from a representative adult-male head, we study the spatial-frequency content in EEG as well as in on- and off-scalp MEG. This analysis suggests that on-scalp MEG, off-scalp MEG and EEG can benefit from up to 280, 90 and 110 spatial samples, respectively. In addition, we suggest a new approach to obtain sensor locations that are optimal with respect to prior assumptions. The approach also allows to control, e.g., the uniformity of the sensor locations. Based on our simulations, we argue that for a low number of spatial samples, model-informed non-uniform sampling can be beneficial. For a large number of samples, uniform sampling grids yield nearly the same total information as the model-informed grids.

Evaluation of movement and brain activity.

Clinical neurophysiology studies can contribute important information about the physiology of human movement and the pathophysiology and diagnosis of different movement disorders. Some techniques can be accomplished in a routine clinical neurophysiology laboratory and others require some special equipment. This review, initiating a series of articles on this topic, focuses on the methods and techniques. The methods reviewed include EMG, EEG, MEG, evoked potentials, coherence, accelerometry, posturography (balance), gait, and sleep studies. Functional MRI (fMRI) is also reviewed as a physiological method that can be used independently or together with other methods. A few applications to patients with movement disorders are discussed as examples, but the detailed applications will be the subject of other articles.

MEGnet: Automatic ICA-based artifact removal for MEG using spatiotemporal convolutional neural networks.

Magnetoencephalography (MEG) is a functional neuroimaging tool that records the magnetic fields induced by neuronal activity; however, signal from non-neuronal sources can corrupt the data. Eye-blinks, saccades, and cardiac activity are three of the most common sources of non-neuronal artifacts. They can be measured by affixing eye proximal electrodes, as in electrooculography (EOG), and chest electrodes, as in electrocardiography (ECG), however this complicates imaging setup, decreases patient comfort, and can induce further artifacts from movement. This work proposes an EOG- and ECG-free approach to identify eye-blinks, saccades, and cardiac activity signals for automated artifact suppression. The contribution of this work is three-fold. First, using a data driven, multivariate decomposition approach based on Independent Component Analysis (ICA), a highly accurate artifact classifier is constructed as an amalgam of deep 1-D and 2-D Convolutional Neural Networks (CNNs) to automate the identification and removal of ubiquitous whole brain artifacts including eye-blink, saccade, and cardiac artifacts. The specific architecture of this network is optimized through an unbiased, computer-based hyperparameter random search. Second, visualization methods are applied to the learned abstraction to reveal what features the model uses and to bolster user confidence in the model's training and potential for generalization. Finally, the model is trained and tested on both resting-state and task MEG data from 217 subjects, and achieves a new state-of-the-art in artifact detection accuracy of 98.95% including 96.74% sensitivity and 99.34% specificity on the held out test-set. This work automates MEG processing for both clinical and research use, adapts to the acquired acquisition time, and can obviate the need for EOG or ECG electrodes for artifact detection.

A systematic evaluation of source reconstruction of resting MEG of the human brain with a new high-resolution atlas: Performance, precision, and parcellation.

Noninvasive functional neuroimaging of the human brain can give crucial insight into the mechanisms that underpin healthy cognition and neurological disorders. Magnetoencephalography (MEG) measures extracranial magnetic fields originating from neuronal activity with high temporal resolution, but requires source reconstruction to make neuroanatomical inferences from these signals. Many source reconstruction algorithms are available, and have been widely evaluated in the context of localizing task-evoked activities. However, no consensus yet exists on the optimum algorithm for resting-state data. Here, we evaluated the performance of six commonly-used source reconstruction algorithms based on minimum-norm and beamforming estimates. Using human resting-state MEG, we compared the algorithms using quantitative metrics, including resolution properties of inverse solutions and explained variance in sensor-level data. Next, we proposed a data-driven approach to reduce the atlas from the Human Connectome Project's multi-modal parcellation of the human cortex based on metrics such as MEG signal-to-noise-ratio and resting-state functional connectivity gradients. This procedure produced a reduced cortical atlas with 230 regions, optimized to match the spatial resolution and the rank of MEG data from the current generation of MEG scanners. Our results show that there is no "one size fits all" algorithm, and make recommendations on the appropriate algorithms depending on the data and aimed analyses. Our comprehensive comparisons and recommendations can serve as a guide for choosing appropriate methodologies in future studies of resting-state MEG.

Optimal design of on-scalp electromagnetic sensor arrays for brain source localisation.

Optically pumped magnetometers (OPMs) are quickly widening the scopes of noninvasive neurophysiological imaging. The possibility of placing these magnetic field sensors on the scalp allows not only to acquire signals from people in movement, but also to reduce the distance between the sensors and the brain, with a consequent gain in the signal-to-noise ratio. These advantages make the technique particularly attractive to characterise sources of brain activity in demanding populations, such as children and patients with epilepsy. However, the technology is currently in an early stage, presenting new design challenges around the optimal sensor arrangement and their complementarity with other techniques as electroencephalography (EEG). In this article, we present an optimal array design strategy focussed on minimising the brain source localisation error. The methodology is based on the Cramér-Rao bound, which provides lower error bounds on the estimation of source parameters regardless of the algorithm used. We utilise this framework to compare whole head OPM arrays with commercially available electro/magnetoencephalography (E/MEG) systems for localising brain signal generators. In addition, we study the complementarity between EEG and OPM-based MEG, and design optimal whole head systems based on OPMs only and a combination of OPMs and EEG electrodes for characterising deep and superficial sources alike. Finally, we show the usefulness of the approach to find the nearly optimal sensor positions minimising the estimation error bound in a given cortical region when a limited number of OPMs are available. This is of special interest for maximising the performance of small scale systems to ad hoc neurophysiological experiments, a common situation arising in most OPM labs.

Exploring MEG brain fingerprints: Evaluation, pitfalls, and interpretations.

Individual characterization of subjects based on their functional connectome (FC), termed "FC fingerprinting", has become a highly sought-after goal in contemporary neuroscience research. Recent functional magnetic resonance imaging (fMRI) studies have demonstrated unique characterization and accurate identification of individuals as an accomplished task. However, FC fingerprinting in magnetoencephalography (MEG) data is still widely unexplored. Here, we study resting-state MEG data from the Human Connectome Project to assess the MEG FC fingerprinting and its relationship with several factors including amplitude- and phase-coupling functional connectivity measures, spatial leakage correction, frequency bands, and behavioral significance. To this end, we first employ two identification scoring methods, differential identifiability and success rate, to provide quantitative fingerprint scores for each FC measurement. Secondly, we explore the edgewise and nodal MEG fingerprinting patterns across the different frequency bands (delta, theta, alpha, beta, and gamma). Finally, we investigate the cross-modality fingerprinting patterns obtained from MEG and fMRI recordings from the same subjects. We assess the behavioral significance of FC across connectivity measures and imaging modalities using partial least square correlation analyses. Our results suggest that fingerprinting performance is heavily dependent on the functional connectivity measure, frequency band, identification scoring method, and spatial leakage correction. We report higher MEG fingerprinting performances in phase-coupling methods, central frequency bands (alpha and beta), and in the visual, frontoparietal, dorsal-attention, and default-mode networks. Furthermore, cross-modality comparisons reveal a certain degree of spatial concordance in fingerprinting patterns between the MEG and fMRI data, especially in the visual system. Finally, the multivariate correlation analyses show that MEG connectomes have strong behavioral significance, which however depends on the considered connectivity measure and temporal scale. This comprehensive, albeit preliminary investigation of MEG connectome test-retest identifiability offers a first characterization of MEG fingerprinting in relation to different methodological and electrophysiological factors and contributes to the understanding of fingerprinting cross-modal relationships. We hope that this first investigation will contribute to setting the grounds for MEG connectome identification.

The impact of 1/f activity and baseline correction on the results and interpretation of time-frequency analyses of EEG/MEG data: A cautionary tale.

Typically, time-frequency analysis (TFA) of electrophysiological data is aimed at isolating narrowband signals (oscillatory activity) from broadband non-oscillatory (1/f) activity, so that changes in oscillatory activity resulting from experimental manipulations can be assessed. A widely used method to do this is to convert the data to the decibel (dB) scale through baseline division and log transformation. This procedure assumes that, for each frequency, sources of power (i.e., oscillations and 1/f activity) scale by the same factor relative to the baseline (multiplicative model). This assumption may be incorrect when signal and noise are independent contributors to the power spectrum (additive model). Using resting-state EEG data from 80 participants, we found that the level of 1/f activity and alpha power are not positively correlated within participants, in line with the additive but not the multiplicative model. Then, to assess the effects of dB conversion on data that violate the multiplicativity assumption, we simulated a mixed design study with one between-subject (noise level, i.e., level of 1/f activity) and one within-subject (signal amplitude, i.e., amplitude of oscillatory activity added onto the background 1/f activity) factor. The effect size of the noise level × signal amplitude interaction was examined as a function of noise difference between groups, following dB conversion. Findings revealed that dB conversion led to the over- or under-estimation of the true interaction effect when groups differing in 1/f levels were compared, and it also led to the emergence of illusory interactions when none were present. This is because signal amplitude was systematically underestimated in the noisier compared to the less noisy group. Hence, we recommend testing whether the level of 1/f activity differs across groups or conditions and using multiple baseline correction strategies to validate results if it does. Such a situation may be particularly common in aging, developmental, or clinical studies.

Magnetoencephalography for epileptic focus localization based on Tucker decomposition with ripple window.

AIMS: To improve the Magnetoencephalography (MEG) spatial localization precision of focal epileptic. METHODS: 306-channel simulated or real clinical MEG is estimated as a lower-dimensional tensor by Tucker decomposition based on Higher-order orthogonal iteration (HOOI) before the inverse problem using linearly constraint minimum variance (LCMV). For simulated MEG data, the proposed method is compared with dynamic imaging of coherent sources (DICS), multiple signal classification (MUSIC), and LCMV. For clinical real MEG of 31 epileptic patients, the ripples (80-250 Hz) were detected to compare the source location precision with spikes using the proposed method or the dipole-fitting method. RESULTS: The experimental results showed that the positional accuracy of the proposed method was higher than that of LCMV, DICS, and MUSIC for simulation data. For clinical real MEG data, the positional accuracy of the proposed method was higher than that of dipole-fitting regardless of whether the time window was ripple window or spike window. Also, the positional accuracy of the ripple window was higher than that of the spike window regardless of whether the source location method was the proposed method or the dipole-fitting method. For both shallow and deep sources, the proposed method provided effective performance. CONCLUSION: Tucker estimation of MEG for source imaging by ripple window is a promising approach toward the presurgical evaluation of epileptics.

Localization accuracy of a common beamformer for the comparison of two conditions.

The linearly constrained minimum variance beamformer is frequently used to reconstruct sources underpinning neuromagnetic recordings. When reconstructions must be compared across conditions, it is considered good practice to use a single, "common" beamformer estimated from all the data at once. This is to ensure that differences between conditions are not ascribable to differences in beamformer weights. Here, we investigate the localization accuracy of such a common beamformer. Based on theoretical derivations, we first show that the common beamformer leads to localization errors in source reconstruction. We then turn to simulations in which we attempt to reconstruct a (genuine) source in a first condition, while considering a second condition in which there is an (interfering) source elsewhere in the brain. We estimate maps of mislocalization and assess statistically the difference between "standard" and "common" beamformers. We complement our findings with an application to experimental MEG data. The results show that the common beamformer may yield significant mislocalization. Specifically, the common beamformer may force the genuine source to be reconstructed closer to the interfering source than it really is. As the same applies to the reconstruction of the interfering source, both sources are pulled closer together than they are. This observation was further illustrated in experimental data. Thus, although the common beamformer allows for the comparison of conditions, in some circumstances it introduces localization inaccuracies. We recommend alternative approaches to the general problem of comparing conditions.

Resting-state magnetoencephalography source magnitude imaging with deep-learning neural network for classification of symptomatic combat-related mild traumatic brain injury.

Combat-related mild traumatic brain injury (cmTBI) is a leading cause of sustained physical, cognitive, emotional, and behavioral disabilities in Veterans and active-duty military personnel. Accurate diagnosis of cmTBI is challenging since the symptom spectrum is broad and conventional neuroimaging techniques are insensitive to the underlying neuropathology. The present study developed a novel deep-learning neural network method, 3D-MEGNET, and applied it to resting-state magnetoencephalography (rs-MEG) source-magnitude imaging data from 59 symptomatic cmTBI individuals and 42 combat-deployed healthy controls (HCs). Analytic models of individual frequency bands and all bands together were tested. The All-frequency model, which combined delta-theta (1-7 Hz), alpha (8-12 Hz), beta (15-30 Hz), and gamma (30-80 Hz) frequency bands, outperformed models based on individual bands. The optimized 3D-MEGNET method distinguished cmTBI individuals from HCs with excellent sensitivity (99.9 ± 0.38%) and specificity (98.9 ± 1.54%). Receiver-operator-characteristic curve analysis showed that diagnostic accuracy was 0.99. The gamma and delta-theta band models outperformed alpha and beta band models. Among cmTBI individuals, but not controls, hyper delta-theta and gamma-band activity correlated with lower performance on neuropsychological tests, whereas hypo alpha and beta-band activity also correlated with lower neuropsychological test performance. This study provides an integrated framework for condensing large source-imaging variable sets into optimal combinations of regions and frequencies with high diagnostic accuracy and cognitive relevance in cmTBI. The all-frequency model offered more discriminative power than each frequency-band model alone. This approach offers an effective path for optimal characterization of behaviorally relevant neuroimaging features in neurological and psychiatric disorders.

A comprehensive study on electroencephalography and magnetoencephalography sensitivity to cortical and subcortical sources.

Signal-to-noise ratio (SNR) maps are a good way to visualize electroencephalography (EEG) and magnetoencephalography (MEG) sensitivity. SNR maps extend the knowledge about the modulation of EEG and MEG signals by source locations and orientations and can therefore help to better understand and interpret measured signals as well as source reconstruction results thereof. Our work has two main objectives. First, we investigated the accuracy and reliability of EEG and MEG finite element method (FEM)-based sensitivity maps for three different head models, namely an isotropic three and four-compartment and an anisotropic six-compartment head model. As a result, we found that ignoring the cerebrospinal fluid leads to an overestimation of EEG SNR values. Second, we examined and compared EEG and MEG SNR mappings for both cortical and subcortical sources and their modulation by source location and orientation. Our results for cortical sources show that EEG sensitivity is higher for radial and deep sources and MEG for tangential ones, which are the majority of sources. As to the subcortical sources, we found that deep sources with sufficient tangential source orientation are recordable by the MEG. Our work, which represents the first comprehensive study where cortical and subcortical sources are considered in highly detailed FEM-based EEG and MEG SNR mappings, sheds a new light on the sensitivity of EEG and MEG and might influence the decision of brain researchers or clinicians in their choice of the best modality for their experiment or diagnostics, respectively.

The Wisdom and Vision From the ACMEGS Inaugural Decade.

Concise history of fascinating magnetoencephalography (MEG) technology and catalog of very selected milestone preclinical and clinical MEG studies are provided as the background. The focus is the societal context defining a journey of MEG to and through clinical practice and formation of the American Clinical MEG Society (ACMEGS). We aspired to provide an objective historic perspective and document contributions of many professionals while focusing on the role of ACMEGS in the growth and maturation of clinical MEG field. The ACMEGS was born (2006) out of inevitability to address two vital issues-fair reimbursement and proper clinical acceptance. A beacon of accountable MEG practice and utilization is now an expanding professional organization with the highest level of competence in practice of clinical MEG and clinical credibility. The ACMEGS facilitated a favorable disposition of insurances toward MEG in the United States by combining the national replication of the grassroots efforts and teaming up with the strategic partners-particularly the American Academy of Neurology (AAN), published two Position Statements (2009 and 2017), the world's only set of MEG Clinical Practice Guidelines (CPGs; 2011) and surveys of clinical MEG practice (2011 and 2020) and use (2020). In addition to the annual ACMEGS Course (2012), we directly engaged MEG practitioners through an Invitational Summit (2019). The Society remains focused on the improvements and expansion of clinical practice, education, clinical training, and constructive engagement of vendors in these issues and pivotal studies toward additional MEG indications. The ACMEGS not only had the critical role in the progress of Clinical MEG in the United States and beyond since 2006 but positioned itself as the field leader in the future.

Towards Best Practices in Clinical Magnetoencephalography: Patient Preparation and Data Acquisition.

A magnetoencephalography (MEG) recording for clinical purposes requires a different level of attention and detail than that for research. As contrasted with a research subject, the MEG technologist must work with a patient who may not fully cooperate with instructions. The patient is on a clinical schedule, with generally no opportunity to return due to an erroneous or poor acquisition. The data will generally be processed by separate MEG analysts, who require a consistent and high-quality recording to complete their analysis and clinical report. To assure a quality recording, (1) MEG technologists must immediately recheck their scalp measurement data during the patient preparation, to catch disturbances and ensure registration accuracy of the patient fiducials, electrodes, and head position indicator coils. During the recording, (2) the technologist must ensure that the patient remains quiet and as far as possible into the helmet. After the recording, (3) the technologist must consistently prepare the data for subsequent clinical analysis. This article aims to comprehensively address these matters for practitioners of clinical MEG in a helpful and practical way. Based on the authors' experiences in recording over three thousand patients between them, presented here are a collection of techniques for implementation into daily routines that ensure good operation and high data quality. The techniques address a gap in the clinical literature addressing the multitude of potential sources of error during patient preparation and data acquisition, and how to prevent, recognize, or correct those.

The 10 Common Evidence-Supported Indications for MEG in Epilepsy Surgery: An Illustrated Compendium.

Unfamiliarity with the indications for and benefits of magnetoencephalography (MEG) persists, even in the epilepsy community, and hinders its acceptance to clinical practice, despite the evidence. The wide treatment gap for patients with drug-resistant epilepsy and immense underutilization of epilepsy surgery had similar effects. Thus, educating referring physicians (epileptologists, neurologists, and neurosurgeons) both about the value of epilepsy surgery and about the potential benefits of MEG can achieve synergy and greatly improve the process of selecting surgical candidates. As a practical step toward a comprehensive educational process to benefit potential MEG users, current MEG referrers, and newcomers to MEG, the authors have elected to provide an illustrated guide to 10 everyday situations where MEG can help in the evaluation of people with drug-resistant epilepsy. They are as follows: (1) lacking or imprecise hypothesis regarding a seizure onset; (2) negative MRI with a mesial temporal onset suspected; (3) multiple lesions on MRI; (4) large lesion on MRI; (5) diagnostic or therapeutic reoperation; (6) ambiguous EEG findings suggestive of "bilateral" or "generalized" pattern; (7) intrasylvian onset suspected; (8) interhemispheric onset suspected; (9) insular onset suspected; and (10) negative (i.e., spikeless) EEG. Only their practical implementation and furtherance of personal and collective education will lead to the potentially impactful synergy of the two-MEG and epilepsy surgery. Thus, while fulfilling our mission as physicians, we must not forget that ignoring the wealth of evidence about the vast underutilization of epilepsy surgery - and about the usefulness and value of MEG in selecting surgical candidates - is far from benign neglect.

Normal Variants in Magnetoencephalography.

Normal variants, although not occurring frequently, may appear similar to epileptic activity. Misinterpretation may lead to false diagnoses. In the context of presurgical evaluation, normal variants may lead to mislocalizations with severe impact on the viability and success of surgical therapy. While the different variants are well known in EEG, little has been published in regard to their appearance in magnetoencephalography. Furthermore, there are some magnetoencephalography normal variants that have no counterparts in EEG. This article reviews benign epileptiform variants and provides examples in EEG and magnetoencephalography. In addition, the potential of oscillatory configurations in different frequency bands to appear as epileptic activity is discussed.