Zoomed MRI Guided by Combined EEG/MEG Source Analysis: A Multimodal Approach for Optimizing Presurgical Epilepsy Work-up and its Application in a Multi-focal Epilepsy Patient Case Study.

In recent years, the use of source analysis based on electroencephalography (EEG) and magnetoencephalography (MEG) has gained considerable attention in presurgical epilepsy diagnosis. However, in many cases the source analysis alone is not used to tailor surgery unless the findings are confirmed by lesions, such as, e.g., cortical malformations in MRI. For many patients, the histology of tissue resected from MRI negative epilepsy shows small lesions, which indicates the need for more sensitive MR sequences. In this paper, we describe a technique to maximize the synergy between combined EEG/MEG (EMEG) source analysis and high resolution MRI. The procedure has three main steps: (1) construction of a detailed and calibrated finite element head model that considers the variation of individual skull conductivities and white matter anisotropy, (2) EMEG source analysis performed on averaged interictal epileptic discharges (IED), (3) high resolution (0.5 mm) zoomed MR imaging, limited to small areas centered at the EMEG source locations. The proposed new diagnosis procedure was then applied in a particularly challenging case of an epilepsy patient: EMEG analysis at the peak of the IED coincided with a right frontal focal cortical dysplasia (FCD), which had been detected at standard 1 mm resolution MRI. Of higher interest, zoomed MR imaging (applying parallel transmission, 'ZOOMit') guided by EMEG at the spike onset revealed a second, fairly subtle, FCD in the left fronto-central region. The evaluation revealed that this second FCD, which had not been detectable with standard 1 mm resolution, was the trigger of the seizures.

Inhibition-induced plasticity in tinnitus patients after repetitive exposure to tailor-made notched music.

OBJECTIVE: Notch-filtered music has been shown to induce frequency-specific inhibition. Here, we investigated which cortical structures are affected by tailor-made notched music (TMNM) in tinnitus patients and how this inhibition-induced plasticity develops over time. METHODS: Nine subjects suffering from chronic tonal tinnitus listened to music passing through a notch-filter centered at the patient's individual tinnitus frequency (TMNM) for three hours on three consecutive days. Before and after each listening session, a tone at the tinnitus frequency and a control tone of 500 Hz were presented in the magnetoencephalograph. Subjective tinnitus loudness was measured via visual analog scales. RESULTS: TMNM exposure reduced subjective tinnitus loudness and neural activity evoked by the tinnitus tone in temporal, parietal and frontal regions within the N1m time interval. Reduction of temporal and frontal activation correlated significantly with tinnitus loudness decline. Reduction of tinnitus related neural activity persisted and accumulated over three days. CONCLUSIONS: Inhibition-induced plasticity occurs in a cortical network, known to be crucial for tinnitus perception. This cortical reorganization evolves fast and accumulates across sessions. SIGNIFICANCE: This study extends previous work on inhibition-induced plasticity, as it demonstrates the involvement of parietal and frontal areas and discovers a cumulative effect of cortical reorganization in tinnitus patients.

Multimodal imaging of functional networks and event-related potentials in performance monitoring.

The stop-signal task is a prototypical experiment to study cognitive processes that mediate successful performance in a rapidly changing environment. By means of simultaneous recording and combined analysis of electroencephalography and functional magnetic resonance imaging on single trial level, we provide a comprehensive view on brain responses related to performance monitoring in this task. Three types of event-related EEG components were analyzed: a go-related N2/P3-complex devoid of motor-inhibition, the stop-related N2/P3-complex and the error-related negativity with its consecutive error positivity. Relevant functional networks were identified by crossmodal correlation analyses in a parallel independent component analysis framework. Go-related potentials were associated with a midcingulate network known to participate in the processing of conflicts, a left-dominant somatosensory-motor network, and deactivations in visual cortices. Stop-related brain responses in association with the N2/P3-complex were seen with networks known to support motor and cognitive inhibition, including parts of the basal ganglia, the anterior midcingulate cortex and pre-supplementary motor area as well as the anterior insula. Error-related brain responses showed a similar constellation with additional recruitment of the posterior insula and the inferior frontal cortex. Our data clearly indicate that the pre-supplementary motor area is involved in inhibitory mechanisms but not in the processing of conflicts per se.

Local sphere-based co-registration for SAM group analysis in subjects without individual MRI.

Synthetic aperture magnetometry (SAM) is a powerful MEG source localization method to analyze evoked as well as induced brain activity. To gain structural information of the underlying sources, especially in group studies, individual magnetic resonance images (MRI) are required for co-registration. During the last few years, the relevance of MEG measurements on understanding the pathophysiology of different diseases has noticeable increased. Unfortunately, especially in patients and small children, structural MRI scans cannot always be performed. Therefore, we developed a new method for group analysis of SAM results without requiring structural MRI data that derives its geometrical information from the individual volume conductor model constructed for the SAM analysis. The normalization procedure is fast, easy to implement and integrates seamlessly into an existing landmark based MEG-MRI co-registration procedure. This new method was evaluated on different simulated points as well as on a pneumatic index finger stimulation paradigm analyzed with SAM. Compared with an established MRI-based normalization procedure (SPM2) the new method shows only minor errors in single subject results as well as in group analysis. The mean difference between the two methods was about 4 mm for the simulated as well as for finger stimulation data. The variation between individual subjects was generally higher than the error induced by the missing MRIs. The method presented here is therefore sufficient for most MEG group studies. It allows accomplishing MEG studies with subject groups where MRI measurements cannot be performed.

Dynamics of auditory plasticity after cochlear implantation: a longitudinal study.

Human representational cortex may fundamentally alter its organization and (re)gain the capacity for auditory processing even when it is deprived of its input for more than two decades. Stimulus-evoked brain activity was recorded in post-lingual deaf patients after implantation of a cochlear prosthesis, which partly restored their hearing. During a 2 year follow-up study this activity revealed almost normal component configuration and was localized in the auditory cortex, demonstrating adequacy of the cochlear implant stimulation. Evoked brain activity increased over several months after the cochlear implant was turned on. This is taken as a measure of the temporal dynamics of plasticity of the human auditory system after implantation of cochlear prosthesis.

Auditory cortex responses to the transition from monophonic to pseudo-stereo sound.

Human cortical responses to the change in spaciousness of sound were recorded with the method of magnetoencephalography (MEG). The phases of dichotically presented 500-Hz tones were shifted so that the sound was perceived as originating either from a point-like source centered in the head or from separated sources in space. The phase shift was embedded in 40-Hz amplitude modulation. Thus, the phase shift could not be detected from a monaural signal. The transition between 'mono' and 'pseudo-stereo' quality of the sound elicited a P1-N1-P2 response similar to the onset response as well as a decrement in the steady-state response. The responses were discussed as reflecting binaural processing in the central auditory system.

Acoustically and electrically evoked responses of the human cortex before and after cochlear implantation.

Multi-channel auditory evoked potentials (AEP) were recorded before and after cochlear implantation (CI) from a patient suffering from severe high frequency hearing loss with residual, but highly fluctuating hearing around 250 Hz. Immediately after CI activation early components of the N1 were present. Later N1 components developed during the use of CI. The unique result of this single case study is the concordance of the cortical AEP pattern obtained by native and artificial peripheral stimulation, which can be regarded as an indicator for the adequate function of the CI.

Short-term plasticity of the human auditory cortex.

Magnetoencephalographic measurements (MEG) were used to examine the effect on the human auditory cortex of removing specific frequencies from the acoustic environment. Subjects listened for 3 h on three consecutive days to music "notched" by removal of a narrow frequency band centered on 1 kHz. Immediately after listening to the notched music, the neural representation for a 1-kHz test stimulus centered on the notch was found to be significantly diminished compared to the neural representation for a 0.5-kHz control stimulus centered one octave below the region of notching. The diminished neural representation for 1 kHz reversed to baseline between the successive listening sessions. These results suggest that rapid changes can occur in the tuning of neurons in the adult human auditory cortex following manipulation of the acoustic environment. A dynamic form of neural plasticity may underlie the phenomenon observed here.