Ictal EEG source imaging in presurgical evaluation: High agreement between analysis methods.

PURPOSE: To determine the agreement between five different methods of ictal EEG source imaging, and to assess their accuracy in presurgical evaluation of patients with focal epilepsy. It was hypothesized that high agreement between methods was associated with higher localization-accuracy. METHODS: EEGs were recorded with a 64-electrode array. Thirty-eight seizures from 22 patients were analyzed using five different methods phase mapping, dipole fitting, CLARA, cortical-CLARA and minimum norm. Localization accuracy was determined at sub-lobar level. Reference standard was the final decision of the multidisciplinary epilepsy surgery team, and, for the operated patients, outcome one year after surgery. RESULTS: Agreement between all methods was obtained in 13 patients (59%) and between all but one methods in additional six patients (27%). There was a trend for minimum norm being less accurate than phase mapping, but none of the comparisons reached significance. Source imaging in cases with agreement between all methods was not more accurate than in the other cases. Ictal source imaging achieved an accuracy of 73% (for operated patients: 86%). CONCLUSION: There was good agreement between different methods of ictal source imaging. However, good inter-method agreement did not necessarily imply accurate source localization, since all methods faced the limitations of the inverse solution.

N400 predicts recovery from disorders of consciousness.

OBJECTIVE: Patients with the unresponsive wakefulness syndrome (UWS; formerly vegetative state) or in a minimally conscious state (MCS) open their eyes spontaneously but show no (UWS) or only marginal (MCS) signs of awareness. Because these states can become permanent, residual information processing capacities need to be determined, and reliable outcome predictors need to be found. We assessed higher-order cortical information processing in UWS or MCS in a large group of patients using electroencephalographic event-related potentials (ERPs) and determined their long-term prognostic value for recovery. METHODS: Cognitive ERPs elicited by sound (P300) and speech (N400) were used to assess information processing in 92 behaviorally unresponsive patients diagnosed as in the state of either UWS (n=53) or MCS (n=39). ERPs were assessed with a clinical standard evaluation method and a computerized method, the t-continuous wavelet transform. The patients' clinical outcome was followed up between 2 and 14 years after discharge from the rehabilitation center. RESULTS: Within the first year of the disease, many patients showed an intact P300 and several also an N400, indicating considerable residual information processing. At clinical follow-up, about 25% of the patients recovered and regained communicative capabilities. A highly significant relationship between N400, but not P300, presence and subsequent recovery was found. INTERPRETATION: Results specify cognitive capabilities in disorders of consciousness, and determine their prognostic value. Specifically the N400 ERP is suggested as an important tool to assess information-processing capacities that can predict the likelihood of recovery of patients in UWS or MCS.

Reduced mismatch negativity and increased variability of brain activity in schizophrenia.

OBJECTIVES: Schizophrenia patients commonly exhibit smaller amplitudes of mismatch negativity (MMN) than in controls. It remains unclear whether this results from deficient processes indexed by MMN or 'normally' though more variable processing. The present magnetoencephalographic study addressed this question by analyzing intra-individual trial-by-trial variability and MMN amplitude. METHODS: Twenty inpatients meeting ICD criteria for schizophrenia and 18 healthy controls participated in an auditory oddball experiment. The neuromagnetic mismatch field (MMNm) was defined as the difference waveform deviant minus standard tone response. Variability index (VI) in different frequency bands was quantified as trial-by-trial variation of stimulus-evoked responses and epoch-by-epoch variation of signal amplitude during a resting condition. RESULTS: Patients displayed a smaller MMNm amplitude and higher VI during the oddball experiment and during the resting condition than in controls. VI and MMNm amplitude were correlated in controls, but not in patients. CONCLUSION: Reduced MMN in schizophrenia cannot be explained by augmented variability of brain activity; deficient auditory sensory memory and stimulus related phase-locking may characterize the disorder. SIGNIFICANCE: Understanding the contribution of diminished temporal stability of neuronal network dynamics to schizophrenia is crucial in modeling the impact of such instability on performance and thus for understanding deviant attention and memory functions.

Evoked and induced oscillatory activity contributes to abnormal auditory sensory gating in schizophrenia.

The ratio of magnetoencephalogram-recorded brain responses occurring 50ms after paired clicks (S2-evoked M50/S1-evoked M50) serves as a measure of sensory gating. An abnormally large ratio is commonly found in schizophrenia. Whether this abnormality indicates impaired gating is debated. Using event-related oscillations the present study sought to elucidate processes contributing to the phenomenon of altered M50 gating ratio. Schizophrenia inpatients (n=50) showed the expected large M50 gating ratio relative to 48 healthy controls, which correlated with less induced frontally generated activity in the 10-15Hz frequency band starting 200ms before the onset of S2. Patients also produced smaller alpha (8-12Hz) and gamma (60-80Hz) responses to S1. Results suggest that the deviant gating ratio in schizophrenia is a consequence of a complex alteration in the processing of incoming information that cannot be attributed to impaired gating alone.

Specific cognitive training normalizes auditory sensory gating in schizophrenia: a randomized trial.

BACKGROUND: The ratio of scalp-recorded brain responses occurring 50 msec after paired clicks (S2-evoked P50/S1-evoked P50) serves as a measure of sensory gating. An abnormally large ratio is commonly found in schizophrenia and is considered as a sign of reduced sensory gating or otherwise dysfunctional organization of the auditory/verbal system as a factor contributing to psychopathology and cognitive dysfunction in schizophrenia. This initial randomized clinical trial compared the efficacy of two 4-week, computer-based cognitive training methods that emphasize either auditory discrimination and verbal memory or a broader range of cognitive functions in schizophrenia. METHODS: Thirty-nine schizophrenia patients (ICD-F20.0 diagnosis) were assigned to Cognitive Exercises (CE) or Cognitive Package (Cogpack). The M50, the magnetoencephalographic analogue of electroencephalographic P50, and performance on verbal learning and memory tests were used to evaluate training effects. RESULTS: As expected, patients exhibited higher pretreatment gating ratios than 28 age-matched healthy comparison participants. Gating ratios decreased after CE but not after Cogpack. Cognitive test performance improved more after CE than after Cogpack. CONCLUSIONS: Appropriately specific psychological training changes the neural performance in schizophrenia, normalizing sensory and cognitive function.

Local Heschl's Gyrus-based coordinate system for intersubject comparison of M50 auditory response modeled by single equivalent current dipole.

Allocating electromagnetic auditory responses to active regions in the human auditory cortex can be difficult because of high interindividual variability of the relevant structures. Location and orientation of the primary auditory cortex (Heschl's Gyrus) and the temporal plane vary with individual features such as age, gender, handedness, or between healthy subjects and patients with a psychiatric disorder (e.g., schizophrenia). Here, we propose a reference coordinate system that considers the individual MRI-based position, orientation and length of the primary auditory cortex to account for interindividual variability. Transformation of the M50 dipole localizations in this new HG-(Heschl's-Gyrus)-coordinate system, accomplished for 10 healthy subjects and 10 schizophrenia patients, confirmed group difference more precisely than other registration methods. We suggest to use the HG-coordinate system for localization of functional measures and evaluation of brain activity differences between groups or measurement conditions.