Resting state functional connectivity changes induced by prior brain state are not network specific.

Resting state functional connectivity (rFC) is used to identify functionally related brain areas without requiring subjects to perform specific tasks. Previous work suggests that prior brain state, as determined by the activity engaged in immediately prior to collection of resting state data, can influence the networks recovered by rFC analyses. We determined the prevalence and network specificity of rFC changes induced by manipulations of prior state (including an unstructured (unconstrained) state, and language and motor tasks). Three blocks of rest data (one after each of the specified prior states) were acquired on each of 25 subjects. We hypothesised that prior state induced changes in rFC would be greatest within the networks most actively recruited by that prior state. Changes in rFC were greatest following the motor task and, contrary to our hypothesis, were not network specific. This was demonstrated by comparing (1) the timecourses within a set of ROIs selected on the basis of task-related de/activation, and (2) seed-based whole brain voxel-wise connectivity maps, seeded from local maxima in the task-related de/activation maps. Changes in connectivity strength tended to manifest as increases in rFC relative to that in the unstructured rest state, with change maps resembling partially complete maps of the primary sensory cortices and the cognitive control network. The majority of rFC changes occurred in areas moderately (but not weakly) connected to the seeds. Constrained prior states were associated with lower across-participant variance in rFC. This systematic investigation of the effect of prior brain state on rFC indicates that the rFC changes induced by prior brain state occur both in brain networks related to that brain activity and in networks nominally unrelated to that brain activity.

Lennox-Gastaut syndrome and phenotype: secondary network epilepsies.

OBJECTIVE: Lennox-Gastaut syndrome (LGS) is a severe epilepsy phenotype with characteristic electroclinical features despite diverse etiologies. We previously found common cerebral networks involved during slow spike-and-wave (SSW) and generalized paroxysmal fast activity (PFA), characteristic interictal discharges. Some patients have a Lennox-Gastaut-like phenotype and cortical lesions. We wished to explore the interaction between cerebral networks and lesions in this group. METHODS: 3 Tesla electroencephalography-functional magnetic resonance imaging (EEG-fMRI) on six subjects with Lennox-Gastaut phenotype and a structural lesion. Timings of SSW and PFA events were used in an event-related fMRI analysis, and to estimate the time course of the hemodynamic response from key regions. RESULTS: (1) PFA-robust fMRI signal increases were observed in frontal and parietal association cortical areas, thalamus, and pons, with simultaneous increases in both "attention" and resting-state (default mode) networks, a highly unusual pattern. (2) SSW showed mixed increased and decreased fMRI activity, with preevent increases in association cortex and thalamus, and then prominent postevent reduction. There was decreased fMRI activity in primary cortical areas. (3) Lesion-variable fMRI increases were observed during PFA and SSW discharges. Three subjects who proceeded to lesionectomy are >1 year seizure-free. SIGNIFICANCE: We conceptualize Lennox-Gastaut phenotype as a being a network epilepsy, where key cerebral networks become autonomously unstable. Epileptiform activity in Lennox-Gastaut phenotype, and by implication in LGS, appears to be amplified and expressed through association cortical areas, possibly because the attention and default-mode networks are widely interconnected, fundamental brain networks. Seizure freedom in the subjects who proceeded to lesionectomy suggests that cortical lesions are able to establish and maintain this abnormal unstable network behavior. LGS may be considered a secondary network epilepsy because the unifying epileptic manifestations of the disorder, including PFA and SSW, reflect network dysfunction, rather than the specific initiating process.

Constructing Carbon Fiber Motion-Detection Loops for Simultaneous EEG-fMRI.

One of the most significant impediments to high-quality EEG recorded in an MRI scanner is subject motion. Availability of motion artifact sensors can substantially improve the quality of the recorded EEG. In the study of epilepsy, it can also dramatically increase the confidence that one has in discriminating true epileptiform activity from artifact. This is due both to the reduction in artifact and the ability to visually inspect the motion sensor signals when reading the EEG, revealing whether or not head motion is present. We have previously described the use of carbon fiber loops for detecting and correcting artifact in EEG acquired simultaneously with MRI. The loops, attached to the subject's head, are electrically insulated from the scalp. They provide a simple and direct measure of specific artifact that is contaminating the EEG, including both subject motion and residual artifact arising from magnetic field gradients applied during MRI. Our previous implementation was used together with a custom-built EEG-fMRI system that differs substantially from current commercially available EEG-fMRI systems. The present technical note extends this work, describing in more detail how to construct the carbon fiber motion-detection loops, and how to interface them with a commercially available simultaneous EEG-fMRI system. We hope that the information provided may help those wishing to utilize a motion-detection/correction solution to improve the quality of EEG recorded within an MRI scanner.

Tonic seizures of Lennox-Gastaut syndrome: periictal single-photon emission computed tomography suggests a corticopontine network.

PURPOSE: Lennox-Gastaut syndrome (LGS) is a severe epileptic disorder with characteristic electroclinical features but diverse etiologies. The shared electroclinical characteristics suggest that common cerebral networks are involved in generating seizures. We sought to reveal these networks by comparing ictal and interictal single-photon emission computed tomography (SPECT). METHODS: We identified 10 ictal-interictal SPECT pairs from seven patients with LGS (median age 11 years; range 1-38) who were studied during video electroencephalography (EEG)-confirmed tonic seizures. We performed a voxel-wise comparison of ictal and interictal SPECT studies across the group. The evolution of blood flow changes was explored by examining early and late injection groups. KEY FINDINGS: Median duration of tonic seizures was 10 s (range 6-29 s), and injection latency from seizure offset was -8 to 48 s. In the early injection group (<10 s; three studies), there was hyperperfusion over pons and cerebellar hemispheres (p < 0.05 cluster corrected family wise error), and hypoperfusion bilaterally over the pericentral region, with a trend toward hyperperfusion over bilateral superior and middle frontal gyri, and lateral parietal cortex. In the late injection group, there was hyperperfusion over midline and lateral cerebellar regions, with hypoperfusion widely over bilateral frontal regions. SIGNIFICANCE: This study suggests that the tonic seizures of LGS result from activity in a network, containing bilateral frontal and parietal association areas and the pons. We postulate that tonic seizures recruit the corticoreticular system, which connects frontal attentional areas to the pontine reticular formation, and is normally responsible for postural tone and orienting behavior.

Nodular heterotopia and absence seizures: fMRI evidence that they may be connected.

In this study we used EEG-fMRI to investigate whether peri-ventricular nodular heterotopia (PNH) are connected to the seizure generating network in individuals initially diagnosed with absence seizures (AS) who were later found to have co-existent PNH. We performed event related EEG-fMRI of the patients typical events as well as performing functional connectivity (FC) seeded from the PNH to answer this question. Both subjects demonstrated event related BOLD change in the "core" absence network. Subject 1 also displayed event related BOLD increase in the nodules while FC analysis demonstrated connectivity between the nodules and the thalami and striatum bilaterally. The second subject did not display event related BOLD in the PNH but FC analysis demonstrated strong connections between the PNH and the parietal cortex. This study demonstrates that the peri-ventricular nodules can show connectivity to the absence network in individuals with AS and may be involved in seizure generation.

Absence epilepsy subnetworks revealed by event-related independent components analysis of functional magnetic resonance imaging.

PURPOSE: The aim of this study was to provide better spatiotemporal description of the brain activity observed during generalized spike-and-wave (GSW) discharges. Simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) studies of these epileptiform events have shown regional differences in the timing of fMRI signal changes, which suggests activities within multiple interacting networks rather than a single unified network. METHODS: EEG-fMRI recordings from eight patients with childhood absence epilepsy (CAE) were studied using event-related independent components analysis (eICA). This technique separates the fMRI signal changes observed during GSW discharges into different spatial components, each showing different event-related timing. Unlike standard independent components analysis (ICA), which is applied to the entire fMRI time series, the eICA method is applied only to the event-related time courses at each voxel, which means that only a small number of components are generated that are all explicitly related to the event of interest. KEY FINDINGS: Six eICA components were identified, representing distinct GSW-related subnetworks. Activations were detected in a number of brain regions, including the striatum, which have not previously been reported in association with GSW in CAE patients. SIGNIFICANCE: The eICA results support previous findings that the earliest activity associated with GSW may be in posterior cortical regions and provide new evidence that the thalamostriate network may play a more important role in the generation of GSW than suggested by previous studies.

Track-weighted functional connectivity (TW-FC): a tool for characterizing the structural-functional connections in the brain.

MRI provides a powerful tool for studying the functional and structural connections in the brain non-invasively. The technique of functional connectivity (FC) exploits the intrinsic temporal correlations of slow spontaneous signal fluctuations to characterise brain functional networks. In addition, diffusion MRI fibre-tracking can be used to study the white matter structural connections. In recent years, there has been considerable interest in combining these two techniques to provide an overall structural-functional description of the brain. In this work we applied the recently proposed super-resolution track-weighted imaging (TWI) methodology to demonstrate how whole-brain fibre-tracking data can be combined with FC data to generate a track-weighted (TW) FC map of FC networks. The method was applied to data from 8 healthy volunteers, and illustrated with (i) FC networks obtained using a seeded connectivity-based analysis (seeding in the precuneus/posterior cingulate cortex, PCC, known to be part of the default mode network), and (ii) with FC networks generated using independent component analysis (in particular, the default mode, attention, visual, and sensory-motor networks). TW-FC maps showed high intensity in white matter structures connecting the nodes of the FC networks. For example, the cingulum bundles show the strongest TW-FC values in the PCC seeded-based analysis, due to their major role in the connection between medial frontal cortex and precuneus/posterior cingulate cortex; similarly the superior longitudinal fasciculus was well represented in the attention network, the optic radiations in the visual network, and the corticospinal tract and corpus callosum in the sensory-motor network. The TW-FC maps highlight the white matter connections associated with a given FC network, and their intensity in a given voxel reflects the functional connectivity of the part of the nodes of the network linked by the structural connections traversing that voxel. They therefore contain a different (and novel) image contrast from that of the images used to generate them. The results shown in this study illustrate the potential of the TW-FC approach for the fusion of structural and functional data into a single quantitative image. This technique could therefore have important applications in neuroscience and neurology, such as for voxel-based comparison studies.

Mapping brain activity using event-related independent components analysis (eICA): specific advantages for EEG-fMRI.

Event-related analyses of functional MRI (fMRI) typically assume that the onset and offset of neuronal activity match stimuli onset and offset, and that evoked fMRI signal changes follow the canonical haemodynamic response function (HRF). Some event types, however, may be unsuited to this approach: brief stimuli might elicit an extended neuronal response; anticipatory effects might result in activity preceding the event; or altered neurovascular coupling may result in a non-canonical HRF. An example is interictal epileptiform discharges (IEDs), which may show a non-canonical HRF and fMRI signal changes preceding their onset as detected on EEG. In such cases, less constrained analyses - capable of detecting early, non-canonical responses - may be necessary. A consequence of less constrained analyses, however, is that artefactual sources of signal change - motion or physiological noise for example - may also be detected and mixed with the neuronally-generated signals. In this paper, to address this issue, we describe an event-related independent components analysis (eICA) that identifies different sources of event-related signal change that can then be separately assessed to identify likely artefacts and separate primary from propagated activity. We also describe a group analysis that identifies eICA components that are spatially and temporally consistent across subjects and provides an objective approach for selecting group-specific components likely to be of neural origin. We apply eICA to patients with rolandic epilepsy - with stereotypical IEDs arising from a focus in the rolandic fissure - and demonstrate that a single event-related component, concordant with this source location, is detected.

Functional MRI interactions between dysplastic nodules and overlying cortex in periventricular nodular heterotopia.

Periventricular nodular heterotopia (PVNH) is a malformation of cortical development associated with epilepsy. It is unclear whether the epileptogenic focus is the nodule, overlying cortex, or both. We performed electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) in a patient with bilateral PVNH, capturing 45 "left temporal" epileptiform discharges. The relative time at which fMRI-involved regions became active was assessed. Additionally, nodule-cortex interactions were explored using fMRI functional connectivity. There was EEG-fMRI activity in specific periventricular nodules and overlying cortex in the left temporoparietal region. In both nodules and cortex, the peak BOLD response to epileptiform events occurred earlier than expected from standard fMRI hemodynamic modeling. Functional connectivity showed nodule-cortex interactions to be strong in this region, even when the influence of fMRI activity fluctuations due to spiking was removed. Nonepileptogenic, contralateral nodules did not show connectivity with overlying cortex. EEG-fMRI and functional connectivity can help identify which of the multiple abnormal regions are epileptogenic in PVNH.

Focal epileptiform spikes do not show a canonical BOLD response in patients with benign rolandic epilepsy (BECTS).

Simultaneous EEG and functional MRI (EEG-fMRI) studies of focal epileptiform spikes commonly use the canonical haemodynamic response function (HRF) to model the blood-oxygenation-level-dependent (BOLD) response to these events. Support for the use of the canonical HRF has come from large studies that contain mixed cohorts of epilepsy syndromes and discharge types, and has demonstrated plausible epileptic localisation results in the majority of patients. Other studies, however, have reported that some patients show a BOLD response that differs markedly from a canonical HRF. Our aim in this study was to see if the BOLD response is well modelled by a canonical HRF in a homogeneous cohort of patients with benign epilepsy with centrotemporal spikes (BECTS), an idiopathic partial epilepsy with stereotypical centrotemporal spikes on the EEG. We studied eight well-characterised and typical BECTS patients and found that the shape of the average BOLD response was different to the canonical HRF. Furthermore, a localisation analysis using the group-average response provided increased sensitivity and specificity compared to the canonical HRF. Our findings suggest that the canonical HRF may not provide the best model for the BOLD response in some epilepsy syndromes or spike-types. In studies of homogeneous patient groups, therefore, localisation results may be improved by using a group-specific BOLD response.

Measurement and reduction of motion and ballistocardiogram artefacts from simultaneous EEG and fMRI recordings.

Recording the electroencephalogram (EEG) during functional magnetic resonance imaging (fMRI) permits the identification of haemodynamic changes associated with EEG events. However, subject motion within the MR scanner can cause unpredictable and frustrating artefacts on the EEG that may appear focally, bilaterally or unilaterally and can sometimes be confused for epileptiform activity. Motion may arise from a number of sources: small involuntary cardiac-related body movements (ballistocardiogram); acoustic vibrations due to the scanner machinery; and voluntary subject movements. Here we describe a new real-time technique for removing ballistocardiogram (BCG) and movement artefact from EEG recordings in the MR scanner using a novel method for recording subject motion. We record the current induced in a number of wire loops, attached to a cap worn by the subject, due to motion in the static magnetic field of the scanner (Faraday's Law). This is the same process that leads to the motion artefacts on the EEG, and hence these signals are ideally suited to filtering these artefacts from the EEG. Our filter uses a linear adaptive technique based upon the Recursive Least Squares (RLS) algorithm. We demonstrate in both simulations and real EEG recordings from epilepsy patients that our filter significantly reduces the artefact power whilst preserving the underlying EEG signal.

Hippocampal sclerosis: MR prediction of seizure intractability.

PURPOSE: Patients with refractory temporal lobe epilepsy (refractory TLE) often have hippocampal sclerosis (HS). However, some HS patients have less-severe, drug-responsive epilepsy (mild TLE). We investigated the pattern of MR changes in these two HS groups. METHODS: We acquired a 3D volumetric sequence, T(2) relaxation times (T2) and proton MR spectroscopy (MRS) in 41 HS patients (24 refractory TLE, 17 mild TLE) and 60 controls. Hippocampal volumes were measured bilaterally. T2 was measured in the hippocampus, amygdala, thalamus, in the white matter of the anterior temporal lobe (ATL), and in the frontal lobe. The temporal lobe MRS established concentrations of N-acetylaspartate (NAA), choline, creatine, myoinositol and glutamine/glutamate. RESULTS: The degree of hippocampal volume loss and hippocampal T2 increase was not different between the two HS groups. However, in refractory TLE, the T2 signal in the ipsilateral ATL was increased, and the ipsilateral NAA concentration was reduced (p < or = 0.05). CONCLUSIONS: In this group of HS patients, the degree of HS was not related to the clinical course, possibly reflecting the common cause of epilepsy. In contrast, refractory TLE patients had pronounced white matter changes and metabolite disturbance in the ipsilateral temporal lobe. These abnormalities may indicate the refractory nature of the epilepsy.