Publications by authors named "Hisako Fujiwara"

39 Publications

Delineation of epileptogenic zones with high frequency magnetic source imaging based on kurtosis and skewness.

Epilepsy Res 2021 May 8;172:106602. Epub 2021 Mar 8.

MEG Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Background: Neuromagnetic high frequency brain signals (HFBS, > 80 Hz) are a new biomarker for localization of epileptogenic zones (EZs) for pediatric epilepsy.

Methods: Twenty three children with drug-resistant epilepsy and age/sex matched healthy controls were studied with magnetoencephalography (MEG). Epileptic HFBS in 80-250 Hz and 250-600 Hz were quantitatively determined by comparing with normative controls in terms of kurtosis and skewness. Magnetic sources of epileptic HFBS were localized and then compared to clinical EZs determined by invasive recordings and surgical outcomes.

Results: Kurtosis and skewness of HFBS were significantly elevated in epilepsy patients compared to healthy controls (p < 0,001 and p < 0.0001, respectively). Sources of elevated MEG signals in comparison to normative data were co-localized to EZs for 22 (22/23, 96 %) patients.

Conclusions: The results indicate, for the first time, that epileptic HFBS can be noninvasively quantified by measuring kurtosis and skewness in MEG data. Magnetic source imaging based on kurtosis and skewness can accurately localize EZs.

Significance: Source imaging of kurtosis and skewness of MEG HFBS provides a novel way for preoperative localization of EZs for epilepsy surgery.
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http://dx.doi.org/10.1016/j.eplepsyres.2021.106602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052290PMC
May 2021

Beta synchrony for expressive language lateralizes to right hemisphere in development.

Sci Rep 2021 Feb 17;11(1):3949. Epub 2021 Feb 17.

Neurosciences and Mental Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.

A left perisylvian network is known to support language in healthy adults. Low-beta (13-23 Hz) event-related desynchrony (ERD) has been observed during verb generation, at approximately 700-1200 ms post-stimulus presentation in past studies; the signal is known to reflect increased neuronal firing and metabolic demand during language production. In contrast, concurrent beta event-related synchrony (ERS) is thought to reflect neuronal inhibition but has not been well studied in the context of language. Further, while low-beta ERD for expressive language has been found to gradually shift from bilateral in childhood to left hemispheric by early adulthood, developmental lateralization of ERS has not been established. We used magnetoencephalography to study low beta ERS lateralization in a group of children and adolescents (n = 78), aged 4 to less than 19 years, who performed covert verb generation. We found that the youngest children had bilateral ERD and ERS. By adolescence, low-beta ERD was predominantly left lateralized in perisylvian cortex (i.e., Broca's and Wernicke's regions), while beta ERS was predominantly right lateralized. Increasing lateralization was significantly correlated to age for both ERD (Spearman's r = 0.45, p < 0.01) and ERS (Spearman's r =  - 0.44, p < 0.01). Interestingly, while ERD lateralized in a linear manner, ERS lateralization followed a nonlinear trajectory, suggesting distinct developmental trajectories. Implications to early-age neuroplasticity and neuronal inhibition are discussed.
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http://dx.doi.org/10.1038/s41598-021-83373-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889886PMC
February 2021

The Value of Source Localization for Clinical Magnetoencephalography: Beyond the Equivalent Current Dipole.

J Clin Neurophysiol 2020 Nov;37(6):537-544

Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.

Source localization for clinical magnetoencephalography recordings is challenging, and many methods have been developed to solve this inverse problem. The most well-studied and validated tool for localization of the epileptogenic zone is the equivalent current dipole. However, it is often difficult to summarize the richness of the magnetoencephalography data with one or a few point sources. A variety of source localization algorithms have been developed to more fully explain the complexity of clinical magnetoencephalography data used to define the epileptogenic network. In this review, various clinically available source localization methods are described and their individual strengths and limitations are discussed.
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http://dx.doi.org/10.1097/WNP.0000000000000487DOI Listing
November 2020

Cortical and subcortical volume differences between Benign Epilepsy with Centrotemporal Spikes and Childhood Absence Epilepsy.

Epilepsy Res 2020 10 23;166:106407. Epub 2020 Jun 23.

Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA. Electronic address:

Objective: Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS) and Childhood Absence Epilepsy (CAE) are the most common childhood epilepsy syndromes and they share a similar age-dependence. However, the two syndromes clearly differ in seizures and EEG patterns. The aim of this study is to investigate whether children of the same age with BECTS, CAE and typically-developing children have significant differences in grey matter volume that may underlie the different profiles of these syndromes.

Methods: Twenty one patients with newly-diagnosed BECTS and 18 newly diagnosed and drug naïve CAE were included and compared to 31 typically-developing children. Voxel-based morphometry was utilized to investigate grey matter volume differences among BECTS, CAE, and controls. We also examined the effect of age on grey matter volume in all three groups. In addition to the whole brain analysis, we chose regions of interest analysis based on previous literature suggesting the involvement of these regions in BECTS or CAE. The group differences of grey matter volume was tested with 2-sample t-test for between two groups' comparisons and ANOVA for three group comparisons.

Results: In the whole brain group comparisons, the grey matter volume in CAE was significantly decreased in the areas of right inferior frontal and anterior temporal compared to BECTS and controls (F  = 27.53, p < 0.001). In the control group, grey matter volume in bifrontal lobes showed a negative correlation with age (r=-0.54, p < 0.05), whereas no correlation was found in either CAE or BECTS. With ROI analyses, the grey matter volume of posterior thalami was increased in CAE compared to other 2 groups (p < 0.05).

Significance: This study shows that there are grey matter volume differences between CAE and BECTS. Our findings of grey matter volume differences may suggest that there may be localized, specific differences in brain structure between these two types of epilepsy.
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http://dx.doi.org/10.1016/j.eplepsyres.2020.106407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494623PMC
October 2020

Development of information sharing in language neocortex in childhood-onset drug-resistant epilepsy.

Epilepsia 2019 03 11;60(3):393-405. Epub 2019 Feb 11.

Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Objective: We studied age-related dynamics of information sharing among cortical language regions with electrocorticographic high-gamma modulation during picture-naming and story-listening tasks.

Methods: Seventeen epilepsy patients aged 4-19 years, undergoing extraoperative monitoring with left-hemispheric subdural electrodes, were included. Mutual information (MI), a nondirectional measure of shared information, between 16 pairs of cortical regions of interest, was computed from trial-averaged 70-150 Hz power modulations during language tasks. Impact of age on pairwise MI between language regions and their determinants were ascertained with regression analysis.

Results: During picture naming, significant increase in MI with age was seen between pairwise combinations of Broca's area, inferior precentral gyrus (iPreC), and frontal association cortex (FAC); Wernicke's area and posterior association cortex (PAC); and Broca's and Wernicke's areas. During story listening, significant age-related increase in MI was seen between Wernicke's area and either Broca's area, FAC, or PAC; and between Broca's area and FAC. Significant impact of baseline intelligence quotient was seen on the relationship between age and MI for all pairs, except between Broca's area and iPreC. The mean MI was higher during naming compared to listening for pairs including iPreC with Broca's area, FAC, or PAC and was lower for pairs of Wernicke's area or PAC with anterior language regions.

Significance: Information sharing matures with age "within" frontal and temporoparietal language cortices, and "between" Broca's and Wernicke's areas. This study provides evidence for distinct patterns of developmental plasticity within perisylvian language cortex and has implications for planning epilepsy surgery.
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http://dx.doi.org/10.1111/epi.14661DOI Listing
March 2019

Neuropsychological outcomes after resection of cortical sites with visual naming associated electrocorticographic high-gamma modulation.

Epilepsy Res 2019 03 29;151:17-23. Epub 2019 Jan 29.

Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Background: Language mapping with high-gamma modulation (HGM) has compared well with electrical cortical stimulation mapping (ESM). However, there is limited prospective data about its functional validity. We compared changes in neuropsychological evaluation (NPE) performed before and 1-year after epilepsy surgery, between patients with/without resection of cortical sites showing HGM during a visual naming task.

Methods: Pediatric drug-resistant epilepsy (DRE) patients underwent pre-surgical language localization with ESM and HGM using a visual naming task. Surgical decisions were based solely on ESM results. NPE difference scores were compared between patients with/without resection of HGM naming sites using principal component (PC) analysis. Follow-up NPE scores were modeled with resection group as main effect and respective pre-surgical score as a covariate, using analysis of covariance.

Results: Seventeen native English speakers (12 females), aged 6.5-20.2 years, were included. One year after epilepsy surgery, first PC score increased by (mean ± standard deviation) 14.4 ± 16.5 points in patients without resection, whereas it decreased by 7.6 ± 24.6 points in those with resection of HGM naming sites (p = 0.040). This PC score represented verbal comprehension, working memory, perceptual reasoning (Wechsler subscales); Woodcock-Johnson Tests of Achievement; and Peabody Picture Vocabulary Test. Subsequent analysis showed significant difference in working memory score between patients with/without resection of HGM naming sites (-15.2 points, 95% confidence limits -29.7 to -0.7, p = 0.041).

Conclusion: We highlight the functional consequences of resecting HGM language sites, and suggest that NPE of DRE patients should include comprehensive assessment of multiple linguistic and cognitive domains besides naming ability.
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http://dx.doi.org/10.1016/j.eplepsyres.2019.01.011DOI Listing
March 2019

Cortical morphology, epileptiform discharges, and neuropsychological performance in BECTS.

Acta Neurol Scand 2018 Nov 10;138(5):432-440. Epub 2018 Jul 10.

Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Objectives: The aim of this study was to understand the relationship between cortical morphology, centrotemporal spike (CTS), and neuropsychological functioning in children with BECTS compared to their typically developing peers.

Materials And Methods: To examine whole-brain differences in cortical thickness between groups, a general linear model approach was applied to T1-weighted structural magnetic resonance imaging (MRI) in children with BECTS and typically developing children. Further region-of-interest (ROI) analyses were performed to examine the effects of frequency and lateralization of CTS. In addition, the relationship between Processing Speed Index (PSI) and cortical thickness was investigated.

Results: Twenty-three patients with BECTS and thirty-two controls were included. There was no statistically significant difference in global cortical thickness between groups. With ROI analyses, we found significantly thinner cortex within right pars opercularis when comparing children with right predominant CTS, and with very frequent right CTS (>10/min) to the control group (P = 0.028 and P = 0.026, respectively). A statistically significant interaction of group (controls vs BECTS) and PSI was seen in bilateral frontal and right superior parietal cortices, indicating a positive relationship between cortical thickness and PSI in healthy controls but not BECTS.

Conclusion: A region of cortex where right CTS may originate was thinner in BECTS compared to children without BECTS. Typically developing children with faster processing speed had thicker cortices in regions supporting visuomotor integration, motor, and executive function, but this relationship was not observed in BECTS. These results suggest that BECTS is associated with atypical cortical morphology that may underlie poorer neuropsychological performance.
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http://dx.doi.org/10.1111/ane.12997DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175642PMC
November 2018

Electrocorticographic high-gamma modulation with passive listening paradigm for pediatric extraoperative language mapping.

Epilepsia 2018 04 20;59(4):792-801. Epub 2018 Feb 20.

Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Objective: This prospective study compared the topography of high-gamma modulation (HGM) during a story-listening task requiring negligible patient cooperation, with the conventional electrical stimulation mapping (ESM) using a picture-naming task, for presurgical language localization in pediatric drug-resistant epilepsy.

Methods: Patients undergoing extraoperative monitoring with subdural electrodes were included. Electrocorticographic signals were recorded during quiet baseline and a story-listening task. The likelihood of 70- to 150-Hz power modulation during the listening task relative to the baseline was estimated for each electrode and plotted on a cortical surface model. Sensitivity, specificity, accuracy, and diagnostic odds ratio (DOR) were estimated compared to ESM, using a meta-analytic framework.

Results: Nineteen patients (10 with left hemisphere electrodes) aged 4-19 years were analyzed. HGM during story listening was observed in bilateral posterior superior temporal, angular, supramarginal, and inferior frontal gyri, along with anatomically defined language association areas. Compared to either cognitive or both cognitive and orofacial sensorimotor interference with naming during ESM, left hemisphere HGM showed high specificity (0.82-0.84), good accuracy (0.66-0.70), and DOR of 2.23 and 3.24, respectively. HGM was a better classifier of ESM language sites in the left temporoparietal cortex compared to the frontal lobe. Incorporating visual naming with the story-listening task substantially improved the accuracy (0.80) and DOR (13.61) of HGM mapping, while the high specificity (0.85) was retained. In the right hemisphere, no ESM sites for aphasia were seen, and the results of HGM and ESM comparisons were not significant.

Significance: HGM associated with story listening is a specific determinant of left hemisphere ESM language sites. It can be used for presurgical language mapping in children who cannot cooperate with conventional language tasks requiring active engagement. Incorporation of additional language tasks, if feasible, can further improve the diagnostic accuracy of language localization with HGM.
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http://dx.doi.org/10.1111/epi.14029DOI Listing
April 2018

Presurgical language localization with visual naming associated ECoG high- gamma modulation in pediatric drug-resistant epilepsy.

Epilepsia 2017 04 22;58(4):663-673. Epub 2017 Feb 22.

Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.

Objective: This prospective study compared presurgical language localization with visual naming-associated high-γ modulation (HGM) and conventional electrical cortical stimulation (ECS) in children with intracranial electrodes.

Methods: Patients with drug-resistant epilepsy who were undergoing intracranial monitoring were included if able to name pictures. Electrocorticography (ECoG) signals were recorded during picture naming (overt and covert) and quiet baseline. For each electrode the likelihood of high-γ (70-116 Hz) power modulation during naming task relative to the baseline was estimated. Electrodes with significant HGM were plotted on a three-dimensional (3D) cortical surface model. Sensitivity, specificity, and accuracy were calculated compared to clinical ECS.

Results: Seventeen patients with mean age of 11.3 years (range 4-19) were included. In patients with left hemisphere electrodes (n = 10), HGM during overt naming showed high specificity (0.81, 95% confidence interval [CI] 0.78-0.85), and accuracy (0.71, 95% CI 0.66-0.75, p < 0.001), but modest sensitivity (0.47) when ECS interference with naming (aphasia or paraphasic errors) and/or oral motor function was regarded as the gold standard. Similar results were reproduced by comparing covert naming-associated HGM with ECS naming sites. With right hemisphere electrodes (n = 7), no ECS-naming deficits were seen without interference with oral-motor function. HGM mapping showed a high specificity (0.81, 95% CI 0.78-0.84), and accuracy (0.76, 95% CI 0.71-0.81, p = 0.006), but modest sensitivity (0.44) compared to ECS interference with oral-motor function. Naming-associated ECoG HGM was consistently observed over Broca's area (left posterior inferior-frontal gyrus), bilateral oral/facial motor cortex, and sometimes over the temporal pole.

Significance: This study supports the use of ECoG HGM mapping in children in whom adverse events preclude ECS, or as a screening method to prioritize electrodes for ECS testing.
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http://dx.doi.org/10.1111/epi.13708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651677PMC
April 2017

Clinical factors predict surgical outcomes in pediatric MRI-negative drug-resistant epilepsy.

Seizure 2016 Oct 20;41:56-61. Epub 2016 Jul 20.

Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Purpose: Lack of a potentially epileptogenic lesion on brain magnetic resonance imaging (MRI) is a poor prognostic marker for epilepsy surgery. We present a single-center series of childhood-onset MRI-negative drug-resistant epilepsy (DRE) and analyze surgical outcomes and predictors.

Methods: Children with MRI-negative DRE who had resective surgery from January 2007 to December 2013 were identified using an institutional database. Relevant clinical, neurophysiological, imaging, and surgical data was extracted. The primary outcome measure was seizure freedom. Predictors of seizure freedom were obtained using multivariate logistic regression.

Results: Out of 47 children with MRI-negative DRE, 12 (25.5%) were seizure free (International League Against Epilepsy [ILAE] outcome class I), after mean follow-up of 2.75 (±1.72) years. Seizure-free proportion was significantly higher in patients with single seizure semiology and concordant ictal EEG (50.0% vs. 15.2%, p=0.025). Multivariate analysis using only non-invasive pre-surgical data showed that children with daily seizures (OR 0.02, 95% CI<0.001-0.55), and earlier onset of seizures (OR 0.72, 95% CI 0.52-0.99) were less likely to be seizure-free. Also, each additional anti-epileptic drug (AED) tried before surgery decreased the probability of seizure-free outcome (OR 0.16, 95% CI 0.04-0.63). Repeat multivariate analysis after including surgical variables found no additional significant predictors of seizure-freedom. Cortical dysplasia (ILAE type IB) was the commonest histopathology.

Conclusion: Surgical outcomes in children with MRI-negative DRE are determined by clinical factors including seizure frequency, age of onset of seizures, and number of failed AEDs.
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http://dx.doi.org/10.1016/j.seizure.2016.07.004DOI Listing
October 2016

Resection of ictal high frequency oscillations is associated with favorable surgical outcome in pediatric drug resistant epilepsy secondary to tuberous sclerosis complex.

Epilepsy Res 2016 10 16;126:90-7. Epub 2016 Jul 16.

Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. Electronic address:

Resective epilepsy surgery can improve seizures when the epileptogenic zone (EZ) is limited to a well-defined region. High frequency oscillations (HFO) have been recognized as having a high association with the seizure onset zone. Therefore, we retrospectively identified ictal HFOs and determined their relationship to specific intracranial features of cortical tubers in children with TSC who underwent resective surgery. We identified 14 patients with drug resistant epilepsy secondary to TSC who underwent subdural grid and strip implantation for presurgical evaluation and subsequent resection with adequate post-surgical follow-up. We aimed to determine the relationship between ictal HFOs, post-resection outcome and neuroimaging features in this population. The largest tuber was identified in all 14 patients (100%). Four patients (29%) had unusual tubers. HFOs were observed at ictal onset in all 14 patients. Seven of 10 patients with complete resection of HFOs were seizure free. The better seizure outcome (ILAE=1-3) was achieved with complete HFO resection regardless of the unique TSC structural features (p=0.0140). Our study demonstrates the presence of ripple and fast ripple range HFOs at ictal onset in children with TSC. Our study showed that complete HFO resection led to the better surgical outcome, independent of MR imaging findings.
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http://dx.doi.org/10.1016/j.eplepsyres.2016.07.005DOI Listing
October 2016

Quantitative neuromagnetic signatures of aberrant cortical excitability in pediatric chronic migraine.

J Headache Pain 2016 26;17:46. Epub 2016 Apr 26.

Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2015, Cincinnati, OH, 45220, USA.

Background: Reports have suggested that abnormal cortical excitability may be associated with acute migraines. The present study quantitatively assesses the degree of cortical excitability in chronic migraine as compared to acute migraine and healthy controls within the pediatric population.

Methods: We investigated 27 children suffering from chronic migraine, 27 children suffering from acute migraine, and 27 healthy controls using a magnetoencephalography (MEG) system, recording at a sampling rate of 6000 Hz. All groups were age-matched and gender-matched. Neuromagnetic brain activation was elicited by a finger-tapping motor task. The spatiotemporal and spectral signatures of MEG data within a 5-2884 Hz range were analyzed using Morlet wavelet transform and beamformer analyses.

Results: Compared with controls, the chronic migraine group showed (1) significantly prolonged latencies of movement-elicited magnetic fields (MEFs) between 5 and 100 Hz; (2) increased spectral power between 100 and 200 Hz, and between 2200 and 2800 Hz; and (3) a higher likelihood of neuromagnetic activation in the ipsilateral sensorimotor cortices, supplementary motor area, and occipital regions. Compared with acute migraine group, chronic migraine patients showed (1) significantly higher odds of having strong MEFs after 150 ms; and (2) significantly higher odds of having neuromagnetic activation from the deep brain areas.

Conclusions: Results demonstrated that chronic migraine subjects were not only different from the healthy controls, but also different from acute migraine subjects. The chronification of migraines may be associated with elevated cortical excitability, delayed and spread neural response, as well as aberrant activation from deep brain areas.
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http://dx.doi.org/10.1186/s10194-016-0641-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844586PMC
October 2016

Should spikes on post-resection ECoG guide pediatric epilepsy surgery?

Epilepsy Res 2016 May 2;122:73-8. Epub 2016 Mar 2.

Division of Pediatric Neurosurgery, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, USA.

Purpose: There is wide variation in clinical practice regarding the role of electrocorticography immediately after resection (post-resection ECoG) for pediatric epilepsy surgery. Results can guide further resection of potentially epileptogenic tissue. We hypothesized that post-resection ECoG spiking represents a biomarker of the epileptogenic zone and predicts seizure outcome in children undergoing epilepsy surgery.

Methods: We retrospectively identified 124 children with post-resection ECoG performed on the margins of resection. ECoG records were scored in a blinded fashion based on presence of frequent spiking. For patients identified as having additional resection based on clinical post-resection ECoG interpretation, these "second-look" ECoG results were re-reviewed for ongoing discharges or completeness of resection. Frequent spike populations were grouped using a standard scoring system into three ranges: 0.1-0.5Hz, 0.5-1Hz, >1Hz. Seizure outcomes were determined at minimum 12-month followup.

Results: Of 124 patients who met inclusion criteria, 60 (48%) had an identified spike population on post-resection ECoG. Thirty (50%) of these had further resection based on clinical interpretation. Overall, good outcome (ILAE 1) was seen in 56/124 (45%). Completeness of resection of spiking (absence of spiking on initial post-resection ECoG or resolution of spiking after further resection) showed a trend toward good outcome (OR 2.03, p=0.099). Patients with completeness of resection had good outcome in 41/80 (51%) of cases; patients with continued spikes had good outcome in 15/44 (35%) of cases.

Conclusions: Post-resection ECoG identifies residual epileptogenic tissue in a significant number of children. Lower frequency or absence of discharges on initial recording showed a trend toward good outcome. Completeness of resection demonstrated on final ECoG recording did not show a significant difference in outcome. This suggests that post-resection discharges represent a prognostic marker rather than a remediable biomarker of the epileptogenic zone in all patients. Resecting residual spike-generating cortex may be beneficial in selected patients, including children with tumors.
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http://dx.doi.org/10.1016/j.eplepsyres.2016.02.011DOI Listing
May 2016

Spatial Heterogeneity of Cortical Excitability in Migraine Revealed by Multifrequency Neuromagnetic Signals.

J Pain 2016 06 10;17(6):694-706. Epub 2016 Mar 10.

MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.

Unlabelled: To investigate the spatial heterogeneity of cortical excitability in adolescents with migraine, magnetoencephalography (MEG) recordings at a sampling rate of 6,000 Hz were obtained from 35 adolescents with an acute migraine and 35 age- and sex-matched healthy control participants during an auditory-motor task. Neuromagnetic activation from low- to high-frequency ranges (5-1,000 Hz) was measured at sensor and source levels. The heterogeneity of cortical excitability was quantified within each functional modality (auditory vs motor) and hemispherical lateralization. MEG data showed that high-frequency, not low-frequency neuromagnetic signals, showed heterogeneous cortical activation in migraine subjects compared with control participants (P < .001). The alteration of the heterogeneity of cortical excitability in migraine subjects was independent of age and sex. The degree of the neuromagnetic heterogeneity of cortical activation was significantly correlated with headache frequency (r = .71, P < .005). The alteration of cortical excitability in migraine subjects was spatially heterogeneous and frequency dependent, which previously has not been reported. The finding may be critical for developing spatially targeted therapeutic strategies for normalizing cortical excitability with the purpose of reducing headache attacks.

Perspective: This article presents a new approach to quantitatively measure the spatial heterogeneity of cortical excitability in adolescents with migraine using MEG signals in a frequency range of 5 to 1,000 Hz. The characteristics of the location and degree of cortical excitability may be critical for spatially targeted treatment for migraine.
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http://dx.doi.org/10.1016/j.jpain.2016.02.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885770PMC
June 2016

Preresection intraoperative electrocorticography (ECoG) abnormalities predict seizure-onset zone and outcome in pediatric epilepsy surgery.

Epilepsia 2016 Apr 25;57(4):582-9. Epub 2016 Feb 25.

Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.

Objective: The predictive value of intraoperative electrocorticography (ECoG) in pediatric epilepsy surgery is unknown. In a population of children undergoing ECoG followed typically by invasive extraoperative monitoring (IEM) and resection, we aimed to determine the relationship between frequent ECoG abnormalities and the seizure onset zone and outcome after resection.

Methods: We retrospectively identified 103 children with preresection ECoG of sufficient technical quality. ECoG records were scored based on electrode location and frequency, blinded to the seizure-onset zone and outcome. Electrographic seizure and spike locations were identified. Locations of seizures and spike populations were then compared to the location of seizure-onset zone defined by IEM using subdural electrodes and resection margin.

Results: Electrographic seizures were identified in 11 (11%) of 103 patients. A spike population of one or more was noted in 79 (77%) of 103 patients. In 50 (63%) of 79 patients, spike populations correlated with seizure-onset zone location. The overall surgical outcome was good (ILAE 1 to 3) in 53 (52%) of 101 patients. Outcome was good in seven (78%) of nine patients when electrographic seizure location was resected. The best outcomes were obtained with resection of both the seizure-onset zone and ECoG abnormalities to include seizures and spike locations (22/33 good outcome, 67%, p = 0.008). There was a significantly better outcome in children with complete resection of ECoG-identified spike populations (14/26, 62% good outcome) compared to when none were resected (4/14, 29%, p = 0.043).

Significance: Electrographic seizures and frequent spikes are frequently seen on pre-resection ECoG in children. The brain locations corresponding to these discharges are highly concordant with the seizure-onset zone; resection of these regions is correlated with good seizure outcome. Further research is needed to design interventions that increase the reliability of ECoG prediction of the epileptogenic zone and obviate the need for IEM.
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http://dx.doi.org/10.1111/epi.13341DOI Listing
April 2016

Physical Feature Encoding and Word Recognition Abilities Are Altered in Children with Intractable Epilepsy: Preliminary Neuromagnetic Evidence.

Behav Neurol 2015 3;2015:237436. Epub 2015 Jun 3.

Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.

Objective evaluation of language function is critical for children with intractable epilepsy under consideration for epilepsy surgery. The purpose of this preliminary study was to evaluate word recognition in children with intractable epilepsy by using magnetoencephalography (MEG). Ten children with intractable epilepsy (M/F 6/4, mean ± SD 13.4 ± 2.2 years) were matched on age and sex to healthy controls. Common nouns were presented simultaneously from visual and auditory sensory inputs in "match" and "mismatch" conditions. Neuromagnetic responses M1, M2, M3, M4, and M5 with latencies of ~100 ms, ~150 ms, ~250 ms, ~350 ms, and ~450 ms, respectively, elicited during the "match" condition were identified. Compared to healthy children, epilepsy patients had both significantly delayed latency of the M1 and reduced amplitudes of M3 and M5 responses. These results provide neurophysiologic evidence of altered word recognition in children with intractable epilepsy.
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http://dx.doi.org/10.1155/2015/237436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469800PMC
March 2016

Multi-frequency localization of aberrant brain activity in autism spectrum disorder.

Brain Dev 2016 Jan 27;38(1):82-90. Epub 2015 Apr 27.

The Kelly O'Leary Center for Autism Spectrum Disorders, Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Autism Treatment Network, Autism Speaks, 85 Devonshire Street, 9th Floor, Boston, MA, USA.

Objective: The abnormality of intrinsic brain activity in autism spectrum disorders (ASDs) is still inconclusive. Contradictory results have been found pointing towards hyper-activity or hypo-activity in various brain regions. The present research aims to investigate the spatial and spectral signatures of aberrant brain activity in an unprecedented frequency range of 1-2884 Hz at source levels in ASD using newly developed methods.

Materials And Methods: Seven ASD subjects and age- and gender-matched controls were studied using a high-sampling rate magnetoencephalography (MEG) system. Brain activity in delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), beta (12-30 Hz), low gamma (30-55 Hz), high gamma (65-90 Hz), ripples (90-200 Hz), high-frequency oscillations (HFOs, 200-1000 Hz), and very high-frequency oscillations (VHFOs, 1000-2884 Hz) was volumetrically localized and measured using wavelet and beamforming.

Results: In comparison to controls, ASD subjects had significantly higher odds of alpha activity (8-12 Hz) in the sensorimotor cortex (mu rhythm), and generally high-frequency activity (90-2884 Hz) in the frontal cortex. The source power of HFOs (200-1000 Hz) in the frontal cortex in ASD was significantly elevated as compared with controls.

Conclusion: The results suggest that ASD has significantly altered intrinsic brain activity in both low- and high-frequency ranges. Increased intrinsic high-frequency activity in the frontal cortex may play a key role in ASD.
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http://dx.doi.org/10.1016/j.braindev.2015.04.007DOI Listing
January 2016

Electrocorticographic language mapping in children by high-gamma synchronization during spontaneous conversation: comparison with conventional electrical cortical stimulation.

Epilepsy Res 2015 Feb 22;110:78-87. Epub 2014 Nov 22.

Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Introduction: This study describes development of a novel language mapping approach using high-γ modulation in electrocorticograph (ECoG) during spontaneous conversation, and its comparison with electrical cortical stimulation (ECS) in childhood-onset drug-resistant epilepsy.

Methods: Patients undergoing invasive pre-surgical monitoring and able to converse with the investigator were eligible. ECoG signals and synchronized audio were acquired during quiet baseline and during natural conversation between investigator and the patient. Using Signal Modeling for Real-time Identification and Event Detection (SIGFRIED) procedure, a statistical model for baseline high-γ (70-116 Hz) power, and a single score for each channel representing the probability that the power features in the experimental signal window belonged to the baseline model, were calculated. Electrodes with significant high-γ responses (HGS) were plotted on the 3D cortical model. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and classification accuracy were calculated compared to ECS.

Results: Seven patients were included (4 males, mean age 10.28 ± 4.07 years). Significant high-γ responses were observed in classic language areas in the left hemisphere plus in some homologous right hemispheric areas. Compared with clinical standard ECS mapping, the sensitivity and specificity of HGS mapping was 88.89% and 63.64%, respectively, and PPV and NPV were 35.29% and 96.25%, with an overall accuracy of 68.24%. HGS mapping was able to correctly determine all ECS+ sites in 6 of 7 patients and all false-sites (ECS+, HGS- for visual naming, n = 3) were attributable to only 1 patient.

Conclusions: This study supports the feasibility of language mapping with ECoG HGS during spontaneous conversation, and its accuracy compared to traditional ECS. Given long-standing concerns about ecological validity of ECS mapping of cued language tasks, and difficulties encountered with its use in children, ECoG mapping of spontaneous language may provide a valid alternative for clinical use.
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http://dx.doi.org/10.1016/j.eplepsyres.2014.11.013DOI Listing
February 2015

Long-term outcomes of resective epilepsy surgery after invasive presurgical evaluation in children with tuberous sclerosis complex and bilateral multiple lesions.

J Neurosurg Pediatr 2015 Jan;15(1):26-33

Divisions of Neurology.

Object: Tuberous sclerosis complex (TSC) with medically refractory epilepsy is characterized by multifocal brain abnormalities, traditionally indicating poor surgical candidacy. This single-center, retrospective study appraised seizurerelated, neuropsychological, and other outcomes of resective surgery in TSC patients with medically refractory epilepsy, and analyzed predictors for these outcomes.

Methods: Patients with multilesional TSC who underwent epilepsy surgery between 2007 and 2012 were identified from an electronic database. All patients underwent multimodality noninvasive and subsequent invasive evaluation. Seizure outcomes were classified using the International League Against Epilepsy (ILAE) scale. The primary outcome measure was complete seizure remission (ILAE Class 1). Secondary outcome measures included 50% responder rate, change in full-scale IQ, electroencephalography improvement, and reduction in antiepileptic drug (AED) burden.

Results: A total of 37 patients with TSC underwent resective surgery during the study period. After a mean follow-up of 5.68 ± 3.67 years, 56.8% achieved complete seizure freedom (ILAE Class 1) and 86.5% had ILAE Class 4 outcomes or better. The full-scale IQ on follow-up was significantly higher in patients with ILAE Class 1 outcome (66.70 ± 12.36) compared with those with ILAE Class 2 or worse outcomes (56.00 ± 1.41, p = 0.025). In 62.5% of the patients with ILAE Class 2 or worse outcomes, the number of AEDs were found to be significantly reduced (p = 0.004).

Conclusions: This study substantiates the evidence for efficacy of resective epilepsy surgery in patients with bilateral multilesional TSC. More than half of the patients were completely seizure free. Additionally, a high proportion achieved clinically meaningful reduction in seizure burden and the number of AEDs.
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http://dx.doi.org/10.3171/2014.10.PEDS14107DOI Listing
January 2015

Comparison of magnetic source estimation to intracranial EEG, resection area, and seizure outcome.

Epilepsia 2014 Nov 13;55(11):1854-63. Epub 2014 Oct 13.

Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.

Objectives: Magnetoencephalography (MEG) is used to guide intracranial electroencephalography (ICEEG) monitoring and determine areas for resection. The purpose of this retrospective cross-sectional study was to report our experience using dipole modeling/dipole scanning, current density reconstructions, and beam-forming methods in a large cohort of pediatric patients with intractable epilepsy.

Methods: Source localization results for each algorithm and seizure-onset zone, defined by ICEEG, were described by three blinded reviewers according to five location criteria. The accuracy of each algorithm was then compared to ICEEG. The relationships between the accuracy of these algorithms (discordant, lobar concordant, sublobar concordant) and long-term seizure outcome was calculated using positive and negative predictive values.

Results: Thirty-two patients (mean age ± SD, 10.8 ± 5 years) were included in this retrospective review. No algorithms had sublobar concordance with ICEEG in all patients, including when algorithms were grouped by type (dipole modeling/dipole scanning, current density reconstruction, beam forming). Synthetic aperture magnetometry (SAM) with excess kurtosis tended to be the most accurate, but there were no significant differences between algorithms. When comparing the source modeling with ICEEG findings, significantly more patients with a seizure-free outcome were found to have lobar or sublobar concordance of multiple signal classification (MUSIC) (61.1%) and standardized low resolution brain electromagnetic tomography (sLORETA) (52.9%). Positive predictive values were highest for MUSIC (61.9%) and equivalent current dipole (ECD) (57.1%). Negative predictive values were highest for SAM(g2 )-VS (83%), minimum norm estimate (MNE) (75%), MUSIC (73.7%), and ECD (73.5%).

Significance: This study describes the use of multiple MEG source estimation techniques and demonstrates that all algorithms have similar rates of concordance with ICEEG. Also, the concordance or discordance of MUSIC with ICEEG was the best predictor of long-term seizure outcome.
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http://dx.doi.org/10.1111/epi.12822DOI Listing
November 2014

Low- and high-frequency oscillations reveal distinct absence seizure networks.

Ann Neurol 2014 Oct 8;76(4):558-67. Epub 2014 Sep 8.

Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH.

Objective: The aim of this study was to determine the frequency-dependent, spatiotemporal involvement of corticothalamic networks to the generation of absence seizures.

Methods: Magnetoencephalography recordings were obtained in 12 subjects (44 seizures) with untreated childhood absence seizures. Time-frequency analysis of each seizure was performed to determine bandwidths with significant power at ictal onset. Source localization was then completed to determine brain regions contributing to generalized spike and wave discharges seen on electroencephalogram.

Results: Significant power in the time-frequency analysis was seen within 1 to 20Hz, 20 to 70Hz, and 70 to 150Hz bandwidths. Source localization revealed that sources localized to the frontal cortex similarly for the low- and gamma-frequency bandwidths, whereas at the low-frequency bandwidth (3-20Hz) significantly more sources localized to the parietal cortex (odds ratio [OR] = 16.7). Cortical sources within the high-frequency oscillation (HFO) bandwidth (70-150Hz) localized primarily to the frontal region compared to the parietal (OR = 7.32) or temporal (OR = 2.78) areas.

Interpretation: Neuromagnetic activity within frontal and parietal cortical regions provides further confirmation of hemodynamic changes reported using functional magnetic resonance imaging that have been associated with absence seizures. The frequency-dependent nature of these networks has not previously been reported, and the presence of HFOs during absence seizures is a novel finding. Co-occurring frontal and parietal corticothalamic networks may interact to produce a pathological state that contributes to the generation of spike and wave discharges. The clinical and pathophysiological implications of HFOs within the frontal cortical region are unclear and should be further investigated.
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http://dx.doi.org/10.1002/ana.24231DOI Listing
October 2014

Accumulated source imaging of brain activity with both low and high-frequency neuromagnetic signals.

Front Neuroinform 2014 21;8:57. Epub 2014 May 21.

Division of Neurology, MEG Center, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA.

Recent studies have revealed the importance of high-frequency brain signals (>70 Hz). One challenge of high-frequency signal analysis is that the size of time-frequency representation of high-frequency brain signals could be larger than 1 terabytes (TB), which is beyond the upper limits of a typical computer workstation's memory (<196 GB). The aim of the present study is to develop a new method to provide greater sensitivity in detecting high-frequency magnetoencephalography (MEG) signals in a single automated and versatile interface, rather than the more traditional, time-intensive visual inspection methods, which may take up to several days. To address the aim, we developed a new method, accumulated source imaging, defined as the volumetric summation of source activity over a period of time. This method analyzes signals in both low- (1~70 Hz) and high-frequency (70~200 Hz) ranges at source levels. To extract meaningful information from MEG signals at sensor space, the signals were decomposed to channel-cross-channel matrix (CxC) representing the spatiotemporal patterns of every possible sensor-pair. A new algorithm was developed and tested by calculating the optimal CxC and source location-orientation weights for volumetric source imaging, thereby minimizing multi-source interference and reducing computational cost. The new method was implemented in C/C++ and tested with MEG data recorded from clinical epilepsy patients. The results of experimental data demonstrated that accumulated source imaging could effectively summarize and visualize MEG recordings within 12.7 h by using approximately 10 GB of computer memory. In contrast to the conventional method of visually identifying multi-frequency epileptic activities that traditionally took 2-3 days and used 1-2 TB storage, the new approach can quantify epileptic abnormalities in both low- and high-frequency ranges at source levels, using much less time and computer memory.
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http://dx.doi.org/10.3389/fninf.2014.00057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033602PMC
June 2014

Real-time functional mapping with electrocorticography in pediatric epilepsy: comparison with fMRI and ESM findings.

Clin EEG Neurosci 2014 Jul;45(3):205-11

SIGFRIED (SIGnal modeling For Real-time Identification and Event Detection) software provides real-time functional mapping (RTFM) of eloquent cortex for epilepsy patients preparing to undergo resective surgery. This study presents the first application of paradigms used in functional magnetic resonance (fMRI) and electrical cortical stimulation mapping (ESM) studies for shared functional cortical mapping in the context of RTFM. Results from the 3 modalities are compared. A left-handed 13-year-old male with intractable epilepsy participated in functional mapping for localization of eloquent language cortex with fMRI, ESM, and RTFM. For RTFM, data were acquired over the frontal and temporal cortex. Several paradigms were sequentially presented: passive (listening to stories) and active (picture naming and verb generation). For verb generation and story processing, fMRI showed atypical right lateralizing language activation within temporal lobe regions of interest and bilateral frontal activation with slight right lateralization. Left hemisphere ESM demonstrated no eloquent language areas. RTFM procedures using story processing and picture naming elicited activity in the right lateral and basal temporal regions. Verb generation elicited strong right lateral temporal lobe activation, as well as left frontal lobe activation. RTFM results confirmed atypical language lateralization evident from fMRI and ESM. We demonstrated the feasibility and usefulness of a new RTFM stimulation paradigm during presurgical evaluation. Block design paradigms used in fMRI may be optimal for this purpose. Further development is needed to create age-appropriate RTFM test batteries.
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http://dx.doi.org/10.1177/1550059413492960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418423PMC
July 2014

What you need to know to become a MEG technologist.

Neurodiagn J 2013 Sep;53(3):191-206

Henry Ford Health System, Detroit, Michigan, USA.

Magnetoencephalography (MEG) is a way to noninvasively localize sources of electrical activity within the human brain, by measuring the very weak magnetic fields just outside of the head. This paper is an introduction to MEG for technologists who are interested in performing MEG studies. We have organized the paper into a brief overview of what MEG measures and how it does it, as well as a short history of the MEG manufacturers. There is a discussion of the differences in coils/sensors used to detect the magnetic fields, followed by a detailed description of what an average MEG technologist does to perform a MEG study. Some MEG centers may require more duties from the MEG technologist than are listed here and others may require fewer duties. We finish the paper with the contraindications for a MEG study, a job description for the MEG technologist, and a MEG procedure checklist to help keep the tasks organized.
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http://dx.doi.org/10.1080/21646821.2013.11079906DOI Listing
September 2013

Focal corticothalamic sources during generalized absence seizures: a MEG study.

Epilepsy Res 2013 Sep 10;106(1-2):113-22. Epub 2013 Jun 10.

Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States.

Magnetoencephalography (MEG) was used to determine cortical and subcortical contributions to the formation of spike and wave discharges in twelve newly diagnosed, drug naïve children during forty-four generalized absence seizures. Previous studies have implicated various cortical areas and thalamic nuclei in the generation of absence seizures, but the relative timing of their activity remains unclear. Beamformer analysis using synthetic aperture magnetometry (SAM) was used to confirm the presence of independent thalamic activity, and standardized Low Resolution Brain Electromagnetic Topography (sLORETA) was used to compute statistical maps indicating source locations during absence seizures. Sources detected in the 50ms prior to the start of the seizure were more likely to be localized to the frontal cortex or thalamus. At the time of the first spike on EEG, focal source localization was seen in the lateral frontal cortex with decreased thalamic localization. Following the spike, localization became more widespread throughout the cortex. Comparison of the earliest spike and wave discharge (SWD) (Ictal Onset) and a SWD occurring 3s into the seizure (mid-Ictal) revealed significant differences during the slow wave portion of the SWDs. This study of MEG recordings in childhood absence seizures provides additional evidence that there are focal brain areas responsible for these seizures which appear bilaterally symmetric and generalized with a conventional 10-20 placement scalp EEG.
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http://dx.doi.org/10.1016/j.eplepsyres.2013.05.006DOI Listing
September 2013

Focal Peak Activities in Spread of Interictal-Ictal Discharges in Epilepsy with Beamformer MEG: Evidence for an Epileptic Network?

Front Neurol 2013 14;4:56. Epub 2013 May 14.

Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA.

Non-invasive studies to predict regions of seizure onset are important for planning intracranial grid locations for invasive cortical recordings prior to resective surgery for patients with medically intractable epilepsy. The neurosurgeon needs to know both the seizure onset zone (SOZ) and the region of immediate cortical spread to determine the epileptogenic zone to be resected. The immediate zone of spread may be immediately adjacent, on a nearby gyrus, in a different lobe, and sometimes even in the contralateral cerebral hemisphere. We reviewed consecutive simultaneous EEG/MEG recordings on 162 children with medically intractable epilepsy. We analyzed the MEG signals in the bandwidth 20-70 Hz with a beamformer algorithm, synthetic aperture magnetometry, at a 2.5 mm voxel spacing throughout the brain (virtual sensor locations, VSLs) with the kurtosis statistic (g 2) to determine presence of excess kurtosis (γ2) consistent with intermittent increased high frequency spikiness of the background. The MEG time series was reconstructed (virtual sensor signals) at each of these VSLs. The VS signals were further examined with a relative peak amplitude spike detection algorithm. The time of VS spike detection was compared to the simultaneous EEG and MEG sensor signals for presence of conventional epileptiform spike morphology in the latter signals. The time of VS spike detection was compared across VSLs to determine earliest and last VSL to show a VS spike. Seven subjects showed delay in activation across VS locations detectable on visual examination. We compared the VS locations that showed earliest and later VS spikes with the locations on intracranial grid locations by electrocorticography (ECoG) that showed spikes and both onset and spread of seizures. We compared completeness of resection of VS locations to postoperative outcome. The VS locations for spike onset and spread were similar to locations for ictal onset and spread by ECoG.
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http://dx.doi.org/10.3389/fneur.2013.00056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653127PMC
May 2013

Magnetoencephalography reveals altered auditory information processing in youth with obsessive-compulsive disorder.

Psychiatry Res 2013 May 30;212(2):132-40. Epub 2013 Mar 30.

Functional Brain Mapping Laboratory, Comprehensive Pediatric Epilepsy Center, Center for Pediatric Research, Walt Disney Pavilion Florida Hospital for Children, Orlando, FL 32803, USA.

Patients with obsessive-compulsive disorder (OCD) often report sensory intolerances which may lead to significant functional impairment. This study used auditory evoked fields (AEFs) to address the question of whether neural correlates of sensory auditory information processing differ in youth with OCD compared with healthy comparison subjects (HCS). AEFs, recorded with a whole head 275-channel magnetoencephalography system, were elicited in response to binaural auditory stimuli from 10 pediatric subjects with OCD (ages 8-13, mean 11 years, 6 males) and 10 age- and gender-matched HCS. Three major neuromagnetic responses were studied: M70 (60-80 ms), M100 (90-120 ms), and M150 (130-190 ms). When compared with HCS, subjects with OCD demonstrated delayed latency of the M100 response. In subjects with OCD the amplitude of the M100 and M150 responses was significantly greater in the right hemisphere compared with the left hemisphere. Current results suggest that when compared with HCS, subjects with OCD have altered auditory information processing, evident from the delayed latency of the M100 response, which is thought to be associated with the encoding of physical stimulus characteristics. Interhemispheric asymmetry with increased M100 and M150 amplitudes over the right hemisphere compared with the left hemisphere was found in young OCD subjects. These results should be interpreted with caution due to the high variability rate of responses in both HCS and OCD subjects, as well as the possible effect of medication in OCD subjects.
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http://dx.doi.org/10.1016/j.pscychresns.2012.11.011DOI Listing
May 2013

Resection of ictal high-frequency oscillations leads to favorable surgical outcome in pediatric epilepsy.

Epilepsia 2012 Sep 20;53(9):1607-17. Epub 2012 Aug 20.

Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.

Purpose: Intracranial electroencephalography (EEG) is performed as part of an epilepsy surgery evaluation when noninvasive tests are incongruent or the putative seizure-onset zone is near eloquent cortex. Determining the seizure-onset zone using intracranial EEG has been conventionally based on identification of specific ictal patterns with visual inspection. High-frequency oscillations (HFOs, >80 Hz) have been recognized recently as highly correlated with the epileptogenic zone. However, HFOs can be difficult to detect because of their low amplitude. Therefore, the prevalence of ictal HFOs and their role in localization of epileptogenic zone on intracranial EEG are unknown.

Methods: We identified 48 patients who underwent surgical treatment after the surgical evaluation with intracranial EEG, and 44 patients met criteria for this retrospective study. Results were not used in surgical decision making. Intracranial EEG recordings were collected with a sampling rate of 2,000 Hz. Recordings were first inspected visually to determine ictal onset and then analyzed further with time-frequency analysis. Forty-one (93%) of 44 patients had ictal HFOs determined with time-frequency analysis of intracranial EEG.

Key Findings: Twenty-two (54%) of the 41 patients with ictal HFOs had complete resection of HFO regions, regardless of frequency bands. Complete resection of HFOs (n = 22) resulted in a seizure-free outcome in 18 (82%) of 22 patients, significantly higher than the seizure-free outcome with incomplete HFO resection (4/19, 21%).

Significance: Our study shows that ictal HFOs are commonly found with intracranial EEG in our population largely of children with cortical dysplasia, and have localizing value. The use of ictal HFOs may add more promising information compared to interictal HFOs because of the evidence of ictal propagation and followed by clinical aspect of seizures. Complete resection of HFOs is a favorable prognostic indicator for surgical outcome.
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http://dx.doi.org/10.1111/j.1528-1167.2012.03629.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520059PMC
September 2012

Ictal MEG onset source localization compared to intracranial EEG and outcome: improved epilepsy presurgical evaluation in pediatrics.

Epilepsy Res 2012 May 16;99(3):214-24. Epub 2011 Dec 16.

Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Purpose: Magnetoencephalography (MEG) has been shown a useful diagnostic tool for presurgical evaluation of pediatric medically intractable partial epilepsy as MEG source localization has been shown to improve the likelihood of seizure onset zone (SOZ) sampling during subsequent evaluation with intracranial EEG (ICEEG). We investigated whether ictal MEG onset source localization further improves results of interictal MEG in defining the SOZ.

Methods: We identified 20 pediatric patients with one habitual seizure during MEG recordings between October 2007 and April 2011. MEG was recorded with sampling rates of 600Hz and 4000Hz for 10 and 2min respectively. Continuous head localization (CHL) was applied. Source localization analyses were applied using multiple algorithms, both at the beginning of ictal onset and for interictal MEG discharges. Ictal MEG onsets were identified by visual inspection and power spectrum using short-time Fourier transform (STFT). Source localizations were compared with ICEEG, surgical procedure and outcome.

Key Findings: Eight patients met all inclusion criteria. Five of the 8 patients (63%) had concordant ictal MEG onset source localization and interictal MEG discharge source localizations in the same lobe, but the source of ictal MEG onset was closer to the SOZ defined by ICEEG.

Significance: Although the capture of seizures during MEG recording is challenging, the source localization for ictal MEG onset proved to be a useful tool for presurgical evaluation in our pediatric population with medically intractable epilepsy.
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http://dx.doi.org/10.1016/j.eplepsyres.2011.11.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520066PMC
May 2012