iEEG Studies Research Articles

Gamma Activation and Alpha Suppression within Human Auditory Cortex during a Speech Classification Task.

The dynamics of information flow within the auditory cortical hierarchy associated with speech processing and the emergence of hemispheric specialization remain incompletely understood. To study these questions with high spatiotemporal resolution, intracranial recordings in 29 human neurosurgical patients of both sexes were obtained while subjects performed a semantic classification task. Neural activity was recorded from posteromedial portion of Heschl's gyrus (HGPM) and anterolateral portion of Heschl's gyrus (HGAL), planum temporale (PT), planum polare, insula, and superior temporal gyrus (STG). Responses to monosyllabic words exhibited early gamma power increases and a later suppression of alpha power, envisioned to represent feedforward activity and decreased feedback signaling, respectively. Gamma activation and alpha suppression had distinct magnitude and latency profiles. HGPM and PT had the strongest gamma responses with shortest onset latencies, indicating that they are the earliest auditory cortical processing stages. The origin of attenuated top-down influences in auditory cortex, as indexed by alpha suppression, was in STG and HGAL. Gamma responses and alpha suppression were typically larger to nontarget words than tones. Alpha suppression was uniformly greater to target versus nontarget stimuli. Hemispheric bias for words versus tones and for target versus nontarget words, when present, was left lateralized. Better task performance was associated with increased gamma activity in the left PT and greater alpha suppression in HGPM and HGAL bilaterally. The prominence of alpha suppression during semantic classification and its accessibility for noninvasive electrophysiologic studies suggests that this measure is a promising index of auditory cortical speech processing.SIGNIFICANCE STATEMENT Understanding the dynamics of cortical speech processing requires the use of active tasks. This is the first comprehensive intracranial electroencephalography study to examine cortical activity within the superior temporal plane, lateral superior temporal gyrus, and the insula during a semantic classification task. Distinct gamma activation and alpha suppression profiles clarify the functional organization of feedforward and feedback processing within the auditory cortical hierarchy. Asymmetries in cortical speech processing emerge at early processing stages. Relationships between cortical activity and task performance are interpreted in the context of current models of speech processing. Results lay the groundwork for iEEG studies using connectivity measures of the bidirectional information flow within the auditory processing hierarchy.

Visual cortex responds to sound onset and offset during passive listening.

Sounds enhance our ability to detect, localize, and respond to co-occurring visual targets. Research suggests that sounds improve visual processing by resetting the phase of ongoing oscillations in visual cortex. However, it remains unclear what information is relayed from the auditory system to visual areas and if sounds modulate visual activity even in the absence of visual stimuli (e.g., during passive listening). Using intracranial electroencephalography (iEEG) in humans, we examined the sensitivity of visual cortex to three forms of auditory information during a passive listening task: auditory onset responses, auditory offset responses, and rhythmic entrainment to sounds. Because some auditory neurons respond to both sound onsets and offsets, visual timing and duration processing may benefit from each. In addition, if auditory entrainment information is relayed to visual cortex, it could support the processing of complex stimulus dynamics that are aligned between auditory and visual stimuli. Results demonstrate that in visual cortex, amplitude-modulated sounds elicited transient onset and offset responses in multiple areas, but no entrainment to sound modulation frequencies. These findings suggest that activity in visual cortex (as measured with iEEG in response to auditory stimuli) may not be affected by temporally fine-grained auditory stimulus dynamics during passive listening (though it remains possible that this signal may be observable with simultaneous auditory-visual stimuli). Moreover, auditory responses were maximal in low-level visual cortex, potentially implicating a direct pathway for rapid interactions between auditory and visual cortices. This mechanism may facilitate perception by time-locking visual computations to environmental events marked by auditory discontinuities.NEW & NOTEWORTHY Using intracranial electroencephalography (iEEG) in humans during a passive listening task, we demonstrate that sounds modulate activity in visual cortex at both the onset and offset of sounds, which likely supports visual timing and duration processing. However, more complex auditory rate information did not affect visual activity. These findings are based on one of the largest multisensory iEEG studies to date and reveal the type of information transmitted between auditory and visual regions.

Direct brain recordings identify hippocampal and cortical networks that distinguish successful versus failed episodic memory retrieval

Human data collected using noninvasive imaging techniques have established the importance of parietal regions towards episodic memory retrieval, including the angular gyrus and posterior cingulate cortex. Such regions comprise part of a putative core episodic retrieval network. In free recall, comparisons between contextually appropriate and inappropriate recall events (i.e. prior list intrusions) provide the opportunity to study memory retrieval networks supporting veridical recall, and existing findings predict that differences in electrical activity in these brain regions should be identified according to the accuracy of recall. However, prior iEEG studies, utilizing principally subdural grid electrodes, have not fully characterized brain activity in parietal regions during memory retrieval and have not examined connectivity between core recollection areas and the hippocampus or prefrontal cortex. Here, we employed a data set obtained from 100 human patients implanted with stereo EEG electrodes for seizure mapping purposes as they performed a free recall task. This data set allowed us to separately analyze activity in midline versus lateral parietal brain regions, and in anterior versus posterior hippocampus, to identify areas in which retrieval-related activity predicted the recollection of a correct versus an incorrect memory. With the wide coverage afforded by the stereo EEG approach, we were also able to examine interregional connectivity. Our key findings were that differences in gamma band activity in the angular gyrus, precuneus, posterior temporal cortex, and posterior (more than anterior) hippocampus discriminated accurate versus inaccurate recall as well as active retrieval versus memory search. The left angular gyrus exhibited a significant power decrease preceding list intrusions as well as unique phase–amplitude coupling properties, whereas the prefrontal cortex was unique in exhibiting a power increase during list intrusions. Analysis of connectivity revealed significant hemispheric asymmetry, with relatively sparse left-sided functional connections compared to the right hemisphere. One exception to this finding was elevated connectivity between the prefrontal cortex and left angular gyrus. This finding is interpreted as evidence for the engagement of prefrontal cortex in memory monitoring and mnemonic decision-making.

Enhancing gesture decoding performance using signals from posterior parietal cortex: a stereo-electroencephalograhy (SEEG) study

Objective. Hand movement is a crucial function for humans’ daily life. Developing brain-machine interface (BMI) to control a robotic hand by brain signals would help the severely paralyzed people partially regain the functional independence. Previous intracranial electroencephalography (iEEG)-based BMIs towards gesture decoding mostly used neural signals from the primary sensorimotor cortex while ignoring the hand movement related signals from posterior parietal cortex (PPC). Here, we propose combining iEEG recordings from PPC with that from primary sensorimotor cortex to enhance the gesture decoding performance of iEEG-based BMI. Approach. Stereoelectroencephalography (SEEG) signals from 25 epilepsy subjects were recorded when they performed a three-class hand gesture task. Across all 25 subjects, we identified 524, 114 and 221 electrodes from three regions of interest (ROIs), including PPC, postcentral cortex (POC) and precentral cortex (PRC), respectively. Based on the time-varying high gamma power (55-150 Hz) of SEEG signal, both the general activation in the task and the fine selectivity to gestures of each electrode in these ROIs along time was evaluated by the coefficient of determination r 2. According to the activation along time, we further assessed the first activation time of each ROI. Finally, the decoding accuracy for gestures was obtained by linear support vector machine classifier to comparatively explore if the PPC will assist PRC and POC for gesture decoding. Main results. We find that a majority(L: 60%, R: 40%) of electrodes in all the three ROIs present significant activation during the task. A large scale temporal activation sequence exists among the ROIs, where PPC activates first, PRC second and POC last. Among the activated electrodes, 15% (PRC), 26% (POC) and 4% (left PPC) of electrodes are significantly selective to gestures. Moreover, decoding accuracy obtained by combining the selective electrodes from three ROIs together is 5%, 3.6%, and 8% higher than that from only PRC and POC when decoding features across, before, and after the movement onset, were used. Significance. This is the first human iEEG study demonstrating that PPC contains neural information about fine hand movement, supporting the role of PPC in hand shape encoding. Combining PPC with primary sensorimotor cortex can provide more information to improve the gesture decoding performance. Our results suggest that PPC could be a rich neural source for iEEG-based BMI. Our findings also demonstrate the early involvement of human PPC in visuomotor task and thus may provide additional implications for further scientific research and BMI applications.

IEEGview: an open-source multifunction GUI-based Matlab toolbox for localization and visualization of human intracranial electrodes

Objective. The precise localization of intracranial electrodes is a fundamental step relevant to the analysis of intracranial electroencephalography (iEEG) recordings in various fields. With the increasing development of iEEG studies in human neuroscience, higher requirements have been posed on the localization process, resulting in urgent demand for more integrated, easy-operation and versatile tools for electrode localization and visualization. With the aim of addressing this need, we develop an easy-to-use and multifunction toolbox called iEEGview, which can be used for the localization and visualization of human intracranial electrodes. Approach. iEEGview is written in Matlab scripts and implemented with a GUI. From the GUI, by taking only pre-implant MRI and post-implant CT images as input, users can directly run the full localization pipeline including brain segmentation, image co-registration, electrode reconstruction, anatomical information identification, activation map generation and electrode projection from native brain space into common brain space for group analysis. Additionally, iEEGview implements methods for brain shift correction, visual location inspection on MRI slices and computation of certainty index in anatomical label assignment. Main results. All the introduced functions of iEEGview work reliably and successfully, and are tested by images from 28 human subjects implanted with depth and/or subdural electrodes. Significance. iEEGview is the first public Matlab GUI-based software for intracranial electrode localization and visualization that holds integrated capabilities together within one pipeline. iEEGview promotes convenience and efficiency for the localization process, provides rich localization information for further analysis and offers solutions for addressing raised technical challenges. Therefore, it can serve as a useful tool in facilitating iEEG studies.

Is intracranial electroencephalography useful for planning resective surgery in intractable epilepsy with ulegyria?

Intractable epilepsy patients with ulegyria could be candidates for resective surgery. Complete resection of ulegyria in the epileptogenic hemisphere is associated with favorable seizure outcome, although the risk of postoperative functional deficits is higher. The authors evaluated the extent of resection and postsurgical outcomes in epilepsy patients with ulegyria who underwent intracranial electroencephalography (iEEG) monitoring prior to resection to clarify the efficacy of iEEG-guided partial resection of ulegyria. Ten consecutive epilepsy patients with ulegyria (7 males and 3 females, age range at surgery 7-34 years) underwent iEEG prior to resective surgery between 2011 and 2017 with a minimum follow-up of 12 months (range 12-72 months). The diagnosis of ulegyria was based on the typical pattern of cortical atrophy especially at the bottom of the sulcus on MRI. An iEEG study was indicated after comprehensive preoperative evaluations, including high-field MRI, long-term video-EEG, magnetoencephalography, and FDG-PET. The resection planning was based on iEEG analysis. Total lesionectomy was not always performed, as preservation of cortical function was prioritized. Ulegyria was seen in the occipital and/or parietal lobe in 9 patients and bilaterally in 5 patients. Ictal EEG onset involved the temporal neocortex in 6 patients. Intracranial electrodes were implanted unilaterally in all except 1 patient with bilateral lesions. The extent of MRI lesion was covered by the electrodes. Seizure onset zones (SOZs) and irritative zones (IZs) were identified in all patients. SOZs and IZs were completely resected in 8 patients but were only partially removed in the remaining 2 patients because the eloquent cortices and the epileptogenic zones overlapped. Ulegyria of the epileptogenic side was totally resected in 1 patient. Seizure freedom was achieved in 4 patients, including 3 after partial lesionectomy. Extended resection of the temporal neocortex was performed in 4 patients, although postoperative seizure freedom was achieved only in 1 of these patients. Visual field deficit was seen in 4 patients. Three of 5 patients with bilateral lesions achieved seizure freedom after unilateral resective surgery. Intracranial EEG-guided partial lesionectomy provides a reasonable chance of postoperative seizure freedom with a lower risk of functional deficits. Patients with bilateral ulegyria should not be excluded from consideration as surgical candidates.

Association of Seizure Spread With Surgical Failure in Epilepsy

Seizures recur in as many as half of patients who undergo surgery for drug-resistant temporal lobe epilepsy (TLE). Understanding why TLE is resistant to surgery in some patients may reveal insights into epileptogenic networks and direct new therapies to improve outcomes. To characterize features of surgically refractory TLE. Medical records from a comprehensive epilepsy center were retrospectively reviewed for 131 patients who received a standard anteromedial temporal resection by a single surgeon from January 1, 2000, to December 31, 2015. Thirteen patients were excluded for having less than 1 year of follow-up. Patients at the highest risk for seizure recurrence were identified. Intracranial electroencephalogram (iEEG) analyses generated 3-dimensional seizure spread representations and quantified rapid seizure spread. The final analyses of seizure outcome and follow-up data were performed in June 2017. The Engel class seizure outcome following surgery was evaluated for all patients, defining seizure recurrence as Engel class II or greater. Intracranial recordings of neocortical grids/strips and depth electrodes were analyzed visually for seizure spread. Fast β power was projected onto reconstructions of patients' brain magnetic resonance imaging scans to visualize spread patterns and was quantified to compare power within vs outside resective margins. Of 118 patients with 1 year of follow-up or more (mean [SD], 6.5 [4.6] years), 66 (55.9%) were women and 52 (44.1%) were men (median age, 39 years [range, 4-66 years]). The cumulative probability of continuous Engel class I seizure freedom since surgery at postoperative year 10 and afterward was 65.6%, with 92% of recurrences in years 1 to 3. Multivariable statistical analyses found that the selection for iEEG study was the most reliable predictor of seizure recurrence, with a mixed-effects model estimating that the Engel score in the iEEG cohort was higher by a mean (SD) of 1.1 (0.33) (P = .001). In patients with iEEG results, rapid seizure spread in less than 10 seconds was associated with recurrence (hazard ratio, 5.99; 95% CI, 1.7-21.1; P < .01). In the first 10 seconds of seizures, fast β power activity outside the resective margins in the lateral temporal cortex was significantly greater in patients whose seizures recurred compared with patients who were seizure-free (mean [SEM], 137.5% [16.8%] vs 93.4% [4.6%]; P < .05). Rapid seizure spread outside anteromedial temporal resection resective margins plays a significant role in the surgical failure of drug-resistant TLE. Seizure control after epilepsy surgery might be improved by investigating areas of early spread as candidates for resection or neuromodulation.

Association between scalp and intracerebral electroencephalographic seizure-onset patterns: A study in different lesional pathological substrates.

Our purpose was to determine the correlation between scalp electroencephalography (EEG) and intracerebral EEG (iEEG) seizure-onset patterns in patients with focal lesional epilepsy to determine whether scalp seizure-onset patterns can be specific to intracerebral seizure-onset patterns and to lesion type. We retrospectively analyzed 61 patients with focal epilepsy and a structural magnetic resonance imaging (MRI)-visible lesion, who first underwent extensive scalp recordings and then iEEG studies (stereo-EEG) for presurgical evaluation, and who showed an iEEG seizure onset in the lesional/perilesional area. Five seizure-onset patterns were recognized on scalp EEG, and 7 on iEEG, and in each patient, only the predominant scalp and iEEG seizure-onset patterns were compared. Because scalp and iEEG recordings were acquired at different times, we followed strict criteria based on semiology and topography to match scalp with intracerebral seizures. Seventy-one pairs of seizure-onset patterns matched between scalp and iEEG were identified. Each scalp pattern did not correspond to a single intracerebral pattern, but there were significant associations: (1) paroxysmal fast activity (≥13 Hz) at scalp onset was associated with low-voltage fast activity at iEEG onset (P < .001), with malformations of cortical development (P < .001), and with superficial seizure-onset zone based on iEEG (P < .001); (2) rhythmic slow activity (<13 Hz) at scalp onset was associated with low-frequency high-amplitude periodic spikes at iEEG onset (P = .0014), with medial temporal atrophy/sclerosis (P < .001), and with deep seizure-onset zone (P < .001); and (3) repetitive epileptiform discharge at scalp onset was associated with a burst of high-amplitude polyspikes at iEEG onset (P = .0002). Our results disclosed that in focal epilepsy patients with seizures generated in an MRI-visible lesion, some scalp seizure-onset patterns are highly associated with a specific intracerebral pattern, with specific pathologies, and with the depth of seizure-onset zone. These findings allow the interpretation of scalp seizure-onset patterns to be significantly more informative.

Temporal dynamics of different levels of feature representation in working memory binding: An EEG and iEEG study

Temporal dynamics of different levels of feature representation in working memory binding: An EEG and iEEG study

35. Practical value of quantitative EEG in epilepsy surgery planning

Objective To assess whether available algorithms of quantitative EEG (qEEG) could practically help in localizing epileptogenic zone (EZ) and modify surgical planning in patients with focal intractable epilepsy. Methods We will present a case report of a 7-year-old boy with catastrophic epilepsy caused by focal cortical dysplasia located in the operculo-insular region of the right hemisphere. Due to the challenging localization of the presumed EZ, uncertain surgical borders and expected significant risks of the resection, the patient was stereotactically implanted with oblique depth electrodes. Intracranial EEG (iEEG) signal was analyzed using different qEEG methods. Our originally developed interictal epileptiform discharges (IED) detecting algorithm, which also extracts repetitive propagation patterns, was applied to localize sources of IED. We also used own network connectivity algorithm to analyze ictal (seizure) iEEG activity in detail. Employing results of qEEG analyses, 2D and 3D dynamic reconstructions of both interictal and ictal iEEG epileptiform changes were created and used to guide surgical approach. Results Both qEEG algorithms clearly proved the EZ localization in the dorso-caudal insular cortex of the right hemisphere and demonstrated sparing of initially suspected frontal opercular area. The dorso-caudal insular cortex generated 89% of IED; remaining 11% IED originated from the primary motor cortex. Surgical approach was adjusted to this qEEG-based hypothesis. Oblique depth electrodes were preserved intraoperatively to help precise targeting of the lesion. Continuous intraoperative motor-evoked potential monitoring was used to preserve motor functions. The boy has been followed for more than one year postoperatively. He is seizure-free with no motor deficit; with normal cognitive functions. Conclusions The case report demonstrates that currently available qEEG methods could help in guiding resective epilepsy surgery in complicated patients indicated for iEEG studies. We suggest our approach could increase patients’ chance to obtain seizure-free outcomes without new deficits and thus ultimately improve their quality of life. Supported by MH CZ–DRO, University Hospital Motol, Prague, Czech Republic 00064203 and IGA NT/11460-4.

Evaluation of Algorithms for Intracranial EEG (iEEG) Source Imaging of Extended Sources: Feasibility of Using iEEG Source Imaging for Localizing Epileptogenic Zones in Secondary Generalized Epilepsy

Precise identification of epileptogenic zones in patients with intractable drug-resistant epilepsy is critical for successful epilepsy surgery. Numerous source-imaging algorithms for localizing epileptogenic zones based on scalp electroencephalography (EEG) and magnetoencephalography (MEG) have been developed and validated in simulation and experimental studies. Recently, intracranial EEG (iEEG)-based imaging of epileptogenic sources has attracted interest as a promising tool for presurgical evaluation of epilepsy; however, most iEEG studies have focused on localization of epileptogenic zones in focal epilepsy. In the present study, we investigated whether iEEG source imaging is a useful supplementary tool for identifying extended epileptogenic sources in secondary generalized epilepsy such as Lennox-Gastaut syndrome (LGS). To this end, we applied four different cortical source imaging algorithms, namely minimum norm estimation (MNE), low-resolution electromagnetic tomography (LORETA), standardized LORETA (sLORETA), and L(p)-norm estimation (p = 1.5, referred to as Lp1.5), to artificial iEEG datasets generated assuming various source sizes and locations. We also applied these four algorithms to clinical ictal iEEG recordings acquired from a pediatric patient with LGS. Interestingly, the traditional MNE algorithm outperformed the other imaging algorithms in most of our experiments, particularly in cases when larger-sized sources were activated. Although sLORETA outperformed both LORETA and Lp1.5, its performance was not as good as that of MNE. Compared to the other algorithms, the performance of Lp1.5 decayed most rapidly as the source size increased. Our findings suggest that iEEG source imaging using MNE is a promising auxiliary tool for the identification of epileptogenic zones in secondary generalized epilepsy. We anticipate that our results will provide useful guidelines for selection of an appropriate imaging algorithm for iEEG source imaging studies.

Investigating the neural correlates of metamemory using functional magnetic resonance imaging (fMRI) and intracranial electroencephalography (IEEG)

Event Abstract Back to Event Investigating the neural correlates of metamemory using functional magnetic resonance imaging (fMRI) and intracranial electroencephalography (IEEG) Anne T. Do Lam1*, Nikolai Axmacher1, Christian E. Elger1 and Juergen Fell1 1 Epileptology University Bonn, Germany Memory performance in everyday life is often far from perfect. Thus, people usually monitor and control the learning progress by metamemory evaluations, such as judgments of learning (JOLs). We first investigated the neural correlates of JOLs using fMRI in 17 healthy subjects with a face – name paired associates design. In general, we found that actual memory success was associated with increased brain activation of bilateral hippocampi but dissociated from predicted memory which was correlated with larger brain activation of a prefrontal network. Since we found that the hippocampus was recruited during the JOL phase, we conducted an iEEG study in 11 presurgical epilepsy patients with hippocampal and rhinal depth electrodes. Patients were presented with unfamiliar faces and had to provide JOLs. In the subsequent retrieval phase, faces were shown again intermixed with 50 % new faces for a recognition memory test. Analyses of event-related potentials (ERP) of remembered versus forgotten trials yielded increases of the rhinal N400 component, as well as of late positive hippocampal ERP components. The memory predictions revealed only significant differences of hippocampal ERPs. However, accurate memory predictions were correlated with effects in the rhinal cortex in an early and late time phase, and with a late ERP effect in the hippocampus. Our data demonstrate that memory predictions per se rely on hippocampal activation, whereas accurate predictions might require an interaction of neocortical areas mediating monitoring/ control of incoming information, and the hippocampus. We suggest that this interaction is reflected by early and late rhinal ERP effects. The latter effects were not observed during memory encoding indicating that JOLs do not reduce to encoding processes. Keywords: cognitive control, ERP Conference: XI International Conference on Cognitive Neuroscience (ICON XI), Palma, Mallorca, Spain, 25 Sep - 29 Sep, 2011. Presentation Type: Poster Presentation Topic: Poster Sessions: Performance Monitoring and Cognitive Control Citation: Do Lam AT, Axmacher N, Elger CE and Fell J (2011). Investigating the neural correlates of metamemory using functional magnetic resonance imaging (fMRI) and intracranial electroencephalography (IEEG). Conference Abstract: XI International Conference on Cognitive Neuroscience (ICON XI). doi: 10.3389/conf.fnhum.2011.207.00245 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 21 Nov 2011; Published Online: 28 Nov 2011. * Correspondence: Dr. Anne T Do Lam, Epileptology University Bonn, Bonn, Germany, anne.dolam@ukb.uni-bonn.de Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Anne T Do Lam Nikolai Axmacher Christian E Elger Juergen Fell Google Anne T Do Lam Nikolai Axmacher Christian E Elger Juergen Fell Google Scholar Anne T Do Lam Nikolai Axmacher Christian E Elger Juergen Fell PubMed Anne T Do Lam Nikolai Axmacher Christian E Elger Juergen Fell Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Intracranial EEG and human brain mapping

This review is an attempt to highlight the value of human intracranial recordings (intracranial electro-encephalography, iEEG) for human brain mapping, based on their technical characteristics and based on the corpus of results they have already yielded. The advantages and limitations of iEEG recordings are introduced in detail, with an estimation of their spatial and temporal resolution for both monopolar and bipolar recordings. The contribution of iEEG studies to the general field of human brain mapping is discussed through a review of the effects observed in the iEEG while patients perform cognitive tasks. Those effects range from the generation of well-localized evoked potentials to the formation of large-scale interactions between distributed brain structures, via long-range synchrony in particular. A framework is introduced to organize those iEEG studies according to the level of complexity of the spatio-temporal patterns of neural activity found to correlate with cognition. This review emphasizes the value of iEEG for the study of large-scale interactions, and describes in detail the few studies that have already addressed this point.

FDG-positron emission tomography and invasive EEG: seizure focus detection and surgical outcome.

To study the value of [18F]2-deoxyglucose (FDG)-positron emission tomography when surface ictal EEG is nonlocalizing. FDG-PET scans were performed in 46 patients with complex partial seizures (CPS) not localized by ictal surface-sphenoidal video-EEG (VEEG) telemetry. Interictal PET was performed with continuous EEG monitoring, and images were analyzed with a standard template. Forty patients subsequently had subdural and 6 had depth electrodes (invasive EEG, IEEG); 22 had bilateral implants. A focus was detected in 40, and 35 had temporal lobectomy based on IEEG localization. There was a close association between IEEG and PET localization (p < 0.01): 26 patients had relative unilateral temporal FDG-PET hypometabolism, all had congruent IEEG, and 18 of 23 were seizure-free after temporal lobectomy. Five patients had unilateral frontotemporal hypometabolism (3 of 5 were seizure-free), 1 had frontal hypometabolism, and 14 had no lateralized PET abnormality (4 of 7 were seizure-free). Patients who became seizure-free had significantly higher lateral temporal asymmetry index (AI). PET showed > or = 15% relative temporal hypometabolism (AI) in 12 of 22 patients with nonlateralized surface ictal VEEG and was capable of distinguishing between frontal and temporal foci in 16 of 24 patients with lateralized, but not localized, surface ictal video-EEG. FDG-PET provides valuable data in patients with unlocalized surface ictal EEG and can reduce the number of patients who require IEEG studies. Quantitation is necessary for optimal PET interpretation.