Scalp Derivations Research Articles

EEG coherence and power spectra during REM sleep related to melatonin intake in mild-to-moderate Alzheimer’s disease: a pilot study

Introduction: It has been reported that melatonin diminishes rapid eye movement (REM) sleep latency in patients with Alzheimer’s disease (AD). Pharmacological studies suggest that melatonin promotes prompt sleep installation through interaction with GABA receptors, and that it is associated with acute suppression of neural electrical activity. Nevertheless, melatonin’s effects on electroencephalographic (EEG) activity related to REM sleep onset in AD patients have not been analyzed. Thus, in this pilot study we analyzed the effects of melatonin on EEG activity during the first episode of REM sleep in eight patients treated with 5-mg of fast-release melatonin. Methods: During a single-blind, placebo-controlled study, polysomnographic recordings were obtained from frontal, central, temporal, and occipital scalp derivations. REM sleep latency, as well as the relative power (RP) and EEG coherences of six EEG bands, were compared between the placebo and melatonin conditions. Results: Results showed that melatonin intake in AD patients decreased REM sleep onset, and that this was associated with lower RP and coherence of the β and γ EEG bands. Discussion: The possibility that the inhibitory GABAergic pathways related to REM sleep generation are well-preserved in mild-to-moderate AD is discussed. We conclude that the short REM sleep onset related to melatonin intake in AD patients is associated with a significant decrease in both RP and EEG coherence, mainly in the fast frequencies.

135 One night of mild sleep restriction affects EEG and behavioural measures of vigilance

Abstract Introduction Much is known about the behavioural and cognitive consequences of chronic sleep loss but relatively little is known about the changes in brain activity associated with reduced vigilance after mild and acute sleep loss. Mild and acute sleep loss is generally thought to be innocuous despite research showing emotional processing, visual attention and behavioural responding are all negatively impacted by even small amounts of sleep loss. The current study investigated behavioural, cognitive, and electrophysiological consequences of mild (i.e., a couple of hours) and acute (i.e., a single night) sleep loss via simultaneous behavioural and physiological measures of vigilance. Methods Participants (N = 23; 18 females, Mage = 22 ± 3 years) came into the lab (from ~12 pm to 3 pm) for two testing days after sleeping from 1 am to 6 am (Sleep Restriction), or from 12 am to 9 am (Normally Rested). Brain activity was recorded using electroencephalography (EEG) from 15 scalp derivations, while vigilance was assessed simultaneously using the psychomotor vigilance task (PVT). Results Vigilance was reduced in the Sleep Restricted vs. Normally Rested condition, (F(1,22)=9.02, p=0.007). This was exacerbated over the course of performing the PVT, (F(5,110)=8.12, p<0.001). Sleep Restriction also resulted in increased intensity of alpha burst activity compared to the Normally Rested condition (F(1,20)=6.19, p=0.022). Lastly, EEG spectral power differed between restriction sleep conditions across deepening stages of sleep onset, particularly for frequencies that reflect arousal e.g., delta, alpha and beta activity (F(1,20)>5.52, p<0.029). Conclusion These results suggest that even a small amount of sleep loss, occurring on only one night significantly reduces vigilance and impacts the physiology of the brain in ways that reflect reduced arousal. Understanding the neural correlates and cognitive processes associated with sleep loss may lead to important advancements in identifying and preventing potentially deleterious or dangerous, sleep-related lapses in vigilance (e.g., in the classroom, workplace), and when lapses in vigilance can be life-threatening (e.g., while driving). Support (if any):

Oscillatory EEG Activity During REM Sleep in Elderly People Predicts Subsequent Dream Recall After Awakenings.

Several findings underlined that the electrophysiological (EEG) background of the last segment of sleep before awakenings may predict the presence/absence of dream recall (DR) in young subjects. However, little is known about the EEG correlates of DR in elderly people. Only an investigation found differences between recall and non-recall conditions during NREM sleep EEG in older adults, while—surprisingly—no EEG predictor of DR was found for what concerns REM sleep. Considering REM sleep as a privileged scenario to produce mental sleep activity related to cognitive processes, our study aimed to investigate whether specific EEG topography and frequency changes during REM sleep in elderly people may predict a subsequent recall of mental sleep activity. Twenty-one healthy older volunteers (mean age 69.2 ± 6.07 SD) and 20 young adults (mean age 23.4 ± 2.76 SD) were recorded for one night from 19 scalp derivations. Dreams were collected upon morning awakenings from REM sleep. EEG signals of the last 5 min were analyzed by the Better OSCillation algorithm to detect the peaks of oscillatory activity in both groups. Statistical comparisons revealed that older as well as young individuals recall their dream experience when the last segment of REM sleep is characterized by frontal theta oscillations. No Recall (Recall vs. Non-Recall) × Age (Young vs. Older) interaction was found. This result replicated the previous evidence in healthy young subjects, as shown in within- and between-subjects design. The findings are completely original for older individuals, demonstrating that theta oscillations are crucial for the retrieval of dreaming also in this population. Furthermore, our results did not confirm a greater presence of the theta activity in healthy aging. Conversely, we found a greater amount of rhythmic theta and alpha activity in young than older participants. It is worth noting that the theta oscillations detected are related to cognitive functioning. We emphasize the notion that the oscillatory theta activity should be distinguished from the non-rhythmic theta activity identified in relation to other phenomena such as (a) sleepiness and hypoarousal conditions during the waking state and (b) cortical slowing, considered as an EEG alteration in clinical samples.

Discrimination of Sleep Spindles in Ear-EEG.

Sleep spindles are brief oscillatory events observed in EEG measurements during sleep, related to both sleep staging and basic neuroscience. The objective of this study was to investigate to which extent sleep spindles are observable from ear-EEG. The analysis was based on single-night recordings from 12 subjects, wearing both a polysomnography setup and two light-weight mobile EEG devices (ear-EEG). By introducing a sleep spindle index capable of discriminating between epochs with distinct spindles and distinctly spindle-free epochs, we describe to which extent the most clear cut sleep spindles (as labeled using scalp EEG) can be detected using ear-EEG. We find that ear-EEG can be used to detect sleep spindles, at a performance level similar to scalp derivations. We speculate that part of the observed discrepancy between ear-EEG and the gold standard (scalp EEG) could be caused by the visibility of different spindles in the ear-EEG.

The use of single bipolar scalp derivation for the detection of ictal events during long-term EEG monitoring.

Epilepsy is difficult to diagnose using routine EEG recordings of short duration in patients who have low seizure frequency. Long-term EEG may be useful but is impractical in an out-of-hospital setting. We investigated whether single-channel scalp EEG placed behind the earlobe is suitable for seizure identification during prolonged EEG monitoring. Scalp EEG samples were selected from subjects over 15 years of age, and comprised two segments of either background followed by seizure or background followed by background. Bipolar EEG derivations in three directions (F8-T8, C4-T8 and T8-P8) were evaluated for the presence of a seizure by two experienced reviewers. For each EEG segment containing a seizure, one pair of electrodes was oriented towards the suspected region of seizure onset, while two pairs of electrodes were oriented elsewhere. The EEG data contained five frontally localized seizures, five parietal, five temporal, two occipital, and four primary or secondary generalized seizures. The sensitivity and specificity for recognition of seizures was 86% and 95% for Reviewer 1, and 79% and 99% for Reviewer 2, respectively. When identifying a seizure with the lead orientation towards the region of seizure onset, both reviewers identified 20 out of 21 seizures (95%). When the lead was not oriented towards the region of seizure onset, the reviewers identified 34 and 30 out of 42 ictal records correctly, respectively. These results suggest that it is possible to identify epileptic seizures by bipolar EEG derivation using only two scalp electrodes. Lead orientation towards the suspected region of seizure onset is important for optimal detection sensitivity.

EEG Markers of Dementia with Lewy Bodies: A Multicenter Cohort Study.

Quantitative EEG (QEEG) has demonstrated good discriminative capacity for dementia with Lewy bodies (DLB) diagnosis as compared to Alzheimer's disease (AD) with a predictive value of 100% in a single cohort study. EEG in DLB was characterized by a dominant frequency (DF) in pre-alpha (5.5-7.5 Hz), theta, or delta bands and DF variability (DFV) >1.2 Hz, frequency prevalence (FP) pre-alpha in >40% and FP alpha in <32% of the epochs. To validate the aforementioned QEEG findings in independent cohorts of clinically diagnosed DLB versus AD patients, we analyzed EEG traces of 79 DLB and 133 AD patients (MMSE >20) collected from four European Centers. EEG traces from 19 scalp derivations were acquired as at least 10 min continuous signals and epoched in off-setting as series of 2-second-long epochs, subsequently processed by Fast Fourier Transform (frequency resolution 0.5 Hz). DLB patients showed EEG specific abnormalities in posterior derivations characterized by DF <8 Hz FP pre-alpha >50%, FP alpha <25%. DFV was >0.5 Hz. AD patients displayed stable alpha DF, DFV <0.5 Hz, FP pre-alpha <30%, and FP alpha >55%. DLB and AD differed for DF (p < 10-6), DFV (p < 0.05), FP pre-alpha (p < 10-12) and FP alpha (p < 10-12). Discriminant analysis detected specific cut-offs for every EEG mathematical descriptor; DF = 8, DFV = 2.2 Hz, FP pre-alpha=33%, FP alpha = 41% for posterior derivations. If at least one of the cut-off values was met, the percentage of DLB and AD patients correctly classified was 90% and 64%, respectively. The findings in this multicenter study support the validity of QEEG analysis as a tool for diagnosis in DLB patients.

When EMG contamination does not necessarily hide high-frequency EEG: scalp electrical recordings before and after Dysport injections

The main aim of the present study was to investigate effects of partial reductions of electromyogram (EMG) on high-frequency scalp electroencephalogram (EEG) at rest and during performance of certain cognitive tasks. Nineteen healthy women performed the same cognitive tasks before and after cosmetic injections of Dysport in certain sites of facial muscles. Scalp EEG and EMG were recorded. Impact of Dysport injections on changes of spectral power in β2 and low γ frequency ranges (18-40Hz) in EEG and EMG derivations was investigated. Also changes of spectral power in EEG and EMG derivations during comparisons of different cognitive states were calculated before and after Dysport injections separately. Dysport injections led to EMG decreases in facial muscles around the injection zones and also led to reductions of power of electric processes in scalp derivations. Along with it results of EEG power comparisons between the pairs of the cognitive states were qualitatively similar before and after Dysport injections. These facts to all appearance demonstrate that though scalp EEGs in the range above 15-40Hz are contaminated by EMG, in certain experimental situations EMG contamination does not preclude qualitative detections of electroencephalographic correlates of mental activities in β2 and low γ frequency ranges. Parallel EEG and EMG registrations can help not to overestimate EMG contamination in psychophysiological EEG studies.

Electrical stimulation of the frontal cortex enhances slow-frequency EEG activity and sleepiness

Our aim was to enhance the spontaneous slow-frequency EEG activity during the resting state using oscillating transcranial direct currents (tDCS) with a stimulation frequency that resembles the spontaneous oscillations of sleep onset. Accordingly, in this preliminary study, we assessed EEG after-effects of a frontal oscillatory tDCS with different frequency (0.8 vs. 5Hz) and polarity (anodal, cathodal, and sham).Two single-blind experiments compared the after effects on the resting EEG of oscillatory tDCS [Exp. 1=0.8Hz, 10 subjects (26.2±2.5years); Exp. 2=5Hz, 10 subjects (27.4±2.4years)] by manipulating its polarity.EEG signals recorded (28 scalp derivations) before and after stimulation [slow oscillations (0.5–1Hz), delta (1–4Hz), theta (5–7Hz), alpha (8–12Hz), beta 1 (13–15Hz) and beta 2 (16–24Hz)] were compared between conditions as a function of polarity (anodal vs. cathodal vs. sham) and frequency of stimulation (0.8 vs. 5Hz).We found a significant relative enhancement of the delta activity after the anodal tDCS at 5Hz compared to that at 0.8Hz. This increase, even though not reaching the statistical significance compared to sham, is concomitant to a significant increase of subjective sleepiness, as assessed by a visual analog scale. These two phenomena are linearly related with a regional specificity, correlations being restricted to cortical areas perifocal to the stimulation site.We have shown that a frontal oscillating anodal tDCS at 5Hz results in an effective change of both subjective sleepiness and spontaneous slow-frequency EEG activity. These changes are critically associated to both stimulation polarity (anodal) and frequency (5Hz). However, evidence of frequency-dependence seems more unequivocal than evidence of polarity-dependence.

Effects of oral temazepam on slow waves during non-rapid eye movement sleep in healthy young adults: A high-density EEG investigation

Slow waves are characteristic waveforms that occur during non-rapid eye movement (NREM) sleep that play an integral role in sleep quality and brain plasticity. Benzodiazepines are commonly used medications that alter slow waves, however, their effects may depend on the time of night and measure used to characterize slow waves. Prior investigations have utilized minimal scalp derivations to evaluate the effects of benzodiazepines on slow waves, and thus the topography of changes to slow waves induced by benzodiazepines has yet to be fully elucidated. This study used high-density electroencephalography (hdEEG) to evaluate the effects of oral temazepam on slow wave activity, incidence, and morphology during NREM sleep in 18 healthy adults relative to placebo. Temazepam was associated with significant decreases in slow wave activity and incidence, which were most prominent in the latter portions of the sleep period. However, temazepam was also associated with a decrease in the magnitude of high-amplitude slow waves and their slopes in the first NREM sleep episode, which was most prominent in frontal derivations. These findings suggest that benzodiazepines produce changes in slow waves throughout the night that vary depending on cortical topography and measures used to characterize slow waves. Further research that explores the relationships between benzodiazepine-induced changes to slow waves and the functional effects of these waveforms is indicated.

Expert and crowd-sourced validation of an individualized sleep spindle detection method employing complex demodulation and individualized normalization.

A spindle detection method was developed that: (1) extracts the signal of interest (i.e., spindle-related phasic changes in sigma) relative to ongoing “background” sigma activity using complex demodulation, (2) accounts for variations of spindle characteristics across the night, scalp derivations and between individuals, and (3) employs a minimum number of sometimes arbitrary, user-defined parameters. Complex demodulation was used to extract instantaneous power in the spindle band. To account for intra- and inter-individual differences, the signal was z-score transformed using a 60 s sliding window, per channel, over the course of the recording. Spindle events were detected with a z-score threshold corresponding to a low probability (e.g., 99th percentile). Spindle characteristics, such as amplitude, duration and oscillatory frequency, were derived for each individual spindle following detection, which permits spindles to be subsequently and flexibly categorized as slow or fast spindles from a single detection pass. Spindles were automatically detected in 15 young healthy subjects. Two experts manually identified spindles from C3 during Stage 2 sleep, from each recording; one employing conventional guidelines, and the other, identifying spindles with the aid of a sigma (11–16 Hz) filtered channel. These spindles were then compared between raters and to the automated detection to identify the presence of true positives, true negatives, false positives and false negatives. This method of automated spindle detection resolves or avoids many of the limitations that complicate automated spindle detection, and performs well compared to a group of non-experts, and importantly, has good external validity with respect to the extant literature in terms of the characteristics of automatically detected spindles.

Event-related potential as biomarkers for preclinical Alzheimer's disease

Event Related Potentials (ERPs) are useful cognitive biomarker for the diagnosis of dementia, tracking disease progression, and evaluating the pro-cognitive effect of therapeutics. Nowadays there is a real need for improved electrophysiological markers to asses' neurplastic changes for the differentiation of Preclinical Alzheimer's Disease (AD) from normal aging. The aim of this study is to asses the value of ERP as potential marker of cognitive decline in frail elderly subjects at risk to develop AD. 100 subjects were eligible for the study. ERPs were obtained in an auditory oddball paradigm with 200 tones: the frequent stimulus (tones at 1000Hz) and around 20% of rare or target stimulus (tones at 1500Hz). Electrical brain activities were recorded from four scalp derivations (frontal: Fz, central: Cz, parietal: Pz, occipital: Oz) according to the international 10/20 standards. Subject was instructed to mentally count the number of rare stimulus. ERP and neuropsychological battery performed at baseline and follow up. 3 subgroups of subjects were identified according to their ERP risk profile (high, mild, lower). Latency of P3b in parietal region strongly discriminated between high ERP risk group and lower ERP risk group (p< 0.0001). Amplitude of P3b in frontal region discriminated high risk group from lower risk group (p<0.01). Pattern of frontal activity in elderly subjects with ERP high risk profile may reflect neural compensation process requires to recruit more attention resources to perform the cognitive task. Frail elderly subjects with high ERP risk profile showed more decline in executive task (Verbal Fluency) than other groups (p< 0.05) and might reflect a faster cognitive decline especially as executive tasks requires high level of attentional resources. Early modifications of ERP components appears early in frail elderly subjects in the absence of global cognitive deficit.

Alpha and beta EEG power reflects L-dopa acute administration in parkinsonian patients.

Aim: To evaluate the effect of an acute L-dopa administration on eye-closed resting state electroencephalographic (EEG) activity of cognitively preserved Parkinsonian patients.Methods: We examined 24 right-handed patients diagnosed as uncomplicated probable Parkinson’s disease (PD). Each patient underwent Unified Parkinson’s Disease Rating Scale (UPDRS)-part-III evaluation before and 60 min after an oral load of L-dopa-methyl-ester/carbidopa 250/25 mg. Resting condition eyes-closed EEG data were recorded both pre- and post L-dopa load. Absolute EEG power values were calculated at each scalp derivation for Delta, Theta, Alpha and Beta frequency bands. UPDRS scores (both global and subscale scores) and EEG data (power values of different frequency bands for each scalp derivation) were submitted to a statistical analysis to compare Pre and Post L-Dopa conditions. Finally, a correlation analysis was carried out between EEG spectral content and UPDRS scores.Results: Considering EEG power spectral analysis, no statistically significant differences arose on Delta and Theta bands after L-dopa intake. Conversely, Alpha and Beta rhythms significantly increased on centro-parietal scalp derivations, as a function of L-dopa administration. Correlation analysis indicated a significant negative correlation between Beta power increase on centro-parietal areas and UPDRS subscores (Rigidity of arms and Bradykinesia). A minor significant negative correlation was also found between Alpha band increase and resting tremor.Conclusions: Assuming that a significant change in EEG power spectrum after L-dopa intake may be related to dopaminergic mechanisms, our findings are consistent with the hypothesis that dopaminergic defective networks are implicated in cortical oscillatory abnormalities at rest in non-demented PD patients.

Topography of age-related changes in sleep spindles

Aging induces multiple changes to sleep spindles, which may hinder their alleged functional role in memory and sleep protection mechanisms. Brain aging in specific cortical regions could affect the neural networks underlying spindle generation, yet the topography of these age-related changes is currently unknown. In the present study, we analyzed spindle characteristics in 114 healthy volunteers aged between 20 and 73 years over 5 anteroposterior electroencephalography scalp derivations. Spindle density, amplitude, and duration were higher in young subjects than in middle-aged and elderly subjects in all derivations, but the topography of age effects differed drastically. Age-related decline in density and amplitude was more prominent in anterior derivations, whereas duration showed a posterior prominence. Age groups did not differ in all-night spindle frequency for any derivation. These results show that age-related changes in sleep spindles follow distinct topographical patterns that are specific to each spindle characteristic. This topographical specificity may provide a useful biomarker to localize age-sensitive changes in underlying neural systems during normal and pathological aging.

EEG and mild cognitive impairment (MCI): Possible predictive value for progression to lewy body dementia

The aim of this study is to investigate whether q-EEG can identify specific patterns that have predictive value for progression from MCI to dementia In the study were enrolled non-demented subjects (n=21) who meet Petersen's criteria for MCI - called isolated MCI (i-MCI) - and 28 Parkinson's disease patients with MCI (p-MCI) matched on age and years of education. All patient's underwent quantitative EEGs (QEEG) from 21 scalp derivations: power spectra measurements or CSA, including the four variables, Dominant Frequency -DF, DF Variability-DFV, Frequency Prevalence -FP and Band Inscription- BI, and the resulting categorization in 5 patterns observed in anterior (F3, F4, Fz) and posterior (P3, P4, O1, O2) pooled derivations were analysed for the purpose of the present study. The neuropsychological battery includes: executive functions, memory, language, attention, visuospatial/constructive skills and evaluation of anxiety and depression. In the i-MCI group 80.9% of the patients showed pattern CSA-1, whereas the most part of PD patients (92.8%) with MCI showed patterns CSA>1. qEEG could be used as a reliable and sensitive biomarker(s) of different subtypes of MCI.

The electric field is a sufficient physical determinant of the human magnetic sense

The onset and offset of weak low-frequency magnetic fields triggered evoked potentials in human subjects that could be detected using nonlinear analysis, but not by means of time averaging. Because the magnetic fields and their induced electric fields were both present in the brain, their respective role in producing the effect on brain activity could not be ascertained. We inquired whether a biophysical coupling mechanism involving only the electric field could explain the occurrence of the brain potentials. An external electric field capable of producing a brain electric field comparable to that induced by the magnetic stimuli was identified by finite-element analysis. The electroencephalogram from 23 subjects was measured from six scalp derivations in the presence and absence of the external electric field, and the presence of evoked potentials was assessed using nonlinear and linear analyses. Evoked potentials were observed in all but one subject (p < 0.05 in each subject); the potentials had the same latency, duration, and distribution of magnitudes as seen in the earlier studies, and were detectable only by means of nonlinear analysis. Using a realistic physical model of an ion channel, we showed that transduction of an electric field could be explained by assuming that the field exerted a force on glycocalyx molecules attached to a channel gate. The evoked potentials described here, as well as those observed previously in response to magnetic stimuli, were probably triggered by the induced electric field.

EEG comparisons in early Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease with dementia patients with a 2-year follow-up

EEG abnormalities have been reported for both dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). Although it has been suggested that variations in mean EEG frequency are greater in the former, the existence of meaningful differences remains controversial. No evidence is as yet available for Parkinson's disease with dementia (PDD). The aim of this study was to evaluate whether EEG abnormalities can discriminate between DLB, AD and PDD in the earliest stages of dementia and to do this 50 DLB, 50 AD and 40 PDD patients with slight cognitive impairment at first visit (MMSE > or = 20) were studied. To improve clinical diagnostic accuracy, special emphasis was placed on identifying cognitive fluctuations and REM-sleep behaviour disorder. EEG variability was assessed by mean frequency analysis and compressed spectral arrays (CSA) in order to detect changes over time from different scalp derivations. Patients' initial diagnoses were revised at a 2-year follow-up visit with neuroimaging evaluation. Initial diagnoses were confirmed in 36 DLB, 40 AD and 35 PDD patients. The most relevant group differences were observed between the AD and DLB patients in EEGs from posterior derivations (P<0.001). Dominant frequencies were 8.3 +/- 0.6 Hz for the AD group and 7.4 +/- 1.6 Hz for the DLB group, in which most of the patients (88%) exhibited a frequency band of 5.6-7.9 Hz. Dominant frequency variability also differed between the AD (1.1 +/- 0.4 Hz) and DLB groups (1.8 +/- 1.2 Hz, P<0.001). Of note, less than a half (46%) of the patients with PDD exhibited the EEG abnormalities seen in those with DLB. Graded according to the presence of alpha activity, five different patterns were identified on EEG CSA from posterior derivations. A pattern with dominant alpha bands was observed in patients with AD alone while, in those with DLB and PDD, the degree to which residual alpha and 5.6-7.9 bands appeared was related to the presence and severity of cognitive fluctuations. At follow-up, EEG abnormalities from posterior leads were seen in all subjects with DLB and in three-quarters of those with PDD. Of interest, in four patients initially labelled as having AD, in whom the occurrence of fluctuations and/or REM-sleep behaviour disorder during the 2-year follow-up had made the diagnosis of AD questionable, the initial EEG was characterized by the features observed in the DLB group. If revised consensus criteria for DLB diagnosis are properly applied (i.e. emphasizing the diagnostic weight of fluctuations and REM sleep behaviour disorder), EEG recording may act to support discrimination between AD and DLB at the earliest stages of dementia, since characteristic abnormalities may even precede the appearance of distinctive clinical features.

Localizing epileptogenic regions in partial epilepsy using three-dimensional statistical parametric maps of background EEG source spectra

This preliminary study sought to localize epileptogenic regions in patients with partial epilepsy by analysis of interictal EEG activity utilizing variable resolution electromagnetic tomography (VARETA), a three-dimensional quantitative electroencephalographic (QEEG) frequency-domain distributed source modeling technique. The very narrow band (VNB) spectra spanned the frequency range 0.39 Hz to 19.1 Hz, in 0.39 Hz steps. These VNB spectra were compared to normative data and transformed to provide Z-scores for every scalp derivation, and the spatial distributions of the probable EEG generators of the most abnormal values were displayed on slices from a probabilistic MRI atlas. Each voxel was color-coded to represent the significance of the deviation relative to age appropriate normative values. We compared the resulting three-dimensional images to the localization of epileptogenic regions based on invasive intracranial EEG recordings of seizure onsets. The VARETA image indicated abnormal interictal spectral power values in regions of seizure onset identified by invasive monitoring, mainly in delta and theta range (1.5 to 8.0 Hz). The VARETA localization of the most abnormal voxel was congruent with the epileptogenic regions identified by intracranial recordings with regard to hemisphere in all 6 cases, and with regard to lobe in 5 cases. In contrast, abnormal findings with routine EEG agreed with invasive monitoring with regard to hemisphere in 3 cases and with regard to lobe in 2 cases. These results suggest that analysis of background interictal EEG utilizing distributed source models should be investigated further in clinical epilepsy.

Asymmetric Distribution of Visual Evoked Potentials in Patients with Migraine with Aura during the Interictal Phase

One of the most commonly described electrocortical phenomena in patients with migraine is an increased interhemispheric asymmetry, in response to different sensory stimuli. This study aims to evaluate the bioelectrical activity of both occipital cortices in patients with migraine with visual aura (MA) during the interictal period, and its possible relationship with visual symptoms. The authors recorded visual evoked potentials (VEPs) simultaneously from the left (O1) and right (O2) occipital cortices (80% contrast 60', 30', 15', and 7.5' checkerboard stimuli reversed at 2 Hz) in 22 patients with MA and 20 control subjects. The main outcome measure was interhemispheric asymmetry (IA) for both implicit time and amplitude, defined as the difference between the left and right scalp derivation (in absolute values). IA was significantly different in patients with MA with respect to controls when employing 60' (p<0.001) and 15' (p<0.05) checkerboard stimuli for implicit times, and 60' (p<0.05) checkerboard stimuli for amplitudes. On the other hand, IA was not statistically different (p>0.05) in patients with MA with respect to controls when employing 30' and 7.5' checkerboards for both implicit times and amplitudes, and 15' checkerboards for amplitudes. No correlations were found between IA and age, onset of disease, attack frequency, or side of headache/aura. Patients with MA presented asymmetries in VEP responses not related to visual aura or to headache side during the pain-free phase. These abnormalities may be ascribed to abnormal visual information processing, resulting in a different cortical activation when both foveal and parafoveal stimuli are used.

Topographic and Dipolar Analysis of Laser‐Evoked Potentials During Migraine Attack

The aim of this study was to perform further evaluation of laser-evoked potentials (LEPs) during migraine attacks using multichannel recording and topographic analysis. Specifically, this study aimed to confirm the pattern previously observed in acute migraine, while also defining the components of LEPs that are mainly modified during headache, as well as the correlation between features of LEPs and clinical variables. In addition, we aimed to conduct a dipolar source analysis of the main LEP waves in migraine patients to check the variability in the source location of LEPs during acute migraine. An amplitude enhancement of LEPs was previously detected during migraine attack using a single scalp derivation on the vertex; hyperalgesia to heat stimuli was also detected for both the face and hand. Eighteen patients suffering from migraine without aura were analyzed. The supraorbital zones and the dorsum of the hand were stimulated on both the symptomatic and nonsymptomatic sides in all patients. The LEPs were recorded via 25 scalp electrodes. Dipolar source analysis of the P2 components was performed using a spherical model in all patients and using a realistic Magnetic Resonance model in four patients. During attacks, the later waves, and particularly the P2 component, were significantly enhanced; the amplitude of the P2 component obtained during the attack by stimulation of the supraorbital zone on the side of the headache was significantly correlated with the intensity of pain and the frequency of headache. In our patients, the P2 wave was generated in the anterior cingulate cortex, with a shift toward its rostrocaudal portion, and was mainly devoted to elaboration of the emotive compound of pain during migraine attack. Cortical activation by laser stimuli during migraine attack was confirmed. This effect was more pronounced in patients with a higher frequency of migraine attacks. This may be due to a lack of inhibitory control over the transmission of pain to the cortex. The increased activation of cortical areas devoted to attention and emotion may be linked to headache.

Individually optimizing posterior tibial somatosensory evoked potential P37 scalp derivations for intraoperative monitoring.

This investigation sought the optimal (highest amplitude) derivation for monitoring the posterior tibial P37 for each side in each individual, and determined whether this may change intraoperatively. Fifty monitored patients were studied using a partial P37 map consisting of FPz, Fz, Cz, Cz', Pz, POz, C4', and C3' to a noncephalic reference. From this, the highest amplitude scalp derivation was determined for each side. Of 100 tibial nerves, the initial optimal input 1 was Cz' in 52%, Pz in 28%, and Cz or iC' in 10%, and optimal input 2 was cC' in 69% and FPz in 31%. The optimal derivation was the same for each side in 34% of patients and different in 66%. Of 31 patients with at least one subsequent trial later during surgery, P37 topography changed in 14 and affected optimal inputs in 12. This occurred regularly during sitting-position posterior fossa surgery because of intracranial air, but sometimes occurred during other surgeries as well. The most common change consisted of FPz replacing cC' as optimal input 2. Input 1 changes were predominantly in an anterior or posterior sagittal direction. The results demonstrate great inter- and intraindividual P37 variability, and document intraoperative topographic changes. Both phenomena can be addressed by a practical method to refine intraoperative monitoring by individually optimizing scalp derivations and identifying topographic P37 changes during surgery.