Contralateral medial temporal lobe damage in right but not left temporal lobe epilepsy: a (1)H magnetic resonance spectroscopy study.

Background: Proton magnetic resonance spectroscopy (MRS) of the hippocampus is useful in lateralising the epileptic focus in temporal lobe epilepsy for subsequent surgical resection. Previous studies have reported abnormal contralateral MRS values in up to 50% of the patients.

Objective: To identify the contributing factors to contralateral damage, as determined by MRS, and its extension in patients with temporal lobe epilepsy.

Ictal bradycardia in a young child with focal cortical dysplasia in the right insular cortex.

We report on a three and a half year old child with episodic sinus bradycardia during habitual seizures and prolonged interictal discharges due to focal cortical dysplasia in the anterior 2/3 of the insula and the inferior frontal cortex. Seizure-induced bradycardia is rarely reported in children. Bradycardia is suspected to be related to sudden death, a rare complication of a chronic seizure disorder.

Direction of saccadic and smooth eye movements induced by electrical stimulation of the human frontal eye field: effect of orbital position.

The present study reports on the direction of saccadic and smooth eye movements, which were induced electrically from the human dorsolateral frontal cortex including the human frontal eye field (FEF). The eye position prior to stimulation was varied in order to examine its effect on induced eye movement direction. The five patients of the study underwent invasive presurgical evaluation for pharmacoresistant epilepsy.

Temporal lobe epilepsy and postural orthostatic tachycardia syndrome (POTS).

We describe a 20-year-old woman suffering from right temporal epilepsy, behavioral disorder, and a complaint of paroxysmal palpitations accompanied by anxiety. Detailed cardiac evaluation revealed that the palpitations were due to episodes of marked sinus tachycardia secondary to a concomitant postural orthostatic tachycardia syndrome (POTS) and not of psychogenic origin as initially thought. Treatment with a beta-blocker resulted in the disappearance of palpitations and the associated anxiety.

Mapping of the neuronal networks of human cortical brain functions.

Objective: The principles and methodology of event-related fMRI, electromagnetic source imaging and intracranial evoked potentials will be described along with some examples of the mapping of the neuronal networks of human cortical brain functions with the use of these techniques.

Introduction: Functional brain mapping using PET or fMRI has provided clues on the functioning brain and notably on the functional neuroanatomy of cognitive functions. These mapping possibilities can be used to delineate in an individual patient the brain areas subserving a cerebral function that might be compromised by a surgery in a nearby location, or to target a functional neurosurgical procedure.

Intracranial Neurophysiological Correlates Related to the Processing of Faces.

Face perception and recognition is an intriguing ability, already present in neonates. Numerous studies in patients with brain lesions identified the temporo-occipital cortex as the crucial structure for this capacity. Analysis of electrical signals (EEG) inside the brain of patients implanted with intracranial electrodes for diagnostic purposes allows researchers to describe the temporal and spatial organization of responses to various aspects of face processing in human subjects.

Electrical cortical stimulation of the human prefrontal cortex evokes complex visual hallucinations.

Complex visual hallucinations are a well-known feature of electrical stimulation or epileptic discharge in the temporal lobe. It has been proposed that these visual hallucinations result from an electrical interference with the ventral visual processing stream in the lateral temporal lobe and the memory system in medial temporal structures, which explains their frequent visual and mnestic features. Even though recent studies have demonstrated visual and memory functions in the prefrontal cortex, up to now epileptic discharge or electrical stimulation of prefrontal structures has only rarely been reported to induce visual phenomena.

Brain activation using triggered event-related fMRI.

EEG-triggered fMRI provides a method for localizing the sources of brain electrical activity, such as epileptic discharges. Extending single-image acquisitions, following an event on the EEG, into triggered image series acquisitions may allow BOLD time courses to be obtained, such as those observed in event-related (ER) fMRI experiments. However, in contrast to the standard ER-fMRI, triggered image series are greatly affected by magnetization non-steady-state effects.

Epileptic source localization with high density EEG: how many electrodes are needed?

Objective: Electroencephalography (EEG) source reconstruction is becoming recognized as a useful technique to non-invasively localize the epileptic focus. Whereas, large array magnetoencephalography (MEG) systems are available since quite some time, application difficulties have previously prevented multichannel EEG recordings. Recently, however, EEG systems which allow for quick (10-20min) application of, and recording from, up to 125 electrodes have become available.

Stimulating illusory own-body perceptions.

'Out-of-body' experiences (OBEs) are curious, usually brief sensations in which a person's consciousness seems to become detached from the body and take up a remote viewing position. Here we describe the repeated induction of this experience by focal electrical stimulation of the brain's right angular gyrus in a patient who was undergoing evaluation for epilepsy treatment. Stimulation at this site also elicited illusory transformations of the patient's arm and legs (complex somatosensory responses) and whole-body displacements (vestibular responses), indicating that out-of-body experiences may reflect a failure by the brain to integrate complex somatosensory and vestibular information.

[Geneva-Lausanne laboratory for presurgical epilepsy diagnosis: experiences with the first 150 patients].

In Switzerland there are approximately 35,000 to 70,000 patients who suffer from epilepsy. In 20% of these patients, seizures cannot be satisfactorily suppressed by medical treatment (so-called pharmacoresistent epilepsy); thus surgical therapy represents an alternative. We report on the first 150 patients who have been investigated in the presurgical epilepsy laboratory Geneva-Lausanne since its foundation in April 1995.

Direction-specific motion blindness induced by focal stimulation of human extrastriate cortex.

Motion blindness (MB) or akinetopsia is the selective disturbance of visual motion perception while other features of the visual scene such as colour and shape are normally perceived. Chronic and transient forms of MB are characterized by a global deficit of direction discrimination (pandirectional), which is generally assumed to result from damage to, or interference with, the motion complex MT+/V5. However, the most characteristic feature of primate MT-neurons is not their motion specificity, but their preference for one direction of motion (direction specificity).

Seizure-like phenomena and propofol: a systematic review.

Data on seizure-like phenomena (SLP) in patients receiving propofol were systematically reviewed. Reports had to provide detailed information on SLP in individual patients who received propofol. Phenomena were classified according to the time point of their occurrence during anesthesia or sedation (induction, maintenance, emergence, delayed [>30 minutes after emergence]) and their clinical presentation (generalized tonic-clonic seizures, focal motor seizures, events presented as increased tone with twitching and rhythmic movements not perceived as generalized tonic-clonic seizures, opisthotonos, involuntary movements).

Is the right amygdala involved in visuospatial memory? Evidence from MRI volumetric measures.

Quantitative MRI measurement of hippocampal sclerosis in patients suffering from temporal lobe epilepsy (TLE) have, as yet, failed to evidence any correlation between the right hippocampus and visuospatial memory. In this report, word learning and design learning tasks were carried out as well as MRI volumetric measurements of the hippocampus and amygdala in order to verify possible modality-specific correlations between function and structure. Delayed recall indices in our memory tasks provided significant results.

Localization of distributed sources and comparison with functional MRI.

Functional mapping of the human brain has made tremendous progress in the past years thanks to new technical developments. Imaging methods are now available; they allow to study brain functions with high spatial and temporal resolution. Single photon emission computer tomography (SPECT), positron emission tomography (PET), functional magnetic resonance imaging (fMRI) and high resolution electro- and magnetoencephalography (EEG and MEG) are currently intensively applied techniques to functional studies, each one having specific properties concerning spatial and temporal resolution.

Volumetric measurements of subcortical nuclei in patients with temporal lobe epilepsy.

Objective: To determine the volumes of subcortical nuclei in patients with chronic epilepsy.

Background: Animal and human data suggest a crucial role for subcortical structures in the modulation of seizure activity, mostly as seizure-suppressing relays. Although cortical epileptogenic foci can vary in localization and extent, it nevertheless appears that these structures subsequently influence seizure propagation in a universal fashion.

Electric source imaging of human brain functions.

We review recent methodological advances in electromagnetic source imaging and present EEG data from our laboratory obtained by application of these methods. There are two principal steps in our analysis of multichannel electromagnetic recordings: (i) the determination of functionally relevant time periods in the ongoing electric activity and (ii) the localization of the sources in the brain that generate these activities recorded on the scalp. We propose a temporal segmentation of the time-varying activity, which is based on determination of changes in the topography of the electric fields, as an approach to the first step, and a distributed linear inverse solution based on realistic head models as an approach to the second step.

EEG mapping and functional MRI in presurgical epilepsy evaluation.

The major goal of presurgical epilepsy evaluation is the correct and precise identification of the epileptic focus. Functional magnetic resonance imaging (fMRI) and EEG source analysis (EEG mapping) are two recent developments that are increasingly used in this particular clinical context. fMRI yields anatomically precise information but low temporal resolution, whereas the inverse situation is true for EEG mapping.

Symptomatic postictal cardiac asystole in a young patient with partial seizures.

This report describes a patient with complex partial seizures arising from the right temporal lobe who developed symptomatic sinus arrest following the end of his seizure activity. A ventricular pacemaker was implanted and was documented to function appropriately, preventing development of bradycardia associated symptoms during subsequent seizures. Possibly relevant cerebral structures are briefly discussed.

Spatiotemporal Dynamics of Human Cognition.

It is still largely unknown how the complex cortical neural network of the human brain can process information so rapidly. Multichannel evoked potential recordings with millisecond time resolution and spatiotemporal analysis methods now allow us to address this question and to unravel the temporal dynamics of the large-scale neurocognitive networks.

Functional MRI with simultaneous EEG recording: feasibility and application to motor and visual activation.

The possibility of combining the high spatial resolution of functional magnetic resonance imaging (fMRI) with the high temporal resolution of electroencephalography (EEG) may provide a new tool in cognitive neurophysiology, as well as in clinical applications such as epilepsy. However, the simultaneous recording of EEG and fMRI raises important practical problems: 1) the patients' safety, in particular the risk of skin burns due to electrodes heating; 2) the impairment of the EEG recording by the static magnetic field, as well as by RF and magnetic field gradients used during MRI; and 3) the quality of MR images, which may be affected by the presence of conductors and electronic devices in the MRI bore. Here we present our experiences on 19 normal volunteers who underwent combined fMRI and 16-channel EEG examination.

Propofol [correction of propfol] versus methohexital for electroconvulsive therapy: a meta-analysis.

A systematic search (Medline, Cochrane library, Embase, bibliographies, to 5.2000, no language restriction) was performed for published reports of randomized comparisons of propofol and methohexital for anesthesia during electroconvulsive therapy. We analyzed 15 trials with data on 706 patients.

Space-oriented segmentation and 3-dimensional source reconstruction of ictal EEG patterns.

Objectives: Characterization of the EEG pattern during the early phase of a seizure is crucial for identifying the epileptic focus. The purpose of the present investigation was to evaluate a method that divides ictal EEG activity into segments of relatively constant surface voltage distribution, and to provide a 3-dimensional localization of the activity during the different segments.

Methods: For each timepoint the electrical voltage distribution on the scalp (the voltage map) was determined from the digitized EEG recording.

Electromagnetic inverse solutions in anatomically constrained spherical head models.

Two classes of functional neuroimaging methods exist: hemodynamic techniques such as PET and fMRI, and electromagnetic techniques such as EEG/ERP and MEG. In order to fusion these images with anatomical information, co-registration with volumetric MRI is needed. While such co-registration techniques are well established for hemodynamic images, additional steps are needed for electromagnetic recordings, because the activity is only recorded on the scalp surface and inverse solutions based on specific head models have to be used to estimate the 3-dimensional current distribution.

MRI, (1)H-MRS, and functional MRI during and after prolonged nonconvulsive seizure activity.

Background: Various structural and functional changes, such as focal edema, blood flow, and metabolism, occur in the cerebral cortex after focal status epilepticus. These changes can be assessed noninvasively by means of MRI techniques, such as fluid-attenuated inversion recovery (FLAIR), EEG-triggered functional MRI (EEG-fMRI), and proton MR spectroscopy (MRS).

Methods: The authors report on a 40-year-old patient with nonlesional partial epilepsy in the left posterior quadrant in whom these MRI techniques were applied in an active seizure focus and repeated during a follow-up of 1 year.