Cerebral current-source distribution associated with pain improvement by non-invasive painless signaling therapy in patients with failed back surgery syndrome

Background@#Non-invasive painless signaling therapy (NPST) is an electro-cutaneous treatment that converts endogenous pain information into synthetic non-pain information. This study explored whether pain improvement by NPST in failed back surgery syndrome (FBSS) patients is related to cerebral modulation. @*Methods@#Electroencephalography (EEG) analysis was performed in 11 patients with FBSS. Subjects received daily NPST for 5 days. Before the first treatment, patients completed the Brief Pain Inventory (BPI) and Beck Depression Inventory and underwent baseline EEG. After the final treatment, they responded again to the BPI, reported the percent pain improvement (PPI), and then underwent post-treatment EEG. If the PPI grade was zero, they were assigned to the ineffective group, while all others were assigned to the effective group. We used standardized low-resolution brain electromagnetic tomography (sLORETA) to explore the EEG current-source distribution (CSD) associated with pain improvement by NPST. @*Results@#The 11 participants had a median age of 67.0 years, and 63.6% were female. The sLORETA images revealed a beta-2 CSD increment in 12 voxels of the right anterior cingulate gyrus (ACG) and the right medial frontal area. The point of maximal CSD changes was in the right ACG. The alpha band CSD increased in 2 voxels of the left transverse gyrus. @*Conclusions@#Pain improvement by NPST in FBSS patients was associated with increased cerebral activity, mainly in the right ACG. The change in afferent information induced by NPST seems to be associated with cerebral pain perception.

Cerebral current-source distribution associated with pain improvement by non-invasive painless signaling therapy in patients with failed back surgery syndrome

Background@#Non-invasive painless signaling therapy (NPST) is an electro-cutaneous treatment that converts endogenous pain information into synthetic non-pain information. This study explored whether pain improvement by NPST in failed back surgery syndrome (FBSS) patients is related to cerebral modulation. @*Methods@#Electroencephalography (EEG) analysis was performed in 11 patients with FBSS. Subjects received daily NPST for 5 days. Before the first treatment, patients completed the Brief Pain Inventory (BPI) and Beck Depression Inventory and underwent baseline EEG. After the final treatment, they responded again to the BPI, reported the percent pain improvement (PPI), and then underwent post-treatment EEG. If the PPI grade was zero, they were assigned to the ineffective group, while all others were assigned to the effective group. We used standardized low-resolution brain electromagnetic tomography (sLORETA) to explore the EEG current-source distribution (CSD) associated with pain improvement by NPST. @*Results@#The 11 participants had a median age of 67.0 years, and 63.6% were female. The sLORETA images revealed a beta-2 CSD increment in 12 voxels of the right anterior cingulate gyrus (ACG) and the right medial frontal area. The point of maximal CSD changes was in the right ACG. The alpha band CSD increased in 2 voxels of the left transverse gyrus. @*Conclusions@#Pain improvement by NPST in FBSS patients was associated with increased cerebral activity, mainly in the right ACG. The change in afferent information induced by NPST seems to be associated with cerebral pain perception.

Current-Source Dipole of Anterior Temporal Spikes: Clinical Significance of Orientation

BACKGROUND: The voltage topography of temporal spikes has two distinct patterns, designated type I and type II; the orientation of the current-dipole source (O-CDS) of type I spikes tends to be oblique, while that of type II spikes tends to be horizontal. The purpose of this study was to identify the effects of the O-CDS of anterior temporal spikes on clinical factors including onset age, seizure frequency, secondary generalization, disease duration, intractability, polytherapy, febrile seizure, hippocampal sclerosis, and neocortical-temporal aura. METHODS: We examined the scalp electroencephalograms of 24 patients with temporal lobe epilepsy (TLE) and anterior temporal spikes. A spatiotemporal dipole model was applied to determine the O-CDS of the averaged spikes in each patient. We performed current-source analysis of multiple spatiotemporal dipole models using Brain Electrical Source Analysis software. The patients were divided into two subgroups according to their O-CDS pattern: oblique and horizontal. Clinical factors were compared between the two groups. RESULTS: Sixteen patients were classified into the oblique group, and 8 patients into the horizontal group. A neocortical-temporal aura was more commonly observed in the horizontal group (p<0.05), while drug-resistance tendencies were more commonly observed in the oblique group (p<0.1). CONCLUSIONS: The horizontal O-CDS of anterior temporal spikes may be more frequently associated with a neocortical-temporal aura than the oblique O-CDS in TLE. In addition, the oblique O-CDS pattern suggests a tendency toward drug resistance. The findings of this study imply that the oblique O-CDS pattern of anterior temporal spikes may provide additional electrophysiologic information regarding drug-resistant mesial TLE.

Distributed Current Source Analysis of Alpha-Frequency Band in Alpha Coma: Drug Intoxication versus Pontine Infarction

Alpha coma is a coma state with predominant alpha activities in electroencephalography. There are two different patterns of alpha coma, depending upon the distribution of alpha activity. The causes may vary with the distribution pattern. To clarify the difference in alpha-activity distribution, we conducted current-source analysis of the alpha-frequency band in two patients with alpha-coma caused by drug intoxication and pontine infarction, respectively. The current-source analysis of alpha-frequency bands may make it easier to distinguish the distribution patterns.

Current-source Analysis of Interictal Spikes in a Patient With Ictal Crying

Ictal crying has been associated with ictal activities in the medial frontal or medial temporal area of the nondominant hemisphere. We applied current-source analysis to the interictal spikes of a patient with episodes of ictal crying without sad feelings, but fear sensation. The current sources were in the medial frontal area of both cerebral hemispheres, the temporal area and the posterior cingulate gyrus of the right hemisphere.

Current Source Analysis of Interictal Spikes in Two Patients With Gelastic Epilepsy-Hypothalamic Hamartoma Syndrome

BACKGROUND: Interictal spikes in gelastic epilepsy-hypothalamic hamartoma syndrome are mainly in the fronto-temporal area. Current source analysis of the interictal spikes has not been done enough. We tried the current source analysis in 2 patients with gelastic epilepsy-hypothalamic hamartoma syndrome using both of the discrete and distributed models. METHODS: Twenty 1 sec epochs including the negative peak of the spikes, were selected from one or two electroencephalographic recordings respectively in each patient. These 20 epochs were averaged into a single spike. The current dipole sources of the averaged spike were analyzed and located on a spherical head model. The current source density of the negative peak point of the averaged spike was located on the Talairach human brain map. RESULTS: The current dipole sources were in the right subcallosal gyrus, or the right or left anterior cingulate gyri. The current source density was distributed in the bilateral medial frontal area including the anterior cingulate gyri. CONCLUSIONS: The interictal spikes of patients with gelastic epilepsy-hypothalamic hamartoma syndrome may be generated by the current sources located in the bilateral medial frontal area.