Targeted density electrode placement achieves high concordance with traditional high-density EEG for electrical source imaging in epilepsy.

OBJECTIVE: High-density (HD) electroencephalography (EEG) is increasingly used in presurgical epilepsy evaluation, but it is demanding in time and resources. To overcome these issues, we compared EEG source imaging (ESI) solutions with a targeted density and HD-EEG montage. METHODS: HD-EEGs from patients undergoing presurgical evaluation were analyzed. A low-density recording was created by selecting the 25 electrodes of a standard montage from the 83 electrodes of the HD-EEG and adding 8-11 electrodes around the electrode with the highest amplitude interictal epileptiform discharges. The ESI solution from this "targeted" montage was compared to that from the HD-EEG using the distance between peak vertices, sublobar concordance and a qualitative similarity measure. RESULTS: Fifty-eight foci of forty-three patients were included. The median distance between the peak vertices of the two montages was 13.2 mm, irrespective of focus' location. Tangential generators (n = 5/58) showed a higher distance than radial generators (p = 0.04). We found sublobar concordance in 54/58 of the foci (93%). Map similarity, assessed by an epileptologist, had a median score of 4/5. CONCLUSIONS: ESI solutions obtained from a targeted density montage show high concordance with those calculated from HD-EEG. SIGNIFICANCE: Requiring significantly fewer electrodes, targeted density EEG allows obtaining similar ESI solutions as traditional HD-EEG montage.

Value of ictal and interictal epileptiform discharges and high frequency oscillations for delineating the epileptogenic zone in patients with focal cortical dysplasia.

OBJECTIVES: There are different neurophysiological markers of the Epileptogenic Zone (EZ), but their sensitivity and specificity for the EZ is not known in Focal Cortical Dysplasia (FCD) patients. METHODS: We studied patients with FCD who underwent stereoelectroencephalography (SEEG) and surgery. We marked in the SEEG: (a) typical and atypical interictal epileptiform patterns, (b) ictal onset patterns, and (c) rates of ripples (80-250 Hz) and fast ripples (FRs) (>250 Hz). High frequency oscillations were marked automatically during one hour of deep sleep. Surgical outcome was defined as good (Engel I) or poor (Engel II-IV). We computed the sensitivity and, as a measure of specificity, the false positive rate to identify the EZ, and compared them across the different neurophysiological markers. RESULTS: We studied 21 patients, 19 with FCD II. Ictal and typical interictal pattern were the markers with highest sensitivity, while the atypical interictal pattern had the lowest. We found no significant difference in specificity among markers. However, there is a tendency that FRs had the lowest false positive rate. CONCLUSION: The typical interictal pattern has the highest sensitivity. The clinical use of FRs is limited by their low sensitivity. SIGNIFICANCE: We suggest to analyze the typical interictal pattern first. FRs should be analyzed in a second step. If, for instance, a focus with FRs and no typical interictal pattern is found, this area could be considered for resection.

Linearly constrained minimum variance spatial filtering for localization of conductivity changes in electrical impedance tomography.

We localize dynamic electrical conductivity changes and reconstruct their time evolution introducing the spatial filtering technique to electrical impedance tomography (EIT). More precisely, we use the unit-noise-gain constrained variation of the distortionless-response linearly constrained minimum variance spatial filter. We address the effects of interference and the use of zero gain constraints. The approach is successfully tested in simulated and real tank phantoms. We compute the position error and resolution to compare the localization performance of the proposed method with the one-step Gauss-Newton reconstruction with Laplacian prior. We also study the effects of sensor position errors. Our results show that EIT spatial filtering is useful for localizing conductivity changes of relatively small size and for estimating their time-courses. Some potential dynamic EIT applications such as acute ischemic stroke detection and neuronal activity localization may benefit from the higher resolution of spatial filters as compared to conventional tomographic reconstruction algorithms.

General bounds for electrode mislocation on the EEG inverse problem.

We analyze the effect of electrode mislocation on the electroencephalography (EEG) inverse problem using the Cramér-Rao bound (CRB) for single dipolar source parameters. We adopt a realistic head shape model, and solve the forward problem using the Boundary Element Method; the use of the CRB allows us to obtain general results which do not depend on the algorithm used for solving the inverse problem. We consider two possible causes for the electrode mislocation, errors in the measurement of the electrode positions and an imperfect registration between the electrodes and the scalp surfaces. For 120 electrodes placed in the scalp according to the 10-20 standard, and errors on the electrode location with a standard deviation of 5mm, the lower bound on the standard deviation in the source depth estimation is approximately 1mm in the worst case. Therefore, we conclude that errors in the electrode location may be tolerated since their effect on the EEG inverse problem are negligible from a practical point of view.