Wavelet analysis of autonomic outflow of normal subjects on head-up tilt, cold pressor test, Valsalva manoeuvre and deep breathing.

Non-invasive autonomic evaluation has used fast Fourier transform (FFT) to assign a range of low (LF) and high frequencies (HF) as markers of sympathetic and parasympathetic influences, respectively. However, FFT cannot be applied to brief transient phenomena, such as those observed on performing autonomic tests where the acute changes of cardiovascular signals (blood pressure and heart rate) that represent the first and most important stage of the autonomic performance towards a new state of equilibrium occur. Wavelet analysis has been proposed as a method to overcome and complement information taken exclusively in the frequency domain. With discrete wavelet transform (DWT), a time-frequency analysis can be done, allowing the visualization in time of the contribution of LF and HF to the observed changes of a particular signal. In this study, we evaluate with wavelets the acute changes in R-R intervals and systolic blood pressure that are observed in normal subjects during four classical autonomic tests: head-up tilt (HUT), cold pressor test (CPT), deep breathing (DB) and Valsalva manoeuvre (VM). Continuous monitoring of ECG and blood presure was performed. Also LF, HF and LF/HF were calculated. Consistent with previous interpretations, data showed an increase of sympathetic activity in HUT, CPT and VM. On DB, results reflected an increase in parasympathetic activity and frequencies. In conclusion, when compared with FFT, wavelet analysis allows the evaluation of autonomic variability during short and non-stationary periods of time and may constitute a useful advance in the assessment of autonomic function in both physiological and pathological conditions.

Evaluation of L1 and L2 minimum norm performances on EEG localizations.

OBJECTIVE: In this work we study the performance of minimum norm methods to estimate the localization of brain electrical activity. These methods are based on the simplest forms of L(1) and L(2) norm estimates and are applied to simulated EEG data. The influence of several factors like the number of electrodes, grid density, head model, the number and depth of the sources and noise levels was taken into account. The main objective of the study is to give information about the dependence, on these factors, of the localization sources, to allow for proper interpretation of the data obtained in real EEG records. METHODS: For the tests we used simulated dipoles and compared the localizations predicted by the L(1) and L(2) norms with the location of these point-like sources. We varied each parameter separately and evaluated the results. RESULTS: From this work we conclude that, the grid should be constructed with approximately 650 points, so that the information about the orientation of the sources is preserved, especially for L(2) norm estimates; in favorable noise conditions, both L(1) and L(2) norm approaches are able to distinguish between more than one point-like sources. CONCLUSIONS: The critical dependence of the results on the noise level and source depth indicates that regularized and weighted solutions should be used. Finally, all these results are valid both for spherical and for realistic head models.

Neurophysiological features of fasciculation potentials evoked by transcranial magnetic stimulation in amyotrophic lateral sclerosis.

We report 13 patients with amyotrophic lateral sclerosis in whom fasciculation potentials (FPs) driven by transcranial magnetic stimulation (TMS) were recorded. A total of 18 different FPs were analyzed. TMS-driven fasciculations had a simple morphology and were stable. Complex potentials were never cortically driven. Recruitment by a slight voluntary contraction was verified in 7 of 13 tested FPs. FPs were driven by threshold stimuli in 7 of 10 patients and by stimuli 5% below threshold in 3 of 6. Mapping demonstrated that FPs were driven in an area close to the center of gravity of the muscle cortical area. In one case FPs were evoked from most of the cortical representation area of a very weak muscle. Three other patients with profuse fasciculations associated with other clinical conditions were also studied. No TMS evoked fasciculation was observed in this group. The results of this systematic study suggest that cortically evoked FPs arise centrally, at spinal cord or even more proximally, and can represent a marker of increased corticomotor excitability, which is predominant at an earlier phase but can persist as the disease progresses.

Cortical muscle representation in amyotrophic lateral sclerosis patients: changes with disease evolution.

Transcranial magnetic stimulation (TMS) mapping was performed regularly on 11 patients with amyotrophic lateral sclerosis (ALS). Map area decreased by 25% (P = 0.03) and normalized volume decreased by 47% (P = 0.01) in those patients who were mapped four times over a period of 11.6 months. The center of gravity (CoG) position moved randomly along the interaural line by distances larger than could be explained by experimental error (P = 0.002). Central conduction time, threshold, and motor evoked potential:compound muscle action potential (MEP:CMAP) amplitude ratio did not change significantly with time (P > 0.05). There were significant linear correlations between strength and CMAP amplitude and between map area and volume. No correlation was found between strength or CMAP amplitude and area or volume. The changes in map parameters were attributed primarily to loss of cortical cells. These results indicate that map parameters may be more sensitive to cortical neuronal loss than other TMS parameters.

No evidence of chaos in the heart rate variability of normal and cardiac transplant human subjects.

INTRODUCTION: The variability observed in the heart rate may reflect fundamental aspects of cardiac activity. It has been under discussion whether heart rate variability (HRV) is due to noise or chaos, which is irregular behavior occurring in deterministic nonlinear systems. METHODS AND RESULTS: Using chaos analysis techniques, we analyzed HRV of five normal and five human cardiac transplant subjects at rest. HRV is studied using the beat-to-beat RR interval time series extracted from the ECG. The cardiac transplant subjects exhibited a much smaller HRV than the normal subjects because of heart denervation. We present the map and correlation dimension estimation for the RR time series. To test for nonlinear correlations in the dynamics, we built surrogate time series that have the same power spectra as the experimental time series, but also have randomized phases. The experimental and the surrogate data were compared using the correlation integral. No correlation dimension was found for the RR time series of either the normal or the cardiac transplant subjects. Nevertheless, nonlinear correlations were detected in the HRV of the normal subjects but not in HRV of the cardiac transplant subjects. For the latter, no significant changes were observed in the correlation integral as a function of time after transplantation. CONCLUSION: We found no evidence of low-dimensional chaos in the HRV of normal and cardiac transplant subjects. However, some nonlinear correlations were detected in the HRV of the normal subjects, which may be associated with autonomic nervous system influence.

Interictal spike localization using a standard realistic head model: simulations and analysis of clinical data.

OBJECTIVES: In this paper realistic and standard realistic head models were applied to neural source localization. METHODS: Three different triangulated head structures; the brain, the skull and the scalp were constructed from MRI information of each patient. For each subject the exact positions of the electrodes were digitized. RESULTS: The influence of the number of triangles and of the skull conductivity on the accuracy of the method was tested. The use of a standard realistic head model instead of spherical models is proposed in cases where detailed MRI information is not available, and the accuracy of this procedure is tested with dipole simulations. These techniques were applied also to EEG signals from 3 patients with focal epilepsy. In all cases the neural activity was assumed to be confined to a small portion of cortical tissue, so that the neural generator was approximated to a current dipole. The realistic head model localization is discussed on the basis of neuroimaging information. CONCLUSIONS: We show that the standard realistic head model is two or 3 times better than the spherical model for dipole localization and we propose it as a good alternative to the spherical model for EEG data processing, in cases where full MRI information is not available.

Influence of learning to read and write on the morphology of the corpus callosum.

Variations in the individual anatomy of the corpus callosum have been reported in several conditions. There seem to be genetic influencing factors, but it is impossible to rule out some environmental ones. This study focuses on the question of the environmental factors, using formal learning to read and write as the main difference in the groups to be compared. Based on magnetic resonance imaging sagital images, the contour of the corpus callosum (CC) of 41 carefully selected women (18 illiterate and 23 literate) was digitized. The comparison between the two groups showed a small difference in the region of the CC where parietal fibres are thought to cross. This region is thinner in illiterate subjects. As illiteracy in this group is the result of social constraints, and the two groups that were compared are well matched for other cultural and pragmatic aspects than literacy, the results are interpreted as showing the possible influence of formal learning to read and write, on the biological development of the brain.

Correlation dimension maps of EEG from epileptic absences.

PURPOSE: The understanding of brain activity, and in particular events such as epileptic seizures, lies on the characterisation of the dynamics of the neural networks. The theory of non-linear dynamics provides signal analysis techniques which may give new information on the behaviour of such networks. METHODS: We calculated correlation dimension maps for 19-channel EEG data from 3 patients with a total of 7 absence seizures. The signals were analysed before, during and after the seizures. Phase randomised surrogate data was used to test chaos. RESULTS: In the seizures of two patients we could distinguish two dynamical regions on the cerebral cortex, one that seemed to exhibit chaos whereas the other seemed to exhibit noise. The pattern shown is essentially the same for seizures triggered by hyperventilation, but differ for seizures triggered by light flashes. The chaotic dynamics that one seems to observe is determined by a small number of variables and has low complexity. On the other hand, in the seizures of another patient no chaotic region was found. Before and during the seizures no chaos was found either, in all cases. CONCLUSIONS: The application of non-linear signal analysis revealed the existence of differences in the spatial dynamics associated to absence seizures. This may contribute to the understanding of those seizures and be of assistance in clinical diagnosis.

Modelling a parasystolic rhythm in a heart-transplant patient.

A parasystole from a heart-transplant patient is analysed using a beat-to-beat RR interval time series obtained from an electrocardiogram (ECG). The dysrhythmia, resulting from the co-existence of two pacemakers, the sinus node and an ectopic focus, presents distinctive regular patterns, with transitions from one pattern to another occurring abruptly. It is shown that the parasystolic rhythm can be simulated by a model involving two oscillators firing at fixed rates, under the restriction that neither is allowed to fire during the other's refractory period. It is found that the structure of the generated RR time series is essentially determined by the ratio of the periods of the two oscillators. In the case of a heart-transplant patient with a small heart-rate variability as a result of heart denervation, the model predicts the RR intervals with an error of less than 6% for an 80-beat sequence. From a physiological point of view, the results imply that the interaction between the two pacemakers in the heart is fairly weak, and hence the parasystole observed in the heart-transplant patient can be modelled as pure parasystole.

A new method for reproducible coil positioning in transcranial magnetic stimulation mapping.

A new method is presented for mapping the motor cortex by transcranial magnetic stimulation in which the position of the stimulation coil on the scalp is measured using a 3D digitizer. The reproducibility of the method was tested by mapping 3 times the left abductor digiti minimi of 6 right-handed subjects and calculating the position of the centre of gravity (CoG), the area and volume of the individual maps. For individual maps, the coordinates of the CoG were found to be reproducible within +/-3 mm and the map areas and normalized volumes to within +/-20%, when the induced current flows anteriorly. Six more subjects were mapped to estimate interindividual variability of the position of the CoG. The method's ability to differentiate the cortical representation of two close muscles was successfully tested by mapping the flexor carpi radialis and the biceps brachii in another subject. Coordinates are given in a Cartesian frame of reference defined by the two tragi and the nasion. This feature will facilitate the comparison of results and their superposition on MR images.

[Localization of brain electric sources in patients with focal epilepsy]. / Localização de fontes eléctricas cerebrais em doentes com epilepsia focal.

In this paper we discuss a non-invasive method to localize neural electrical sources using EEG data. In this method, the human head is modelled by a set of four concentric spheres with different conductivities which represent the scalp, the skull, the CSF and the brain or by three triangulated surfaces which approximate the exact head shape (in this model we do not consider the CSF layer) using NMR images. In this case the computer effort is very high, since the calculations imply thousands of equations. Therefore, the number of research groups working with this improved model, in the world, is very small. In both models, we assume that the neural source is a current dipole. This makes the model suitable for cases where the active brain areas are limited and localized. We discuss some error factors associated with the method, as the geometry of the head, the conductivity of the different layers and the number of electrodes used in the EEG measurements. Comparing the more realistic head model, with the spherical one we often have differences of 1-2 cm. However, we can reach even more pronounced differences in the frontal areas. Concerning the skull conductivity, we realized that it could introduce errors of 1-2 cm. We observed that at least 50 electrodes should be used only since 21 electrodes could imply errors of about 0.5 cm. The method was applied, both in the spherical version and the realistic one, to clinical cases of focal epileptic patients. The results are discussed in terms of the other clinical information available and they are coherent with the remaining clinical data.

Relationships between the dimensions of the human aortic and pulmonary valve leaflets: implications on Ross' operation.

The technique of replacing the aortic valve with the patient's pulmonary valve and the implantation of a homograft in the pulmonary position was first introduced by D. Ross in 1967. Despite the many advantages and successes of this procedure, it frequently results in some degree of valve insufficiency. In order to optimize the results of Ross' operation, we carried out a comparative study (n = 22) of the relative dimensions of the human aortic and pulmonary valve leaflets using a digitizer. The digitizer supplies the spatial coordinates of a given point (in a pre-chosen reference frame), by the positioning of its sensor on that point. By digitizing relevant points marked on the arterial wall we were able to calculate the distance between the commissures and the perimeter of each leaflet. Analysing the values thus obtained, we found that in 17 of the 22 cases studied (77.3%) there was one orientation (out of the three anatomically possible orientations) of the pulmonary valve, relative to the configuration of the recipient aortic root, that was clearly better than the other two. This study led to the formulation of a "rule" that, in most of the cases studied (86.4%), led to the best fitting orientation of the autograft using the knowledge of the intercommissural distances.

Magnetoencephalographic localization of subdural dipoles in a patient with temporal lobe epilepsy.

We report magnetoencephalographic localization of subdural electrode dipoles placed at the basal and mesial surfaces of the temporal lobe in a patient with temporal lobe epilepsy. The locations of the three dipoles were predicted from their magnetic fields with a computer model of the head as a conducting sphere. The predicted locations were within 1, 3, and 4 mm of the actual locations. These results, obtained in an area of the brain from which epileptiform discharges are frequently recorded, strongly support the capability of magnetoencephalography to accurately localize electrical events in this brain region.

Subdural electrode as a dipole source for magnetoencephalography.

A subdural electrode was designed and constructed with 3 pairs of contacts to make 3 dipoles. The dipoles well approximate the expected magnetic behavior for a current dipole and can be used clinically to test localization capabilities of magnetoencephalography.

Improved accuracy of MEG localization in the temporal region with inclusion of volume current effects.

We studied the magnetic field maps generated by six dipoles in the temporal region of a plastic skull filled with conducting gel. The data were processed with two mathematical models. One, using Biot-Savart's law, considered only the magnetic field generated by a localized current dipole, and the other considered a dipole in a sphere and included volume current effects. The contribution of volume current effects to the MEG maps was significant. The localizing capability of MEG improved from an average distance of 2.9 cm to 0.9 cm when volume current effects were considered.