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G Lantz

Publications and source records attributed to G Lantz.

18 recordsLinked to original sources
PubMed2003

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. The purpose of the current investigation was to systematically compare the accuracy of epileptic source localization with high electrode density to that obtained with sparser electrode setups. METHODS: Interictal epileptiform activity was recorded with 123 electrodes in 14 epileptic patients undergoing presurgical evaluation. Each single epileptiform potential was down sampled to 63 and 31 electrodes, and a distributed source model (EPIFOCUS) was used to reconstruct the sources with the 3 different electrode configurations. The localization accuracy with the 3 electrode setups was then assessed, by determining the distance from the inverse solution, maximum of each single spike to the epileptogenic lesion. RESULTS: In 9/14 patients, the distance from the EEG source to the lesion was significantly smaller with 63 than with 31 electrodes, and increasing the number of electrodes to 123 increased this number of patients from 9 to 11. Simulations confirmed the relation between the number of electrodes and localization accuracy. CONCLUSIONS: The results illustrate the necessity of multichannel EEG recordings for high source location accuracy in epileptic patients.

Adolescent↗
PubMed2001

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. Through a spatial cluster analysis time sequences where the maps did not change much (segments) were identified, and a 3-dimensional source reconstruction of the activity corresponding to the different mean maps was performed using a distributed linear inverse solution algorithm. RESULTS: Segments dominating early in seizure development were identified, and source reconstruction of the EEG activity corresponding to the maps of these segments yielded results which were consistent with the results from invasive recordings. In some cases a sequence of consecutive segments was obtained, which might reflect ictal propagation. CONCLUSIONS: Segmentation of ictal EEG with subsequent 3-dimensional source reconstruction is a useful method to non-invasively determine the initiation and perhaps also the spread of epileptiform activity in patients with epileptic seizures.

Adolescent↗
PubMed2001

Noninvasive localization of electromagnetic epileptic activity. I. Method descriptions and simulations.

This paper considers the solution of the bioelectromagnetic inverse problem with particular emphasis on focal compact sources that are likely to arise in epileptic data. Two linear inverse methods are proposed and evaluated in simulations. The first method belongs to the class of distributed inverse solutions, capable of dealing with multiple simultaneously active sources. This solution is based on a Local Auto Regressive Average (LAURA) model. Since no assumption is made about the number of activated sources, this approach can be applied to data with multiple sources. The second method, EPIFOCUS, assumes that there is only a single focal source. However, in contrast to the single dipole model, it allows the source to have a spatial extent beyond a single point and avoids the non-linear optimization process required by dipole fitting. The performance of both methods is evaluated with synthetic data in noisy and noise free conditions. The simulation results demonstrate that LAURA and EPIFOCUS increase the number of sources retrieved with zero dipole localization error and produce lower maximum error and lower average error compared to Minimum Norm, Weighted Minimum Norm and Minimum Laplacian (LORETA). The results show that EPIFOCUS is a robust and powerful tool to localize focal sources. Alternatives to localize data generated by multiple sources are discussed. A companion paper (Lantz et al. 2001, this issue) illustrates the application of LAURA and EPIFOCUS to the analysis of interictal data in epileptic patients.

Artifacts↗
PubMed2001

Noninvasive localization of electromagnetic epileptic activity. II. Demonstration of sublobar accuracy in patients with simultaneous surface and depth recordings.

Seven patients with complex partial epileptic seizures undergoing invasive video/EEG-monitoring were investigated with a combination of 10 subdural strip electrode contacts (subtemporal + lateral temporal), and 22 extracranial recording sites. In each patient spikes with different intracranial distributions were identified, and for those with similar distributions the extracranial activity was averaged. A new inverse solution method called EPIFOCUS (Grave et al. 2001, this issue) was used to reconstruct the sources of both single and averaged spikes in a standard 3D-MRI, and a statistical analysis was performed in order to demonstrate location differences between spikes with different intracranial distributions. The results revealed significantly more anterior and ventral source locations for subtemporal compared to lateral temporal spikes. Within the subtemporal group, medial spikes had more mesial and dorsal locations compared to lateral ones. In the lateral temporal group, more anterior and ventral locations were obtained for anterior compared to posterior spikes. The results demonstrate the applicability of EPIFOCUS in the localization of sources in the temporal lobe with sublobar accuracy. This possibility may become important in the future, for instance in identifying cases where amygdalo-hippocampectomy or other limited temporal lobe resections may replace the standard en bloc resections.

Adult↗
PubMed2001

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. The success of these methods in basic neuroscience research has led to the demand for applying them to clinical questions. Diseases of the central nervous system that lead to brain dysfunction can be ideally explored using these techniques. Of particular importance are those diseases in which a focal neuronal dysfunction is the primary cause and where surgical resection of this focus might be the cure. This is often the case for epilepsy, where a discrete primary focus might exist from which pathological rhythms evolve and propagate throughout the brain, leading to seizures that severely handicap the patient. Surgical resection of the primary focus is only possible if the focus can be exactly localized and adequately separated from functionally important areas. This is where these new functional imaging tools become important. The use of SPECT and PET for focus localization has been most extensively studied and their specificity and sensitivity are intensively discussed. In the last few years functional MRI has evolved as a new interesting tool in epileptic focus localization. The most important limitation of these techniques, however, is the temporal resolution. Since epileptic activity can propagate very fast, several hyper- or hypoactive regions are seen in the images and primary areas cannot be distinguished from regions of propagation. The only methods that have sufficient temporal resolution to follow neuronal activity in real time are the electrophysiological measures, i.e. the EEG and the MEG. Localization of the sources in the brain that produced a given surface electromagnetic field has become possible through algorithms that solve the so-called "inverse problem". Several different algorithms exist and many groups begun to apply them to epileptic data with the aim to localize the focus of the pathological electrical discharges. This review article discusses the use of distributed EEG source localization procedures in the presurgical evaluation of patients with intractable focal epilepsy. In contrast to equivalent dipole models, distributed localization methods do not localize one active point in the brain but rather assume extended active areas, which is generally the case in epileptic activity. The methods shown here are based on linear numerical methods and are therefore less prone to errors when working with scattered solution spaces such as the one defined by anatomical constraints. Solutions constraint to the gray matter determined in the individual MRI are shown here. We illustrate three methods to increase the spatial resolution of the source localization procedures: One is to increase the number of recording channels to more than 100, the second to use linear methods of high precision to detect focal sources (EPIFOCUS), and the third to combine EEG source localization with EEG-triggered functional magnetic resonance imaging. The importance of EEG source localization for the interpretation of fMRI data will be particularly discussed in view of the important difference of the temporal resolution by the two methods. The localization methods can be applied to interictal as well as to ictal activity. In case of analysis of ictal EEG we propose to use full scalp frequency analysis to determine the time period of seizure onset and to localize the sources of the initial dominant frequency.

Journal Article↗
PubMed2000

Temporal and spatial determination of EEG-seizure onset in the frequency domain.

OBJECTIVE: A quantitative analysis of scalp electric fields in patients suffering from pharmacoresistant temporal lobe epilepsy was performed in order to study the development of rhythmic ictal activities over time. METHODS: A method that calculates phase-corrected voltage maps in the frequency domain (FFT-approximation) was applied to ictal multichannel recordings in 10 epileptic patients. The onset of the ictally dominant frequency was determined and its temporal evolution over a time period of 46 s around the ictal EEG onset was studied. The analysis was completed by a linear inverse solution that estimated the sources of the dominant frequency. RESULTS: This method permitted the identification of an ictally dominant frequency which started on the average prior to the onset of initial EEG signs as determined by visual inspection. The frequency incremented during the evolution of the seizure in all patients. The linear inverse solution algorithm localized the source of this frequency to the brain region which was clinically determined as the site of seizure onset and whose resection rendered all patients seizure-free. CONCLUSIONS: Our data suggest that the constant increase of the ictally dominant frequency is related to the amount of temporal lobe tissue generating the ictal discharges. Frequential analysis of ictal electric fields can be reliably used to detect focal pathological activity early during seizure onset arising in deep structures such as the mesial temporal lobe.

Adult↗
PubMed2000

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. To date most of the experimental and clinical studies use multi-shell concentric sphere models of the head, solve the inverse problem on this simplistic model, and then co-register the solution with the MRI using homogeneous transform operations. Contrary to this standard method, we here propose to map the MRI to the spherical system by defining transformation operations that transform the MRI to a best-fitting sphere. Once done so, the solution points are defined in the cerebral tissue of this deformed MRI and the lead field for the distributed linear inverse solutions is calculated for this solution space. The method, that we call SMAC (Spherical Model with Anatomical Constrains) is tested with simulations, as well as with the following real data: 1) estimation of the sources of visual evoked potentials to unilateral stimulation from data averaged over subjects, and 2) localization of interictal discharges of two epileptic patients, one with a temporal, the other with an occipital focus, both confirmed by seizure freedom after resection of the epileptogenic region.

Brain↗
PubMed2000

Methods for robust clustering of epileptic EEG spikes.

We investigate algorithms for clustering of epileptic electroencephalogram (EEG) spikes. Such a method is useful prior to averaging and inverse computations since the spikes of a patient often belong to a few distinct classes. Data sets often contain outliers, which makes algorithms with robust performance desirable. We compare the fuzzy C-means (FCM) algorithm and a graph-theoretic algorithm. We give criteria for determination of the correct level of outlier contamination. The performance is then studied by aid of simulations, which show good results for a range of circumstances, for both algorithms. The graph-theoretic method gave better results than FCM for simulated signals. Also, when evaluating the methods on seven real-life data sets, the graph-theoretic method was the better method, in terms of closeness to the manual assessment by a neurophysiologist. However, there was some discrepancy between manual and automatic clustering and we suggest as an alternative method a human choice among a limited set of automatically obtained clusterings. Furthermore, we evaluate geometrically weighted feature extraction and conclude that it is useful as a supplementary dimension for clustering.

Algorithms↗
PubMed2000

Applied ethics: what kind of ethics and what kind of ethicist?

Types of ethics are classified as more or less holistic in three respects. Current forms of applied ethics (among them reflective equilibrium) are criticized for being reductionist rather than holistic. It is claimed that applied ethics ought to be of a holistic kind. Two examples (tracing of hereditary cancer and active euthanasia) are used for maintaining that a reductionist ethic is of limited use for solving practical moral problems. Some possible roles of the ethicist are discussed. It is maintained that the ethicist ought to be a life philosopher mapping the moral landscape or a personal mentor rather than being a policeman or an ethics engineer.

Ethical Theory↗
PubMed1999

Frequency domain EEG source localization of ictal epileptiform activity in patients with partial complex epilepsy of temporal lobe origin.

The aim of this study was to investigate whether EEG source localization in the frequency domain, using the FFT dipole approximation (Lehmann, D. and Michel, C.M. Electroenceph. clin. Neurophysiol., 1990, 76: 271-276), would be useful for quantifying the frequency content of epileptic seizure activity. Between one and 7 extracranially recorded seizures were analyzed in each of 7 patients with mesolimbic epilepsy, who were seizure-free after temporal lobe resection. The full scalp frequency spectrum for the first 4 s after seizure onset, as well as for subsequent periods, was determined. Power peaks in the spectra were identified, and an instant dipole fit was performed for the frequencies corresponding to these peaks. Ictal frequencies, ranging between 3.5 and 8.5 Hz, showed a variable degree of stability over time in the different patients. For a particular frequency, dipole results were similar during the different phases of seizure development. In patients with more than one prominent frequency, dipole results for the different frequencies were similar. Dipole results were also similar between patients. We conclude that dipole localization of dominant frequencies, as obtained from full scalp FFT analysis, gives quite reproducible results for seizures originating in the mesial temporal area. The method may become a useful tool for the pre-surgical identification of patients with mesolimbic epilepsy.

Adult↗
PubMed1999

Spatiotemporal EEG analysis and distributed source estimation in presurgical epilepsy evaluation.

In the attempts to localize electric sources in the brain on the basis of multichannel EEG and/or MEG measurements, distributed source estimation procedures have become of increasing interest. Several commercial software packages offer such localization programs and results using these methods are seen more and more frequently in the literature. It is crucial that the users understand the similarities and differences of these methods and that they become aware of the advantages and limitations that are inherent to each approach. This review provides this information from a theoretical as well as from a practical point of view. The theoretical part gives the algorithmic basis of the electromagnetic inverse problem and shows how the different a priori assumptions are formally integrated in these equations. The authors restrict this formalism to the linear inverse solutions i.e., those solutions in which the inversion procedure can be represented as a matrix applied to the data. It will be shown that their properties can be best characterized by their resolution kernels and that methods with optimal resolution matrices can be designed. The authors also discuss the important problem of regularization strategies that are used to minimize the influence of noise. Finally, a new kind of inverse solution, termed ELECTRA (for ELECTRical Analysis), is presented that is based on constraining the source model on the basis of the currents that can actually be measured by the scalp recorded EEG. The practical part of the review illustrates the localization procedures with different clinical data sets. Three aspects become important when working with real data: 1) Clinical data is usually far from ideal (limited number of electrodes, noise, etc.). The behavior of inverse procedures in such unfortunate situations has to be evaluated. 2) The selection of the time points or time periods of interest is crucial, especially in the analysis of spontaneous EEG. 3) Additional information coming from other modalities is usually available and can be incorporated. The authors are illustrating these important points in the case of interictal and ictal epileptiform activity. Spike averaging, frequency domain source localization, and temporal segmentation based on electric field topographies will be discussed. Finally, the technique of EEG-triggered functional magnetic resonance imaging (fMRI) will be illustrated, where EEG is recorded in the magnet and is used to synchronize fMRI acquisition with interictal events. The analysis of both functional data, i.e. the EEG in terms of three-dimensional source localization and the EEG-triggered fMRI, combines the advantages of the two techniques: the temporal resolution of the EEG and the spatial resolution of the fMRI.

Adult↗
PubMed1998

Categorization of interictal epileptiform potentials using a graph-theoretic method.

OBJECTIVES: In patients with epileptic seizures, localization of the source of interictal epileptiform activity is of interest. For correct source localization, a favorable signal to noise ratio is important, and to achieve this, averaging of several epileptiform potentials is often necessary. Before averaging, a careful categorization of epileptiform potentials with different potential distributions is crucial. The aim of this study was to investigate whether a a hierarchic, graph-theoretic algorithm could be used for this categorization. METHODS: In 4 patients, 50-100 sharp waves with different surface distributions were categorized independently with the algorithm, and by visual inspection of the traces. As an independent evaluation of the algorithm, a dipole reconstruction was performed for each sharp wave, and the dipole results for the sharp waves from the different automatically obtained categories were compared. RESULTS: All patients showed a high degree of correspondence between the results of the automatic analysis and the visual estimation. There were clear differences in dipole results between the sharp waves of the different categories obtained from the automatic categorization. CONCLUSION: The results indicate that the graph-theoretic categorization algorithm provides a reliable clustering of interictal epileptiform potentials, and that the method may become a useful tool in the pre-averaging categorization of interictal epileptiform potentials prior to source localization.

Action Potentials↗
PubMed1997

Extracranial localization of intracranial interictal epileptiform activity using LORETA (low resolution electromagnetic tomography).

Besides the standard clinical methods of EEG waveshape analysis, mathematical models for reconstruction of dipolar sources from the digitized surface EEG have been introduced in epilepsy research. Although useful for localizing focal sources, these methods are inadequate for analyzing widespread epileptiform activity. A recently introduced alternative method called LORETA (low resolution electromagnetic tomography, Pascual-Marqui et al., 1994), directly computes the current distribution throughout the full brain volume, assuming that neighboring neuronal populations are simultaneously and synchronously activated. In mathematical terms the method selects the smoothest of all possible 3-dimensional current distributions, inherently introducing a certain amount of dispersion. In 7 patients, undergoing simultaneous EEG recording from 10 intracranial (subdural) and 22 extracranial electrodes, 111 subdural discharges (61 subtemporal and 50 lateral temporal) were identified. The exact time point of maximal intracranial activity was automatically identified, and the LORETA solution at that timepoint was computed from the surface EEG. Statistical comparison revealed significantly higher LORETA current density in the area corresponding to the subdurally recorded spike compared to other areas, and a more anterior and more medial LORETA location for subtemporal compared to lateral temporal spikes. This study indicates that the LORETA technique may become a useful method to localize electrical activity in the brain.

Adolescent↗
PubMed1997

Dipole reconstruction as a method for identifying patients with mesolimbic epilepsy.

The aim of the study was to evaluate whether or not dipole analysis of extracranially recorded epileptiform activity, using a spherical three-shell head model, may distinguish epilepsy of mesolimbic origin from origins of other locations. Dipole analysis was performed on previously extracranially recorded interictal epileptiform discharges in 22 patients investigated for ictal onset patterns with subdural electrodes over one or both subtemporal areas. The dipole results in two groups of patients were compared. Group A contained patients in whom the subdural investigation showed subtemporal seizure onset (indicating mesolimbic epilepsy) ipsilateral to the dipole locations. Group B contained patients in whom seizure onset was other than ipsilateral subtemporal, or in whom seizure onset could not be determined. Group A patients had uniform dipole results, with an oblique posterior, slightly elevated dipole orientation, and an anterior temporal dipole location. Group B patients had more variable dipole results. If dipoles with anterior temporal location, and oblique posterior and elevated orientation are obtained, epilepsy of mesolimbic origin should be suspected. If the dipole locations or orientations markedly deviate from this pattern, the epileptogenic region is likely to be other than mesolimbic.

Adolescent↗
PubMed1996

Simultaneous intracranial and extracranial recording of interictal epileptiform activity in patients with drug resistant partial epilepsy: patterns of conduction and results from dipole reconstructions.

Ten patients with complex partial epileptic seizures undergoing invasive video/EEG-monitoring were recorded with a combination of 10 subdural strip electrode contacts (subtemporal + lateral temporal), and 22 extracranial recording sites. In each patient several spikes with different intracranial distributions were identified, and spikes with similar distributions were averaged together with their extracranial activity. Dipole analysis of the extracranial activity was performed with the BESA program (Scherg, Garching Instrumente, München). In the horizontal plane subtemporal spikes gave oblique posterior, and lateral temporal spikes straight lateral or oblique anterior dipole orientations. In the coronal plane all spikes had an elevated orientation, most pronounced for medial subtemporal spikes. Dipole locations did not separate as well as dipole orientations. In our opinion our results would be difficult to explain without postulating a substantial degree of volume conduction from deep temporal areas to the surface. We conclude that dipole analysis of the interictal epileptiform activity does provide substantial information about which parts of the temporal lobe are involved in the epileptogenic process, making the method a useful tool in the preoperative investigation of patients with drug resistant partial epilepsy.

Adult↗
PubMed1993

Seizures as the presenting symptom of brain tumors in children.

Epileptic seizures caused by tumors in children have been regarded as uncommon. We have studied 99 consecutive cases of brain tumors during the period 1980-1987. In 20 cases the tumor was localized to one of the hemipheres and 10 of the cases had seizures, in 9 as the only initial symptom. Details of the clinical picture and the course are presented. Delay from initial symptoms to correct diagnosis was considerable in 4 cases--more than six years. The factors mainly responsible for this delay were: initial EEG normal or soon normalized, misinterpretation of computerized tomography and seizure freedom with or without antiepileptic drug treatment. We conclude that regional slowing in the EEG is a common, although not obligatory, finding. Computerized tomography should be performed in all children with newly presented epilepsy of partial type, except for those with benign partial epilepsy with centro-temporal spikes.

Adolescent↗
PubMed1992

Histologic findings after in vivo placement of small intestine submucosal vascular grafts and saphenous vein grafts in the carotid artery in dogs.

A small caliber vascular graft from porcine small intestine submucosa (SIS) was implanted in a canine carotid artery (n = 24) and compared with an autogenous saphenous vein graft that was implanted in the contralateral carotid artery. In this study, four grafts were evaluated at the following times after surgery: 2, 7, 14, 28, 90, and 180 days. One SIS graft thrombosed at 2 days, two SIS and two saphenous vein grafts were thrombosed at 90 days, and one SIS and one saphenous vein graft were thrombosed at 180 days. At 2 days after implant, the luminal surface of the SIS graft was covered by a thin (30 mu) fibrin meshwork. By 14 days after surgery, endothelial cells on the fibrin meshwork were staining for FVIII-related antigen. Smooth muscle cells were observed in the new intima (fibrin meshwork) by 28 days. At 90 days, both types of graft had arterialized with an intima covered by endothelium, a smooth muscle media, and marked adventitial fibrosis. Similar histology was observed at 180 days. These results indicate that this SIS graft was similar to saphenous vein graft in the dog.

Animals↗