C. Hummel

Cerebral chemosensory evoked potentials elicited by chemical stimulation of the human olfactory and respiratory nasal mucosa

A stimulation method was employed by which chemosensory evoked potentials were recorded without tactile somatosensory contamination. The purpose of the study was to determine whether potential components evoked by stimulation of the chemoreceptors of the trigeminal nerve can be distinguished from those of the olfactory nerve. The stimulants (vanillin, phenylethyl alcohol, limonene, menthol, anethol, benzaldehyde, carbon dioxide and a mixture of vanillin and carbon dioxide) were presented in a randomized order to 13 volunteers. Chemosensory evoked potentials to substances which anosmics are unable to perceive (vanillin, phenylethyl alcohol) were termed olfactory evoked potentials; potentials to CO2, which effected no olfactory sensations were termed chemo-somatosensory potentials. Analysis of variance revealed that the different substances resulted in statistically significant changes in the amplitudes and latencies of the evoked potentials, and also in the subjective estimates of intensity. An increased excitation of the somatosensory system resulted in reduced latencies and enhanced amplitudes of the evoked potentials. Responses to the mixture of carbon dioxide and vanillin appeared significantly earlier (50-150 msec) than responses to either substance alone.

Chemosensory event-related potentials in man: relation to olfactory and painful sensations elicited by nicotine ☆

The aim of this study was to investigate the topographical distribution of chemosensory event-related potentials in relation to stimulation with nicotine. The recognition thresholds of 3 different sensations elicited by nicotine (odor, burning, stinging) were determined. Subsequently, 3 concentrations of nicotine were applied which were just above mean threshold for each of the 3 sensations. Subjects rated the intensity of odor, burning, and stinging. Additionally, they tracked the time course of these sensations. Odor and stinging appeared immediately after stimulus onset. Burning started after several seconds. Intensity ratings of burning and stinging increased with rising stimulus concentrations, whereas the odorous sensation was strongest at medium concentrations. After low and medium stimuli largest mean amplitudes were parietally obtained, whereas following stimulation with the highest concentration, amplitudes peaked at Cz.

Magnetoencephalography in extratemporal epilepsy.

Epilepsy surgery candidates with extratemporal foci represent a particular diagnostic and therapeutic challenge, because of anatomic and functional features of the pertaining areas. In the last decade, novel developments in the field of electrophysiological techniques have offered new approaches to detailed localization of specific epileptic discharges as well as eloquent regions. Magnetoencephalography, in combination with neuroimaging data and simultaneously recorded EEG, yields promising results to clarify centers of epileptic activity and their relationship to structural abnormalites and functionally significant areas. Examples are given to illustrate the range of applications of this method as a contribution to routine presurgical evaluation.

Postoperative multichannel magnetoencephalography in patients with recurrent seizures after epilepsy surgery

Objective – Assessment of usefulness of magnetoencephalography (MEG) as a novel non‐invasive technique in the diagnostic evaluation of patients with recurrent seizures after unsuccessful epilepsy surgery. Material and methods – Seventeen patients in whom epilepsy surgery had failed underwent reevaluation by means of MEG in addition to standard presurgical investigations (EEG, MRI, SPECT, and neuropsychologic testing). Results – Source analysis of interictal epileptic MEG discharges revealed dipole localizations immediately adjacent to the borders of previous resection in 10 of 17 patients. Standard non‐invasive presurgical evaluation suggested epileptogenicity over the general area of previous resection in all patients, but did not provide any detailed spatial localizing data. Invasive EEG recordings confirmed the MEG focus localization in all of 5 patients who were selected for reoperation. Second operation at the site of previous resection achieved complete seizure control in 3 and cessation of tonoclonic seizures in 1 of these patients. Conclusion – MEG may provide useful information in the diagnostic reevaluation of postoperative epileptic patients in whom skull and dura defects produce a “breach effect” which alters non‐invasive and invasive EEG.

Epilepsy surgery, resection volume and MSI localization in lesional frontal lobe epilepsy.

To verify whether interictal noninvasive information detected by magnetoencephalography (MEG) recordings can contribute to localize focal epileptic activity relevant for seizure generation in lesional frontal lobe epilepsy, magnetic source imaging (MSI) localizations of epileptic discharges were compared to the extent of neurosurgical resection and postoperative outcome. Preoperative MEG spike localizations were displayed in postoperative magnetic resonance imaging (MRI) scans to check whether dipole sites were located within the resection cavity. Moreover, MEG localizations were compared with results of prolonged video-EEG monitoring and, in three cases, with invasive EEG recordings. Our results in five cases with lesional frontal lobe epilepsy showed that good surgical outcome could be achieved in those patients where the majority of MEG spike localizations were located within the resected brain volume.

Ictal onset localization of epileptic seizures by magnetoencephalography

Objective– The aim of this study was to localize the ictal onset zone of focal epileptic seizures by magnetoencephalography (MEG) and to compare the results with interictal MEG localizations, ictal and interictal electroencephalography (EEG) results and magnetic resonance imaging (MRI) in epilepsy surgery candidates. Material and methods – Data of 13 patients with partial seizures during MEG recording were analysed. Measurements were performed with a Magnes II dual unit system. Results– In six of 13 cases, the ictal onset zone could be localized by MEG, with all interictal MEG findings being confirmed by ictal MEG results. In four cases, the ictal MEG localization results were corresponding to the ictal EEG localization results. In two cases, EEG yielded no comparable information. Conclusion – Ictal onset localization is feasible with MEG. Both interical and ictal MEG contribute valuable information to the presurgical assessment of epilepsy patients.

Alteration of the somatosensory cortical map in peripheral mononeuropathy due to carpal tunnel syndrome.

Substantial plasticity of the mature mammalian somatosensory cortex was demonstrated after deprivation of sensory input produced by amputation or somatosensory deafferentation. Following transection of the median nerve, adult owl and squirrel monkeys exhibit extensive reorganization in the cortical representation of the hand in areas 3b and 1. In the present study we investigated the possible effect of incomplete median nerve damage on sensory cortex somatotopy in a patient with unilateral carpal tunnel syndrome. We assessed interhemispheric differences of the hand representation in SI by means of magnetic source imaging. Additional intersubject data comparison was performed for specific results on the basis of available normal data from the literature and from own investigations in five healthy volunteers. Our results demonstrated a decreased extension of the cortical zone representing the injured median nerve and suggested invasion of the deprived area by cortical sectors receiving inputs from the little finger (supplied by the ulnar nerve) and from the dorsum of the thumb (innervated by the radial nerve). The study indicates topographic rearrangement of the hand representational zone in the human primary somatosensory cortex in a case of chronic median nerve injury.

Clonidine- and Methohexital-Induced Epileptiform Discharges Detected by Magnetoencephalography (MEG) in Patients with Localization-Related Epilepsies

Summary: Purpose: During presurgical evaluation, 14 patients with medically intractable focal epilepsies underwent magnetoencephalographic (MEG) recordings to localize the epileptogenic focus. To increase the number of epileptiform discharges required for MEG analysis, methohexital a short‐acting barbiturate that is known to activate epileptiform activity, was used. Additionally, we investigated the spike‐provoking properties of clonidine in comparison to methohexital.

Spatial relationship of source localizations in patients with focal epilepsy: Comparison of MEG and EEG with a three spherical shells and a boundary element volume conductor model

Epilepsy surgery is an option for patients with pharmacoresistant focal epilepsies, but it requires a precise focus localization procedure. Magnetoencephalography (MEG) and electroencephalography (EEG) can be used for analysis of interictal activity. The aim of this prospective study was to compare clusters of source localization results with MEG and EEG using a three spherical shells (3SS) and a boundary element method (BEM) volume conductor model. The study was closed when 100 patients met the inclusion criteria. Simultaneous MEG and EEG were recorded during presurgical evaluation. Epileptiform signals were analyzed using an equivalent current dipole model. Centroids of source localizations from MEG, EEG, 3SS, and BEM in their respective combinations were compared. In a 3SS model, MEG source localizations were 5.6 mm inferior to those obtained by EEG, while in a BEM model MEG source localizations were 6.3 mm anterior and 4.8 mm superior. The mean scattering of source localizations between both volume conductor models was 19.5 mm for EEG and 9.6 mm for MEG. For MEG no systematic difference between BEM and 3SS source localizations was found. For EEG, source localizations with BEM were 5.9 mm posterior and 11.7 mm inferior to those determined using 3SS. No differences were found between the 46 temporal and the 54 extratemporal lobe epilepsy patients. The observed systematic differences of source localizations of epileptic spikes due to the applied source signal modality and volume conductor model should be considered in presurgical evaluation when only one source signal and volume conductor model is available. Hum Brain Mapp, 2007.

Somatotopic Organization of the Ventral and Dorsal Finger Surface Representations in Human Primary Sensory Cortex Evaluated by Magnetoencephalography

Cortical reorganization of the subtly differentiated hand map after peripheral nerve injury might be better understood if there was a topographic conception of the homuncular representation of the dorsal finger surfaces in humans, in addition to the well-established sequential rostrocaudal array of the ventral finger aspects in cortical area 3b. In the present magnetoencephalographic study, tactile pneumatic stimulation was delivered to the fingertip and to the ventral and dorsal proximal phalanx of each digit of the dominant hand in 20 right-handed volunteers. Source localization of equivalent current dipoles underlying the recorded somatosensory evoked magnetic field was performed using a Cartesian coordinate system established by the anatomical landmarks nasion and preauricular points. Of the first major peak of each somatosensory evoked field, the region with the maximum field power (root-mean-square across channels) was selected for source reconstruction. Analysis of variance for repeated measures yielded significant results with respect to the arrangement of digits along the vertical coordinate axis, demonstrating a sequential array from the most inferiorly located D1 to the most superiorly located D5 for all different stimulus positions. This is the first study providing evidence for a sequential topographical arrangement of not only the ventral but also the dorsal surface representations of the individual digits in the human somatosensory cortex. The study contributes to a better understanding of the somatosensory hand representation in human primary cortex and provides useful information with regard to cortical plasticity studies in patients with peripheral nerve injuries at the upper extremity.