Guilherme C. Beltramini

Structural brain abnormalities are related to retinal nerve fiber layer thinning and disease duration in neuromyelitis optica spectrum disorders

Background: Although aquaporin-4 (AQP4) is widely expressed in the human brain cortex, lesions are rare in neuromyelitis optica (NMO) spectrum disorders (NMOSD). Recently, however, several studies have demonstrated occult structural brain atrophy in NMO. Objective: This study aims to investigate magnetic resonance imaging (MRI) patterns of gray matter (GM) and white matter (WM) abnormalities in patients with NMOSD and to assess the visual pathway integrity during disease duration correlation of the retinal nerve fiber layer (RNFL) and pericalcarine cortex thickness. Methods: Twenty-one patients with NMOSD and 34 matched healthy controls underwent both high-field MRI (3T) high-resolution T1-weighted and diffusion-tensor MRI. Voxel-based morphometry, cortical analyses (Freesurfer) and diffusion-tensor imaging (DTI) analyses (TBSS-FSL) were used to investigate brain abnormalities. In addition, RNFL measurement by optic-coherence tomography (OCT) was performed. Results: We demonstrate that NMOSD is associated with GM and WM atrophy, encompassing more frequently the motor, sensory and visual pathways, and that the extent of GM atrophy correlates with disease duration. Furthermore, we demonstrate for the first time a correlation between RNFL and pericalcarine cortical thickness, with cortical atrophy evolving over the course of disease. Conclusions: Our findings indicate a role for retrograde and anterograde neurodegeneration in GM atrophy in NMOSD. However, the presence atrophy encompassing almost all lobes suggests that additional pathomechanisms might also be involved.

White matter abnormalities associate with type and localization of focal epileptogenic lesions

To evaluate white matter (WM) integrity of distinct groups of patients with antiepileptic drug (AED)–resistant localization‐related epilepsies.

Distinct functional and structural MRI abnormalities in mesial temporal lobe epilepsy with and without hippocampal sclerosis

We aimed to investigate patterns of electroencephalography‐correlated functional MRI (EEG‐fMRI) and subtle structural abnormalities in patients with mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (MTLE‐HS) or normal MRI (MTLE‐NL).

Aberrant topological patterns of brain structural network in temporal lobe epilepsy

Although altered large‐scale brain network organization in patients with temporal lobe epilepsy (TLE) has been shown using morphologic measurements such as cortical thickness, these studies, have not included critical subcortical structures (such as hippocampus and amygdala) and have had relatively small sample sizes. Here, we investigated differences in topological organization of the brain volumetric networks between patients with right TLE (RTLE) and left TLE (LTLE) with unilateral hippocampal atrophy.

Diffusion abnormalities of the corpus callosum in patients with malformations of cortical development and epilepsy

PURPOSE Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) technique that can characterize white matter (WM) architecture and microstructure. DTI has demonstrated extensive WM changes in patients with several epileptic syndromes, but few studies have focused on patients with malformations of cortical development (MCD). Our aim was to investigate the quantitative diffusion properties of the corpus callosum (CC), a major commissural bundle critical in inter-hemispheric connectivity, in a large group of patients with MCD. METHODS Thirty-two MCD patients and 32 age and sex-matched control subjects were evaluated with DTI at 3.0 T. We analyzed the three major subdivisions of the CC (genu, body, and splenium) with deterministic tractography to yield fractional anisotropy (FA), mean diffusivity (MD), parallel diffusivity (λ||) and perpendicular diffusivity (λ⊥). We further assessed the CC with region of interest (ROI)-based analyses and evaluated different subgroups of MCD (polymicrogyria/schizencephaly, heterotopia, and cortical dysplasia). Partial correlations between diffusion changes and clinical parameters (epilepsy duration and age at disease onset) were also queried. RESULTS There were significant reductions of FA, accompanied by increases in MD and λ⊥ in all segments of the CC in the patients group with both analytical methods. The absolute differences in FA were greater on ROI-analyses. There were no significant differences between the MCD subgroups, and no correlations between clinical parameters of epilepsy and FA. CONCLUSIONS Our study indicates DTI abnormalities consistent with microstructural changes in the corpus callosum of MCD patients. The findings support the idea that patients with epilepsy secondary to cortical malformations present widespread WM changes that extend beyond the macroscopic MRI-visible lesions.

EEG-fMRI in the presurgical evaluation of temporal lobe epilepsy

Objective Drug-resistant temporal lobe epilepsy (TLE) often requires thorough investigation to define the epileptogenic zone for surgical treatment. We used simultaneous interictal scalp EEG-fMRI to evaluate its value for predicting long-term postsurgical outcome. Methods 30 patients undergoing presurgical evaluation and proceeding to temporal lobe (TL) resection were studied. Interictal epileptiform discharges (IEDs) were identified on intra-MRI EEG and used to build a model of haemodynamic changes. In addition, topographic electroencephalographic correlation maps were calculated between the average IED during video-EEG and intra-MRI EEG, and used as a condition. This allowed the analysis of all data irrespective of the presence of IED on intra-MRI EEG. Mean follow-up after surgery was 46 months. International League Against Epilepsy (ILAE) outcomes 1 and 2 were considered good, and 3–6 poor, surgical outcome. Haemodynamic maps were classified according to the presence (Concordant) or absence (Discordant) of Blood Oxygen Level-Dependent (BOLD) change in the TL overlapping with the surgical resection. Results The proportion of patients with good surgical outcome was significantly higher (13/16; 81%) in the Concordant than in the Discordant group (3/14; 21%) (χ2 test, Yates correction, p=0.003) and multivariate analysis showed that Concordant BOLD maps were independently related to good surgical outcome (p=0.007). Sensitivity and specificity of EEG-fMRI results to identify patients with good surgical outcome were 81% and 79%, respectively, and positive and negative predictive values were 81% and 79%, respectively. Interpretation The presence of significant BOLD changes in the area of resection on interictal EEG-fMRI in patients with TLE retrospectively confirmed the epileptogenic zone. Surgical resection including regions of haemodynamic changes in the TL may lead to better postoperative outcome.

Longitudinal analysis of hippocampal T2 relaxometry in FMTLE

PURPOSE To investigate the degree of T2 relaxometry changes over time in groups of patients with familial mesial temporal lobe epilepsy (FMTLE) and asymptomatic relatives. METHODS We conducted both cross-sectional and longitudinal analyses of T2 relaxometry with Aftervoxel, an in-house software for medical image visualization. The cross-sectional study included 35 subjects (26 with FMTLE and 9 asymptomatic relatives) and 40 controls; the longitudinal study was composed of 30 subjects (21 with FMTLE and 9 asymptomatic relatives; the mean time interval of MRIs was 4.4 ± 1.5 years) and 16 controls. To increase the size of our groups of patients and relatives, we combined data acquired in 2 scanners (2T and 3T) and obtained z-scores using their respective controls. General linear model on SPSS21® was used for statistical analysis. RESULTS In the cross-sectional analysis, elevated T2 relaxometry was identified for subjects with seizures and intermediate values for asymptomatic relatives compared to controls. Subjects with MRI signs of hippocampal sclerosis presented elevated T2 relaxometry in the ipsilateral hippocampus, while patients and asymptomatic relatives with normal MRI presented elevated T2 values in the right hippocampus. The longitudinal analysis revealed a significant increase in T2 relaxometry for the ipsilateral hippocampus exclusively in patients with seizures. CONCLUSIONS The longitudinal increase of T2 signal in patients with seizures suggests the existence of an interaction between ongoing seizures and the underlying pathology, causing progressive damage to the hippocampus. The identification of elevated T2 relaxometry in asymptomatic relatives and in patients with normal MRI suggests that genetic factors may be involved in the development of some mild hippocampal abnormalities in FMTLE.

Music versus motor imagery for BCI systems a study using fMRI and EEG: Preliminary results

The development of brain-computer interfaces (BCIs) for disabled patients is currently a growing field of research. Most BCI systems are based on electroencephalography (EEG) signals, and within this group, systems using motor imagery (MI) are amongst the most flexible. However, for stroke patients, the motor areas of the brain are not always available for use in these types of devices. The aim of this work was to evaluate a set of imagery-based cognitive tasks (right-hand MI versus music imagery, with rest or “blank” periods in between), using functional Magnetic Resonance Imaging (fMRI) and EEG. Eleven healthy subjects (control group) and four stroke patients were evaluated with fMRI, and nine of the healthy subjects also underwent an EEG test. The fMRI results for the control group showed specific and statistically differentiable activation patterns for motor versus music imagery (t-test, p <; 0.001). For stroke patients the fMRI results showed a very large variability, with no common activation pattern for either of the imagery tasks. Corroborating this fact, EEG results concerning feature selection for minimizing the classification error (using the Davies-Bouldin index) have also found no common activation pattern, although a well-defined set of meaningful electrodes and frequencies was found for some subjects. In terms of classification performance using EEG data, this work has detected a group of subjects with classifier rate of success up to 60%, which is promising in view of the cognitive complexity of the adopted tasks.

The use of fMRI for the evaluation of the effect of training in motor imagery BCI users

The development of brain computer interfaces (BCIs) for patient rehabilitation is a growing field of research. The BCI experimental paradigms consist mainly of selective attention BCI models and motor imagery (MI) BCIs. Selective attention models require an external stimulus (screen) but achieve high rates of classification accuracy fairly quickly. MI systems do not require external stimuli but require extensive training. The goal of our study was to gauge how much a short training paradigm requiring seven six-minute sessions of video attention would change fMRI BOLD activity between two sessions of MI ± one acquired before and another after the training protocol took place. The study used four MIs: 1) right hand 2) left hand 3) feet 4) tongue; and it was carried out on ten subjects. We found an increase of the BOLD response after training, both in amplitude and spatial extent, for the majority (6 out of 10) of subjects and MIs (all except left hand). Our results corroborate other literature results regarding the effect of training in MI based BCIs.

Cerebral vasoreactivity with breath holding test in Transcranial Doppler and functional MRI in patients with carotid stenosis

WCN 2013 No: 1856 Topic: 3 — Stroke Cerebral vasoreactivity with breath holding test in Transcranial Doppler and functional MRI in patients with carotid stenosis C.R. Campos-Herrera, G.C. Beltramini, W.M. Avelar, L.M. Li. Neurology, Faculty of Medical Sciences, State University of Campinas, Brazil; ‘Gleb Wataghin’ Physics Institute, State University of Campinas,