Howard W. Blume

Evidence for rapid face recognition from human scalp and intracranial electrodes

It is still generally believed that complex visual analysis is not carried out within the first 100 ms. Here we show that intra-and extracranial visual evoked potentials (VEPs) differentiate previously seen faces from novel faces as early as 50 ms after stimulus onset. EEG was recorded from scalp electrodes in 12 male healthy volunteers (group I) and intracranially from implanted depth electrodes in the temporal and frontal cortex of seven epilepsy patients (group II). Both groups were engaged in a face recognition task. All subjects showed significant differential responses which occurred very early (50–90 ms) and later (190–600 ms). In group II, the early responses were recorded more frequently in the right hemisphere, whereas the late differential VEPs were found in both hemispheres. Both types of VEPs were more frequent in the temporal neocortex, underlining its role as a major contributor to these fast recognition processes.

NBQX Blocks Acute and Late Epileptogenic Effects of Perinatal Hypoxia

Summary: Clinically, and in experimental models, perinatal hypoxic encephalopathy is commonly associated with seizures. We previously described a rat model in which hypoxia induces seizures and permanently increases in seizure susceptibility in immature rats [postnatal day (P) 10–121 but not in older rats. In the present study, we compared the effect of pretreatment with the excitatory amino acid antagonists MK‐801 and NBQX versus lorazepam in our rat model of perinatal hypoxia. Animals exposed to hypoxia at P10 without treatment have frequent seizures during hypoxia and subsequently exhibit increased seizure susceptibility to flurothyl. Treatment with 6‐nitro‐7‐sulfamoylbenzo(f)quinoxaline‐2,3‐dione(NBQX 20 mglkg) effectively suppressed hypoxia‐induced seizures in immature rats and also protected against permanent changes in flurothyl threshold in adult‐hood, whereas treatment with MK‐801 (1 mg/kg) or lorazepam (LZP 1 mg/kg) did not prevent these hypoxia‐related epileptogenic effects. These results suggest that activation of a‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazol propionic acid (AMPA) receptors may partly mediate the age‐dependent epileptogenic effect of hypoxia in the perinatal period

Neocortical Dendritic Pathology in Human Partial Epilepsy: A Quantitative Golgi Study

Summary: We used a computerized image‐analysis system to perform a quantitative analysis of rapid Golgiimpregnated pyramidal neurons of the third cortical layer of histologically normal cerebral cortex surgically removed from patients with partial epilepsy. Various parameters of 51 neurons from 9 patients and 29 neurons from 5 age‐matched controls were compared. Dendritic spine density decreased progressively with increasing duration of seizures, and dendritic swellings were most numerous in epilepsy cases of uncertain etiology and in patients with seizures of longer standing. Neurons from seizure cases showed fewer dendritic branching points and fewer proximal dendritic branches than those from controls, suggesting a simplified dendritic architecture. These findings indicate that neurons in cortex distant from the primary site of epileptogenic activity may be undergoing subtle, progressive degeneration, which may explain the propensity of chronic epilepsy patients to have increased seizure activity and interictal behavioral and cognitive aberrations.

Abnormal pulsatile secretion of luteinizing hormone in men with epilepsy Relationship to laterality and nature of paroxysmal discharges

We compared the pulsatile secretion of luteinizing hormone (LH) between 13 men with clinically and electrographically documented temporal lobe seizures and 8 age-matched controls. Serum for LH measurement was drawn every 15 minutes during 8 hours of EEG telemetry in both groups. The 2 groups did not differ significantly in average mean baseline LH secretion, total LH secretion, or average pulse amplitude. The group with seizures, however, showed a significantly greater (p < 0.05) variability of baseline LH secretion and pulse frequency. Among the men with unilateral paroxysmal EEG findings, pulse frequency was significantly greater (p = 0.05) with right epileptiform discharges or left slowing (6.4 ± 0.4) than with left epileptiform discharges or right slowing (3.0 ± 1.3). The relationship of pulse frequency to the nature and laterality of paroxysmal discharges makes it unlikely that endocrine abnormalities can be attributed to medication alone and strengthens the notion that temporal lobe epileptiform discharges may disrupt hypothalamic regulation of pituitary secretion.

Experimental tests of EEG source localization accuracy in spherical head models

OBJECTIVES The locations of electrical sources in the brain can be calculated using EEG data. However, the accuracy of these calculations is not well known because it is usually not possible to compare calculated source locations with actual locations since little accurate location information is available about most sources in the brain. METHODS In this study, sources at known locations are created by injecting current into electrodes implanted in the brains of human subjects. The locations of the implanted and scalp EEG electrodes are determined from CTs. The EEG signals produced by these dipolar sources are used to calculate source locations in spherical head models containing brain, skull, and scalp layers. The brain and scalp layers have the same electrical conductivity while 3 different skull conductivity ratios of 1/80th, 1/40th, and 1/20th of brain and scalp conductivity are used. Localization errors have been determined for 177 sources in 13 subjects. RESULTS An average localization error of 10.6 (SD=5.5) mm for all 177 source was obtained for a skull conductivity ratio of 1/40. The average errors for the other ratios are only a few millimeters larger. The average localization error for 108 sources at superior locations in the brain is 9.2 (4.4) mm. The average error for 69 inferior location sources is 12.8 (6.2) mm. There are no significant differences in localization accuracy for deep and superficial sources. CONCLUSIONS These results indicate that the best average localization that can be achieved using a spherical head model is approximately 10 mm. More realistic head models will be required for greater localization accuracy.

Connections of the hippocampal formation in humans: I. The mossy fiber pathway

The hippocampal formation has been one of the most extensively studied cortical regions in rats, yet little is known about the anatomical connections of the hippocampus in primates, especially humans. With the use of an antibody against the calcium‐binding protein, calbindin‐D28K, in normal autopsy tissue and the neuronal tracers biocytin or biotinylated dextrans in in vitro slice preparations from tissue removed during surgery for intractable epilepsy, we examined the human hippocampal mossy fiber pathway. The injections of biocytin into the dentate granule cell layer labeled neurons in a Golgi‐like manner, revealing the presence of basal dendrites on about 30% of the granule cells. The granule cell axons, the mossy fibers, initially formed a diffuse plexus of fibers in the polymorphic layer before organizing into fiber fascicles in the hilar pyramidal region. These fiber fascicles were much more prominent rostrally than caudally. Within the hilus and proximal portions of the extrahilar CA3 field, the mossy fibers ran through the pyramidal cell layer, and while near the transition to field CA2, the fibers turned superficially and crossed the pyramidal layer to run in the stratum lucidum. All of these features, seen following injections of tracer into hippocampal slices from the brains of epileptics, were confirmed by calbindin‐staining of mossy fibers in normal brains.

Embolization of solitary spinal metastases from renal cell carcinoma: alternative therapy for spinal cord or nerve root compression.

Four patients with a solitary vertebral metastasis from a renal cell carcinoma presented with acute spinal cord or nerve root compression. Because of the markedly hypervascular nature of the metastases it was decided to palliate the lesions by transarterial catheter embolization. The embolization reduced the venous blood pool within the tumors, resulting in progressive neurological improvement often lasting for 12 weeks or more. With such palliation, surgical decompression may be obviated, postponed, or at least made manageable.

Experimental tests of EEG source localization accuracy in realistically shaped head models

OBJECTIVES To determine the accuracy with which electrical sources in the human brain can be located using realistically shaped boundary element models of the head and to compare this accuracy with that using spherical head models. METHODS In a previous study, electroencephalographs (EEGs) produced by sources at known locations in the brains of human subjects were recorded. The sources were created by injecting current into implanted depth electrodes. The locations of the implanted depth and scalp EEG electrodes and head shape were determined from computerized tomography images. The EEGs were used to calculate source locations in spherical head models and localization accuracy was determined by comparing the calculated and actual locations. In this study, these same EEGs are used to determine localization accuracy in realistically shaped head models. RESULTS An average localization error of 10.5 (SD=5.4) mm was obtained in the realistically shaped models for all 176 sources in 13 subjects. This compares with 10.6 (5.5) mm in the spherical models. The average localization error for 105 sources at superior locations in the brain is 9.1 (4.2) mm. The average error for 71 inferior location sources is 12.4 (6.4) mm. The corresponding values for the spherical models are 9.2 (4.4) and 12.8 (6.2) mm. CONCLUSIONS The realistically shaped head boundary element models used in this study produced very nearly the same localization accuracy as spherical models.

Connections of the hippocampal formation in humans: II. The endfolial fiber pathway

We investigated the anatomical connections of the pyramidal neurons located within the hilar region of the dentate gyrus of the human hippocampus, neurons which do not have a rodent equivalent. The myeloarchitectural patterns of the human hippocampus indicated the presence of a distinct fiber pathway, the endfolial fiber pathway, in the stratum oriens of the hilus and field CA3. By using the fluorescent lipophilic dye DiI in formalin‐fixed human hippocampal tissue, we demonstrated that this is a continuous fiber pathway between the deep hilar region and CA2. This fiber pathway did not enter the fimbria or alveus along the entire distance of the traced pathway and ran exclusively in the stratum oriens of the hilus and CA3. Tracing studies with biocytin in in vitro human hippocampal slices indicated that the hilar and CA3 pyramidal neurons contributed to this pathway. Out distally in field CA3, the long transverse fibers became short and choppy, suggesting that they were beginning to move out of the plane of the tissue slice. Numerous fibers from this pathway were seen crossing the pyramidal layer.

Visual neglect during intracarotid armobarbital testing

The unilateral suppression of hemispheric function by sodium amobarbital may result in hemispatial visual neglect, as measured by performance on a random letter cancellation task. Our study not only investigates this hypothesis but also attempts to identify more precisely the anatomic locus of control for directed attention to extrapersonal space by correlating scanning performance with EEG activity. Forty-eight consecutive patients with epilepsy underwent preoperative intracarotid amobarbital tests. The results indicated that disruption of scanning and contralateral neglect occurred only after right- hemisphere suppression and seemed specifically related to changes in right frontal lobe EEG activity. This pattern of perfor- mance held not only for right-handed subjects, but also for those who were left-handed, and even for those who had right- hemisphere language dominance.