Laurent Koessler

Focal electrical intracerebral stimulation of a face-sensitive area causes transient prosopagnosia

Face perception is subtended by a large set of areas in the human ventral occipito-temporal cortex. However, the role of these areas and their importance for face recognition remain largely unclear. Here we report a case of transient selective impairment in face recognition (prosopagnosia) induced by focal electrical intracerebral stimulation of the right inferior occipital gyrus. This area presents with typical face-sensitivity as evidenced by functional neuroimaging right occipital face area (OFA). A face-sensitive intracerebral N170 was also recorded in this area, supporting its contribution as a source of the well-known N170 component typically recorded on the scalp. Altogether, these observations indicate that face recognition can be selectively impaired by local disruption of a single face-sensitive area of the network subtending this function, the right OFA.

Combined SEEG and source localisation study of temporal lobe schizencephaly and polymicrogyria.

OBJECTIVES Type 1 schizencephaly (SZ) is a cerebral malformation characterised by a cleft lined and surrounded by a polymicrogyric cortex, extending from the pial region to the peri-ventricular heterotopia. Our purpose was to combine and compare dipole source imaging technique and Stereo-EEG (SEEG) technique in determining the irritative and epileptogenic zones in a case of type 1 schizencephaly. METHODS High-resolution (64-channel) video-EEG with electrical source imaging and SEEG recordings were performed during a pre-surgical evaluation for medically intractable epilepsy. RESULTS Anatomo-electro-clinical correlations based on SEEG and source localisation identified two irritative and epileptogenic zones partially overlapping the polymicrogyric cortex surrounding the SZ: an anterior medio-lateral network primarily involving dysplasic limbic structures and a lateral network involving the anterior and middle part of the cleft and polymicrogyric cortex. The most posterior part (at the temporo-parieto-occipital junction) displayed a normal background activity. CONCLUSIONS Both epileptogenic and electrophysiologically normal cortices coexisted within the same widespread malformation: only the anterior part belonged to the anterior medio-lateral epileptogenic network defined by the SEEG. SIGNIFICANCE In cases of widespread cortical malformation such as SZ, source localization techniques can help to define the irritative zone and relevant targets for SEEG.

Intracranial evaluation of the epileptogenic zone in regional infrasylvian polymicrogyria

Purpose:  To define the relationship between the epileptogenic zone and the polymicrogyric area using intracranial electroencephalography (EEG) recordings in patients with structural epilepsy associated with regional infrasylvian polymicrogyria (PMG).

From perception to recognition memory: Time course and lateralization of neural substrates of word and abstract picture processing

Through study of clinical cases with brain lesions as well as neuroimaging studies of cognitive processing of words and pictures, it has been established that material-specific hemispheric specialization exists. It remains however unclear whether such specialization holds true for all processes involved in complex tasks, such as recognition memory. To investigate neural signatures of transition from perception to recognition, according to type of material (words or abstract pictures), high-resolution scalp ERPs were recorded in adult humans engaged either in categorization or in memory recognition tasks within the same experimental setup. Several steps in the process from perception to recognition were identified. Source localization showed that the early stage of perception processing (N170) takes place in the fusiform gyrus and is lateralized according to the nature of stimuli (left side for words and right side for pictures). Late stages of processing (N400/P600) corresponding to recognition are material independent and involve anterior medial-temporal and ventral prefrontal structures bilaterally. A crucial transitional process between perception (N170) and recognition (N400/P600) is reflected by the N270, an often overlooked component, which occurs in anterior rhinal cortices and shows material-specific hemispheric lateralization.

Electrical source imaging in cortical malformation–related epilepsy: A prospective EEG‐SEEG concordance study

Delineation of the epileptogenic zone (EZ) in refractory epilepsy related to malformations of cortical development (MCDs) often requires intracranial electroencephalography (EEG) recordings, especially in cases of negative magnetic resonance imaging (MRI) or discordant MRI and video‐EEG findings. It is therefore crucial to promote the development of noninvasive methods such as electrical source imaging (ESI). We aimed to (1) analyze the localization concordance of ESI derived from interictal discharges and EZ estimated by stereo‐EEG (SEEG); (2) compare the concordance of ESI, MRI, and electroclinical correlations (ECCs) with SEEG‐EZ; and (3) assess ESI added value in the EZ localization.

Simultaneous subdural and scalp EEG correlates of frontal lobe epileptic sources

To assess the visibility and detectability in scalp electroencephalography (EEG) of cortical sources in frontal lobe epilepsy (FLE) as to their localization, and the extent and amplitude of activation.

Seizure lateralization in scalp EEG using Hjorth parameters

OBJECTIVE This paper describes and assesses a new semi-automatic method for temporal lobe seizures lateralization using raw scalp EEG signals. METHODS We used the first two Hjorth parameters to estimate quadratic mean and dominant frequency of signals. Their mean values were computed on each side of the brain and segmented taking into account the seizure onset time identified by the electroencephalographist, to keep only the initial part of the seizure, before a possible spreading to the contralateral side. The means of segmented variables were used to characterize the seizure by a point in a (frequency, amplitude) plane. Six criteria were proposed for the partitioning of this plane for lateralization. RESULTS The procedure was applied to 45 patients (85 seizures). The two best criteria yielded, for the first one, a correct lateralization for 96% of seizures and, for the other, a lateralization rate of 87% without incorrect lateralization. CONCLUSIONS The method produced satisfactory results, easy to interpret. The setting of procedure parameters was simple and the approach was robust to artifacts. It could constitute a help for neurophysiologists during visual inspection. SIGNIFICANCE The difference of quadratic mean and dominant frequency on each side of the brain allows lateralizing the seizure onset.

Right hemispheric dominance of visual phenomena evoked by intracerebral stimulation of the human visual cortex.

Electrical brain stimulation can provide important information about the functional organization of the human visual cortex. Here, we report the visual phenomena evoked by a large number (562) of intracerebral electrical stimulations performed at low‐intensity with depth electrodes implanted in the occipito‐parieto‐temporal cortex of 22 epileptic patients. Focal electrical stimulation evoked primarily visual hallucinations with various complexities: simple (spot or blob), intermediary (geometric forms), or complex meaningful shapes (faces); visual illusions and impairments of visual recognition were more rarely observed. With the exception of the most posterior cortical sites, the probability of evoking a visual phenomenon was significantly higher in the right than the left hemisphere. Intermediary and complex hallucinations, illusions, and visual recognition impairments were almost exclusively evoked by stimulation in the right hemisphere. The probability of evoking a visual phenomenon decreased substantially from the occipital pole to the most anterior sites of the temporal lobe, and this decrease was more pronounced in the left hemisphere. The greater sensitivity of the right occipito‐parieto‐temporal regions to intracerebral electrical stimulation to evoke visual phenomena supports a predominant role of right hemispheric visual areas from perception to recognition of visual forms, regardless of visuospatial and attentional factors. Hum Brain Mapp 35:3360–3371, 2014.

In-vivo measurements of human brain tissue conductivity using focal electrical current injection through intracerebral multicontact electrodes.

In‐vivo measurements of human brain tissue conductivity at body temperature were conducted using focal electrical currents injected through intracerebral multicontact electrodes. A total of 1,421 measurements in 15 epileptic patients (age: 28 ± 10) using a radiofrequency generator (50 kHz current injection) were analyzed. Each contact pair was classified as being from healthy (gray matter, n = 696; white matter, n = 530) or pathological (epileptogenic zone, n = 195) tissue using neuroimaging analysis of the local tissue environment and intracerebral EEG recordings. Brain tissue conductivities were obtained using numerical simulations based on conductivity estimates that accounted for the current flow in the local brain volume around the contact pairs (a cube with a side length of 13 mm). Conductivity values were 0.26 S/m for gray matter and 0.17 S/m for white matter. Healthy gray and white matter had statistically different median impedances (P < 0.0001). White matter conductivity was found to be homogeneous as normality tests did not find evidence of multiple subgroups. Gray matter had lower conductivity in healthy tissue than in the epileptogenic zone (0.26 vs. 0.29 S/m; P = 0.012), even when the epileptogenic zone was not visible in the magnetic resonance image (MRI) (P = 0.005). The present in‐vivo conductivity values could serve to create more accurate volume conduction models and could help to refine the identification of relevant intracerebral contacts, especially when located within the epileptogenic zone of an MRI‐invisible lesion. Hum Brain Mapp 38:974–986, 2017.

The standardized EEG electrode array of the IFCN

Standardized EEG electrode positions are essential for both clinical applications and research. The aim of this guideline is to update and expand the unifying nomenclature and standardized positioning for EEG scalp electrodes. Electrode positions were based on 20% and 10% of standardized measurements from anatomical landmarks on the skull. However, standard recordings do not cover the anterior and basal temporal lobes, which is the most frequent source of epileptogenic activity. Here, we propose a basic array of 25 electrodes including the inferior temporal chain, which should be used for all standard clinical recordings. The nomenclature in the basic array is consistent with the 10-10-system. High-density scalp EEG arrays (64-256 electrodes) allow source imaging with even sub-lobar precision. This supplementary exam should be requested whenever necessary, e.g. search for epileptogenic activity in negative standard EEG or for presurgical evaluation. In the near future, nomenclature for high density electrodes arrays beyond the 10-10 system needs to be defined, to allow comparison and standardized recordings across centers. Contrary to the established belief that smaller heads needs less electrodes, in young children at least as many electrodes as in adults should be applied due to smaller skull thickness and the risk of spatial aliasing.