Steven J. Schiff

Noninvasive assessment of language dominance in children and adolescents with functional MRI: a preliminary study.

Background Assessment of language organization is crucial in patients considered for epilepsy surgery. In children, the current techniques, intra-carotid amobarbital test (IAT) for language dominance, and cortical electrostimulation mapping (ESM), are invasive and risky. Functional magnetic resonance imaging (fMRI) is an alternative method for noninvasive functional mapping, through the detection of the hemodynamic changes associated with neuronal activation. We used fMRI to assess language dominance in children with partial epilepsy. Methods Eleven right handed children and adolescents performed a word generation task during fMRI acquisition focused on the frontal lobes. Areas where the signal time course correlated with the test paradigm (r = 0.7) were considered activated. Extent and magnitude of signal changes were used to calculate asymmetry indices. Seven patients had IAT, ESM, or surgery outcome available for comparison. Results fMRI language dominance always agreed with IAT (6 cases) and ESM (1 case), showing left dominance in six and bilateral language in one. fMRI demonstrated left dominance in three additional children, and right dominance in one with early onset of left temporal epilepsy. Four children whose initial studies were equivocal due to noncompliance or motion artifacts were restudied successfully. Conclusions fMRI can be used to assess language lateralization noninvasively in children. It has the potential to replace current functional mapping techniques in patients, and to provide important data on brain development.

Long-Term Follow-Up Data from the Shunt Design Trial

Background: A previously reported multicenter randomized trial assessed whether 2 new shunt valve designs would reduce shunt failure rates compared to differential pressure valves. The study did not show a significant difference in the time to first shunt failure. Patients entered the trial between October 1, 1993, and October 31, 1995. The primary results were based on the patients’ status as of October 31, 1996 (a minimum follow-up of 1 year). This report describes the late complications based on the patients’ most recent follow-up. Methods: Three hundred and forty-four hydrocephalic children at 12 North American and European centers were randomized to 1 of 3 valves: a standard differential pressure valve; a Delta valve (PS Medical-Medtronic) or a Sigma valve (NMT Cordis). Patients were followed until their first shunt failure. Shunt failure was defined as shunt surgery for obstruction, overdrainage, loculation or infection. If the shunt did not fail, follow-up was continued until August 31, 1999. Results: One hundred and seventy-seven patients had shunt failure. Shunt obstruction occurred in 131, overdrainage in 13, loculated ventricles in 2 and infection in 29. The overall shunt survival was 62% at 1 year, 52% at 2 years, 46% at 3 years, 41% at 4 years. The survival curves for the 3 valves were similar to those from the original trial and did not show a survival advantage for any particular valve. Conclusions: Prolonged follow-up to date does not alter the primary conclusions of the trial: there does not appear to be one valve that is clearly the best for the initial treatment of pediatric hydrocephalus.

Spiral Waves in Disinhibited Mammalian Neocortex

Spiral waves are a basic feature of excitable systems. Although such waves have been observed in a variety of biological systems, they have not been observed in the mammalian cortex during neuronal activity. Here, we report stable rotating spiral waves in rat neocortical slices visualized by voltage-sensitive dye imaging. Tissue from the occipital cortex (visual) was sectioned parallel to cortical lamina to preserve horizontal connections in layers III-V (500-μm-thick, ∼4 × 6 mm2). In such tangential slices, excitation waves propagated in two dimensions during cholinergic oscillations. Spiral waves occurred spontaneously and alternated with plane, ring, and irregular waves. The rotation rate of the spirals was ∼10 turns per second, and the rotation was linked to the oscillations in a one-cycle- one-rotation manner. A small (<128 μm) phase singularity occurred at the center of the spirals, about which were observed oscillations of widely distributed phases. The phase singularity drifted slowly across the tissue (∼1 mm/10 turns). We introduced a computational model of a cortical layer that predicted and replicated many of the features of our experimental findings. We speculate that rotating spiral waves may provide a spatial framework to organize cortical oscillations.

Fast wavelet transformation of EEG

Wavelet transforms offer certain advantages over Fourier transform techniques for the analysis of EEG. Recent work has demonstrated the applicability of wavelets for both spike and seizure detection, but the computational demands have been excessive. We compare the quality of feature extraction of continuous wavelet transforms using standard numerical techniques, with more rapid algorithms utilizing both polynomial splines and multiresolution frameworks. We further contrast the difference between filtering with and without the use of surrogate data to model background noise, demonstrate the preservation of feature extraction with critical versus redundant sampling, and perform the analyses with wavelets of different shape. Comparison is made with windowed Fourier transforms, similarly filtered, at different data window lengths. We here report a dramatic reduction in computational time required to perform this analysis, without compromising the accuracy of feature extraction. It now appears technically feasible to filter and decompose EEG using wavelet transforms in real time with ordinary microprocessors.

Synchronization and desynchronization in epilepsy: controversies and hypotheses.

Abstract  Epilepsy has been historically seen as a functional brain disorder associated with excessive synchronization of large neuronal populations leading to a hypersynchronous state. Recent evidence showed that epileptiform phenomena, particularly seizures, result from complex interactions between neuronal networks characterized by heterogeneity of neuronal firing and dynamical evolution of synchronization. Desynchronization is often observed preceding seizures or during their early stages; in contrast, high levels of synchronization observed towards the end of seizures may facilitate termination. In this review we discuss cellular and network mechanisms responsible for such complex changes in synchronization. Recent work has identified cell‐type‐specific inhibitory and excitatory interactions, the dichotomy between neuronal firing and the non‐local measurement of local field potentials distant to that firing, and the reflection of the neuronal dark matter problem in non‐firing neurons active in seizures. These recent advances have challenged long‐established views and are leading to a more rigorous and realistic understanding of the pathophysiology of epilepsy.

Early seizure detection.

Summary: For patients with medically intractable epilepsy, there have been few effective alternatives to resective surgery, a destructive, irreversible treatment. A strategy receiving increased attention is using interictal spike patterns and continuous EEG measurements from epileptic patients to predict and ultimately control seizure activity via chemical or electrical control systems. This work compares results of seven linear and nonlinear methods (analysis of power spectra, cross‐correlation, principal components, phase, wavelets, correlation integral, and mutual prediction) in detecting the earliest dynamical changes preceding 12 intracranially‐recorded seizures from 4 patients. A method of counting standard deviations was used to compare across methods, and the earliest departures from thresholds determined from non‐seizure EEG were compared to a neurologists judgement. For these data, the nonlinear methods offered no predictive advantage over the linear methods. All the methods described here were successful in detecting changes leading to a seizure between one and two minutes before the first changes noted by the neurologist, although analysis of phase correlation proved the most robust. The success of phase analysis may be due in part to its complete insensitivity to amplitude, which may provide a significant source of error.

The influence of sodium and potassium dynamics on excitability, seizures, and the stability of persistent states: I. Single neuron dynamics

In these companion papers, we study how the interrelated dynamics of sodium and potassium affect the excitability of neurons, the occurrence of seizures, and the stability of persistent states of activity. In this first paper, we construct a mathematical model consisting of a single conductance-based neuron together with intra- and extracellular ion concentration dynamics. We formulate a reduction of this model that permits a detailed bifurcation analysis, and show that the reduced model is a reasonable approximation of the full model. We find that competition between intrinsic neuronal currents, sodium-potassium pumps, glia, and diffusion can produce very slow and large-amplitude oscillations in ion concentrations similar to what is seen physiologically in seizures. Using the reduced model, we identify the dynamical mechanisms that give rise to these phenomena. These models reveal several experimentally testable predictions. Our work emphasizes the critical role of ion concentration homeostasis in the proper functioning of neurons, and points to important fundamental processes that may underlie pathological states such as epilepsy.

The effects of temperature on synaptic transmission in hippocampal tissue slices

Fully submerged rat hippocampal tissue slices were exposed to temperature changes, and the effects on CA1 pyramidal cell electrophysiology studied. Raising the temperature from 29 to 33 or 37 degrees C simultaneously increased the focal-excitatory postsynaptic potentials and decreased the population spikes. These changes were largely reversible for slices warmed to 33 degrees C, but not for slices warmed to 37 degrees C. During warming transiently increased excitatory transmission was observed; the degree of increased transmission was related to the rate of temperature rise. It is postulated that neuronal membrane hyperpolarization with warming is responsible for several of the effects seen.

High dose barbiturate therapy in neurosurgery and intensive care.

&NA; To assess the uses of high dose barbiturate therapy in neurosurgery and intensive care, the authors have undertaken a concise survey of relevant experimental investigations and a comprehensive review of published clinical experiences. (Neurosurgery 15:427‐444, 1984)

Neuronal spatiotemporal pattern discrimination: The dynamical evolution of seizures

We developed a modern numerical approach to the multivariate linear discrimination of Fisher from 1936 based upon singular value decomposition that is sufficiently stable to permit widespread application to spatiotemporal neuronal patterns. We demonstrate this approach on an old problem in neuroscience--whether seizures have distinct dynamical states as they evolve with time. A practical result was the first demonstration that human seizures have distinct initiation and termination dynamics, an important characterization as we seek to better understand how seizures start and stop. Our approach is broadly applicable to a wide variety of neuronal data, from multichannel EEG or MEG, to sequentially acquired optical imaging data or fMRI.