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Biomedical subjects

J Gotman

Publications and source records attributed to J Gotman.

At least 55 records · Page 3Linked to original sources
PubMed1999

Relation of interictal spike frequency to 1H-MRSI-measured NAA/Cr.

PURPOSE: Whereas EEG spiking and decreases of the neuronal marker N-acetyl-aspartate (NAA) both localize well the epileptic focus, the significance of the intensity of these variables is unclear. Therefore we investigated whether the frequency of interictal surface spikes is related to the degree of N-acetyl-aspartate/creatine (NAA/Cr) ratio decrease as measured by proton magnetic resonance (MR) spectroscopic imaging (1H-MRSI) in patients with intractable partial epilepsy. METHODS: We retrospectively studied 14 patients, nine with temporal lobe epilepsy and five with frontal lobe epilepsy. Spikes that occurred during prolonged video-EEG monitoring from electrodes placed according to the International 10-20 system were counted blinded to the 1H-MRSI results. Eight electrode positions (F3/4, C3/4, T3/4, T5/6) were assigned to underlying brain subregions in the 1H-MRSI volume of interest. We converted NAA/Cr ratios into z-scores (NAA/Cr(z)) to compared NAA/Cr values directly across subregions. We calculated Spearman rank-order (p) and Pearson product-moment (r) correlations between spike frequency and NAA/Cr(z) values overall, as well as within each brain subregion. RESULTS: We found an overall negative relation between spike-frequency data and NAA/Cr(z) data (p = -0.341). When analyzing only spiking subregions, this negative relation became slightly stronger (p = -0.442; r = -0.338). When data from the eight sites were considered separately, this negative relation remained in most instances. CONCLUSIONS: Our results reveal a trend toward higher interictal spike frequencies on surface EEG in regions of pronounced neuronal metabolic damage or dysfunction. This suggests that both variables parallel an underlying pathologic substrate, although the pathophysiologic processes may be distinct.

Adolescent↗
PubMed1999

EEG background delta activity in temporal lobe epilepsy: correlation with volumetric and spectroscopic imaging.

PURPOSE: With quantitative electroencephalogram (EEG) and neuroimaging methods, we examined delta activity, atrophy, and neuronal-axonal dysfunction of the cerebral gray and white matter in patients with intractable temporal lobe epilepsy (TLE). Based on evidence that lesions of the white matter result in EEG delta activity, we postulated that background abnormalities in patients with TLE are related to changes of the temporal lobe white matter. METHODS: We measured interictal delta activity in 34 TLE patients and 10 controls. Spike-free and artifact-free EEG samples were selected by visual inspection. A spectral analysis was used to compute the energy in the delta frequency band. We compared the results of the spectral analysis to magnetic resonance imaging- (MRI) based volumes of the temporal lobe white and gray matter, the hippocampus and the amygdala; and N-acetyl aspartate (NAA) in the lateral and posterior temporal lobe by using proton magnetic resonance spectroscopic imaging (1H-MRSI). The degree of correlation between delta activity and the neuroimaging measurements was assessed by using the Pearson correlation coefficient (r). An analysis of variance (ANOVA) was used to examine the influence of the seizure-focus lateralization on the delta activity and the neuroimaging parameters. RESULTS: There was no significant difference in the amount of delta activity in the temporal lobe between the controls and patients. We found no correlation between delta activity and the neuroimaging measures (p>0.05). The ANOVA showed significant differences between the patients and controls for the volume of the gray and white matter of the temporal lobe and for the NAA in the lateral and posterior temporal lobe (p<0.002). CONCLUSIONS: The interictal background delta activity was not explained by reduced volume of the temporal lobe white matter, gray matter, or by abnormalities seen in 1H-MRSI.

Adult↗
PubMed1998

An expert system for EEG monitoring in the pediatric intensive care unit.

OBJECTIVES: was to design a warning system for the pediatric intensive care unit (PICU). The system should be able to make statements at regular intervals about the level of abnormality of the EEG. The warnings are aimed at alerting an expert that the EEG may be abnormal and needs to be examined. METHODS: A total of 188 EEG sections lasting 6 h each were obtained from 74 patients in the PICU. Features were extracted from these EEGs, and with the use of fuzzy logic and neural networks, we designed an expert system capable of imitating a trained EEGer in providing an overall judgment of abnormality about the EEG. The 188 sections were used in training and testing the system using the rotation method, thus separating training and testing data. RESULTS: The EEGer and the expert system classified the EEGs in 7 levels of abnormality. There was concordance between the two in 45% of cases. The expert system was within one abnormality level of the EEGer in 91% of cases and within two levels in 97%. CONCLUSIONS: We were therefore able to design a system capable of providing reliably an assessment of the level of abnormality of a 6 h section of EEG. This system was validated with a large data set, and could prove useful as a warning device during long-term ICU monitoring to alert a neurophysiologist that an EEG requires attention.

Algorithms↗
PubMed1998

Segmentation and classification of EEG during epileptic seizures.

We present a method for the automatic comparison of epileptic seizures in EEG, allowing the grouping of seizures having similar overall patterns. Each channel of the EEG is first broken down into segments having relatively stationary characteristics. Features are then calculated for each segment and all segments of all channels of the seizures of one patient are grouped into clusters of similar morphology. This clustering allows labeling of every EEG segment. Methods derived from string matching procedures are then used to obtain an overall edit distance between two seizures, a distance that represents how the two seizures, taken in their entirety and including the channels not actually involved in the discharge, resemble each other. Examples from 5 patients, 3 with intracerebral electrodes and two with scalp electrodes, illustrate the ability of the method to group seizures of similar morphology.

Algorithms↗
PubMed1998

Automatic EEG analysis during long-term monitoring in the ICU.

To assist in the reviewing of prolonged EEGs, we have developed an automatic EEG analysis method that can be used to compress the prolonged EEG into two pages. The proposed approach of Automatic Analysis of Segmented-EEG (AAS-EEG) consists of 4 basic steps: (1) segmentation; (2) feature extraction; (3) classification; and (4) presentation. The idea is to break down the EEG into stationary segments and extract features that can be used to classify the segments into groups of like patterns. The final step involves the presentation of the processed data in a compressed form. This is done by providing the EEGer with a representative sample from each group of EEG patterns and a compressed time profile of the complete EEG. To verify the above approach, 41 6 h EEG records were assessed for normality via the AAS-EEG and conventional EEG approaches. The difference between the overall assessment via compressed and conventional EEG was within one abnormality level 100% of the time, and within one-half level for 73.6% of the records. We demonstrated the feasibility and reliability of automatically segmenting and clustering the EEG, thus allowing the reduction of a 6 h tracing to a few representative segments and their time sequence. This should facilitate review of long recordings during monitoring in the ICU.

Child↗
PubMed1998

Regional cerebral blood flow and language dominance: SPECT during intracarotid amobarbital testing.

We examined the relation between language dominance and regional cerebral blood flow (rCBF) during the intracarotid amobarbital procedure (IAP). A previous report limited to three patients suggested that dominant rather than nondominant hemisphere IAP may have a differential effect on rCBF. Behavioral assessment during the IAP also suggests that dominant hemisphere injection results in a differential effect on memory and affective symptoms rather than nondominant injection. Thirteen patients were assessed using single-photon emission CT (SPECT) brain imaging during both left and right IAP. The SPECTs were coregistered with the individual's MRI. Changes in rCBF during each IAP were compared with the patient's baseline SPECT. Nine patients had left hemisphere dominance, two were right dominant, and two had bilateral speech representation. In the left dominant subjects, left-hemisphere injection had a consistently greater effect on rCBF than right-hemisphere injection in the anterior (p < 0.005) and posterior (p < 0.01) temporal neocortex. There was also a trend for greater hypoperfusion in the frontal lobe of the left hemisphere. rCBF in the ipsilateral hippocampus was not significantly different after each injection (p > 0.05). In the two patients with right hemisphere speech, the reverse pattern was seen, with greater hypoperfusion after right (dominant) hemisphere injection. There was no consistent asymmetry in the two patients with bilateral speech. Dominant hemisphere IAP results in significantly greater hypoperfusion than does nondominant injection. These data provide a physiologic basis for behavioral differences noted after dominant versus nondominant IAP.

Adolescent↗
PubMed1997

Regional cerebral blood flow changes as a function of delta and spindle activity during slow wave sleep in humans.

In the present study, we investigated changes in regional cerebral blood flow (rCBF) in humans during the progression from relaxed wakefulness through slow wave sleep (SWS). These changes were examined as a function of spindle (12-15 Hz) and delta (1.5-4.0 Hz) electroencephalographic (EEG) activity of SWS. rCBF was studied with positron emission tomography (PET) using the H215O bolus method. A maximum of six 60 sec scans were performed per subject during periods of wakefulness and stages 1-4 of SWS, as determined by on-line EEG monitoring. Spectral analysis was performed off-line on the EEG epochs corresponding to the scans for computation of activity in specific frequency bands. The relationship between EEG frequency band activity and normalized rCBF was determined by means of a voxel-by-voxel analysis of covariance. delta activity covaried negatively with rCBF most markedly in the thalamus and also in the brainstem reticular formation, cerebellum, anterior cingulate, and orbitofrontal cortex. After the effect of delta was removed, a significant negative covariation between spindle activity and the residual rCBF was evident in the medial thalamus. These negative covariations may reflect the disfacilitation and active inhibition of thalamocortical relay neurons in association with delta and spindles, as well as the neural substrates underlying the progressive attenuation of sensory awareness, motor responsiveness, and arousal that occur during SWS. delta activity covaried positively with rCBF in the visual and auditory cortex, possibly reflecting processes of dream-like mentation purported to occur during SWS.

Adult↗
PubMed1997

Assessment of the functional effect of the intracarotid sodium amobarbital procedure using co-registered MRI/HMPAO-SPECT and SEEG.

We studied the functional effect of injection of sodium amobarbital (SA) in 10 patients with intractable epilepsy. During the intracarotid amobarbital procedure, we measured delta activity in EEG recording from implanted electrodes and regional cerebral blood flow (rCBF) using HMPAO-SPECT co-registered with MRI. SA injection resulted in an increase in delta activity and a decrease in rCBF in all areas examined. Direct functional changes were observed in structures perfused by the carotid artery injected. In addition, we observed indirect effects, probably owing to deafferentation of neuronal pathways connecting these structures to ipsilateral and contralateral regions, including middle and posterior hippocampus.

Amobarbital↗
PubMed1997

Automatic seizure detection in the newborn: methods and initial evaluation.

Seizures are most common in the newborn period, but at that age seizures can be very difficult to identify by clinical observation. Therefore the EEG plays an even greater role in newborns than in older children and adults. The electrographic features of seizures and EEG background in the newborn are, however, very different to those found in adults. We present a set of methods for the automatic detection of seizures in the newborn. The methods are aimed at detecting a wide range of patterns, including rhythmic paroxysmal discharges at a wide range of frequencies, as well as repetitive spike patterns, even when they are not very rhythmic. The methods were developed using EEGs obtained from 55 newborns, recorded at 3 hospitals that used differing monitoring protocols. A total of 281 h of recordings containing 679 seizures were analyzed. An initial evaluation indicated that 71% of the seizures and 78% of seizure clusters (group of seizures separated by less than 90 s) were detected, with a false detection rate of 1.7/h. The methods were developed so that they can be implemented to operate in real time.

Electroencephalography↗
PubMed1997

Evaluation of an automatic seizure detection method for the newborn EEG.

In another publication, we described a set of methods for automatic detection of EEG seizures in the newborn. We describe here the evaluation of these methods using a completely new set of data, which were not used in developing the method. This testing data set consisted of recording from 54 patients, lasting an average of 4.4 h. Recordings had 8-16 channels and were obtained, in approximately equal numbers, from 3 institutions in Canada, the USA and Australia. Recording conditions varied from short recordings fully attended by a technologist to overnight recordings largely unattended. The average seizure detection rate was 69% (77%, 53%, 84% in the 3 institutions). False detections occurred at the average rate of 2.3/h (4.1, 1.0, 2.7 in the 3 institutions), with fluctuations that reflected largely the technical quality and level of supervision of the recordings. The results are similar to those obtained in the commonly used method of epilepsy monitoring in adults and allow us to envisage clinical application.

Electroencephalography↗
PubMed1997

High-frequency gamma electroencephalogram activity in association with sleep-wake states and spontaneous behaviors in the rat.

The occurrence of high-frequency gamma activity (30-60 Hz) and its relationship to other frequency band activities were examined by spectral analysis of the electroencephalogram in association with sleep wake states and spontaneous behaviors in the rat. In the electroencephalogram, gamma wave activity was evident in unfiltered and high-frequency filtered recordings, in which it was prominent during attentive or active Wake episodes and during Paradoxical Sleep, when theta-like activity was also apparent. In amplitude spectra from these episodes, multiple peaks were evident within the gamma frequency band, indicating broad-band high-frequency activity, in association with a single low-frequency peak in the theta band. gamma peaks were attenuated during quiet Waking, in association with a low-frequency peak between theta and delta, and during Slow Wave Sleep, in association with a low-frequency peak in the delta band. In coherence spectra from ipsilateral cortical leads, peaks were also present within the gamma range and were significantly higher in Waking moving and Paradoxical Sleep than in Waking quiet and Slow Wave Sleep. In measures of frequency band amplitude, gamma activity (30.5-58.0 Hz) varied significantly across the sleep waking cycle, being similarly high during Wake and Paradoxical Sleep and lowest during Slow Wave Sleep. Across these states, gamma was negatively correlated with delta (1.5-4.0 Hz). In contrast, high beta (19.0-30.0 Hz) was significantly lower in Wake than in Slow Wave Sleep and was positively correlated with delta. gamma differed significantly across specific behaviors, being highest in Paradoxical Sleep with twitches and during Waking eating and moving behaviors, slightly lower in Waking attentive, lower in Waking grooming and as low in Waking quiet as during Slow Wave Sleep. These results indicate that the reciprocal variation of high-frequency gamma activity (and not beta) with low-frequency delta activity reflects the sleep waking cycle of the rat. Moreover, gamma activity reflects the degree of behavioral arousal, since it is high during active Waking, when the electromyogram is high, and low during quiet Waking, when the electromyogram is low. It also reflects cortical arousal, independent of motor activity, since it attains high levels in association with attentive immobility and maximal levels only during particular active behaviors (eating and moving and not grooming), and it also attains maximal levels during Paradoxical Sleep, when the nuchal electromyogram is minimal, but small twitches evidence dreaming. The co-variation of gamma and a slow oscillation in the theta band across states and behaviors suggests that a common system may modulate these fast and slow electroencephalogram rhythms, and that such modulation, potentially emanating from the basal forebrain, could predominate during certain states or behaviors, such as Paradoxical Sleep.

Animals↗
PubMed1997

A patient-specific algorithm for the detection of seizure onset in long-term EEG monitoring: possible use as a warning device.

During long-term electroencephalogram (EEG) monitoring of epileptic patients, a seizure warning system would allow patients and observers to take appropriate precautions. It would also allow observers to interact with patients early during the seizure, thus revealing clinically useful information. We designed patient-specific classifiers to detect seizure onsets. After a seizure and some nonseizure data are recorded in a patient, they are used to train a classifier. In subsequent monitoring sessions, EEG patterns have to pass this classifier to determine if a seizure onset occurs. If it does, an alarm is triggered. Extreme care has been taken to ensure a low false-alarm rate, since a high false-alarm rate would render the system ineffective. Features were extracted from the time and frequency domains and a modified nearest-neighbor (NN) classifier was used. The system reached an onset detection rate of 100% with an average delay of 9.35 a after onset. The average false-alarm rate was only 0.02/h. The method was evaluated in 12 patients with a total of 47 seizures. Results indicate that the system is effective and reasonably reliable. Computation load has been kept to a minimum so that real-time processing is possible.

Algorithms↗
PubMed1997

Relations between EEG seizure morphology, interhemispheric spread, and mesial temporal atrophy in bitemporal epilepsy.

PURPOSE: A strong relation exists between lateralization of seizure onset in temporal-lobe epilepsy and atrophic mesial structures measured by volumetric magnetic resonance imaging (MRI). We examined whether this relation extended to subregions of the mesial temporal lobe and whether the trend for seizures to spread contralaterally could be related to the localization of atrophy. METHODS: We analyzed 362 seizures (with and without clinical signs) from 23 patients having bitemporal epilepsy in whom intracerebral electrodes were implanted for presurgical evaluation. Patients had measurements of hippocampal and amygdala volumes, including comparison with normal controls. We assessed on EEG the lateralization and localization of seizure onset and the trend to spread to the contralateral side (proportion of seizures that spread for each patient). We included all seizures, independent of the presence of clinical manifestations. These features were related to presence and localization of atrophy. RESULTS: Among the 19 patients with mesial atrophy, agreement between side of prevalent seizure onset and predominant atrophy was found in 10 (53%). From 99 seizures starting in a temporal lobe with atrophy limited to the hippocampus, 67% started simultaneously in amygdala and hippocampus, 20% in hippocampus, and 13% in amygdala. From 137 seizures starting in a temporal lobe with amygdala and hippocampal atrophy, 47% started in amygdala and hippocampus, 48% in hippocampus, and 5% in amygdala. The trend to spread was 45% to the most atrophic side and 62% to the normal or less atrophic side. CONCLUSIONS: When examining amygdala and hippocampus in this group of patients with bitemporal epilepsy, regions of seizure onset did not correspond to regions of predominant atrophy. The likelihood that seizures spread contralaterally was not influenced by atrophy in the region targeted by the spread. Precise relation between mesial temporal atrophy and seizures remain to be elucidated.

Adolescent↗
PubMed1996

Amygdala-hippocampus relationships in temporal lobe seizures: a phase-coherence study.

We analyzed temporal lobe seizures in patients with intracerebral electrodes to assess which of hippocampus and amygdala have a predominant role at seizure onset. Seizures were divided into those of mesial temporal onset, in which amygdala and hippocampus were involved but the neocortex was not (77 seizures from 17 patients), and those of regional onset in which mesial structures and neocortex were involved (89 seizures from 16 patients). We measured coherence and phase between one amygdala channel and one or two hippocampal channels during the first 10 s to determine which structure was leading the discharge. The following results are from 33 focal-mesial seizures and 30 regional seizures in which amygdala-hippocampus coherence was sufficiently high to measure time delays: the amygdala was leading in 21.2% of focal-mesial and 53.3% of regional seizures, and the hippocampus was leading in 48.5% of focal-mesial and 26.7% of regional seizures (chi-square, P < 0.02); in the remaining seizures, discharges were synchronous in the two structures. We conclude that the amygdala is more likely to lead when seizures are of regional onset, whereas the hippocampus is more likely to lead in focal-mesial seizures. This is probably due to the many connections of the amygdala with surrounding temporal neocortex.

Adult↗
PubMed1996

Significance of mesial temporal atrophy in relation to intracranial ictal and interictal stereo EEG abnormalities.

We studied 31 consecutive patients with temporal and extratemporal epilepsy who underwent presurgical evaluation with stereotaxic depth EEG (SEEG) to assess the relationships between amygdalo-hippocampal (AM-HF) atrophy and the location of SEEG seizure onset and SEEG interictal abnormalities. Scalp EEG recordings with sphenoidal electrodes had shown bitemporal ictal or interictal epileptic abnormalities in all. Patients underwent high quality MRI scans, including MRI volumetric measurements of mesial temporal structures. None had foreign tissue lesions. The final conclusions of the SEEG investigation coincided with the lateralization obtained by MRI volumetric measurements in the eight patients who had significant unilateral atrophy of the amygdala, hippocampus or both (> 2 SD below the mean of controls). In these patients with unilateral atrophy, all or > 75% of clinical seizures originated from the atrophic side. The seven patients with bilateral, but significantly asymmetrical, mesial atrophy had bilateral seizure onsets with > 70% originating from the more atrophic side in four, from the less atrophic side in two, and without predominance in one. The one patient with severe bilateral symmetrical atrophy had seizures originating equally from both sides. Five patients had no atrophy on MRI, but depth electrodes revealed predominant unilateral ictal temporal onsets in four of them. There was no significant correlation between the frequency of SEEG interictal spikes and the amount of AM-HF atrophy. However, we found a significant correlation between the severity of SEEG background disturbance in AM and HF and the degree of atrophy of these structures. Patients with unilateral atrophy were more frequently free of seizures after surgery than those with bilateral or no atrophy (P < 0.05). We conclude that unilateral mesial atrophy predicts ipsilateral mesial SEEG seizure onset despite bitemporal extracranial EEG foci. However, in patients with significant bilateral mesial atrophy, SEEG seizures may originate from either side, even in the presence of significant asymmetry. Finally, the identification of unilateral mesial atrophy has prognostic importance.

Adult↗
PubMed1995

The relation of spike foci and of clinical seizure characteristics to different patterns of mesial temporal atrophy.

We reviewed clinical data and scalp electroencephalograms in 61 consecutive patients with temporal lobe epilepsy and mesial temporal atrophy assessed with volumetric magnetic resonance imaging: 39 patients had unilateral and 22 patients had bilateral atrophy. We attempted to determine whether any aspects of seizure symptoms and any electrographic features could be correlated to degree and anatomic pattern of mesial temporal atrophy. Spikes were always confined to temporal regions and were frequently bilateral without a statistically significant difference between patients with unilateral atrophy (33%) and those with bilateral atrophy (50%). Twenty-five of 40 foci associated with amygdala atrophy had maximum field over the anterior temporal regions. In contrast, 19 of 19 foci with isolated hippocampal formation atrophy were never maximum anteriorly. Secondarily generalized seizures and temporal lobe syncopes were correlated with anatomically extensive, particularly amygdala, atrophy. Prolonged postictal confusion was always associated with bitemporal abnormalities in the form of atrophy or spiking. These results explain some of the variability in the clinical and electrographic manifestations of temporal epilepsy and outline the specific role of amygdala involvement in addition to the commonly reported hippocampal atrophy.

Action Potentials↗
PubMed1995

Focal intermittent delta activity in patients with mesiotemporal atrophy: a reliable marker of the epileptogenic focus.

We attempted to determine the significance of background abnormalities and their relation with spikes and location of atrophy in 56 patients with temporal lobe epilepsy (TLE) and mesiotemporal atrophy (MTA) assessed by volumetric magnetic resonance imaging (MRI): 35 patients had unilateral (group I) and 21 had bilateral atrophy with lateralized predominance (group II). Trains of delta waves over temporal regions were observed in > or = 90% of patients. They lateralized with accuracy equal to that of the spikes to the site of atrophy (delta 92% or 29 of 32 patients in group I and 63% or 12 of 19 of group II; spikes 85% or 28 of 33 of group I and 65% or 13 of 20 of group II). Delta waves and spikes occurred together in > 85% of cases. With respect to their location, a striking concordance was observed: delta activity almost always occurred ipsilateral with unilateral spiking (90% or 19 of 21 of patients with unilateral and 88% or 7 of 8 of patients with bilateral atrophy) and bilaterally independently with bilateral spiking (67% or 6 of 9 of patients in group I and 100% or 10 of 10 in group II). Furthermore, spiking and delta activity were never in disagreement with respect to lateralization. In TLE related to MTA, delta transients are a reliable indicator of the epileptogenic focus and presumably reflect the epileptogenic process rather than the underlying structural pathology.

Adolescent↗