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Biomedical subjects

Margitta Seeck

Publications and source records attributed to Margitta Seeck.

At least 19 recordsLinked to original sources
PubMed2006

Induction of an illusory shadow person.

Stimulation of a site on the brain's left hemisphere prompts the creepy feeling that somebody is close by. The strange sensation that somebody is nearby when no one is actually present has been described by psychiatric and neurological patients, as well as by healthy subjects, but it is not understood how the illusion is triggered by the brain. Here we describe the repeated induction of this sensation in a patient who was undergoing presurgical evaluation for epilepsy treatment, as a result of focal electrical stimulation of the left temporoparietal junction: the illusory person closely 'shadowed' changes in the patient's body position and posture. These perceptions may have been due to a disturbance in the multisensory processing of body and self at the temporoparietal junction.

Adult↗
PubMed2006

Contralateral smile and laughter, but no mirth, induced by electrical stimulation of the cingulate cortex.

The cerebral representation of laughter is dissociated. The emotional aspects seem to be processed in the temporal lobe; whereas the motor features apparently rely on the frontal cortex. In a few prior studies of patients in whom laughter was elicited by electrical stimulation (ES), it always was associated with mirth. We report a patient in whom ES in the right cingulate gyrus elicited smile and laughter, but no mirth. At low voltages, smiling was seen first contralaterally and became bilateral with increasing currents. Our observation supports the concept of the motor representation of laughter in the mesial frontal cortex.

Adult↗
PubMed2006

EEG source imaging in pediatric epilepsy surgery: a new perspective in presurgical workup.

PURPOSE: Epilepsy is a relatively frequent disease in children, with considerable impact on cognitive and social life. Successful epilepsy surgery depends on unambiguous focus identification and requires a comprehensive presurgical workup, including several neuroimaging techniques [magnetic resonance imaging, positron emission tomography (PET), and single-photon emission computed tomography (SPECT)]. These may be difficult to apply in younger or developmentally delayed children or both, requiring sedation, and hence, a significant workforce. Modern electric source imaging (ESI) provides accurate epileptic source-localization information in most patients, with minimal patient discomfort or need for cooperation. The purpose of the present study was to determine the usefulness of ESI in pediatric EEG recordings performed with routine electrode arrays. METHODS: Preoperative EEGs recorded from 19 to 29 scalp electrodes were reviewed, and interictal epileptiform activity was analyzed by using a linear source-imaging procedure (depth-weighted minimum norm) in combination with statistical parametric mapping. RESULTS: In 27 (90%) of 30 patients, the ESI correctly localized the epileptogenic region. These numbers compare favorably with the results from other imaging techniques in the same patients (PET, 82%; ictal SPECT, 70%). In extratemporal epilepsy, ESI was correct in all cases, and in temporal lobe epilepsy, in 10 of 13 cases. In two temporal lobe patients showing less-accurate ESI results, 128-electrode data could be analyzed, and in both cases, the 128-electrode ESI was correct. CONCLUSIONS: ESI with standard clinical EEG recordings provides excellent localizing information in pediatric patients, in particular in extratemporal lobe epilepsy. The lower yield in temporal lobe epilepsy seems to be due to undersampling of basal temporal areas with routine scalp recordings.

Adolescent↗
PubMed2006

Postictal but not interictal hemispatial neglect in patients with seizures of lateralized onset.

PURPOSE: Unilateral spatial neglect, defined as a failure to report, respond, or orient to stimuli that are presented contralaterally, has been widely documented after brain damage to right, and to a lesser degree, left frontotemporoparietal networks. Group studies involving patients with seizures with a lateralized focus have demonstrated transient dysfunctions in memory and language; however, so far, only two case reports have described transient neglect after an epileptic seizure. METHODS: To assess the existence and consistency of this phenomenon, we evaluated 33 epilepsy patients on a line-bisection task in interictal and postictal states as compared with an age- and sex-matched control group. RESULTS: Spatial neglect, as determined by this test, was found in the postictal but not interictal examination in patients with right parietal epileptic foci and was maximal for the left-positioned lines, whereas no neglect was found in other groups. CONCLUSIONS: Our findings indicate that patients with right parietal foci can present a transient neglect phenomenon on the line-bisection task in the postictal period, even in the absence of overt clinical neglect signs. These findings might be useful in establishing the laterality and even localization of epileptic foci based on the postictal neuropsychological evaluation.

Adolescent↗
PubMed2005

Linking out-of-body experience and self processing to mental own-body imagery at the temporoparietal junction.

The spatial unity of self and body is challenged by various philosophical considerations and several phenomena, perhaps most notoriously the "out-of-body experience" (OBE) during which one's visual perspective and one's self are experienced to have departed from their habitual position within one's body. Although researchers started examining isolated aspects of the self, the neurocognitive processes of OBEs have not been investigated experimentally to further our understanding of the self. With the use of evoked potential mapping, we show the selective activation of the temporoparietal junction (TPJ) at 330-400 ms after stimulus onset when healthy volunteers imagined themselves in the position and visual perspective that generally are reported by people experiencing spontaneous OBEs. Interference with the TPJ by transcranial magnetic stimulation (TMS) at this time impaired mental transformation of one's own body in healthy volunteers relative to TMS over a control site. No such TMS effect was observed for imagined spatial transformations of external objects, suggesting the selective implication of the TPJ in mental imagery of one's own body. Finally, in an epileptic patient with OBEs originating from the TPJ, we show partial activation of the seizure focus during mental transformations of her body and visual perspective mimicking her OBE perceptions. These results suggest that the TPJ is a crucial structure for the conscious experience of the normal self, mediating spatial unity of self and body, and also suggest that impaired processing at the TPJ may lead to pathological selves such as OBEs.

Adult↗
PubMed2005

Reversible cytotoxic edema in the splenium of the corpus callosum related to antiepileptic treatment: report of two cases and literature review.

PURPOSE: Clinically silent lesions localized in the splenium of the corpus callosum (SCC) are a rare finding in the magnetic resonance imaging (MRI) of patients receiving antiepileptic drugs (AEDs). They are usually of benign character but may induce unnecessary complementary examinations if their nature is unrecognized. So far, 22 cases have been described in the literature, for which different etiologies have been proposed. We describe two further cases and discuss the probable lesion etiology. METHODS: We report two cases including a 25-year-old male patient and a 12-year-old female patient with a transient SCC lesion discovered in the context of a presurgical epilepsy evaluation. RESULTS: Comprehensive MRIs, including diffusion tensor imaging-based fiber tracking of the lesion, revealed a cytotoxic edema not disrupting neuronal fibers. Serum arginine vasopressin (AVP) measurements revealed an altered secretion during the acute phase in one patient. CONCLUSIONS: On the basis of our results, we hypothesize that the lesion consists of a cytotoxic edema, possibly induced by abrupt AED concentration changes and associated to alterations of AVP secretion.

Adolescent↗
PubMed2005

Subcortical nuclei volumetry in idiopathic generalized epilepsy.

PURPOSE: The exact anatomic and neurophysiologic correlates of idiopathic generalized epilepsy (IGE) in humans are still not well understood, although the thalamus has frequently been invoked as the crucial structure in the generation of primary generalized seizures. The few in vivo magnetic resonance (MR)-based studies in IGE patients suggest an altered cortical/subcortical gray matter ratio, but with no evidence of structural alterations of the thalamus. In this study, we sought to determine the volumes of the other subcortical structures. METHODS: The volumes of the caudate nucleus, putamen, pallidum as well as the thalamus were each determined in both hemispheres in 11 patients with various IGE syndromes, normalized for whole-brain volumes and then compared with 15 age-matched controls. RESULTS: No differences were noted in thalamic volumes, confirming previous reports. However, smaller subcortical volumes were noted in the IGE patients (p < 0.009), mainly due to smaller putamen bilaterally (p < or = 0.015). CONCLUSIONS: It is speculated that the presence of discrete frontal dysfunction, as noted in neuropsychological studies in IGE patients, indirectly supports our results because the putamen projects predominantly to the frontal cortex. Larger studies with more homogeneous patient populations are needed to determine the robustness of these findings and whether they are specific for particular IGE syndromes.

Adult↗
PubMed2004

Cortical motion deafness.

The extent to which the auditory system, like the visual system, processes spatial stimulus characteristics such as location and motion in separate specialized neuronal modules or in one homogeneously distributed network is unresolved. Here we present a patient with a selective deficit for the perception and discrimination of auditory motion following resection of the right anterior temporal lobe and the right posterior superior temporal gyrus (STG). Analysis of stimulus identity and location within the auditory scene remained intact. In addition, intracranial auditory evoked potentials, recorded preoperatively, revealed motion-specific responses selectively over the resected right posterior STG, and electrical cortical stimulation of this region was experienced by the patient as incoming moving sounds. Collectively, these data present a patient with cortical motion deafness, providing evidence that cortical processing of auditory motion is performed in a specialized module within the posterior STG.

Acoustic Stimulation↗
PubMed2004

The speed of visual cognition.

Intracranial electrophysiological recordings in primates showed repeatedly that neurons in several cortical areas are activated very early after visual stimulus presentation, practically at the same time (or even before) the activation of primary sensory neurons. Even neurons at the highest hierarchical levels of the visual system are activated in less than 100 ms. These findings challenge the classical interpretation of human evoked potential (EP) data that assume that the first, "exogenous", EP components from 50 to 150 ms reflect the initial volley of sensory activation in the striate and extrastriate visual cortex and are not yet influenced by cognitive task demands. Indeed, several recent EP studies using analysis methods that go beyond the classical approach of defining "components" at certain scalp positions indicate that highly complex stimulus features can influence EP responses within the first 100 ms. This indicates that sophisticated cognitive processing is much faster than previously thought and opens new perspectives with respect to the role of both, bottom-up as well as top-down mechanisms in visual processing.

Acoustic Stimulation↗
PubMed2003

Out-of-body experience and autoscopy of neurological origin.

During an out-of-body experience (OBE), the experient seems to be awake and to see his body and the world from a location outside the physical body. A closely related experience is autoscopy (AS), which is characterized by the experience of seeing one's body in extrapersonal space. Yet, despite great public interest and many case studies, systematic neurological studies of OBE and AS are extremely rare and, to date, no testable neuroscientific theory exists. The present study describes phenomenological, neuropsychological and neuroimaging correlates of OBE and AS in six neurological patients. We provide neurological evidence that both experiences share important central mechanisms. We show that OBE and AS are frequently associated with pathological sensations of position, movement and perceived completeness of one's own body. These include vestibular sensations (such as floating, flying, elevation and rotation), visual body-part illusions (such as the illusory shortening, transformation or movement of an extremity) and the experience of seeing one's body only partially during an OBE or AS. We also find that the patient's body position prior to the experience influences OBE and AS. Finally, in five patients, brain damage or brain dysfunction is localized to the temporo-parietal junction (TPJ). These results suggest that the complex experiences of OBE and AS represent paroxysmal disorders of body perception and cognition (or body schema). The processes of body perception and cognition, and the unconscious creation of central representation(s) of one's own body based on proprioceptive, tactile, visual and vestibular information-as well as their integration with sensory information of extrapersonal space-is a prerequisite for rapid and effective action with our surroundings. Based on our findings, we speculate that ambiguous input from these different sensory systems is an important mechanism of OBE and AS, and thus the intriguing experience of seeing one's body in a position that does not coincide with its felt position. We suggest that OBE and AS are related to a failure to integrate proprioceptive, tactile and visual information with respect to one's own body (disintegration in personal space) and by a vestibular dysfunction leading to an additional disintegration between personal (vestibular) space and extrapersonal (visual) space. We argue that both disintegrations (personal; personal-extrapersonal) are necessary for the occurrence of OBE and AS, and that they are due to a paroxysmal cerebral dysfunction of the TPJ in a state of partially and briefly impaired consciousness.

Body Image↗
PubMed2003

Direction of saccadic and smooth eye movements induced by electrical stimulation of the human frontal eye field: effect of orbital position.

The present study reports on the direction of saccadic and smooth eye movements, which were induced electrically from the human dorsolateral frontal cortex including the human frontal eye field (FEF). The eye position prior to stimulation was varied in order to examine its effect on induced eye movement direction. The five patients of the study underwent invasive presurgical evaluation for pharmacoresistant epilepsy. The present data show that the direction of electrically induced eye movements was always contralateral and either horizontal or oblique upward if the eye started from the primary position. The elicited direction was changed if the eyes started from an eccentric position. The frequency of oblique eye movements was increased and oblique downward responses were induced, which were not observed if the eye started from the primary position. This was found for saccades and, especially, for smooth eye movements. Head movements, which were almost exclusively induced with saccades, did not depend on initial orbital position. Four conclusions can be drawn. Firstly, saccades and smooth eye movements induced from the human dorsolateral cortex including the human FEF have the same directional bias. Secondly, the frequent upward responses and the absence of downward responses induced from the primary position suggests either a more numerous or a more superficial representation of neurons that code for the former direction. Thirdly, at some sites the direction of saccades and smooth eye movements varies depending on the initial orbital position. Since these directional changes were observed without changes in eye-head coordination, our data suggest that stimulation of the FEF might evoke goal-directed saccades or interferes with a resettable saccade integrator. Fourthly, human studies that investigate eye movements induced from the lateral frontal cortex need to control eye position prior to stimulation.

Adolescent↗
PubMed2003

Brain activation using triggered event-related fMRI.

EEG-triggered fMRI provides a method for localizing the sources of brain electrical activity, such as epileptic discharges. Extending single-image acquisitions, following an event on the EEG, into triggered image series acquisitions may allow BOLD time courses to be obtained, such as those observed in event-related (ER) fMRI experiments. However, in contrast to the standard ER-fMRI, triggered image series are greatly affected by magnetization non-steady-state effects. The purpose of this paper is to show that the BOLD responses can be recovered using subtraction between two triggered image series having different functional contrasts. In order to evaluate this technique, a comparison with standard ER-fMRI using motor cortex activation task was made in 5 volunteers. We conclude that this can be a useful technique for studying brain activation associated with irregularly appearing stimuli.

Attention↗
PubMed2003

[Surgical treatment of epilepsy: another therapeutic option].

Around 10,000 patients with pharmacoresistant epilepsy are living in Switzerland for whom surgical treatment potentially represents an alternative to medical treatment. Here we discuss the results of the first 250 patients investigated in the presurgical epilepsy unit Geneva-Lausanne since its foundation in April 1995. Two thirds of these patients were adults and one third children and adolescents. In 85% of cases, non-invasive methods (Phase I) were sufficient for the diagnosis of the epileptic syndrome. In our unit non-invasive techniques include the following: prolonged Video-EEG monitoring, high resolution MRI, PET, neurological and neuropsychological evaluation during the ictal and interictal periods and a psychiatric examination. Globally, more than 90% of patients benefited significantly from the surgical intervention: 76% of patients were seizure free and 18% significantly improved. A psychiatric evaluation was also systematically carried out and demonstrated that two thirds of the examined patients suffered from a concomitant psychiatric disorder. Depression was encountered most often (31%). The necessity of a rapid diagnosis of pharmacoresistant epilepsy, amenable to surgical treatment, is discussed in order to obtain an optimal seizure control and preservation of the integrity of cognitive functions.

Adolescent↗
PubMed2003

[New brain imaging techniques].

Neuroimaging technologies have improved neurology and neurosurgery by providing tools to look inside the brain and investigate its functions and diseases. As for any tool, the users should know the basics of each technique and be aware about their uses and limitations. Here we review these new techniques and illustrate their use with examples from studies at the University Hospital in Geneva. From all the techniques, MRI (Magnetic Resonance Imagery) has the highest spatial resolution. Taking advantage of the magnetic properties of the hydrogen nucleus, it is possible to reach a sub-millimeter resolution in 3D. When MRI images are digitized, they can be treated to perform re-slicing, segmentation and 3D reconstruction of cortical surfaces, as well as to measure anatomical structures (volumetry). Functional MRI (fMRI) is based on blood oxygenation changes when a task is performed or when epileptic activity occurred. Then it can be used to non-invasively show for example language, motor or epileptic network activation. Electromagnetic imaging techniques, based on EEG and MEG, have the power to localize in 3D the electrical activity of the brain with millisecond temporal resolution and then to follow the temporal activation of neuronal networks. These techniques use mathematical models and algorithms to compute 3D tomography from 2D recordings on the scalp. In the case of epilepsy, EEG allows epileptic foci identification among propagation sites when it is recorded with a sufficient number of electrodes (> 100) and when realistic head models are used. The functional imaging techniques from nuclear medicine (PET and SPECT) have become very useful in neuroscience to explore cerebral changes associated with neuronal pathologies as well as cognitive and sensory tasks. Many efforts have been made to develop new cameras and models to increase the range of research and clinical applications. Co-registration of structural and functional images allows us to add functional information to a structural deficit, or conversely to better interpret functional images such as PET, SPECT and EEG in terms of specific anatomy. In the case of SPECT and fMRI, substraction between ictal and interictal exams points out areas involved in epileptic processes.

Brain Diseases↗