Geertjan Huiskamp

McGill University, Montréal, Quebec, Canada

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Publications (77)184.08 Total impact

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    ABSTRACT: Background: Intra-operative electrocorticography, based on interictal spikes and spike patterns, is performed to optimize delineation of the epileptogenic tissue during epilepsy surgery. High frequency oscillations (HFOs, 80-500 Hz) have been identified as more precise biomarkers for epileptogenic tissue. The aim of the trial is to determine prospectively if ioECoG-tailored surgery using HFOs, instead of interictal spikes, is feasible and will lead to an equal or better seizure outcome. METHODS\DESIGN: We present a single-blinded multi-center randomized controlled trial "The HFO Trial" including patients with refractory focal epilepsy of all ages who undergo surgery with intra-operative electrocorticography. Surgery is tailored by HFOs (arm 1) or interictal spikes (arm 2) in the intra-operative electrocorticography. Primary outcome is post-operative outcome after 1 year, dichotomized in seizure freedom (Engel 1A and 1B) versus seizure recurrence (Engel 1C-4). Secondary outcome measures are the volume of resected tissue, neurologic deficits, surgical duration and complications, cognition and quality of life. The trial has a non-inferiority design to test feasibility and at least equal performance in terms of surgical outcome. We aim to include 78 patients within 3 years including 1 year follow-up. Results are expected in 2018. Discussion: This trial provides a transition from observational research towards clinical interventions using HFOs. We address methodological difficulties in designing this trial. We expect that the use of HFOs as a biomarker for tailoring will increase the success rate of epilepsy surgery while reducing resection volume. This may reduce neurological deficits and yield a better quality of life. Future technical developments, such as validated automatic online HFO identification, could, together with the attained clinical knowledge, lead to a new objective tailoring approach in epilepsy surgery. Trial registration: This trial is registered at the US National Institutes of Health ( #NCT02207673 (31 July 2014) and the Central Committee on Research Involving Human Subjects, The Netherlands #NL44257.041.13 (18 March 2014).
    Trials 09/2015; 16(1):422. DOI:10.1186/s13063-015-0932-6 · 1.73 Impact Factor
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    ABSTRACT: Objective: Single Pulse Electrical Stimulation (SPES) probes epileptogenic cortex during electrocorticography. Two SPES responses are described: pathological delayed responses (DR, >100ms) associated with the seizure onset zone (SOZ) and physiological early responses (ER, <100ms) that map cortical connectivity. We analyzed properties of ERs, including frequencies >80Hz, in the SOZ and seizure propagation areas. Methods: We used data from 12 refractory epilepsy patients. SPES consisted of 10 pulses of 1ms, 4-8mA and 5s interval on adjacent electrodes pairs. Data were available at 2048samples/s for six and 512samples/s (22 bits) for eight patients and analyzed in the time-frequency (TF) and time-domain (TD). Results: Electrodes with ERs were stronger associated with SOZ than non-SOZ electrodes. ERs with frequency content >80Hz exist and are specific for SOZ channels. ERs evoked by stimulation of seizure onset electrodes were associated with electrodes involved in seizure propagation. Conclusion: Analysis of ERs can reveal aspects of pathology, manifested by association with seizure propagation and areas with high ER numbers that coincide with the SOZ. Significance: Not only DRs, but also ERs could have clinical value for mapping epileptogenic cortex and help to unravel aspects of the epileptic network.
    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 09/2015; DOI:10.1016/j.clinph.2015.07.031 · 3.10 Impact Factor
  • Anne H. Mooij · Geertjan J.M. Huiskamp · Peter H. Gosselaar · Cyrille H. Ferrier ·
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    ABSTRACT: Objective: Electrocorticographic (ECoG) mapping of high gamma activity induced by language tasks has been proposed as a more patient friendly alternative for electrocortical stimulation mapping (ESM), the gold standard in pre-surgical language mapping of epilepsy patients. However, ECoG mapping often reveals more language areas than considered critical with ESM. We investigated if critical language areas can be identified with a listening task consisting of speech and music phrases. Methods: Nine patients with implanted subdural grid electrodes listened to an audio fragment in which music and speech alternated. We analysed ECoG power in the 65-95Hz band and obtained task-related activity patterns in electrodes over language areas. We compared the spatial distribution of sites that discriminated between listening to speech and music to ESM results using sensitivity and specificity calculations. Results: Our listening task of alternating speech and music phrases had a low sensitivity (0.32) but a high specificity (0.95). Conclusions: The high specificity indicates that this test does indeed point to areas that are critical to language processing. Significance: Our test cannot replace ESM, but this short and simple task can give a reliable indication where to find critical language areas, better than ECoG mapping using language tasks alone.
    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 08/2015; DOI:10.1016/j.clinph.2015.08.005 · 3.10 Impact Factor
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    ABSTRACT: We studied whether residual high-frequency oscillations (80-500 Hz; ripples, 80-250 Hz), especially fast ripples (FRs, 250-500 Hz), in post-resection intraoperative electrocorticography (ECoG) predicted seizure recurrence in comparison to residual interictal spikes and ictiform spike patterns. We studied, retrospectively, ECoG recorded at 2,048 Hz after resection in a cohort of patients with refractory focal epilepsy. We analyzed occurrence and number of residual FRs, ripples, interictal spikes, and ictiform spike patterns within the last minute of each recording and compared these to seizure recurrence. We included 54 patients (median age 15.5 years) with 25 months median follow-up. Twenty-four patients had recurrent seizures. We found residual FRs, ripples, spikes, and ictiform spike patterns in 12, 51, 38, and 9 patients. Nine out of 12 patients with residual FRs had recurrent seizures (p = 0.016, positive predictive value 75%). Other ECoG events did not predict seizure recurrence. Patients with seizures had higher FR rates than seizure-free patients (p = 0.022). FRs near the resection and in distant pathologic areas could have changed the resection in 8 patients without harming functionally eloquent areas. One seizure-free patient had FRs in distant functionally eloquent areas. Residual FRs in post-resection ECoG are prognostic markers for seizure recurrence, especially if their number is high. Tailoring could rely on FRs, but requires careful assessment of the ECoG, as FRs in functionally eloquent areas might not be pathologic. © 2015 American Academy of Neurology.
    Neurology 06/2015; 85(2). DOI:10.1212/WNL.0000000000001727 · 8.29 Impact Factor
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    ABSTRACT: Objective: To investigate whether delirious patients differ from nondelirious patients with regard to blinks and eye movements to explore opportunities for delirium detection. Methods: Using a single-center, observational study in a tertiary hospital in the Netherlands, we studied 28 delirious elderly and 28 age- and gender-matched (group level) nondelirious elderly, postoperative cardiac surgery patients. Patients were evaluated for delirium by a geriatrician, psychiatrist, or neurologist using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Blinks were automatically extracted from electro-oculograms and eye movements from electroencephalography recordings using independent component analysis. The number and duration of eye movements and blinks were compared between patients with and without delirium, based on the classification of the delirium experts described above. Results: During eyes-open registrations, delirious patients showed, compared with nondelirious patients, a significant decrease in the number of blinks per minute (median: 12 [interquartile range {IQR}: 5-18] versus 18 [IQR: 8-25], respectively; p = 0.02) and number of vertical eye movements per minute (median: 1 [IQR: 0-13] versus 15 [IQR: 2-54], respectively; p = 0.01) as well as an increase in the average duration of blinks (median: 0.5 [IQR: 0.36-0.95] seconds versus 0.34 [IQR: 0.23-0.53] seconds, respectively; p <0.01). During eyes-closed registrations, the average duration of horizontal eye movements was significantly increased in delirious patients compared with patients without delirium (median: 0.41 [IQR: 0.15-0.75] seconds versus 0.08 [IQR: 0.06-0.22] seconds, respectively; p <0.01). Conclusion: Spontaneous eye movements and particularly blinks appear to be affected in delirious patients, which holds promise for delirium detection.
    The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 12/2014; 22(12). DOI:10.1016/j.jagp.2014.01.001 · 4.24 Impact Factor
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    ABSTRACT: Purpose [18F] Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is a semi-invasive, interictal method of localization of hypometabolic epileptic foci. FDG-PET can be useful in the clinical work-up prior to epilepsy surgery, especially in equivocal cases. We investigated whether we could increase the yield of presurgical FDG-PET in patients with difficult epilepsy requiring chronic subdural electrocorticography (ECoG). Methods We retrospectively studied patients with refractory focal epilepsy in whom there was uncertainty about the focus localization and who underwent FDG-PET and ECoG. Two experts (epileptologist and nuclear medicine radiologist) together systematically re-assessed the scans visually (PETRE), blinded to their initial reports. Scans were also re-analyzed by comparing them to a normal control dataset with statistical parametric mapping (SPM), using a liberal (PETSPM1), and strict (PETSPM2) statistical threshold. Regions with hypometabolism and regions containing the seizure onset zone (SOZ) in ECoG were marked as positive anatomical regions (PARs). We compared the concordance of these PARs for the different PET re-assessments. We calculated the sensitivity, specificity and accuracy of the PET results for the SOZ. The added value of the re-assessments was evaluated with emphasis on scans initially reported as negative. Results 41 Patients (63% extra-temporal) were included. PETRE identified the SOZ best, with a sensitivity of 62% and specificity of 93%. PETSPM1 had a sensitivity of 62% and specificity 69%, for PETSPM2 this was 35% and 85% respectively. The overlap between PETRE vs. PETSPM1 and vs. PETSPM2 was 71% and 37%. Visual re-assessment and PETSPM1 identified the SOZ in four out of five scans that were initially reported as negative. Conclusions Pre-surgical re-assessment of PET scans is worthwhile in epilepsy patients who undergo ECoG, especially when results were reported as negative before. Visual re-assessment itself has a higher combined specificity, sensitivity and accuracy than SPM analysis alone. SPM analysis could be used as a guide for visual (re-)assessment, because of its high sensitivity.
    Epilepsy Research 08/2014; 108(6). DOI:10.1016/j.eplepsyres.2014.04.011 · 2.02 Impact Factor

  • Clinical Neurophysiology 06/2014; 125:S46-S47. DOI:10.1016/S1388-2457(14)50163-0 · 3.10 Impact Factor
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    ABSTRACT: Removal of brain tissue showing high frequency oscillations (HFOs; ripples: 80-250Hz and fast ripples: 250-500Hz) in preresection electrocorticography (preECoG) in epilepsy patients seems a predictor of good surgical outcome. We analyzed occurrence and localization of HFOs in intra-operative preECoG and postresection electrocorticography (postECoG). HFOs were automatically detected in one-minute epochs of intra-operative ECoG sampled at 2048Hz of fourteen patients. Ripple, fast ripple, spike, ripples on a spike (RoS) and not on a spike (RnoS) rates were analyzed in pre- and postECoG for resected and nonresected electrodes. Ripple, spike and fast ripple rates decreased after resection. RnoS decreased less than RoS (74% vs. 83%; p=0.01). Most fast ripples in preECoG were located in resected tissue. PostECoG fast ripples occurred in one patient with poor outcome. Patients with good outcome had relatively high postECoG RnoS rates, specifically in the sensorimotor cortex. Our observations show that fast ripples in intra-operative ECoG, compared to ripples, may be a better biomarker for epileptogenicity. Further studies have to determine the relation between resection of epileptogenic tissue and physiological ripples generated by the sensorimotor cortex. Fast ripples in intra-operative ECoG can help identify the epileptogenic zone, while ripples might also be physiological.
    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 03/2014; 125(11). DOI:10.1016/j.clinph.2014.03.004 · 3.10 Impact Factor
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    ABSTRACT: EEG-correlated functional MRI (EEG-fMRI) visualizes brain regions associated with interictal epileptiform discharges (IEDs). This technique images the epileptiform network, including multifocal, superficial and deeply situated cortical areas. To understand the role of EEG-fMRI in presurgical evaluation, its results should be validated relative to a gold standard. For that purpose, EEG-fMRI data were acquired for a heterogeneous group of surgical candidates (n=16) who were later implanted with subdural grids and strips (ECoG). The EEG-fMRI correlation patterns were systematically compared to brain areas involved in IEDs ECoG, using a semi-automatic analysis method, as well as to the seizure onset zone, resected area, and degree of seizure freedom. In each patient at least one of the EEG-fMRI areas was concordant with an interictally active ECoG area, always including the early onset area of IEDs in the ECoG data. This confirms that EEG-fMRI reflects a pattern of onset and propagation of epileptic activity. At group level, 76% of the BOLD regions that were covered with subdural grids, were concordant with interictally active ECoG electrodes. Due to limited spatial sampling, 51% of the BOLD regions were not covered with electrodes and could, therefore, not be validated. From an ECoG perspective it appeared that 29% of the interictally active ECoG regions were missed by EEG-fMRI and that 68% of the brain regions were correctly identified as inactive with EEG-fMRI. Furthermore, EEG-fMRI areas included the complete seizure onset zone in 83% and resected area in 93% of the data sets. No clear distinction was found between patients with a good or poor surgical outcome: in both patient groups, EEG-fMRI correlation patterns were found that were either focal or widespread. In conclusion, by comparison of EEG-fMRI with interictal invasive EEG over a relatively large patient population we were able to show that the EEG-fMRI correlation patterns are spatially accurate at the level of neurosurgical units (i.e. anatomical brain regions) and reflect the underlying network of IEDs. Therefore, we expect that EEG-fMRI can play an important role for the determination of the implantation strategy.
    NeuroImage 02/2013; 75. DOI:10.1016/j.neuroimage.2013.02.033 · 6.36 Impact Factor
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    ABSTRACT: Purpose: Epileptic high-frequency oscillations (HFOs; 80–500 Hz) may be used to guide neurosurgeons during epilepsy surgery to identify epileptogenic tissue. We studied the effect of the anesthetic agent propofol on the occurrence of HFOs in intraoperative electrocorticography (ECoG). Methods: We selected patients who were undergoing surgery for temporal lobe epilepsy with a standardized electrode grid placement. Intraoperative ECoG was recorded at 2,048 Hz following cessation of propofol. The number and distribution of interictal spikes, ripples (R [80–250 Hz]), and fast ripples (FRs; 250–500 Hz) were analyzed. The amount of events on mesiotemporal channels and lateral neocortical channels were compared between patients with a suspected mesiotemporal and lateral epileptogenic area (Student’s t-test), and HFOs were compared with the irritative zone, using correlation between amounts of events per channel, to provide evidence for the epileptic nature of the HFOs. Next, the amount of events within the first minute and the last minute were compared to each other and the change in events over the entire epochs was analyzed using correlation analyses of 10 epochs during the emergence periods (Spearman rank test). We studied whether the duration of HFOs changed over time. The change in events within presumed epileptogenic area was compared to the change outside this area (Student’s t-test). Periods of burst suppression and continuous background activity were compared between and within patients (t-test). Key Findings: Twelve patients were included: five with suspected mesiotemporal epileptogenic area and three with suspected lateral epileptogenic area (and four were “other”). Spikes, ripples, and FRs were related to the suspected epileptogenic areas, and HFO zones were related to the irritative zones. Ripples and FRs increased during emergence from propofol anesthesia (mean number of ripples from first minute–last minute: 61.5–73.0, R = 0.46, p < 0.01; FRs: 3.1–5.7, R = 0.30, p < 0.01) and spikes remained unchanged (80.1–79.9, R = −0.05, p = 0.59). There was a decrease in number of channels with spikes (R = −0.18, p = 0.05), but no change in ripples (R = −0.13, p = 0.16) or FRs (R = 0.11, p = 0.45). There was no change in the durations of HFOs. The amount of HFOs in the presumed epileptogenic areas did not change more than the amount outside the presumed epileptogenic area, whereas spikes paradoxically decreased more within the suspected epileptogenic area. Six patients showing burst-suppression had lower rates of ripples than six other patients with continuous background activity (p = 0.02). No significant difference was found between burst suppression and continuous background activity in four patients, but there was a trend toward showing more ripples during continuous background activity (p = 0.16). Significance: Propofol, known for its antiepileptic effects, reduces the number of epileptic HFOs, but has no effect on spikes. This enforces the hypothesis that, in epilepsy, HFOs mirror the disease activity and HFOs might be useful for monitoring antiepileptic drug treatment. It is feasible to record HFOs during surgery, but propofol infusion should be interrupted for some minutes to improve detection.
    Epilepsia 09/2012; 53(10):1799-809. DOI:10.1111/j.1528-1167.2012.03650.x · 4.57 Impact Factor
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    ABSTRACT: Magnetoencephalography (MEG) is used in the presurgical work-up of patients with focal epilepsy. In particular, localization of MEG interictal spikes may guide or replace invasive electroencephalography monitoring that is required in difficult cases. From literature, it is not clear which MEG source localization method performs best in this clinical setting. Therefore, we applied three source localization methods to the same data from a large patient group for which a gold standard, interictal spikes as identified in electrocorticography (ECoG), was available. The methods used were multiple signal classification (MUSIC), Synthetic Aperture Magnetometry kurtosis [SAM(g2)], and standardized low-resolution electromagnetic tomography. MEG and ECoG data from 38 patients with refractory focal epilepsy were obtained. Results of the three source localization methods applied to the interictal MEG data were assigned to predefined anatomical regions. Interictal spikes as identified in ECoG were also assigned to these regions. Identified regions by each MEG method were compared to ECoG. Sensitivity and positive predictive value (PPV) of each MEG method were calculated. All three MEG methods showed a similar overall correlate with ECoG spikes, but the methods differ in which regions they detect. The choice of the inverse model thus has an unexpected influence on the results of magnetic source imaging. Combining inverse methods and seeking consensus can be used to improve specificity at the cost of some sensitivity. Combining MUSIC with SAM(g2) gives the best results (sensitivity = 38% and PPV = 82%). Hum Brain Mapp, 2012. © 2012 Wiley Periodicals, Inc.
    Human Brain Mapping 03/2012; 34(9). DOI:10.1002/hbm.22049 · 5.97 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the contribution of posterior circulation to memory function by comparing memory scores between patients with and without a foetal-type posterior cerebral artery (FTP) during the intracarotid amobarbital procedure (IAP) in epilepsy patients. Patients undergoing bilateral IAP between January 2004 and January 2010 were retrospectively included. Pre-test angiograms were assessed for the presence of a FTP. Memory function scores (% correct) after right and left injections were obtained. Functional significance of FTP was affirmed by relative occipital versus parietal EEG slow-wave increase during IAP. Memory and EEG scores were compared between patients with and without FTP (Mann-Whitney U test). A total of 106 patients were included, 73 with posterior cerebral arteries (PCA) without FTP ('non-FTP'), 28 patients with unilateral FTP and 5 with a bilateral FTP. Memory scores were lower when amytal was injected to the hemisphere contralateral to the presumed seizure focus (on the right decreasing from 98.3 to 59.1, and on the left decreasing from 89.1 to 72.4; p < 0.001). When IAP was performed on the side of FTP memory scores were significantly lower (70.8) compared to non-FTP (82.0; p = 0.02). Relative occipital EEG changes were 0.44 for FTP cases and 0.36 for non-FTP patients (p = 0.01). A relationship between vasculature and brain function was demonstrated by lower memory scores and more slow-wave activity on occipital EEG during IAP in patients with foetal-type PCA compared to patients with non-FTP. This suggests an important contribution of brain areas supplied by the PCA to memory function.
    Journal of Neurology 01/2012; 259(8):1632-8. DOI:10.1007/s00415-011-6391-4 · 3.38 Impact Factor
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    ABSTRACT: Epilepsy surgery depends on reliable pre-surgical markers of epileptogenic tissue. The current gold standard is the seizure onset zone in ictal, i.e. chronic, electrocorticography recordings. Single pulse electrical stimulation can evoke epileptic, spike-like responses in areas of seizure onset also recorded by electrocorticography. Recently, spontaneous pathological high-frequency oscillations (80-520 Hz) have been observed in the electrocorticogram that are related to epileptic spikes, but seem more specific for epileptogenic cortex. We wanted to see whether a quantitative electroencephalography analysis using time-frequency information including the higher frequency range could be applied to evoked responses by single pulse electrical stimulation, to enhance its specificity and clinical use. Electrocorticography data were recorded at a 2048-Hz sampling rate from 13 patients. Single pulse electrical stimulation (10 stimuli, 1 ms, 8 mA, 0.2 Hz) was performed stimulating pairs of adjacent electrodes. A time-frequency analysis based on Morlet wavelet transformation was performed in a [-1 s : 1 s] time interval around the stimulus and a frequency range of 10-520 Hz. Significant (P = 0.05) changes in power spectra averaged for 10 epochs were computed, resulting in event-related spectral perturbation images. In these images, time-frequency analysis of single pulse-evoked responses, in the range of 10-80 Hz for spikes, 80-250 Hz for ripples and 250-520 Hz for fast ripples, were scored by two observers independently. Sensitivity, specificity and predictive value of time-frequency single pulse-evoked responses in the three frequency ranges were compared with seizure onset zone and post-surgical outcome. In all patients, evoked responses included spikes, ripples and fast ripples. For the seizure onset zone, the median sensitivity of time-frequency single pulse-evoked responses decreased from 100% for spikes to 67% for fast ripples and the median specificity increased from 17% for spikes to 79% for fast ripples. A median positive predictive value for the evoked responses in the seizure onset zone of 17% was found for spikes, 26% for ripples and 37% for fast ripples. Five out of seven patients with <50% of fast ripples removed by resection had a poor outcome. A wavelet transform-based time-frequency analysis of single pulse electrical stimulation reveals evoked responses in the frequency range of spikes, ripples and fast ripples. We demonstrate that time-frequency analysis of single pulse electrical stimulation can assist in delineation of the epileptogenic cortex using time-frequency single pulse-evoked fast ripples as a potential new marker.
    Brain 09/2011; 134(Pt 10):2855-66. DOI:10.1093/brain/awr211 · 9.20 Impact Factor
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    ABSTRACT: Electrocorticography, primarily used in a clinical context, is becoming increasingly important for fundamental neuroscientific research, as well as for brain-computer interfaces. Recordings from these implanted electrodes have a number of advantages over non-invasive recordings in terms of band width, spatial resolution, smaller vulnerability to artifacts and overall signal quality. However, an unresolved issue is that signals vary greatly across electrodes. Here, we examine the effect of blood vessels lying between an electrode and the cortex on signals recorded from subdural grid electrodes. Blood vessels of different sizes cover extensive parts of the cortex causing variations in the electrode-cortex connection across grids. The power spectral density of electrodes located on the cortex and electrodes located on blood vessels obtained from eight epilepsy patients is compared. We find that blood vessels affect the power spectral density of the recorded signal in a frequency-band-specific way, in that frequencies between 30 and 70 Hz are attenuated the most. Here, the signal is attenuated on average by 30-40% compared to electrodes directly on the cortex. For lower frequencies this attenuation effect is less pronounced. We conclude that blood vessels influence the signal properties in a non-uniform manner.
    Journal of Neural Engineering 06/2011; 8(4):044002. DOI:10.1088/1741-2560/8/4/044002 · 3.30 Impact Factor
  • G. Huiskamp ·
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    ABSTRACT: Interictal spikes as observed in epilepsy patients are assumed to be generated by relatively large patches of activated cortex. In order to check the validity of single dipole solutions to such spikes in EEG and MEG a simulation study is performed in a realistically shaped cortical model. It is shown that both in EEG and MEG the center of activated cortex can be misrepresented by single dipole solutions by more then 1 cm. The geometry of sulci and gyri determines where, for which modality, this effect is larger.
    Noninvasive Functional Source Imaging of the Brain and Heart & 2011 8th International Conference on Bioelectromagnetism (NFSI & ICBEM), 2011 8th International Symposium on; 01/2011
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    ABSTRACT: The simultaneous recording of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) can be used to localize interictal epileptiform discharges (IEDs). Previous studies have reported varying degrees of concordance of EEG-fMRI with electroclinical findings. The aim of the present study is to evaluate to what extent this variability is determined by the analytical strategy or by the properties of the EEG data. For that purpose, 42 IED sets obtained in 29 patients with epilepsy were reanalyzed using a finite impulse response approach, which estimates the hemodynamic response function (HRF) from the data and allows non-causal effects. Cardiac effects were treated as additional confounders in the model. This approach was compared to the classical approach assuming a fixed HRF for each voxel in the brain. The performance of each method was assessed by comparing the fMRI results to the EEG focus. The flexible model revealed more significantly activated voxels, which resulted in more activated brain regions concordant with the EEG focus (26 vs. 16). Correction for cardiac effects improved the results in 7 out of the 42 data sets. Furthermore, design theory for event-related experiments was applied in order to determine the influence of the number of IEDs and their temporal distribution on the success of an experiment. It appeared that this success is highly dependent upon the number of IEDs present during the recording and less on their temporal spacing. We conclude that the outcome of EEG-fMRI can be improved by using an optimized analytical strategy, but also depends on the number of IEDs occurring during the recording.
    Magnetic Resonance Imaging 10/2010; 28(8):1078-86. DOI:10.1016/j.mri.2010.03.022 · 2.09 Impact Factor
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    ABSTRACT: Invasive brain signal recordings generally rely on bioelectrodes implanted on the cortex underneath the dura. Subdural recordings have strong advantages in terms of bandwidth, spatial resolution and signal quality. However, subdural electrodes also have the drawback of compromising the long-term stability of such implants and heighten the risk of infection. Epidurally implanted electrodes might provide a viable alternative to subdural electrodes, offering a compromise between signal quality and invasiveness. Determining the feasibility of epidural electrode implantation for e.g., clinical research, brain-computer interfacing (BCI) and cognitive experiments, requires the characterization of the electrical properties of the dura, and its effect on signal feature detection. In this paper we report measurements of brain signal attenuation by the human dura in vivo. In addition, we use signal detection theory to study how the presence of the dura between the sources and the recording electrodes affects signal power features in motor BCI experiments. For noise levels typical of clinical brain signal recording equipment, we observed no detrimental effects on signal feature detection due to the dura. Subdural recordings were found to be more robust with respect to increased instrumentation noise level as compared to their epidural counterpart nonetheless. Our findings suggest that epidural electrode implantation is a viable alternative to subdural implants from the feature detection viewpoint.
    Journal of Neuroscience Methods 03/2010; 187(2):270-9. DOI:10.1016/j.jneumeth.2010.01.019 · 2.05 Impact Factor
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    Geertjan Huiskamp · Zaloa Agirre-Arrizubieta · Frans Leijten ·
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    ABSTRACT: MEG interictal spikes as recorded in epilepsy patients are a reflection of intracranial interictal activity. This study investigates the relationship between the estimated sources of MEG spikes and the location, distribution and size of interictal spikes in the invasive ECoG of a group of 38 epilepsy patients that are monitored for pre-surgical evaluation. An amplitude/surface area measure is defined to quantify and rank ECoG spikes. It is found that all MEG spikes are associated with an ECoG spike that is among the three highest ranked in a patient. Among the different brain regions considered, the fronto-orbital, inter-hemispheric, tempero-lateral and central regions stand out. In an accompanying simulation study it is shown that for hypothesized extended sources of larger sizes, as suggested by the data, source location, orientation and curvature can partly explain the observed sensitivity of MEG for interictal spikes.
    Brain Topography 02/2010; 23(2):159-64. DOI:10.1007/s10548-010-0134-1 · 3.47 Impact Factor
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    ABSTRACT: To study 3T compared to 1.5T phased array magnetic resonance imaging (MRI) in the presurgical work-up of patients with epilepsy with complex focus localization. In all, 37 patients (>10 years) in preoperative work-up for epilepsy surgery were offered 3T in addition to 1.5T MRI if ambiguity existed about the epileptic focus. Scans were randomly reviewed by two observers, blinded for prior imaging, patient-identifying information, and each other's assessments, followed by a consensus meeting. The number of abnormal scans, detected lesions, and interobserver agreement were calculated and compared. The final consensus was compared to original scan reports. One observer identified 22 lesions in both 3 and 1.5T scans, while the second identified more lesions in 1.5T scans (28 vs. 20). 3T MRI had better interobserver agreement. 3T revealed more dysplasias, while 1.5T revealed more tissue loss and mesial temporal sclerosis (MTS). The final consensus yielded 29 lesions, whereas original reports identified only 17 lesions. The 3T scans revealed different lesions compared to 1.5T. Patients can benefit most from 3T scans when a dysplasia is suspected. Reevaluation by another experienced neuroradiologist is advised in case of negative or equivocal MRIs.
    Journal of Magnetic Resonance Imaging 08/2009; 30(2):256-62. DOI:10.1002/jmri.21811 · 3.21 Impact Factor
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    ABSTRACT: Magnetoencephalography (MEG) is considered a useful tool for planning electrode placement for chronic intracranial subdural electrocorticography (ECoG) in candidates for epilepsy surgery or even as a substitute for ECoG. MEG recordings are usually interictal and therefore, at best, reflect the interictal ECoG. To estimate the clinical value of MEG, it is important to know how well interictal MEG reflects interictal activity in the ECoG. From 1998 to 2008, 38 candidates for ECoG underwent a 151-channel MEG recording and 3D magnetic resonance imaging as a part of their presurgical evaluation. Interictal MEG spikes were identified, clustered, averaged and modelled using the multiple signal classification algorithm and co-registered to magnetic resonance imaging. ECoG was continuously recorded with electrode grids and strips for approximately 1 week. In a representative sample of awake interictal ECoG, interictal spikes were identified and averaged. The different spikes were characterized and quantified using a combined amplitude and synchronous surface-area measure. The ECoG spikes were ranked according to this measure and plotted on the magnetic resonance imaging surface rendering. Interictal spikes in MEG and ECoG were allocated to a predefined anatomical brain region and an association analysis was performed. All interictal MEG spikes were associated with an interictal ECoG spike. Overall, 56% of all interictal ECoG spikes had an interictal MEG counterpart. The association between the two was >or=90% in the interhemispheric and frontal orbital region, approximately 75% in the superior frontal, central and lateral temporal regions, but only approximately 25% in the mesial temporal region. MEG is a reliable indicator of the presence of interictal ECoG spikes and can be used to plan intracranial electrode placements. However, a substantial number of interictal ECoG spikes are not detected by MEG, and therefore MEG cannot be considered a substitute for ECoG.
    Brain 06/2009; 132(Pt 11):3060-71. DOI:10.1093/brain/awp137 · 9.20 Impact Factor

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2k Citations
184.08 Total Impact Points


  • 2015
    • McGill University
      Montréal, Quebec, Canada
  • 1998-2014
    • University Medical Center Utrecht
      • • Department of Neurosurgery
      • • Department of Neurology
      Utrecht, Utrecht, Netherlands
  • 1999-2005
    • Utrecht University
      Utrecht, Utrecht, Netherlands
  • 2003
    • Kempenhaeghe
      Heeze, North Brabant, Netherlands
  • 1989-1999
    • Radboud University Nijmegen
      Nymegen, Gelderland, Netherlands
  • 1990-1998
    • University of California, Irvine
      • Department of Radiological Sciences
      Irvine, California, United States