Background: The aim of electroencephalogram (EEG) source localization is to find the brain areas responsible for EEG waves of interest. It consists of solving forward and inverse problems. The forward problem is solved by starting from a given electrical source and calculating the potentials at the electrodes. These evaluations are necessary to solve the inverse problem which is defined as finding brain sources which are responsible for the measured potentials at the EEG electrodes.

SUMMARYPurpose: Fifteen percent to 25% of patients with refractory epilepsy require invasive video-electroencephalography (EEG) monitoring (IVEM) to precisely delineate the ictal-onset zone. This delineation based on the recorded intracranial EEG (iEEG) signals occurs visually by the epileptologist and is therefore prone to human mistakes. The purpose of this study is to investigate whether effective connectivity analysis of intracranially recorded EEG during seizures provides an objective method to localize the ictal-onset zone. Methods: In this study data were analyzed from eight patients who underwent IVEM at Ghent University Hospital in Belgium. All patients had a focal ictal onset and were seizure-free following resective surgery. The effective connectivity pattern was calculated during the first 20 s of ictal rhythmic iEEG activity. The outdegree, which is reflective of the number of outgoing connections, was calculated for each electrode contact for every single seizure during these 20 s. The seizure specific out-degrees were summed per patient to obtain the total out-degree. The electrode contact with the highest total out-degree was considered indicative of localization of the ictal-onset zone. This result was compared to the conclusion of the visual analysis of the epileptologist and the resected brain region segmented from postoperative magnetic resonance imaging (MRI). Key findings: In all eight patients the electrode contact with the highest total out-degree was among the contacts identified by the epileptologist as the ictal onset. This contact, that we named "the driver," always laid within the resected brain region. Furthermore, the patient-specific connectivity patterns were consistent over the majority of seizures. Significance: In this study we demonstrated the feasibility of correctly localizing the ictal-onset zone from iEEG recordings by using effective connectivity analysis during the first 20 s of ictal rhythmic iEEG activity.

To improve the EEG source localization in the brain, the conductivities used in the head model play a very important role. In this study, we focus on the modeling of the anisotropic conductivity of the white matter. The anisotropic conductivity profile can be derived from diffusion weighted magnetic resonance images (DW-MRI). However, deriving these anisotropic conductivities from diffusion weighted MR images of the white matter is not straightforward. In the literature, two methods can be found for calculating the conductivity from the diffusion weighted images. One method uses a fixed value for the ratio of the conductivity in different directions, while the other method uses a conductivity profile obtained from a linear scaling of the diffusion ellipsoid. We propose a model which can be used to derive the conductivity profile from the diffusion tensor images. This model is based on the variable anisotropic ratio throughout the white matter and is a combination of the linear relationship as stated in the literature, with a constraint on the magnitude of the conductivity tensor (also known as the volume constraint). This approach is stated in the paper as approach A. In our study we want to investigate dipole estimation differences due to using a more simplified model for white matter anisotropy (approach B), while the electrode potentials are derived using a head model with a more realistic approach for the white matter anisotropy (approach A). We used a realistic head model, in which the forward problem was solved using a finite difference method that can incorporate anisotropic conductivities. As error measures we considered the dipole location error and the dipole orientation error. The results show that the dipole location errors are all below 10 mm and have an average of 4 mm in gray matter regions. The dipole orientation errors ranged up to 66.4 degrees, and had a mean of, on average, 11.6 degrees in gray matter regions. In a qualitative manner, the results show that the orientation and location error is dependent on the orientation of the test dipole. The location error is larger when the orientation of the test dipole is similar to the orientation of the anisotropy, while the orientation error is larger when the orientation of the test dipole deviates from the orientation of the anisotropy. From these results, we can conclude that the modeling of white matter anisotropy plays an important role in EEG source localization. More specifically, accurate source localization will require an accurate modeling of the white matter conductivity profile in each voxel.

Many implementations of electroencephalogram (EEG) dipole source localization neglect the anisotropical conductivities inherent to brain tissues, such as the skull and white matter anisotropy. An examination of dipole localization errors is made in EEG source analysis, due to not incorporating the anisotropic properties of the conductivity of the skull and white matter. First, simulations were performed in a 5 shell spherical head model using the analytical formula. Test dipoles were placed in three orthogonal planes in the spherical head model. Neglecting the skull anisotropy results in a dipole localization error of, on average, 13.73 mm with a maximum of 24.51 mm. For white matter anisotropy these values are 11.21 mm and 26.3 mm, respectively. Next, a finite difference method (FDM), presented by Saleheen and Kwong (1997 IEEE Trans. Biomed. Eng. 44 800-9), is used to incorporate the anisotropy of the skull and white matter. The FDM method has been validated for EEG dipole source localization in head models with all compartments isotropic as well as in a head model with white matter anisotropy. In a head model with skull anisotropy the numerical method could only be validated if the 3D lattice was chosen very fine (grid size < or = 2 mm).

Electroencephalographic source localization (ESL) relies on an accurate model representing the human head for the computation of the forward solution. In this head model, the skull is of utmost importance due to its complex geometry and low conductivity compared to the other tissues inside the head. We investigated the influence of using different skull modeling approaches on ESL. These approaches, consisting in skull conductivity and geometry modeling simplifications, make use of X-ray computed tomography (CT) and magnetic resonance (MR) images to generate seven different head models. A head model with an accurately segmented skull from CT images, including spongy and compact bone compartments as well as some air-filled cavities, was used as the reference model. EEG simulations were performed for a configuration of 32 and 128 electrodes, and for both noiseless and noisy data. The results show that skull geometry simplifications have a larger effect on ESL than those of the conductivity modeling. This suggests that accurate skull modeling is important in order to achieve reliable results for ESL that are useful in a clinical environment. We recommend the following guidelines to be taken into account for skull modeling in the generation of subject-specific head models: (i) If CT images are available, i.e., if the geometry of the skull and its different tissue types can be accurately segmented, the conductivity should be modeled as isotropic heterogeneous. The spongy bone might be segmented as an erosion of the compact bone; (ii) when only MR images are available, the skull base should be represented as accurately as possible and the conductivity can be modeled as isotropic heterogeneous, segmenting the spongy bone directly from the MR image; (iii) a large number of EEG electrodes should be used to obtain high spatial sampling, which reduces the localization errors at realistic noise levels.

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The use of inertial measurement units (IMUs) has gained popularity for the estimation of lower limb kinematics. However, implementations in clinical practice are still lacking. The aim of this review is twofold—to evaluate the methodological requirements for IMU-based joint kinematic estimation to be applicable in a clinical setting, and to suggest future research directions. Studies within the PubMed, Web Of Science and EMBASE databases were screened for eligibility, based on the following inclusion criteria: (1) studies must include a methodological description of how kinematic variables were obtained for the lower limb, (2) kinematic data must have been acquired by means of IMUs, (3) studies must have validated the implemented method against a golden standard reference system. Information on study characteristics, signal processing characteristics and study results was assessed and discussed. This review shows that methods for lower limb joint kinematics are inherently application dependent. Sensor restrictions are generally compensated with biomechanically inspired assumptions and prior information. Awareness of the possible adaptations in the IMU-based kinematic estimates by incorporating such prior information and assumptions is necessary, before drawing clinical decisions. Future research should focus on alternative validation methods, subject-specific IMU-based biomechanical joint models and disturbed movement patterns in real-world settings.

It is not well established whether seizures and epilepsy after an ischaemic stroke increase the disability of patients. Seventy-two patients with delayed seizures after a hemispheric infarct (37 with a single seizure and 35 with epilepsy) were included in the study. The modified Rankin scale was used to compare disability of the patients at 1 month after stroke and at 2 weeks after single or the last seizure, in case of epilepsy. The size of the X-ray hypoattenuation zone was compared on computed tomographic (CT) scans, performed in the weeks after the stroke and 1 week after single or repeated seizures. Lesion size was determined by superimposing the CT slices on digital cerebral vascular maps, on which the contours of the infarct area were delineated. The extent of the infarcts was expressed as the percentage fraction of the total surface area of the cerebral hemisphere. Groups with a single seizure and with epilepsy were mutually compared. Infarcts predominated in the parieto-temporal cortical regions. In the overall group the median Rankin score worsened significantly after seizures. The average size of the X-ray hypoattenuation zone was also significantly increased on the CT scans after the seizures, compared with those after stroke, without clear evidence of recent infarction. Mutual comparison of patients with a single seizure episode and of those with epilepsy showed only a trend of more severe disability and of increase in lesion size in the post-stroke epilepsy group. Delayed seizures and epilepsy after ischaemic stroke are accompanied by an increase in lesion size on CT and by worsening of the disability of the patients. This study does not allow to determine whether this is due to stroke recurrence or due to additional damage as a result of the seizures themselves.