České a slovenské spoleČnosti pro klinickou neurofyziologii

Transcription

Univerzita Palackého v Olomouci
Česká lékařská komora
Pod záštitou těchto odborných společností
Česká společnost pro klinickou neurofyziologii ČLS J. E. Purkyně
Slovenská spoločnosť pre klinickú neurofyziológiu SLS
Společnost biomedicínského inženýrství a lékařské informatiky ČLS JEP
Sekce pro funkční mapování mozku ČSKN ČLS JEP
International Parkinson and Movement Disorder Society
61. společný sjezd
České a slovenské společnosti
pro klinickou neurofyziologii
OLOMOUC, 15.–18. října 2014
PROGRAM
SBORNÍK ABSTRAKT
www.czech-slovakneurophysiol2014.upol.cz
www.trends-neurophysiol2014.upol.cz
TEĎ
JE
ČAS
…OBJEVIT SÍLU
TYSABRI®
Reference:1)PolmanCH,O’ConnorPW,HavrdovaEetal.,AFFIRMinvestigators.Arandomized,placbo-controlledtrialofnatalizumabforrelapsingmultiplesclerosis.NEnglJMed2006;354(9):899-910.2)HavrdovaE,GalettaS,HutchinsonMetal.Effect
of natalizumab on clinical and radiological disease activity in multiple sclerosis: a retrospective analysis of the natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis (AFFIRM) study. Lancet Neurol. 2009;8(3):254-260.
Zkrácená informace o léčivém přípravku Tysabri. Název přípravku: TYSABRI 300 mg koncentrát pro přípravu infuzního roztoku. Složení: Jeden ml koncentrátu obsahuje natalizumabum 20 mg. Úplný seznam pomocných látek je uveden v SPC.
Terapeutické indikace: TYSABRI je indikován v monoterapii jako onemocnění modifikující léčba u následujících skupin pacientů s vysoce aktivní relabující-remitující roztroušenou sklerózou (RR RS): dospělí pacienti ve věku 18 let a starší s vysokou aktivitou
onemocnění navzdory léčbě interferonem beta nebo glatiramer-acetátem, dospělí pacienti ve věku 18 let a starší s rychle se vyvíjející těžkou RR RS. Dávkování a způsob podání: Přípravek TYSABRI 300 mg se podává intravenózní infuzí jednou za 4 týdny.
Kontraindikace: Hypersenzitivita na natalizumab nebo na kteroukoliv pomocnou látku přípravku. Progresivní multifokální leukoencefalopatie (PML). Pacienti se zvýšeným rizikem oportunních infekcí (OI) včetně pacientů s narušenou imunitou (včetně pacientů
podstupujících imunosupresivní terapie nebo těch, u nichž došlo k narušení imunity předchozími terapiemi). Kombinace s interferony beta nebo glatiramer-acetátem. Známá aktivní maligní onemocnění s výjimkou pacientů s bazocelulárním karcinomem kůže. Děti
a dospívající ve věku do 18 let. Zvláštní upozornění: PML: Použití TYSABRI bývá spojováno se zvýšeným rizikem PML, oportunní infekcí vyvolanou JC virem, která může být fatální nebo vést k těžké invaliditě. Lékař musí posoudit výhody a rizika léčby TYSABRI.
Pacient musí být poučen o časných příznacích PML. Rizikové faktory spojené se zvýšeným rizikem PML jsou: přítomnost anti-JCV protilátek; trvání léčby, zvláště trvá-li déle než 2 roky; užívání imunosupresiv před užíváním TYSABRI. *Testování na anti-JCV protilátky se
doporučuje před zahájením léčby TYSABRI nebo u pacientů užívajících TYSABRI při neznámém stavu protilátek. Pacienti s negativním nálezem anti-JCV protilátek mohou být vystaveni riziku vzniku PML. Doporučuje se opakované testování pacientů s negativním
nálezem anti-JCV protilátek každých 6 měsíců. Před zahájením léčby TYSABRI musí být k dispozici současné MRI. Pacienti musí být sledováni v pravidelných intervalech po celou dobu léčby. Po 2 letech léčby musí být pacient znovu informován o riziku vzniku PML
při užívání TYSABRI. Jestliže se objeví příznaky, které mohou svědčit pro PML, je do doby, dokud nebude PML vyloučena, nutné další podávání pozastavit. *PML byla hlášena po přerušení podávaní TYSABRI u pacientů, u nichž nebyly zjištěny nálezy, které by na PML
v době vysazení upozorňovaly. V průběhu 6 měsíců od vysazení TYSABRI je nutné zachovávat bdělost vůči jakýmkoliv příznakům naznačujícím přítomnost PML. Jestliže se u pacienta vyvine PML, podávání TYSABRI musí být trvale ukončeno. PML a IRIS
(imunorestituční zánětlivý syndrom): IRIS se vyskytuje téměř u všech pacientů s PML léčených TYSABRI po jeho vysazení nebo eliminaci z oběhu. Jiné OI: Při podezření na OI je třeba podávání TYSABRI pozastavit, dokud nebude možné takovou infekci vyloučit.
Jestliže se u pacienta vyvine OI, musí být podávání TYSABRI trvale ukončeno. Doporučení: Lékaři se musí obeznámit s Informacemi pro lékaře a Pokyny k léčbě. Lékaři musí s pacientem projednat výhody a rizika léčby a předat mu Kartu pacienta. Lékař a
pacient musí podepsat Formulář o zahájení či o pokračování v léčbě. Pacienti musí být poučeni, že v případě výskytu jakékoliv infekce, musí lékaře informovat, že jsou léčeni TYSABRI. Hypersenzitivita: S TYSABRI byly spojovány hypersenzitivní reakce včetně
závažných systémových reakcí. Pacienty je třeba sledovat během infuze a až 1 hodinu od ukončení infuze. Pacienti, u nichž se objevila hypersenzitivní reakce, musí být trvale vyřazeni z léčby TYSABRI. Současná či předchozí léčba imunosupresivy: U pacientů s
anamnézou léčby imunosupresivními léčivy existuje zvýšené riziko vzniku PML. Imunogenicita: Zhoršení choroby nebo příhody spojené s infuzí mohou signalizovat vývoj antinatalizumabových protilátek. Jaterní příhody: Byly hlášeny závažné nežádoucí účinky
poškožení jater. V případě závažné poruchy funkce jater by měl být TYSABRI vysazen. Ukončení léčby TYSABRI: Natalizumab zůstává v krvi cca 12 týdnů od poslední dávky. Nežádoucí účinky: Časté: infekce močového traktu, nasofaryngitida, kopřivka,
bolesti hlavy, závratě, zvracení, nevolnost, artralgie, ztuhlost, pyrexie, únava. Méně časté: hypersenzitivita, PML. Podmínky uchovávání: Koncentrát: Uchovávejte v chladničce (2°C – 8°C). Chraňte před mrazem a světlem. Naředěný roztok: Po naředění
neprodleně použijte. Pokud se nepoužije okamžitě, naředěný roztok se musí uchovávat při teplotě 2°C - 8°C a musí být podán do 8 hodin od naředění. Balení: 15 ml koncentrátu v injekční lahvičce se zátkou, těsněním a odnímatelným víčkem. Jedna injekční
lahvička v krabičce. Držitel rozhodnutí o registraci: Biogen Idec Limited, Maidenhead, Berkshire, SL6 4AY Velká Británie. Reg. č.: EU/1/06/346/001. Způsob úhrady a výdeje: Přípravek je vázán na lékařský předpis a je plně hrazen z prostředků
veřejného zdravotního pojištění jako zvláš¶ účtovaný léčivý přípravek (ZULP). Datum revize textu: 10/2013.
▼ Tento léčivý přípravek podléhá dalšímu sledování. To umožní rychlé získání nových informací o bezpečnosti. Žádáme zdravotnické pracovníky, aby hlásili jakákoli podezření na nežádoucí účinky.
Před předepsáním léku se prosím seznamte s úplnou informací o přípravku.
Biogen Idec (Czech Republic) s.r.o., Na Pankráci 1683/127, 140 00 Praha 4, tel.: 255 706 200, fax: 255 706 229, www.biogenidec.cz
* Všimněte si prosím změn v informacích o léčivém přípravku.
• 37 % pacientů bez jakékoli aktivity onemocnění 2
• Snížení progrese disability o 54 % 1
• Snížení počtu relapsů o 68 % 1
RS
NEČEKÁ...
TYS-CZ-0032e leden 2014
CZ.ALE.13.10.01
Genzyme, a Sanoﬁ company, Evropská 846/176a, 160 00 Praha 6
tel.: +420 233 086 111, fax: +420 233 086 222, e-mail: [email protected]
Již více než 30 let vyvíjíme léky na vzácná střádavá
metabolická onemocnění a nově se zaměřujeme
i na léčbu roztroušené sklerózy.
Snažíme se zlepšovat kvalitu života
pacientů a jejich rodin.
GENZYME
Inovace v neurologii
Biotechnologie v neurologii
61. SPOLEČNÝ SJEZD ČESKÉ A SLOVENSKÉ SPOLEČNOSTI PRO NEUROFYZIOLOGII
Termín konání: 15.–18. října 2014
Místo konání:
• Arcibiskupský palác, Wurmova 9, Olomouc
• Krajské Vlastivědné muzeum, nám. Republiky 822/6,
Olomouc
• Umělecké centrum UP – Konvikt, Univerzitní 3, Olomouc
Jednací jazyk: český, slovenský, anglický
ORGANIZÁTOŘI
Předseda sjezdu:
prof. MUDr. Ing. Petr Hluštík, Ph.D., CSc.
Čestné předsednictvo sjezdu:
doc. Ing. Jan Kremláček, Ph.D.
předseda České společnosti pro klinickou neurofyziologii ČLS JEP
prof. MUDr. Ing. Petr Hluštík, Ph.D., CSc.
doc. MUDr. Robert Jech, Ph.D.
prof. MUDr. Petr Kaňovský, CSc.
doc. MUDr. Pavol Kučera, Ph.D.
prof. MUDr. Egon Kurča, Ph.D.
doc. Ing. Lenka Lhotská, CSc.
prof. MUDr. Jan Mareš, Ph.D.
doc. MUDr. Petr Marusič, Ph.D.
doc. MUDr. Ivana Štětkářová, CSc.
Organizační výbor:
prof. MUDr. Petr Kaňovský, CSc.
Mgr. Hana Hettychová
prof. MUDr. Ing. Petr Hluštík, Ph.D.
As. MUDr. Kateřina Menšíková, Ph.D.
prim. MUDr. Pavel Otruba, MBA
doc. MUDr. Pavol Kučera, Ph.D.
Vzdělávací akce je pořádaná dle Stavovského předpisu ČLK
č. 16.
Vědecký a programový výbor:
prof. MUDr. Martin Bareš, Ph.D.
prof. MUDr. Josef Bednařík, CSc.
prof. MUDr. Milan Brázdil, Ph.D.
Odborný garant:
prof. MUDr. Petr Kaňovský, CSc.,
předseda Slovenské spoločnosti pre klinickú neurofyziológiu SLS
2
OLOMOUC 15.–18. 10. 2014
přednosta Neurologické kliniky FN, I. P. Pavlova 6, 775 20 Olomouc
OLOMOUC 15.–18. 10. 2014
Společnost biomedicínského inženýrství a lékařské informatiky (SBMILI) při České lékařské společnosti J. E. Purkyně
jako profesní organizace techniků a inženýrů pracujících
ve zdravotnictví přiznala akci statut odborné konference jako
formy celoživotního vzdělávání podle Vyhl. 423/2004 Sb.
v platném znění (Vyhl. 321/2008Sb.) se základním počtem
(4 kredity za každý den s nejméně 4 hodinami odborného
programu, nejvýše však 12 kreditů)
Akce je zařazena do celoživotního vzdělávání nelékařských
zdravotnických povolání.
Souhlasné stanovisko udělila Profesní odborová unie
zdravotnických pracovníků (POUZP) dle vyhlášky MZ ČR
423/2004Sb. a její novelizace 4/2010 Sb.
REGISTRACE:
– Arcibiskupský palác, Wurmova 6
15. 10. 2014
14.00 – 18.00
16. 10. 2014
8.00 – 18.00
17. 10. 2014
8.00 – 18.00
Instalace stánků:
15. 10. 2014 16. 10. 2014
9.00 – 15.00
8.00 – 9.00
3
OLOMOUC 15.–18. 10. 2014
TRENDS IN NEUROPHYSIOLOGY OF MULTIPLE SCLEROSIS
Special symposium of The Czech and Slovak Society for Clinical Neurophysiology Annual Conference 2014
15–16 October 2014, Olomouc, Czech Republic
Arcibiskupský palác,
Wurmova 9, 771 01 Olomouc, Czech Republic
Convenor: Jan Mareš, Olomouc, Czech Republic
SCIENTIFIC AND PROGRAMME COMMITTEE
prof. MUDr. Ing. Petr Hluštík, Ph.D.
prof. MUDr. Petr. Kaňovský, CSc.
prof. MUDr. Egon Kurča, Ph.D.
prof. MUDr. David Stejskal, Ph.D., MBA, EurChem
doc. MUDr. Ivana Štětkářová, Ph.D.
4
OLOMOUC 15.–18. 10. 2014
PROGRAMME
Wednesday, 15 October 2014
Arcibiskupský palác
16.00 Sympozium společnosti Genzyme: Lemtrada, Aubagio v léčbě roztroušené sklerózy
Předsedající: Štourač P.
Lemtrada part
16:00 Alemtuzumab – klinický přehled
Štourač P. (Brno, CZ)
Aubagio part
16.30 Přehled klinických studií a vlastní zkušenosti s Aubagio v ČR
Dufek M. (Brno, CZ)
16.45 Komu je Aubagio určeno?
Mareš J. (Olomouc, CZ)
17.00 The Opening Ceremony of the Symposium
prof. MUDr. Petr Kaňovský, CSc. – Chairman of the Organizing Committee of the Symposium and Head of the
Department of Neurology University Hospital Olomouc
prof. MUDr. Ing. Petr. Hluštík, Ph.D. – President of the Symposium
prof. MUDr. Jan Mareš, Ph.D. – Head of MS Center of the Department of Neurology University Hospital Olomouc
5
OLOMOUC 15.–18. 10. 2014
17.15 Neurophysiology of Multiple Sclerosis and Pathogenetically Oriented MS Therapy
Chairs: Štourač P., Mareš J.
17.15 Trends in pathogenetically oriented MS therapy
Hartung H.-P. (Duesseldorf, DE)
Přednáška podpořena grantem společnosti Genzyme
17.55 Electrophysiological assessment in Multiple Sclerosis
Fuhr P. (Basel, CH)
Přednáška podpořena grantem společnosti Biogen Idec
18.35 Clinical aspects of influencing MS pathogenesis by emerging therapies
Vila Primavesi
19.00 Welcome Reception – Music: barokní trio Serpens cantat
Thursday, 16 October 2014
9.00 Trendy v neurofyziologii roztroušené sklerózy
Předsedající: Štětkářová I.
9.00 Diagnostický a prognostický význam neurofyziologických metod u RS
Štětkářová I. (Praha, CZ)
9.20 Zrakové evokované potenciály v diagnostice RS
Otruba P. (Olomouc, CZ)
6
OLOMOUC 15.–18. 10. 2014
9.40 Somatosenzorické a motorické evokované potenciály u RS
Kurča E. (Martin, SK)
10.00 Přestávka
10.40
11.00
11.20
11.40
12.00
Funkční magnetická rezonance v diagnostice a prognóze RS
Hluštík P. (Olomouc, CZ)
Neurofyziologické metody v testování bolesti u RS
Vlčková E. (Praha, CZ)
Hodnocení spasticity u RS pomocí neurofyziologických metod
Neurofyziologické testování autonomních poruch u RS
Vlčková E. (Praha, CZ)
Ukončení sekce – Trendy v neurofyziologii roztroušené sklerózy
12.30 Oběd
13.30 Satelitní sympozium společnosti Biogen Idec (Czech Republic) s.r.o.: Klinické aspekty péče
o pacienty s RS
Předsedající: Mareš J.
13.30 Význam adherence u léčby pacientů s RS
14.00 MRI monitorace u pacientů s RS
Vaněčková M. (Praha, CZ)
7
OLOMOUC 15.–18. 10. 2014
TRENDS IN NEUROPHYSIOLOGY OF MOVEMENT DISORDERS
Special symposium of The Czech and Slovak Society for Clinical Neurophysiology Annual Conference 2014
16–17 October 2014, Olomouc, Czech Republic
Archbishop’s Palace
Wurmova 562/9, 775 20 Olomouc, Czech Republic
Convenor: Petr Kaňovský, Olomouc, Czech Republic
Thursday 16, October 2014
Chairs: Martin Bareš, Robert Jech
17:00 Opening and Welcome
Petr Hluštík, Jan Kremláček, Petr Kaňovský, Olomouc and Hradec Králové, Czech Republic
17:15 Neurophysiologic mechanism of neural efficiency in humans: can it explain performances of athletes and patients
with neurodegenerative diseases?
Claudio Babiloni, Roma, Italy
18:15 Simultaneous imaging of the brain and spinal cord: accounting for the brain-spine interaction into functional models
of human motor system
Ovidiu Lungu, Montreal, Canada
Restaurace Podkova
19.30 Společenský večer, vystoupí Horňácká cimbálová muzika Petra Mičky
8
OLOMOUC 15.–18. 10. 2014
Friday 17, October 2014
Chairs: Dirk Dressler, Egon Kurča
9:00 9:30 10:00 Central physiology of dystonia – insights from deep brain recordings
Andrea Kühn, Berlin, Germany
Sensory functions in primary dystonia
Michele Tinazzi, Verona, Italy
The anatomy and pathophysiology of dystonia assessed by neuroimaging
Stéphane Lehéricy, Paris, France
Break
Chairs: Marek Baláž, Kateřina Menšíková
11:00 Neurophysiology and treatment of dystonia: non-invasive brain stimulation studies
Ulf Ziemann, Tübingen, Germany
11:30 Stimulation of the pedunculo-pontine area: insights from neurophysiology and clinical outcomes
Elena Moro, Grenoble, France
12:00 Physiological mechanisms and ways of improving subthalamic DBS in Parkinson’s disease
Jens Volkmann, Würzburg, Germany
Break
Chairs: Ivana Štětkářová, František Cibulčík
13:00 Neurophysiological assessment of myoclonus and tremor
Martin Bareš, Robert Jech, Brno, Prague, Czech Republic
13:30 Neurophysiology of balance and gait
Kai Boetzel, Munich, Germany
9
OLOMOUC 15.–18. 10. 2014
Lunch
Chairs: Ivana Štětkářová, Alois Krobot
15:30 16:30 Electromyography – guided injections of botulinum toxin in adult spasticity
Interactive workshop
Martin Bareš, Edvard Ehler, Robert Jech, Petr Kaňovský, Brno, Pardubice, Prague and Olomouc, Czech Republic
Closing remarks
Petr Kaňovský, Olomouc, Czech Republic
Atrium Konviktu – Umělecké centrum Univerzity Palackého
19:00 Společenský večer, vystoupí skupina Meteor z Prahy
Středa 15. 10. 2014
Čas
Vlastivědné muzeum
Sál Václava III
Zasedací místnost
16:00-17:00
Sympozium společnosti Genzyme:
Lemtrada, Aubagio
17:00-17:15
Opening Ceremony of
Trends in Multiple Sclerosis
17:15-19:00
Trends in Multiple Sclerosis
19.00
10
Sál Radeckého
Zbrojnice UP
Společenský večer, restaurace Vila Primavesi
V rámci večera vystoupí barokní trio Serpens cantat
OLOMOUC 15.–18. 10. 2014
Čtvrtek 16. 10. 2014
Čas
Sál Václava III
09:30-11:00
Sál Radeckého
Zbrojnice UP
Zasedací místnost
Zkoušení FO EP (doc. Jech)
11:00-13:00
LOC ECCN
13:00-14:00
Oběd – Svatováclavský pivovar
Trends in Multiple
Sclerosis
14:00-15:00
Škola NF – SEP
– základy
Škola NF – zrakové EP
– pokročilí
Trends in Multiple
Sclerosis
15:00-16:00
Škola NF – SEP
– hands on
Škola NF – zrakové EP
– hands on
Škola NF – EEG
– základy
16:00-17:00
Škola NF – funkční
zobrazování – základy
Škola NF – funkční
zobrazování – pokročilí
Škola NF – EEG
– pokročilí
17:00-17:15
Opening and Welcome
Trends in NF of
Movement Disorders
17:15-19:00
Trends in NF of Movement
Disorders
19.30
Společenský večer, restaurace Podkova
V rámci večera vystoupí Horňácká cimbálová muzika Petra Mičky
11
OLOMOUC 15.–18. 10. 2014
Pátek 17. 10. 2014
Čas
Sál Václava III
Sál Radeckého
08:00-09:00
09:00-10:00
EMG
12:30-13:00
13.00-14.00
14:00-15:00
FMRI 1
16:15-16:45
NF VNČ 1
Trends in NF of Movement Disorders
Funkční odbornosti
Přestávka
Epilepsie 1
Varia
EEG 1
15:00-15:15
15:15-16:15
Zasedací místnost
Přestávka
11:15-11:30
11:30-12:30
Výbor ČSKN
10:00-10:15
10:15-11:15
Zbrojnice UP
IOM
Zkoušení FO EMG
(prof. Kadaňka)
Trends in NF of Movement Disorders
Přestávka
Epilepsie 2
NF VNČ 2
Postery
17:00-17:30
Předání cen ČSKN
17:30-18:30
Amblerova přednáška: Diagnostika polyneuropatie: pokrok a perspektivy
18:30-22:00 Společenský večer, atrium Konviktu. V rámci večera vystoupí v 19.00 skupina Meteor z Prahy
12
OLOMOUC 15.–18. 10. 2014
Sobota 18. 10. 2014
Čas
09:00-10:00
Sál Václava III
Sál Radeckého
FMRI 2
Workshop EEG
10:00-10:15
10:15-11:15
Přestávka
NF “resting state”
11:15-11:30
11:30-12:30
12:30-14:00
EEG 2
Přestávka
NF VNČ 3
13
OLOMOUC 15.–18. 10. 2014
Škola klinické neurofyziologie
Čtvrtek 16. 10. 2014
Čas
Sál Václava III
14:00-14:50 Somatosenzorické evokované potenciály – základy
Lektor:
• princip a typy SEP
• SEP v klinické diagnostice
• praktické cvičení
Kurz SEP pro začátečníky seznamuje účastníky se základními principy této metody s důrazem na určení běžných klinických aplikací. Důraz je kladen na fyziologii a patofyziologii
vedení vzruchu, generátory vzruchu, sledované a hodnocené parametry SEP, stimulační a registrační parametry,
základní vyšetřovací principy, závislosti SEP na zevních
a vnitřních faktorech. Bude probráno klinické využití metody
SEP v praxi v korelaci s neurologickým onemocněním.
Kurz je určen pro zájemce, kteří metodu neznají a chtějí
získat základní informace. Součástí kurzu bude praktická
demonstrace
14
Sál Radeckého
Zrakové evokované potenciály – pokročilí
Lektor:
doc. Ing. Jan Kremláček, CSc.
• motion-onset VEPs
• zraková ,,mismatch“ negativita
• multifokální VEPs
• hodnocení ,,habituace“ ve VEPs
• praktické cvičení
Neurofyziologická škola bude věnována dvěma variantám
vyšetření zrakových evokovaných potenciálů, které nejsou
součástí standardu IFCN/IFCN. První variantou budou odpovědi na stimulace pohybujícím se podnětem v zorném poli
(pohybové VEPs: M-VEPs), druhou jsou potenciály spojené
s automatickou detekcí narušení temporální regularity (zraková „mismatch“ negativita: vMMN). Na klinických datech bude
prezentována využitelnost a odlišná citlivost těchto metod
v klinickém výzkumu a diagnostice, dále budou rozebrány
metodické aspekty použití. Obě témata budou doplněna
ukázkou hodnocení „habituace“ ve VEPs a zkušenostmi s multifokálními VEPs.
Čas
Sál Václava III
15:00-15:50 Somatosenzorické EP – hands on
Lektor:
• Praktické cvičení
Sál Radeckého
Zrakové EP – hands on
Lektor :
doc. Ing. Jan Kremláček, CSc.
• Praktické cvičení
OLOMOUC 15.–18. 10. 2014
Zbrojnice UP
Zasedací místnost
Elektroencefalografie – základy
Lektor:
MUDr. Ing. Svojmil Petránek, CSc.
Kurz je zaměřen prakticky na to jak pořídit
EEG záznam – od přípravy pacienta
k nastavení přístroje (vliv filtrů, zesílení,
vzorkovací frekvence) k délce natáčení, stimulačním metodám až k digitální
kosmetice záznamu. Ve druhé části kurzu
se bude hovořit o korelaci EEG a dlouhodobého mapování, o nutnosti sledování
stavu vědomí během natáčení a o nových
možnostech a trendech zpracování EEG
záznamu.
15
Čas
Sál Václava III
16:00-16:50 Funkční zobrazování – základy
Lektoři:
prof. MUDr. Ing. Petr Hluštík, PhD.
doc. MUDr. Robert Jech, PhD.
• Princip fMRI
• Klinické aplikace fMRI
V úvodní části bude vysvětlen princip
funkční magnetické rezonance (fMR)
založený na tzv. BOLD efektu. Budou
vysvětleny základní typy experimentů (blokový design, event-related,
resting-state) a způsoby individuální
a skupinové analýzy. Na příkladech
bude vysvětlen diagnostický potenciál
a omezení této metody.
16
Sál Radeckého
Funkční zobrazování – pokročilí
Lektoři:
Ing. Michal Mikl, PhD.
prof. MUDr. Irena Rektorová, PhD.
• analýza Resting state fMRI
• nemoci mozku v obraze resting
state fMRI
Lekce představí základní koncepci resting-state sítí analyzovaných prostřednictvím
funkční magnetické rezonance (fMRI).
V první části budou vysvětleny rozdíly
resting-state fMRI od klasického (task-based
či aktivačního) fMRI a to z hlediska zásad
měření, plánování studie, zpracování dat,
možností a limitací získaných informací.
První část představí zejména technické
a metodické principy. Ve druhé části se
lekce zaměří na popis známých resting-state sítí včetně default-mode sítě. Lekce
představí zjištěné odlišnosti v resting-state
sítích u zdravých a nemocných jedinců
(např. Alzheimerova nemoc, Parkinsonova nemoc) a jejich vztah ke kognitivním
poruchám či možným kompenzatorním
mechanismům. Bude diskutován význam
studia resting-state sítí pro hodnocení efektu
terapie.
OLOMOUC 15.–18. 10. 2014
Zbrojnice UP
Zasedací místnost
Elektroencefalografie – pokročilí
Lektoři:
MUDr. Jana Zárubová
MUDr. Martin Tomášek
• Jednotná kritéria popisu EEG
• Zajímavé EEG kasuistiky
Základem srozumitelné komunikace
je používání jednotné terminologie.
Seminář představí jasně definované
kategorie pro popis a interpretaci
EEG. Tyto mají pomoci popis EEG
zjednodušit, sdílet a reprodukovat,
nezávisle na pracovišti. Bude vysvětleno, jakých vyjádření je vhodné
se v popisech vyvarovat. V rámci
semináře bude vedena interaktivní
diskuze nad doprovodnými kazuistikami.
OLOMOUC 15.–18. 10. 2014
Pátek 17. 10. 2014
Čas
Sál Václava III
8.00-9.00
9.00-10.00
Sál Radeckého
Schůze výboru ČSKN
Elektromyografie
NF vyšší nervové činnosti 1
Předsedající: Ehler E., Kurča E.
Předsedající: Rektor I., Bednařík J.
Neuromuscular transmission disorders in Miller Fisher
syndrome
Ehler, E.
fMRI and EEG studies of the role of basal ganglia in epilepsy
Rektor, I. et al.
Autoimmune lower motor neurone syndrome: Case report
Kurča, E. et al.
Electrophysiology study of distal median to ulnar nerve transfer to restore ulnar motor function - case report
Valeš, J. et al.
10:15 -11.15 fMRI 1
Předsedající: Bareš M., Keller J.
The contribution of intracranial EEG to research on the
empathy for pain
Brázdil, M. et al.
The occurrence of alpha activity during cyclical repetitive movement
Pánek, D. et al.
Hippocampal negative event-related potential recorded in
humans is not time-locked to the motor response execution
Roman, R. et al.
Funkční odbornosti – otázky a odpovědi
Předsedající: Kremláček, J.
Movement sequencing abnormalities in schizophrenia: changes in cortical activity during finger-tapping task
Zemánková, P. et al.
Longitudinal fMRI assessment in chronic spinal cord injury
treated by intrathecal baclofen – pilot data
Keller, J. et al.
Plasticity of the sensorimotor system induced by sustained
pressure stimulation
Hok, P. et al.
17
OLOMOUC 15.–18. 10. 2014
Čas
Sál Václava III
11:30-12:30 Epilepsie 1
Předsedající: Zárubová J., Marusič P.
Sál Radeckého
Varia
Předsedající: Štětkářová I., Hok P.
Photic stimulation in the EEG laboratory – European algorithm
Zárubová, J. et al.
Detection of postural oscillatory movement without clinically
manifested tremor in multiple sclerosis: a pilot study
Štětkářová, I. et al.
Statistical parametric mapping of regional glucose metabolism in mesial temporal lobe epilepsy associated with
hippocampal sclerosis
Kojan, M. et al.
Reduction of stuttering through bronchodilatation with Beta2
sympathomimetic drug formoterol
Pešák, J. et al.
Quantitative EEG assessment in epileptology – a possible
way to improve the diagnostics and treatment
Ježdík, P. et al.
Meta-analytic and resting-state functional connectivity of
claustrum
Hok, P. et al.
Cluster organization of the irritative zone in neocortical
epilepsy: implications for pathophysiology, surgery planning
and outcome
Marusič, P. et al.
14:00-15:00 EEG 1
Předsedající: Faber J., Petránek E.
18
IOM
Předsedající: Ostrý S., Holečková I.
EEG diagnosa plochých grafů během mentace, REM spánku
a aktivní vigility
Faber, J. et al.
Perioperative Monitoring of Cognitive Functions by Event-Related Potentials and Psychometric Tests
Holečková, I. et al.
Automated system for quantitative analysis of the EEG
background
Jombík, P. et al.
Intraoperative neurophysiological monitoring of brain perfusion during cardiac surgery in patients with asymptomatic
internal carotid stenosis
Ostrý, S. et al.
Clinical evaluation versus automatic detection of interictal
epileptiform discharges – who can we trust?
Janča, R. et al.
Structural connectivity of eloquent speech areas defined by
direct cortical stimulation mapping
Hok, P. et al.
OLOMOUC 15.–18. 10. 2014
Čas
Sál Václava III
15:15-16:15 Epilepsie 2
Sál Radeckého
Předseající: Kršek P., Brázdil M.
Předsedající: Baláž M., Bednařík J.
Practical value of quantitative EEG in epilepsy surgery
planning
Kršek, P. et al.
The effect of repetitive transcranial magnetic stimulation on
attention and psychomotor speed in patients with mild cognitive impairment and early Alzheimer’s disease
Influence of Data Processing Pipelines on EEG-fMRI Results in Anderková, Ľ. et al.
Patients with Epilepsy
Prediction of cognitive changes in patients with Parkinson‘s
Mikl, M. et al.
disease after DBS STN with the use of P300 cognitive event
related potential
Importance of weak connections in functional network
Baláž, M. et al.
analysis of left TLE
Alpha and beta power decrease during enhanced cognitive
effort in the basal ganglia: An intracerebral recording study
Bočková, M. et al.
Bujnošková, E. et al.
16:15-16:45 Posterová sekce
Předsedající: Kremláček, J., Hluštík, P.
Doležal J.: Application of eye tracking in neuroscience
Štěpánová K.: Differences of EEG signal
between gifted and average adolescents
Filip P.: Cerebellar activity in cervical
dystonia during a motor timing task: An
fMRI study
17:00-17:30
Předání cen ČSKN
17:30-18:30
Amblerova přednáška: Diagnostika polyneuropatie: pokrok a perspektivy
19
OLOMOUC 15.–18. 10. 2014
Sobota 18. 10. 2014
Čas
Sál Václava III
9.00-10.00
fMRI 2
Předsedající: Jech R., Mikl M.
Dealing with noise in psychophysiological interaction analysis
Bartoň, M. et al.
Sál Radeckého
Workshop Automatická klasifikace EEG grafoelementů
Předsedající: Krajča V., Petránek S.
A novel cognitive fMRI task to assess brain mechanisms underlying visual processing and attention
Elfmarková, N. et al.
Could it be possible to distinguish bending and crossing fibers
in diffusion MRI data?
Labounek, R. et al.
10:15-11.15
NF „Resting State“
EEG 2
fMRI for study of brain resting state networks in patients with
degenerative brain diseases
Rektorová, I. et al.
Initiatives and Projects for Collaboration in Neuroinformatics
(EEG/ERP)
Mouček, R. et al.
Inter-areal frontal lobe communication during rest: a depth
EEG connectivity study
Šimová, L. et al.
Non-linear analysis of newborn EEG
Radisavljevič, D. V. et al.
Předsedající: Bareš M., Rektorová I.
Comparison of Canonical Correlation Analysis and Pearson
Correlation in Resting State fMRI in Patients with Parkinson’s
Disease
Gajdoš, M. et al.
20
Předsedající: Lhotská L., Krajča V.
Methods of High Frequency Oscillations detection: Advantages and Disadvantages
Balach, J. et al.
OLOMOUC 15.–18. 10. 2014
11:30-12:30 NF vyšší nervové činnosti 3
Předsedající: Hluštík, P., Kremláček, J.
False visual mismatch negativity
Kremláček, J. et al.
Is nucleus subthalamicus involved in thinking? Separation of
conscious and subconscious cognition component in the subthalamic nucleus using P300 and MMN protocols.
Minks, E. et al.
21
OLOMOUC 15.–18. 10. 2014
TRENDS IN NEUROPHYSIOLOGY OF MULTIPLE SCLEROSIS
VISUAL EVOKED POTENTIALS IN THE
DIAGNOSIS OF MULTIPLE SCLEROSIS
Pavel Otruba
Department of Neurology, Faculty of Medicine and Dentistry and
Faculty Hospital Olomouc, Czech Republic
Demyelination of optic nerve fibres causing deficit of visual acuity is often the first clinical manifestation of multiple
sclerosis. Patients are indicated for visual evoked potential
(VEP) examination to confirm slowing of conduction velocity in the optic nerve. A typical finding during VEP examination and full-field visual stimulation is prolongation of P100
wave latency with relatively preserved shape of the N-P-N
complex and normal amplitude. The most sensitive paramete
is the side-to-side difference in P100 latency. In some cases,
response amplitude is reduced as well and the N-P-N complex is more poorly reproduced but the P100 latency prolongation is present in all cases.
Sensitivity to detect demyelination damage in optic nerve
fibres is very high, between 90-100% in the literature. The
VEP examination assists in detecting pathology even when
the neuro-ophthalmology examination is normal. Past retrobulbar neuritis may be detected by VEP even after recovery.
22
VEP examination, thanks to its high sensitivity, has a fundamental position in the differential diagnosis of disorders
of visual acuity and in diagnosis of demyelination damage
to the optic nerve as clinically isolated deficit in the form of
retrobulbar neuritis. Correct and early indication of the VEP
examination plays an important role in the initiation of proper
treatment and lowering the risk of irreversible consequences.
FUNCTIONAL MRI IN THE DIAGNOSIS
AND PROGNOSIS OF MULTIPLE
SCLEROSIS
Petr Hluštík
Department of Neurology, Faculty of Medicine and Dentistry and
Faculty Hospital Olomouc, Czech Republic
Whereas morphological MR imaging provides clear evidence
of white and gray matter lesions reflecting multiple sclerosis
(MS) pathology, functional MRI (fMRI) studies of the motor,
visual and cognitive networks in MS patients have provided
evidence of more diffuse cortical changes. Compared with
healthy subjects, fMRI changes are characterized by expansi-
on within physiological task-related networks, such as more
prominent participation of higher-level areas or recruitment
of additional areas, as well as differences in resting state
networks and disrupted within-network connectivity. Longitudinal fMRI studies have demonstrated that the observed
abnormalities vary over the course of the disease, even in
patients in disease remission (i.e., outside of relapses). Treatment interventions, such as treatment of leg spasticity with
intramuscular botulinum toxin, may cause notable, even if
transient, normalization of task-related networks. Functional
MRI changes in MS reflect morphological MRI abnormalities, especially when more sensitive techniques are applied to
detect normal-appearing white and gray matter of the brain
and spinal cord. This phenomenon fits in the more widely
described mechanism of increased recruitment within functional networks to at least partially compensate for structural
damage in brain diseases as diverse as stroke and amyotrophic lateral sclerosis (Weiller et al., 2006).
OLOMOUC 15.–18. 10. 2014
References
Filippi, M., Rocca, M.A., 2013. Present and future of fMRI in multiple sclerosis. Expert Rev. Neurother. 13, 27–31. doi:10.1586/14
737175.2013.865871
Kalincik, T., Vaneckova, M., Tyblova, M., Krasensky, J., Seidl, Z.,
Havrdova, E., Horakova, D., 2012. Volumetric MRI markers and
predictors of disease activity in early multiple sclerosis: a longitudinal cohort study. PloS One 7, e50101. doi:10.1371/journal.
pone.0050101
Weiller, C., May, A., Sach, M., Buhmann, C., Rijntjes, M., 2006.
Role of functional imaging in neurological disorders. J. Magn.
Reson. Imaging 23, 840–50.
Zivadinov, R., Bergsland, N., Dolezal, O., Hussein, S., Seidl, Z.,
Dwyer, M.G., Vaneckova, M., Krasensky, J., Potts, J.A., Kalincik, T., Havrdová, E., Horáková, D., 2013. Evolution of cortical
and thalamus atrophy and disability progression in early relapsing-remitting MS during 5 years. AJNR Am. J. Neuroradiol. 34,
1931–1939. doi:10.3174/ajnr.A3503
While notable progress has been made to improve prognosis
of the clinical course of MS using sophisticated morphological markers, e.g., (Kalincik et al., 2012; Zivadinov et al.,
2013), functional MRI might also contribute to improve disease monitoring prognosis. Finally, functional MRI may be
used to study the effects of different therapies on central nervous system engagement (Filippi and Rocca, 2013).
23
NEUROPHYSIOLOGICAL METHODS IN
EVALUATION OF PAIN IN MULTIPLE
SCLEROSIS
Vlčková E1,2
1
CEITEC - Central European Institute of Technology, Masaryk
University, Brno, Czech Republic
2
Department of Neurology, School of Medicine, Masaryk University and Faculty Hospital Brno, Czech Republic
Pain of various origin is a common symptom in patients with
multiple sclerosis (MS) with the estimated prevalence between 50 to 85%. Central neuropathic pain (which is defined
as a pain arising as a direct consequence of a lesion or disease
affecting the somatosensory nervous system) affects about
30% of this group of patients. According to current EFNS
(European Federation of Neuropathic Societies) guidelines
on neuropathic pain assessment, neurophysiological and
psychophysiological methods play an important role in the
diagnostic process of neuropathic pain, together with clinical
examination and validated screening tools and questionnaires, and functional neuroimaging.
Psychophysiological measures are mainly based on quantitative sensory testing (QST) and its dynamic applications.
Common QST methods may be defined as a measurement of
perception in response to external stimuli of controlled inten-
24
OLOMOUC 15.–18. 10. 2014
sity, which allows the evaluation of detection and pain thresholds for various modalities. A detailed QST protocol has
recently been developed and validated by German Research
Network on Neuropathic Pain. This protocol consists of the
assessment of 13 parameters reflecting the sensitivity and
pain perception for thermal, touch, pressure, vibration and
pinprick stimuli, and allows the detailed clinical description
of particular patient with the evaluation of complex sensory
profile. In neuropathic pain patients, it may help to characterize particular painful neuropathic syndromes, and predict or
monitor treatment effects including effect of treatments upon
different pain components.
So called “dynamic QST“ (dQST) is a group of methods,
where the pain-perceiving system is stimulated in a way that
exposes a certain mechanism of pain processing, particularly its central modulation These methods include the tests of
central integration, such as temporal summation (TS, also
called wind-up) and spatial summation, and tests of descending control, e.g., the conditioned pain modulation (CPM).
These methods can´t be used for diagnosis or confirmation of
the presence of pain. However, their setting is probably one
of the factors, predetermining the development of chronic
pain. They thus may reflect the „pro-nociceptive“ disposition
of the particular patient.
Among neurophysiological methods, pain-related evoked
potentials and some of the pain-related reflexes are the most
relevant tests for the assessment of pain in MS patients.
Pain-related evoked potentials are the easiest and most reliable neurophysiological methods for assessing the function
of nociceptive sensory pathways. Various types of stimuli
can be used to evoke the response of pain-related neuronal
structures: laser-evoked potentials (LEPs), contact-heat evoked potentials (CHEPs) and potentials elicited by a surface
concentric electrode that provides a preferential activation of
superficial terminals (i.e. small-diameter afferents) (PREPs).
These methods show a clear correlation with pain and are
highly specific in its confirmation, while their sensitivity depends on the definition of abnormality (being quite low if
only the absence of the response is considered to be abnormal, with a rapid increase if also a reduction of amplitude is
taken into consideration).
Pain-related reflexes appear to be diagnostically useful particularly for facial pain (e.g. trigeminal neuralgia, which represents one of the most frequent types of pain in MS patients).
Two brainstem reflexes (early (R1) blink reflex and early
(SP1) masseter inhibitory reflex) are efficient tools to reveal
symptomatic forms of trigeminal neuralgia with a very satisfactory sensitivity and specificity.
The cutaneous silent period (CSP) is a spinal inhibitory reflex with cortical modulation. The response is recorded from
the small hand muscles after noxious stimulation of the fin-
OLOMOUC 15.–18. 10. 2014
gers, which reflects the suppression of activity in spinal motor nuclei. The method has been tested in various pain conditions and is clearly related to clinical symptoms of thermal
and pain perception disturbance. CSP was not systematically
studied multiple sclerosis, but has repeatedly been shown to
display clear abnormalities in spinal cord lesions (e.g. cervical myelopathy). However, its correlation with presence of
pain seems to be limited.
Supported by MH CZ-DRO (FNBr, 65269705) and IGA CR
NT13523-4.
References:
Cruccu G, Sommer C, Anand P, Attal N, Baron R, Garcia-Larrea
L, Haanpaa M, Jensen TS, Serra J, Treede RD. EFNS guidelines on neuropathic pain assessment: revised 2009. Eur J Neurol
2010;17:1010-1018.
Haanpää M, Attal N, Backonja M, Baron R, Bennett M, Bouhassira D, Cruccu G, Hansson P, Haythornthwaite JA, Iannetti GD,
Jensen TS, Kauppila T, Nurmikko TJ, Rice AS, Rowbotham M,
Serra J, Sommer C, Smith BH, Treede RD. NeuPSIG guidelines
on neuropathic pain assessment. Pain 2011;152:14-27.
Osterberg A, Boivie J, Thuomas KA. Central pain in multiple
sclerosis--prevalence and clinical characteristics. Eur J Pain
2005;9:531-542.
25
NEUROPHYSIOLOGICAL ASSESSMENT
OF SPASTICITY IN MULTIPLE SCLEROSIS
Ivana Stetkarova
Department of Neurology, Charles University, Third Faculty of Medicine, Prague, Czech Republic
Objective: Spasticity is a frequent and often disabling feature of multiple sclerosis (MS). Up to 80%–85% of MS
cases suffer from different levels of spasticity. Appropriate
management of spasticity is therefore an important part of
the patient’s care. Muscle hypertonia is generally easy to recognize clinically, quantifying it is quite a complex matter.
Correlation between the clinical and neurophysiological measures makes it especially difficult. The aim of the study is to
review the main methods of evaluating spasticity published
in the scientific literature with stress on our own experience.
Methods: In this session we will present neurophysiologic
tests used in assessment of spasticity with a special stress
on the comparison of commonly used Modified Ashworth
Scales scores (MAS), H-reflex testing, cutaneous and cortical silent periods, and brainstem reflexes. The main treatment
options of pharmacological and non-pharmacological approaches will be discussed.
Results: Oral antispastic medication, therapeutic exercise
and physical modalities are commonly used. From a phar-
26
OLOMOUC 15.–18. 10. 2014
macological perspective of spasticity treatment, it is strongly
recommended to use local chemodenervation with botulinum
toxin for intramuscular administration under the EMG guidance. A modern approach to treat generalised spasticity is
a continuous intrathecal baclofen (ITB) administration directly into the cerebrospinal fluid under neurophysiological
monitoring.
Conclusion: Adequate evaluation and management of spasticity requires multidisciplinary approach and the setting of
realistic goals that need to be achieved on an individual level,
with regard to every single patient’s needs. Different options
for spasticity management are available, however, choice
of treatment hinges on a combination of the extent of symptoms, patient preference, and availability of services.
Supported by Research Project of Charles University PRVOUK
P34, Czech Republic
NEUROPHYSIOLOGICAL METHODS
OF AUTONOMIC NERVOUS SYSTEM
TESTING IN MULTIPLE SCLEROSIS
Vlčková E1,2
1
2
Department of Neurology, School of Medicine, Masaryk University and Faculty Hospital Brno, Czech Republic
Autonomic dysfunction (AD) is commonly seen in patients
with multiple sclerosis (MS). The most common manifestations of AD in MS patients include bladder or bowel dysfunction, impairment of sexual performance, pupillomotor or
sweating alterations and orthostatic hypotension. Furthermore, AD is supposed to be related to fatigue. The incidence and
severity of the symptoms related to AD correlated with the
degree of disability. The lifetime prevalence of autonomic
impairment reaches up to 80 % in MS population.
Besides medical history and validated questionnaires, neurophysiological testing of cardiovascular and sudomotor functions are most commonly used for evaluation of autonomic
nervous system impairment in MS patients.
Of the cardiovascular tests, analysis of heart-rate variability
in the time- and frequency-domain has repeatedly been pub-
OLOMOUC 15.–18. 10. 2014
lished as a suitable method for evaluation of cardiovascular
autonomic nervous system status in MS patients (the latter
being mainly represented by spectral analysis of heart-rate
variability). Autonomic challenge manoeuvres (suited for
activation of sympathetic or parasympathetic nervous system) are also frequently used for this purpose and comprise
Valsalva manoeuvre, deep metronomic breathing, response
to active standing, sustained handgrip test, cold pressor test
or cold face test. Furthermore, orthostatic challenge testing
represented by head-up tilting (besides above mentioned
active standing) can be useful in MS patients.
Sudomotor functions in MS are most frequently tested using
the sympathetic skin response (mainly because of wide availability of testing equipment), which seems to be less sensitive comparing cardiovascular tests. The availability of other
testing methods, which may be used for the sweating evaluation (thermoregulatory sweat test, quantitative sudomotor
axon reflex or similar tests) is lower, but they seem to have
higher sensitivity in evaluation of sudomotor dysfunction in
multiple sclerosis.
References:
Hilz MJ, Dütsch M. Quantitative studies of autonomic function.
Muscle Nerve 2006;33:6-20.
Kale N, Magana S, Agaoglu J, Tanik O. Assessment of autonomic
nervous system dysfunction in multiple sclerosis and association
with clinical disability. Neurol Int 2009;1(1):e5.
27
Lensch E, Jost WH. Autonomic disorders in multiple sclerosis. Autoimmune Dis 2011;2011:803841.
NEUROPHYSIOLOGY IN DIAGNOSIS AND
PROGNOSIS OF MULTIPLE SCLEROSIS
IN AGE OF MAGNETIC RESONANCE
IMAGING
Ivana Stetkarova
Department of Neurology, Charles University, Third Faculty of Medicine, Prague, Czech Republic
Objective: The advent of magnetic resonance imaging
techniques has greatly reduced the diagnostic value of neurophysiological tests in MS, particularly evoked potentials.
In disease progression, most of MS patients accumulate inflammatory lesions, axonal damage, and progressive brain
atrophy, along with an increasing degree of disability. More
promising is the utilization of neurophysiological tests to
quantify the severity of white matter involvement.
Methods: Evoked potentials (EP) have been still used in
multiple sclerosis (MS) especially in its early diagnosis. Recently, multimodal EPs appears to be a prognostic factor for
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OLOMOUC 15.–18. 10. 2014
disease progression. Deeper insights about causal and functional relationships in plasticity of the motor system in patients with MS were gained by neurophysiological techniques,
predominantly by transcranial magnetic stimulation.
Results: Visual evoked potential (VEP) are preferentially
used in early diagnosis of MS for detection of subclinical optic neuritis. Somatosensory (SEP) and motor (MEP) evoked
potentials reveal subclinical lesions in the CNS and could
be a supplementary diagnostic tests for sensory and motor
system disturbances. MEP abnormalities correlate with the
degree of motor impairment and disability. A number of
functional imaging studies have assessed patterns of brain
activation during simple motor tasks in MS patients and their
relationship with CNS damage and motor function.
Conclusion: Evoked potentials are functional neurophysiological methods highly sensitive in revealing „silent lesions“
especially at the beginning of MS. Multimodal evoked potentials have indisputable benefit of prognostic value to determine non-responders, „benign“ course of the disease and
identification of patients with significant disease progression.
A battery of neurophysiological tests could be useful in monitoring the disease progression in individual patient and as
surrogate endpoints in clinical trials.
Supported by Research Project of Charles University PRVOUK
P34, Czech Republic
References
Schlaeger R, D‘Souza M, Schindler C, Grize L, Dellas S, Radue
EW, Kappos L, Fuhr P. Prediction of long-term disability in multiple sclerosis. Mult Scler 2012 Jan;18(1):31-8. Epub 2011 Aug
25.
Invernizzi P, Bertolasi L, Bianchi MR, Turatti M, Gajofatto A, Benedetti MD.Prognostic value of multimodal evoked potentials in
OLOMOUC 15.–18. 10. 2014
multiple sclerosis: the EP score. Neurol 2011 Nov;258(11):19339. Epub 2011 Apr 9.
Schlaeger R, D‘Souza M, Schindler C, Grize L, Kappos L, Fuhr
P.Combined evoked potentials as markers and predictors of disability in early multiple sclerosis.Clin Neurophysiol 2012
Feb;123(2):406-10. Epub 2011 Jul 22.
TRENDS IN NEUROPHYSIOLOGY OF MOVEMENT DISORDERS
NEUROPHYSIOLOGIC MECHANISM
OF NEURAL EFFICIENCY IN HUMANS:
CAN IT EXPLAIN PERFORMANCES
OF ATHLETES AND PATIENTS WITH
NEURODEGENERATIVE DISEASES?
Claudio Babilonia,b*, Claudio Del Percioc, Nicola Marzanod,
Francesco Infarinatoc, Pierluigi Aschierie, and Cristina Limatolaa
a
Dipartimento di Fisiologia e Farmacologia, Università di Roma
“Sapienza”, Rome, Italy
b
Casa di Cura San Raffaele Cassino
c
IRCCS SDN Istituto di Ricerca Diagnostica e Nucleare, Napoli,
Italy
d
IRCCS San Raffaele Pisana Roma – Italy
e
Italian Federation of Judo, Karate and Marshall Arts.
Keywords: EEG, cognitive-motor processes, Elite athletes
Problem identification. Purpose of our research is the development and testing of procedures for the study of functional
brain organization in elite athletes and patients with cerebral
neurodegenerative processes to test “neural efficiency” hypothesis (i.e. selective cortical activity in experts).
Methodology. Cortical activity in elite athletes and patients
with Alzheimer‘s disease (AD) was indexed by the study of
29
electroencephalographic (EEG) oscillations in the resting
state condition and during events.
Results. ATHLETES (Del Percio et al., 2008, 2009, 2010;
Babiloni et al., 2009, 2010). More resting state eyes-closed
posterior cortical alpha (8-12 Hz) power was observed in
elite athletes than in amateur athletes and non-athletes, thus
suggesting that athletes’ brain is more inhibited in this condition. Furthermore, there was a reduced event-related alpha
desynchronization as a sign of less cortical activation in elite athletes than in amateur athletes and non-athletes, during
both cognitive and motor events, with some exceptions to
be better understood. AD PATIENTS (Babiloni et al., 2004,
2007, 2010, 2013). Less resting state eyes-closed posterior
cortical alpha (8-10 Hz) power was observed in prodromic
and overt AD than in normal elderly subjects, thus suggesting
that patients’ brain is less inhibited in this condition. Furthermore, there was a reduced event-related alpha desynchronization as a sign of less cortical activation in the former than
in the latter ones during eyes opening.
Conclusions. “Neural efficiency” as a sign of more selectivity and inhibitory capability of brain oscillatory processes
may explain at least in part high cognitive-motor performance in athletes and some cognitive-motor abnormalities in AD
patients.
30
OLOMOUC 15.–18. 10. 2014
References
Del Percio C, Rossini PM, Marzano N, Iacoboni M, Infarinato F,
Aschieri P, Lino A, Fiore A, Toran G, Babiloni C, Eusebi F. Is there a „neural efficiency“ in athletes? A high-resolution EEG study.
Neuroimage. 2008 Oct 1;42(4):1544-53
Del Percio C, Babiloni C, Marzano N, Iacoboni M, Infarinato F,
Vecchio F, Lizio R, Aschieri P, Fiore A, Toràn G, Gallamini M,
Baratto M, Eusebi F. „Neural efficiency“ of athletes‘ brain for
upright standing: a high-resolution EEG study. Brain Res Bull.
2009 May 29;79(3-4):193-200.
Del Percio C, Infarinato F, Iacoboni M, Marzano N, Soricelli A,
Aschieri P, Eusebi F, Babiloni C. Movement-related desynchronization of alpha rhythms is lower in athletes than non-athletes: a high-resolution EEG study. Clin Neurophysiol. 2010
Apr;121(4):482-91.
Babiloni ,C., Binetti, G., Cassetta, E., Cerboneschi, D., Dal Forno,
G., Del Percio, C., Ferreri, F., Ferri, R., Lanuzza, B., Miniussi,
C., Moretti, D.V., Nobili, F., Pascual-Marqui, R.D., Rodriguez,
G., Romani, G.L., Salinari, S., Tecchio, F., Vitali,P., Zanetti, O.,
Zappasodi, F., Rossini. Mapping Distributed Sources of Cortical
Rhythms in Mild Alzheimers Disease. A Multi-Centric EEG Study. NeuroImage. 2004; 22(1):57-67.
Babiloni, C., Cassetta, E., Binetti, G., Tombini, M., Del Percio, C.,
Ferreri ,F., Ferri, R., Frisoni, G., Lanuzza, B., Nobili, F., Parisi,
L., Rodriguez, G., Frigerio, L., Gurzì ,M., Prestia, A., Vernieri,
F., Eusebi, F., Rossini, P,M. Resting EEG sources correlate with
attentional span in mild cognitive impairment and Alzheimer‘s
disease. Eur J Neurosci. 2007; 25(12):3742-57.
Babiloni C, Del Percio C, Lizio R, Infarinato F, Blin O, Bartres-Faz
D, Dix SL, Bentivoglio M, Soricelli A, Bordet R, Rossini PM,
Richardson JC1.Bakker A., Krauss G.L. A review of the effects of
hypoxia, sleep deprivation and transcranial magnetic stimulation.
Babiloni C, Del Percio C, Rossini PM, Marzano N, Iacoboni M,
Infarinato F, Lizio R, Piazza M, Pirritano M, Berlutti G, Cibelli G,
Eusebi F. Judgment of actions in experts: a high-resolution EEG
study in elite athletes. Neuroimage. 2009 Apr 1;45(2):512-21.
Babiloni C, Marzano N, Infarinato F, Iacoboni M, Rizza G, Aschieri
P, Cibelli G, Soricelli A, Eusebi F, Del Percio C. „Neural efficiency“ of experts‘ brain during judgment of actions: a high-resolution EEG study in elite and amateur karate athletes. Behav Brain
Res. 2010 Mar 5;207(2):466-75.
Babiloni C, Carducci F, Lizio R, Vecchio F, Baglieri A, Bernardini S, Cavedo E, Bozzao A, Buttinelli C, Esposito F, Giubilei F,
Guizzaro A, Marino S, Montella P, Quattrocchi CC, Redolfi A,
Soricelli A, Tedeschi G, Ferri R, Rossi-Fedele G, Ursini F, Scrascia F, Vernieri F, Pedersen TJ, Hardemark HG, Rossini PM, Frisoni GB. Resting state cortical electroencephalographic rhythms
are related to gray matter volume in subjects with mild cognitive
impairment and Alzheimer‘s disease. Hum Brain Mapp. 2013
Jun;34(6):1427-46.
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SIMULTANEOUS IMAGING OF THE
BRAIN AND SPINAL CORD: ACCOUNTING
FOR THE BRAIN-SPINE INTERACTION
INTO FUNCTIONAL MODELS OF HUMAN
MOTOR SYSTEM
Ovidiu Lungu
Department of Psychiatry, University of Montreal Medical School,
Montreal, Canada
A large body of neurophysiological work in animals and humans has revealed that the spinal cord is not a simple bystander of the central nervous system or just a bundle of nerves
relaying signals from brain to the muscles and from sensory
organs back to the brain. Yet, the spinal cord is like a Cinderella for the neuroimaging community at large, which focuses
on the brain and mainly ignoring the spine when building and
testing models of human motor functions. Thus, the functional models of human motor system proposed based on neuroimaging evidence will always be incomplete as long as
they do not include both the brain and the spinal cord in their
description. One solution to this problem is the simultaneous
functional imaging of the brain and spinal cord in order to
assess the brain-spine interaction during various motor tasks.
This will allow researchers to partial out the role of each level of the central nervous system in the course of different
31
motor functions. In my presentation I will first outline the
technical challenges of spinal cord imaging, both by itself
or simultaneously with the brain. After that, I will present
an integrated approach that will address these challenges by
using the standard magnetic resonance imaging equipment in
combination with a specific slice prescription during acquisition and well-known statistical models during data analysis.
Then, I will illustrate the use of this approach in the area of
motor skill learning and I will finish with the presentation of
possible uses in the study of movement disorders.
CENTRAL PHYSIOLOGY OF DYSTONIA
– INSIGHTS FROM DEEP BRAIN
RECORDINGS
Andrea Kühn,
Charité, University of Medicine, Berlin, Germany
The pathophysiology of dystonia is not fully understood, and
pathological findings are evident at the cortical, brainstem
and basal ganglia levels of the motor and sensory network.
Deep brain stimulation (DBS) of the globus pallidus internus
is a highly effective treatment in patients with dystonia. Ho-
32
OLOMOUC 15.–18. 10. 2014
wever, the mechanism is still not entirely understood. One
hypothesis is that DBS suppresses abnormally enhanced
synchronized oscillatory activity within the motor cortico –
basal ganglia network. Several electrophysiological studies
in patients undergoing DBS for movement disorders have
revealed evidence for disease-specific oscillatory patterns of
neuronal basal ganglia activity that may act as a noisy disruptive signal disturbing both local and distant neuronal network
functioning causing characteristic movement disorders. In
patients with dystonia, increasing evidence suggests that
neuronal activity in the basal ganglia is characterized by enhanced synchronized oscillations in the low frequency band
(4 - 12 Hz). Such synchronization correlates and is coherent
with EMG activity during involuntary (mainly phasic) dystonic muscle contractions, suggesting that it may contribute
to the pathophysiology of dystonia. Pallidal low frequency
activity significantly drives EMG of the affected muscles,
increases during involuntary movements and correlates with
the strength of the muscle spasms.
In my presentation, I will discuss the role of neuronal oscillations in the basal ganglia for the pathophysiology of dystonia.
I will show most recent findings from our group in dystonia
patients undergoing DBS using a specially designed amplifier allowing simultaneous high frequency stimulation (HFS)
at therapeutic parameter settings and neuronal recordings.
Here, HFS led to a significant reduction of mean power in
the 4-12 Hz band by 24.8 ± 7.0% in patients with predominantly phasic dystonia. Our findings suggest that HFS may
suppress pathologically enhanced low frequency activity in
patients with phasic dystonia. These dystonic features are
the quickest to respond to HFS and may thus directly relate
to modulation of pathological basal ganglia activity, whereas improvement in tonic features may depend on long-term
plastic changes within the motor network.
SENSORY FUNCTIONS IN PRIMARY
DYSTONIA
Michele Tinazzi
Department of Neurological and Movement Sciences, University of
Verona, Italy
The pathophysiology of primary dystonia is thought to involve dysfunction of the basal ganglia cortico-striatal-thalamo-cortical motor circuits. In the past, emphasis was placed
on the role of the basal ganglia in controlling movements;
in more recent times, however, it has also become clear that
they play an important part in sensory functions. Thus, although the most dramatic symptoms in dystonia seem to be
OLOMOUC 15.–18. 10. 2014
motor in nature, marked somatosensory perceptual deficits
are also present in this disease. Recent behavioral studies
have shown that these sensory functions are compromised
in patients with several forms of primary of primary dystonia. Changes have been found in temporal discrimination
and integration of sensory signals, spatial discrimination of
tactile stimuli, perception of the vibration-induced illusion of
movement, and other illusions (the rubber hand and Aristotele’s illusion). The search for abnormalities of sensation was
stimulated by the observation in a primate model of dystonia
that showed enlarged and overlapped receptive fields of the
hand in the S1 after stereotypic movements of the hand. Abnormal representation in S1 of the fingers involved in dystonia characterized by smaller distance between the fingers has
been also observed in patients affected by focal hand dystonia using neuroimaging studies. One possible pathophysiological mechanisms for these abnormalities could be a loss
of inhibition at multiple levels of the somatosensory system,
as documented by somatosensory evoked potentials studies.
Consequently, abnormal processing of the somatosensory input may lead to an inefficient sensorimotor integration, thus
contributing to the generation of dystonic movements.
This talk focuses on sensory function abnormalities described in primary dystonia using different approaches and techniques and their possible role in the pathophysiology of this
syndrome, highlighting potential implications for innovative
therapeutic strategies to aid functional recovery.
33
NEUROPHYSIOLOGY AND TREATMENT
OF DYSTONIA: NON-INVASIVE BRAIN
STIMULATION STUDIES
processing of sensory input is abnormal. Finally, surround
inhibition is reduced in FHD, supporting the idea that this
alteration may be a principal pathophysiological mechanism
of activity spillover to antagonist muscles in dystonia.
Ulf Ziemann
In addition to measuring motor cortical excitability, repetitive
TMS can also be employed for induction of plasticity. It was
found that patients with FHD display exaggerated levels of
LTP-like plasticity. In addition, while healthy subjects show
homeostatic control of plasticity, FHD patients often exhibit
non-homeostatic metaplasticity that may lead to non-physiological run-away plasticity. Finally, FHD patients display
a failure of depotentiation of LTP-like plasticity, which may
contribute to the inability to erase or correct unwanted motor
activation patterns once they have been encoded.
Department of Neurology, University of Tübingen, Germany
Focal hand dystonia (FHD) is characterized by task-dependent involuntary co-contraction of hand muscles. Functional
MRI studies demonstrated excessive activation of primary
sensorimotor cortex during dystonic motor action while premotor cortex and supplementary motor area are underactive.
Transcranial magnetic stimulation (TMS) has substantially
contributed to our understanding of the cortical pathophysiology underlying these abnormalities. These TMS studies will
be reviewed in this presentation. Motor evoked potentials
(MEP) are significantly stronger facilitated during voluntary
target muscle contraction in FHD compared to healthy controls, indicating hyperexcitability of the corticospinal system.
The cortical silent period (CSP), a marker of GABABergic
inhibition in motor cortex is shortened during dystonic contractions in FHD, and short-interval intracortical inhibition
(SICI), a marker of GABAAergic inhibition in motor cortex is reduced in FHD, indicating significant alteration of
inhibitory motor cortical control. The long-latency afferent
inhibition (LAI) is reduced in FHD, indicating that central
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OLOMOUC 15.–18. 10. 2014
In summary, TMS research has provided detailed knowledge
on the cortical pathophysiology of dystonia. The data support
the notion that hyperexcitability, disturbed inhibition, altered
sensorimotor integration and abnormal regulation of synaptic plasticity significantly contribute to the clinical picture of
dystonia. In the final part of this presentation, initial studies
will be presented that use repetitive TMS as a therapeutic
tool for treatment of dystonia aiming at correcting these abnormalities of motor cortex excitability and plasticity.
OLOMOUC 15.–18. 10. 2014
Tématické sekce sjezdu
Elektromyografie
NEUROMUSCULAR TRANSMISSION
DISORDERS IN MILLER FISHER
SYNDROME
Edvard Ehler
Department of neurology, Regional hospital and Pardubice University
Introduction: Miller Fisher syndrome (MFS) is a variant of
Guillain-Barré syndrome (GBS). MFS is clinically defined by
trias – ophthalmoplegia, ataxia, areflexia. Antibodies against
ganglioside GQ1b are bound on the nodal and paranodal sections of oculomotor nerves, sensory nerves (including spinal
ganglia) and cerebellum. Ophthalmoparesis is usually severe
with prominent fatiguability. In these patients neuromuscular
transmission disorders are suspected.
Case report: A 52-year man was admitted to neurological
department for progressive external ophthalmoparesis with
generalized ataxia. The neurological signs and symptoms developer during 5 days with preceding upper respiratory tract
infection. The first diagnosis was MFS. There was very prominent especially oculomotor fatiguability with worsening
during the day and after rehabilitation, that neuromuscular
transmission was suspected too.
Neurophysiological investigation: Motor conduction studies (including F-waves) were normal, sensory conduction
studies with very low amplitude of sensory nerve action potentials. H-reflex was not elicitable. Needle EMG of biceps
brachii was normal (14 days after disease onset). Repetitive
stimulation (3 Hz) with recording from trapezius with 7 %
decrement (4th response) and from nasalis 5.8%. Axonal
stimulated SF EMG with recording by concentric needle
electrode from frontalis muscle presented an increased jitter
-32.91 µs and 9% blocking - with the stimulation rate 3 Hz.
With stimulation rate 10 Hz the jitter decreased to 26.26 µs
and without blocking, with 20 Hz stimulation rate was the
jitter normal (21.83 µs) and without blocking.
Other investigations: GQ1b antibody level was prominent
– 315.7% (norm – up to 9%), antibodies against acetylcholin receptors were not found. MR of brain and thorax were
normal.
The patient was treated with a series of plasma exchange.
After 14 days he began to walk with crutches and ptosis and
35
diplopia significantly decreased. 6 weeks later he was able to
walk without support and oculomotor function normalized.
tions are known to cause PMA variants also called LMND
(lower motor neurone disease).
Neurophysiological findings in MFS are discussed
Selected LMND cases are associated to specific autoantibodies. For example an asymmetric lower motor neurone
syndrome with predominant distal involvement is associated
to IgM anti–GM1 or to IgM anti–GalNAc-GD1a. Another
LMND variant is an asymmetric lower motor neurone syndrome with particular damage of proximal upper extremities
muscles (also known as Vulpian-Bernhard syndrome, brachial amyotrophic diplegia or flail arm syndrome) can be associated in 10-20% cases to anti–asialo GM1 autoantibodies. We
present a patient’s case report with suspected Vulpian-Bernhard syndrome with bilateral non-symmetric cervico-brachial amyotrophy without sensory impairment. The autoimmune aetiology was clearly proven by clinical responsiveness
to immunosuppression/immunomodulation therapy mainly
to repetitive intravenous human polyclonal immunoglobulin
application (IVIG).
Conclusion: In our patient with MFS we diagnosed presynaptic type (axonal) disorder of neuromuscular transmission.
AUTOIMMUNE LOWER MOTOR
NEURONE DISORDER – CASE REPORT
Kurča E., Grofik M., Turčanová Koprušáková M.
Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak republic
Motor neurone diseases (MND) traditionally include a broad
spectrum of neuromuscular disorders. First, we have to mention sporadic forms of ALS (amyotrophic lateral sclerosis)
with mixed clinical presentation (syndromes with upper and
lower motor neurone signs), then the isolated central type
(primary lateral sclerosis, PLS) and at last the isolated peripheral type (primary muscular atrophy, PMA). The existence
of familiar hereditary and genetic MND forms is well known,
e.g. superoxide dismutase (SOD-1) and dynactin gene muta-
36
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ELECTROPHYSIOLOGY STUDY OF
DISTAL MEDIAN TO ULNAR NERVE
TRANSFER TO RESTORE ULNAR MOTOR
FUNCTION - CASE REPORT
OLOMOUC 15.–18. 10. 2014
Objectives: We present a patient with recovery of the hand
intrinsic functions after interposition nerve grafting. It has
been well documented, step by step, by pre-operative, intra-operative and post-operative electrophysiological examinations.
Results: A 10 year old boy was referred to the neurosurgeon
for ulnar nerve cut on his non-dominant arm. Urgent nerve
suture was performed. Repeated EMG carried out 6 and 12
months later revealed the evidence of reinnervation potentials in the flexor carpi ulnaris muscle and no recovery in
the hand´s intrinsic muscles. Repeated surgical intervention
– anterior interosseous to ulnar motor nerve transfer – was
recommended. Intraoperative ulnar neurography confirmed
complete nerve lesion with no nerve action potential. Ulnar
nerve cortical SEPs were recorded to identify sensory division of the nerve and to reduce the misdirected connection of
the motor fibres. Surprisingly, cortical SEPs of ulnar nerve
were recorded from both motor and sensory division. We explain it by the cross-reinnervation between motor and sensory fibres after the first nerve suture. The motor division had
to be identified only by anatomic signs. Post-operative EMG
study showed the recovery of action potentials from ulnar intrinsic muscles by median and not by ulnar nerve stimulation.
The findings confirmed reinnervation by anterior interosseous nerve. In the post-operative follow-up we detected restored muscle strength (grade IV) of intrinsic muscles, which
confirmed successful functional regeneration of the nerve.
Methods: Electromyography (EMG) was performed before and after the surgery. Ulnar nerve neurography and ulnar
nerve cortical somatosensory evoked potentials (SEPs) were
examined at both motor and sensory division of ulnar nerve
during the surgery.
Conclusion: The anterior interosseous to ulnar motor nerve
transfer is the unique treatment of ulnar nerve injury. Electromyography is commonly used for diagnosis, however, intraoperative electrophysiological methods we used seems to be
so far underestimate in routine clinical practice.
J. Valeš, I. Holečková, D. Štěpánek
Dpt. of Neurosurgery, The University Hospital and The Faculty of
Medicine in Pilsen, Charles University, Czech Republic
Introduction: Traumatic lesions of ulnar nerve can be responsible for a great loss of hand motor function. Nerve suture of the anterior interosseous nerve, especially the pronator
quadratus branch, with deep branch of ulnar nerve can restore ulnar motor nerve´s intrinsic function of the hand and prevent hand clawing. Electrophysiological methods help with
diagnosis and guide surgery.
37
fMRI AND EEG STUDIES OF THE ROLE
OF BASAL GANGLIA IN EPILEPSY
Ivan Rektor, Robert Kuba, Jan Chrastina, Irena Rektorová,
Milan Brázdil
1
Central European Institute of Technology (CEITEC) and the Brno
Epilepsy Centre, First Department of Neurology and Department
of Neurosurgery, Masaryk University, St. Anne’s Hospital, Brno,
Czech Republic
1. In the fMRI study the impact of epilepsy on the functional brain connectivity (FC) of the BG in two large-scale
networks, the default mode network (DMN) and somatomotor network (SMN), was studied in 10 healthy control subjects (HC) and 24 patients with epilepsy. In HC, the BG were
functionally negatively correlated with typical DMN regions.
This negative correlation as well as the FC between the BG
and SMN was significantly lower in patients [3].
2. SEEG studies: The human striatum and pallidum did not
generate specific epileptic EEG activity, not even when the
seizures were generalized. The visually observed slowing
and amplitude increase in the BG was found with the spread
of the epileptic activity from the hippocampus to other areas
[1]. Significant frequency components of 2-10 Hz, with the
38
OLOMOUC 15.–18. 10. 2014
maximum in the 5-10 Hz range, were constantly observed
in the BG [2]. The frequency of this component slowed by
around 2 Hz during seizures. There was a significant ictal increase of power spectral density in all frequency ranges. The
changes in the BG were consistent while the seizure activity
spread over the cortex, and they partially persisted after the
clinical seizure ended. They were inconsistently present in
the first period after the seizure onset.
Conclusion: Unlike in HC, in TLE the BG are not correlated
with a DMN component, and the FC of the BG is decreased
with SMN. The epileptic process reduces the FC between the
BG and large-scale brain networks. This may reflect an altered function of the BG in epilepsy.
Based on our SEEG studies, the time course of the oscillatory activities together with the absence of the epileptiform
EEG activities in the BG lead us to suggest an inhibitory role
of the BG in temporal lobe seizures.. This “filtering effect”
of the BG may act as an obstacle to the spread of ictal activity. The BG should be seriously considered as a potential
target for neuromodulatory and pharmacological treatment
of TLE.
References:
[1] Rektor I, Kuba R, Brázdil M. Interictal and ictal EEG activity in
the basal ganglia. Epilepsia 2002;43:253-62.
[2] Rektor I, Kuba R, Brázdil M, Halámek J, Jurák P. Ictal and peri-ictal oscillations in the human basal ganglia in temporal lobe
epilepsy. Epilepsy Behav 2011; 20(3):512-7.
[3] Rektor I, Tomčík J, Mikl M, Mareček R, Brázdil M, Rektorová
I. Association between the basal ganglia and large-scale brain networks in epilepsy. 2013 ;26(2):355-62
THE CONTRIBUTION OF INTRACRANIAL
EEG TO RESEARCH ON THE EMPATHY
FOR PAIN
Milan Brázdil1,2, Igor Riecansky3, Robert Roman1, Jan Chládek1, Radek Mareček1,2, Daniel J. Shaw1, Claus Lamm3
1
Behavioral and Social Neuroscience Research Group, Central
European Institute of Technology, Masaryk University, Brno,
Czech Rep.
2
Brno Epilepsy Center, Department of Neurology, St. Anne University Hospital and Medical Faculty of Masaryk University,
Brno, Czech Rep.
3
Social, Cognitive and Affective Neuroscience Unit, University of
Vienna, Austria
OLOMOUC 15.–18. 10. 2014
In the last decade, a number of functional neuroimaging studies have identified a set of neural structures that are involved in empathy for another person’s pain. Bilateral anterior
insular cortex and medial/anterior cingulate cortex seem to
play a crucial role, but several other brain regions are also
co-activated; this includes structures associated mostly with
“Theory of Mind” or “mentalizing”, including precuneus,
ventral prefrontal cortex, superior temporal cortex, and temporo-parietal junction. Electrophysiological pain-empathy
responses have been analyzed to investigate the temporal dynamics of neural activity underlying this process. To the best
of our knowledge, however, this has been performed with
scalp recordings only; pain empathy-related brain potentials
have not recorded using intracranial electrodes until now.
In the present study, we investigated intracranial event-related brain potentials (ERPs) from three intractable epileptic
patients who underwent preoperatively diagnostic invasive
video-EEG monitoring. During the experiment, patients
watched 3-second dynamic visual stimuli depicting needle
injections into a left hand (N=42), or the same left hand touched by a cue tip (N=42). Intracranial EEGs were recorded
using intracerebral and subdural electrodes, investigating in
total more than 300 brain sites. The ERPs in each condition
(needle and cue tip) were averaged separately off-line, and
statistical differences in response amplitudes after painful vs.
non-painful stimuli were detected.
39
In all three subjects, significantly different event-related responses to painful vs. non-painful stimuli were observed in
some investigated neural structures, including left-hemispheric temporo-parietal junction, right-sided temporo-occipital
junction, and right-sided lateral occipital cortex. In these
brain sites, painful needle stimuli evoked more prominent
ERPs compared to cue-tip touch. The latency of these intracranial ERPs can be used for direct measurement of local
activation with millisecond temporal resolution, and can be
compared across different brain structures as well as with the
scalp ERPs.
Our pilot data demonstrate the ability of intracranial ERP recordings to contribute to our understanding of pain empathy.
More generally, these data provide important insights into
more complex social phenomena, and complement widely
available functional neuroimaging data which are limited by
their reliance on hemodynamic rather than direct neural measurements.
OLOMOUC 15.–18. 10. 2014
THE OCCURRENCE OF ALPHA ACTIVITY
DURING CYCLICAL REPETITIVE
MOVEMENT
Pánek DL1, Kovářová L2, Pavlů D1, Krajča V3, Pospíšilová E1
1
Department of physiotherapy, Faculty of Physical Education and
Sports, Charles University, Prague, Czech Republic
2
Laboratory of Sport Motor Activities, Faculty of Physical Education and Sports, Charles University, Prague, Czech Republic
3
Czech Technical University in Prague, Faculty of Biomedical Engineering, Kladno, Czech Republic
E-mail: [email protected]
AIM: Traditionally, electroencephalographic research describes the occurrence of alpha activity on condition of a relaxed state and with closed eyes only. However, some recent
studies have detected alpha activity during motor tasks such
as cyclical repetitive movement. The aim of our study was to
monitor the occurrence, frequency and distribution of scalp
alpha activity during qi gong practice both with open and
closed eyes.
METHODS: Five volunteers were tested (three men, two
women), all with more than twelve month experience with
qi gong practice. We selected simple basic movements which
all volunteers were familiar with. They were asked to per-
40
form the given movements for ten minutes with open eyes
first, and subsequently for ten minutes with eyes closed. Simultaneously, electroencephalographic activity was recorded
with the telemetric 32-channel Nicolet EEG Wireless Amplifier by Natus Neurology Inc. The recorded data of subjects
performing movements was then compared with their native
EEG recorded before qi gong practice.
RESULTS: During native EEG testing before qi gong practice (in a relaxed resting state with closed eyes) alpha activity
was registered with four subjects. In the same fours subjects,
alpha activity was also recorded during qi gong practice with
closed eyes, and in three subjects also during qi gong practice
movements with open eyes. Only with one subject there was
beta activity both in the resting and exercising mode (both
with open and closed eyes).
CONCLUSION: Many studies have looked into the correlation of brain activity and alpha activity. To sum up, it can be
said that there is a negative correlation between alpha activity and cerebral neocortex activity, and positive correlation
between alpha activity and the deeper structures of the brain
(thalamus, amygdala and insula, anterior cingulum and cerebellum). The results of this pilot study indicate that there
is a subcortical steering process for acquired movement stereotypes which are accompanied with a decrease in cerebral
neocortex activity and an increase in the activity of certain
limbic structures.
OLOMOUC 15.–18. 10. 2014
This article was written with support from the GAČR 1307776P grant project.
HIPPOCAMPAL NEGATIVE EVENTRELATED POTENTIAL RECORDED IN
HUMANS IS NOT TIME-LOCKED TO THE
MOTOR RESPONSE EXECUTION
Robert Roman,1,2,* Milan Brázdil,2,4 Jan Chládek,2,3 Ivan
Rektor,2,4 Pavel Jurák,3 Miroslav Světlák,1 Alena Damborská,1,2 Daniel J. Shaw,2 Miloslav Kukleta2
1
Department of Physiology, Medical Faculty, Masaryk University,
Brno, Czech Republic
2
3
Institute of Scientific Instruments, Academy of Sciences of the
Czech Republic, Brno, Czech Republic
4
Department of Neurology, St. Anne Hospital, Masaryk University, Brno, Czech Republic
A hippocampal-prominent event-related potential (ERP) with
a peak latency at around 450 ms is consistently observed as
41
a correlate of hippocampal activity during various cognitive
tasks. Some intracranial EEG studies demonstrated that the
amplitude of this hippocampal potential was greater in response to stimuli requiring an overt motor response, in comparison with stimuli for which no motor response is required. These findings could indicate that hippocampal evoked
activity is related to movement execution as well as stimulus
evaluation and associated memory processes. The aim of the
present study was to investigate the temporal relationship
between the hippocampal negative potential latency (hippocampal slow negativity, hipp SNe) and motor responses. We
analyzed ERPs recorded with 22 depth electrodes implanted
into the hippocampi of 11 epileptic patients. Subjects were
instructed to press a button after the presentation of a tone.
All investigated hippocampi generated a prominent negative
event-related potential peaking at approximately 420 ms. In
16 from 22 cases we found that the ERP latency did not correlate with the reaction time; in different subjects, this potential could either precede or follow the motor response. Our
results indicate that hippocampal slow negativity is not time-locked to the motor response. We suggest that hippocampal
evoked activity, recorded in a simple sensorimotor task, is
related to the full-value evaluation of stimulus significance
within the context of situation.
OLOMOUC 15.–18. 10. 2014
fMRI 1
MOVEMENT SEQUENCING
ABNORMALITIES IN SCHIZOPHRENIA:
CHANGES IN CORTICAL ACTIVITY
DURING FINGER-TAPPING TASK
Petra Zemankova1, Ovidiu Lungu2, Tomas Kasparek1,3, Jitka
Hüttlova3, Milos Kerkovsky4, Martin Bares1,5
1
Behavioral and Social Neuroscience Research Group, CEITEC
- Central European Institute of Technology, Masaryk University,
2
Centre de recherche de l‘Institut Universitaire de Gériatrie de
Montréal, Montréal, Québec, Canada
3
Department of Psychiatry, Masaryk University and University
Hospital Brno, Brno, Czech Republic
4
Department of Radiology, Masaryk University and University
Hospital Brno, Brno, Czech Republic
5
First Department of Neurology, St. Anne’s University Hospital
and School of Medicine, Masaryk University, Brno, Czech Republic
Minor motor and sensory impairments, including movement
sequencing, are frequent symptoms in schizophrenia. In
42
a previous study (Kasparek et al., 2012) we showed abnormal cortico-cerebellar functional connectivity during execution of motor task only in schizophrenia patients (SZP) with
sequencing deficit. This suggests that the abnormal connectivity reflects rather symptoms that are domain-specific, than
the diagnoses of schizophrenia per se. In order to parse out
the differences in brain activity during motor learning that
are disease-specific (i.e. common to all SZP relative to healthy controls) versus domain-specific (i.e. specific only to
SZP with sequencing deficit), we conducted a new and more
detailed analysis of the data from the previous study. We used
functional magnetic resonance imaging to examine brain
activity during finger-tapping task in 24 SZP and 24 healthy
control participants. The task had two experimental conditions, in which participants had to execute blocks of sequenced
finger movements (SQ condition) and non-sequenced movements (ALL condition). Prior to the imaging session, outside
the scanner the movement sequencing skills were assessed
through Neurological Evaluation Scale (NES). Based on the
NES scores the patients were subdivided into two groups,
those with sequencing abnormalities (SQ+), and those without movement sequencing deficit (SQ-). We performed
whole brain analysis to identify regions with higher activation during SQ as compared to ALL blocks and we analyze
these results as a function of movement sequencing skill. In
the left motor and parietal cortices all patients had higher
activation than healthy subjects in both ALL and SQ con-
OLOMOUC 15.–18. 10. 2014
ditions. However, our analysis revealed that this effect was
driven mainly by the SQ- subgroup in motor cortex, and by
SQ+ group in parietal cortex. No such differences were seen
in the contra-lateral cortices. We conclude that executing
a non-sequenced motor task is more demanding for SZP than
controls (disease-specific), since they show constantly higher
activation in left motor and parietal cortex. Notably, although
the overactivation of motor cortex seems to be a good compensating strategy to achieve adequate motor performance,
the hyperactivation of parietal cortex seems to be linked to
motor deficit symptoms (domain-specific).
Reference
Kasparek T, Rehulova J, Kerkovsky M, Sprlakova A, Mechl M,
Mikl M. Cortico-cerebellar functional connectivity and sequencing of movements in schizophrenia. BMC Psychiatry C7 - 17.
2012;12(1):1-9.
Acknowledgement
The study was supported by the Ministry of Health of the Czech
Republic (research grant No. NT13437) and by the University
Hospital Brno from the Institutional Support Fund.
43
LONGITUDINAL FMRI ASSESSMENT
IN CHRONIC SPINAL CORD INJURY
TREATED BY INTRATHECAL BACLOFEN
- PILOT DATA
Jiri Keller1,2, Robert Jech3, Ivana Stetkarova1
Department of Neurology, Third Faculty of Medicine, Charles
University, Prague,
1
Department of Radiology, Na Homolce Hospital, Prague, Czech
Republic
2
Department of Neurology and Center of Clinical Neuroscience,
Charles University
3
Introduction: Spasticity is a frequent disabling sign of upper
motor neuron lesion in chronic spinal cord injury (SCI). In
severe cases intrathecal baclofen (ITB) is recommended as
a choice of effective treatment. Baclofen, being as a strong
GABAB agonist, modulates cortical and spinal inhibitory
circuits. The aim of this study was to assess longitudinal
changes in brain activation after continuous ITB delivery during simple motor tasks performed by functional magnetic
resonance imaging (fMRI).
Material and Methods: Two subjects (27 and 35 years-old
males, 5.5 years after SCI) with chronic posttraumatic cervical spinal cord injury at C4-5 level underwent ITB pump
implantation (Synchromed II, 20ml, Medtronic). Spasticity
44
OLOMOUC 15.–18. 10. 2014
was assessed by modified Modified Ashworth Scale (MAS,
0 to 4). Both subjects were studied by 1.5T fMRI with three
tasks employed: i) finger-tapping and mental movement simulating, ii) finger taping and iii) foot flexion. Tasks were
performed before, 12 weeks and one year after ITB pump implantation. Analysis was processed in SPM8 using the FWE
corrected threshold (p< 0.05).
Results: Both patients were classified as AIS-A and they presented no active movements of lower limbs. In both subjects,
MAS score declined in the lower extremities from 4 to 1 before and after ITB implantation, respectively. Before-ITB pump
implantation fMRI showed weak activations in all tasks. Post-ITB tasks extensively raised activation in the motor system
network, namely the primary sensorimotor cortex and supplementary motor area. In one year follow-up, the activation in
foot-flexion mental tasks were detectable only in one of the
subjects, with slightly increased volume. One of the most important factors, influencing all the results, is subject motion.
Conclusions: Continuous ITB administration relieving spasticity in SCI patients was associated with increased activation of sensorimotor cortex. ITB treatment may cause distant
functional reorganization of sensorimotor network probably
by increased GABAB-mediated inhibitory activity at cortical
level.
Supported by Research Projects PRVOUK P34, UNCE 204010/2012
and IGA NT12282.
PLASTICITY OF SENSORIMOTOR
SYSTEM INDUCED BY SUSTAINED
PRESSURE STIMULATION
Pavel Hok1,2, Petr Hluštík1,2, Miroslav Kutín3, Jaroslav Opavský4, Zbyněk Tüdös2,5, Petr Kaňovský1,2
1
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc
2
University Hospital Olomouc
3
KM KINEPRO PLUS s.r.o., Olomouc
4
Department of Physiotherapy, Faculty of Physical Culture, Palacký University Olomouc, Olomouc
5
Department of Radiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc
Introduction: The aim of this study was to assess functional
changes occurring at central nervous system (CNS) in healthy volunteers after sustained pressure stimulation according
to Vojta1, a physiotherapeutic method involving induction of
a complex motor response, so called reflex locomotion. Although the therapy has been widely used in clinical practice,
its underlying neurobiological basis remains a speculation.
We hypothesize that the stimulation-driven response induces
CNS plasticity at subcortical level detectable by functional
magnetic resonance imaging (fMRI), possibly involving spe-
OLOMOUC 15.–18. 10. 2014
cific changes in task-related sensorimotor system activation
as well as modulation of resting state networks.
Methods: Two groups of healthy volunteers were included
(17 females and 5 males in each group, mean age 24.5 and
24.7 respectively): Group A receiving stimulation at the Vojta
right heel zone and Group B receiving control stimulation of
the right ankle. All subjects underwent a single fMRI session
using a 1.5T Siemens scanner, including 6 experimental runs
employing 3 different conditions: rest (6 min); dominant
hand finger tapping alternating with rest (6 min); intermittent
pressure stimulation applied by an experienced therapist (10
min). Both rest and finger tapping conditions were tested before and after two consecutive stimulation runs. Statistical
analysis, including standard pre-processing, nuisance signal regression and group post-hoc contrasts, was carried out
using FEAT, and MELODIC followed by Dual Regression,
parts of FSL2 5.0. The resulting statistical maps were thresholded at corrected significance level p<0.05.
Results: In finger tapping task, diffuse activation decrease
within sensorimotor system was observed in both groups.
However, there was significant activation increase mainly in
motor nuclei of left thalamus detected only in group A. Additionally, group A showed significant decrease of functional
connectivity in the left superior parietal lobule within the bilateral sensorimotor resting-state network.
45
Conclusions: Our findings provide evidence that stimulation
according to Vojta is associated with specific and persistent
changes of brain activation, as compared to the control stimulation. The observed changes could represent neurophysiological correlate of Vojta therapy and suggest an important
role of subcortical structures.
OLOMOUC 15.–18. 10. 2014
Epilepsie 1
PHOTIC STIMULATION IN THE EEG
LABORATORY – EUROPEAN ALGORITHM
Jana Zárubová
References:
1. Bauer, H., et al. (1992) Indian Journal of Pediatrics 59(1), 37-51.
2. Jenkinson, M., et al. (2012) Neuroimage 62, 782–790.
Acknowledgement:
Supported by grant GACR 14-22572S.
46
Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital
Intermittent photic stimulation (IPS) is a common procedure performed in the EEG laboratories in children and adults
to detect photosensitivity. In clinical practice, a considerable
variability in outcome can be observed which is caused due
to many different methodologies used per laboratory. Standardization of this procedure based on scientific and clinical
data should permit reproducible identification and quantification of photosensitivity. A survey of IPS methodologies used
in different EEG laboratories in the Czech Republic will be
presented and compared to the algorithm proposed as a consensus of European experts in this field in 2011.
STATISTICAL PARAMETRIC MAPPING
OF REGIONAL GLUCOSE METABOLISM
IN MESIAL TEMPORAL LOBE EPILEPSY
ASSOCIATED WITH HIPPOCAMPAL
SCLEROSIS
Martin Kojan,1* Irena Doležalová,1,2 Eva Janoušová,3 Radek
Mareček,1,4 Zdeněk Řehák,5 Markéta Hermanová,6 Milan
Brázdil,1,2 Robert Kuba,1,2
1
Brno Epilepsy Center, Department of Neurology, St. Anne’s
University Hospital and Medical Faculty of Masaryk University,
2
– Central European Institute of Technology, Masaryk University,
3
Institute of Biostatistics and Analyses, Masaryk University, Brno,
Czech Republic
4
Multi-modal and Functional Neuroimaging Research Group,
CEITEC – Central European Institute of Technology, Masaryk
Department of Nuclear Medicine, PET Centre, RECAMO, Masaryk Memorial Cancer Institute (MMCI), School of Medicine Brno,
Czech Republic
5
First Department of Pathological Anatomy, St. Anne’s University Hospital and Medical Faculty of Masaryk University, Brno, Czech Rep.
6
OLOMOUC 15.–18. 10. 2014
Objective: This study was designed to use statistical parametric mapping (SPM) of preoperative interictal FDG-PET
to compare the brain metabolisms of patients with mesial
temporal lobe epilepsy/hippocampal sclerosis (MTLE/HS)
who underwent resective surgery and controls. Another aim
of this study was to analyze potential differences in SPM-PET within the group of MTLE/HS patients in terms of gender, side of HS, histopathological findings, and postoperative
outcomes.
Methods: We analyzed FDG-PET scans from 49 patients
with MTLE/HS and 24 control subjects. Using SPM, we
analyzed the differences in regional glucose metabolism between the patient and the control groups and within the patient group using multiple variables.
Results: We revealed widespread hypometabolism in the patient group in comparison to the control group in temporal
and extratemporal areas on the epileptogenic side (ES). On
the nonepileptogenic side (NES), we observed most the hypometabolism in the thalamus and the anterior and middle
cingulate gyri (GCA and GCM). In the group of patients with
more severe HS (Wyler III/IV), we observed statistically significant hypometabolism in the insula on the ES in comparison to the patients with Wyler I/II HS. In patients with poor
postoperative outcomes (ILAE III-V), we found statistically
significant hypometabolism in the insula on the ES and the
TP on the NES compared to the ILAE I and II group. Patients
47
with encephalitis/meningoencephalitis and/or febrile seizures in their history showed significant hypermetabolism in
the TP either on the ES or the NES and in the middle temporal gyrus on the NES compared to the patients without any
insult in their history.
Significance: Our study showed that there are widespread
significant changes in metabolism in MTLE/HS patients in
comparison to controls, either inside or outside the temporal
lobe and mostly ipsilateral to the side of HS. There are significant differences among these patients in terms of postoperative outcomes, degree of HS, and insults in their history.
References:
- Takahashi M, Soma T, Kawai K, et al. Voxel-based comparison
of preoperative FDG-PET between mesial temporal lobe epilepsy
patients with and without postoperative seizure-free outcomes.
Ann Nucl Med. 2012 Nov;26(9):698-706.
- Soma T, Momose T, Takahashi M, et al. Usefulness of extent
analysis for statistical parametric mapping with asymmetry index
using inter-ictal FGD-PET in mesial temporal lobe epilepsy. Annals of Nuclear Medicine 2012;26:319-326
- Van Bogaert P, Massager N, Tugendhaft P, et al. Statistical parametric mapping of regional glucose metabolism in mesial temporal lobe epilepsy. Neuroimage. 2000 Aug;12(2):129-38.
48
OLOMOUC 15.–18. 10. 2014
QUANTITATIVE EEG ASSESSMENT IN
EPILEPTOLOGY – A POSSIBLE WAY
TO IMPROVE THE DIAGNOSTICS AND
TREATMENT
Ježdík P.1, Janča R.1, Čmejla R.1, Marusič P.2, Jiruška P.3, Kršek P.4
Department of Circuit theory, Faculty of Electrical engineering,
Czech Technical University in Prague
1
Department of Neurology, Charles University, 2nd Faculty of
Medicine, Motol University Hospital
2
Department of Developmental Epileptology, Institute of Physiology, Academy of Sciences of Czech Republic
3
Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital
4
Novel and quantitative methods EEG signal analysis are being developed by close multidisciplinary collaborations between epilepsy specialists, biomedical engineers and mathematicians. Quantitative analysis of the long-term monitoring
from intracranial electrodes is expected to provide precise
and objective results. High performance computational algorithms will be presented, not only from technical point of
view, but also to demonstrate that output of these techniques
can provide quantitative and clinically relevant diagnostic information. Three types of automatic and semi-automatic al-
OLOMOUC 15.–18. 10. 2014
gorithms of quantitative EEG analysis will be presented and
their benefits for epilepsy surgery planning discussed.
cult-to-treat cases and offer surgery to patients formerly classified as not suitable for surgery.
Interictal epileptiform discharges and high-frequency oscillations represent electrographic markers of epileptic tissue. Methods of their automatic detection can substantially
facilitate analysis of multi-channel long-term intracranial recordings and extract unbiased meaningful information about
spatiotemporal and morphological properties of these markers.
Supported by grants from IGA NT11460, NT13357, NT14489,
GACR 14-02634S and Neuron Fund (NFKJ 001/2012).
Visual identification of seizure onset zone in intracranial recordings is challenging and prone to bias. Methods of seizure
onset identification represent one of the main research directions of intracranial signal processing. It has been demonstrated that introduction of causality measures and network
analysis can provide useful information about epileptic network organization. These techniques are capable to identify
the seizure onset zone in both ictal and interictal recordings.
Application of average Directed Transfer Function and Granger’s causality to intracranial recordings demonstrate that
seizure onset zone is characterized by the disconnection from
the rest of the epileptic network.
Increased information yield and quantitative results lead to
increased integration of the above mentioned methods into
presurgical diagnosis. These methods of intracranial signal
analysis can improve guiding of resective surgery in diffi-
FUNCTIONAL ORGANIZATION OF THE
IRRITATIVE ZONE IN NEOCORTICAL
EPILEPSY
Petr Marusic1, Radek Janca2, Pavel Krsek3, Petr Jezdik2, Roman Cmejla2, Martin Tomasek1, John G. R. Jefferys4, Vladimir Komarek3, Premysl Jiruska1,4
Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague, 150 06,
Czech Republic
1
Department of Circuit Theory, Faculty of Electrical Engineering,
Czech Technical University in Prague, Prague, 166 35, Czech Rep.
2
Department of Paediatric Neurology, 2nd Faculty of Medicine,
Charles University in Prague, Motol University Hospital, Prague,
150 06, Czech Republic
3
Department of Developmental Epileptology, Institute of Physiology, Academy of Sciences of Czech Republic, Prague, CZ-14220,
Czech Republic
4
49
Rationale: The irritative zone is an area of the brain generating interictal epileptiform discharges (IEDs) that is used
together with other results when planning epilepsy surgery.
This zone possesses relatively low diagnostic value due to
lack of a specific marker that would identify IEDs generated
within the epileptogenic tissue. To increase diagnostic yield
of irritative zone, we examined its functional organization.
Methods: Intracranial EEG recordings from 14 patients with
refractory neocortical epilepsy were analysed using an algorithm that separates IEDs according to their spatial distribution into clusters. Analysis of cluster properties enabled to
determine: 1) activity - percentage contribution to all IEDs
in the given recording; 2) origins - the contacts where cluster
initiates and 3) active region - the area of the most common
propagation.
Results: On average 16,868±16,813 IEDs per patient were
analysed. The results demonstrated that in all patients the
irritative zone was composed of multiple clusters with an
average number of 12.5±4.7 clusters per patient. The strongest cluster generated 43.5±18.9% of all IEDs Average size
of active region was 4.5±4.5 contacts and contained 2.2±1.7
origins. Evaluation of the cluster resection with the outcome
suggested that the topology of the irritative zone may determine the success of the resection.
Conclusion: This study demonstrates the complex organization and modular nature of the neocortical irritative zone
50
OLOMOUC 15.–18. 10. 2014
in epilepsy patients. It can be stratified into functional components, each with distinct pathophysiological and clinical
significance. The ability to identify the key components of
this network and its topology has potential to improve the
results of epilepsy surgery.
Varia
DETECTION OF POSTURAL
OSCILLATORY MOVEMENT WITHOUT
CLINICALLY MANIFESTED TREMOR IN
MULTIPLE SCLEROSIS: A PILOT STUDY
Stetkarova I.1, Zeman J.2, Vavrova D.3, Rybnickova M.3,
Dobrovodska G.3, Zimova D.1, Havlik J.4, , Rasova K.3
Department of Neurology, Third Faculty of Medicine, Charles
University in Prague
1
Faculty of Engineering, Czech University of Life Sciences Prague
2
Department of Rehabilitation, Third Faculty of Medicine, Charles University in Prague
3
OLOMOUC 15.–18. 10. 2014
Faculty of Electrical Engineering, Czech Technical University in
Prague
oscillatory movements in MS was profoundly higher than in
healthy individuals.
Background: Tremor is an involuntary rhythmic oscillatory
movement of a body. It belongs to one of the most prevalent
and disabling feature in multiple sclerosis (MS).
Conclusions: Difference of frequency of oscillatory movements in MS with the most prominent manifestation at 7-10
Hz may correspond to early desinhibition of motor control
probably at subcortical level.
4
Objectives: The types of tremor in MS are still not unified.
The aim of our work was to detect which types of oscillatory
movements of upper extremities are present in MS without
clinical manifestation of the tremor.
Material and Methods: Ten patients with MS (9 women,
mean age 37  11years, mean EDSS 3,9  0,8, mean length
of the disease 10,2  7,3) and 10 healthy controls participated in this study. Postural tremor was measured with open
and closed eyes using an accelerometer LIS 3LV02DQ, ST
Micro. The most complex resting signal was measured in
upright position, when one arm was hanging freely next to
the body and second arm was raised forward. Tremor sensor was placed on the index finger of arm that was raised
forward. Frequency, rhythmicity and change of amplitudes
were analyzed by spectral analysis.
Results: In healthy subjects with open eyes the spectral analysis showed 3 prevailing frequencies of oscillatory movements: a) 2-3 Hz, b) 7-10 Hz, and c) 12-14 Hz. When eyes
were closed, the lowest frequencies disappeared. Oscillatory
movement of 7-10 Hz was the most frequent type in MS and
significantly differs from healthy subjects. The amplitude of
Supported by Research Projects of Charles University PRVOUK
P34, 260045/SVV/2014.
REDUCTION OF STUTTERING
THROUGH BRONCHODILATATION
WITH Β2-SYMPATHOMIMETIC DRUG
FORMOTEROL
Josef Pešák
Faculty of Medicine and Dentistry, Palacký University in Olomouc,
Czech Republic
About 60 million people on the planet suffer from stuttering.
Speech fluency disorder caused by stuttering (F98.5) was
known already in the ancient civilizations of Egypt, Mesopotamia and China 7000 years ago (1). Despite of this the
etiology of stuttering has remained unknown and its causal
51
treatment has not been possible. According to ICD-10, 10th
revision (2), stuttering belongs to „Other behavioral disorders
including emotional ones with their beginning in childhood
and adolescence“ (F98) and is related to Chapter V „Mental and behavioral disorders“ (F00-F99). A multi-centric clinical study FORZAK-0503 (3), confirmed (4) hypothetical
assumption (5) of the influence of pneumoobstruction of
the tracheobronchial tree on the fluency disorder. Poetically
spoken, the door opened towards causal reduction of speech
disfluency accompanied often by tormentous stuttering (6)
then (7). Besides publishing new findings on the etiology of
stuttering, it is needed to transfer stuttering under different
classification and different identification code within ICD-10
(MKN-10).
OLOMOUC 15.–18. 10. 2014
(4) Pešák, J., Grézl, T.: Bronchodilatace β2 sympatomimetikem
u balbuties. Sborník přednášek 15. semináře univerzitního Společenství pro studium hlasu a řeči (Ed.:) J. Pešák, Ústav lékařské
biofyziky LFUP v Olomouci, Olomouc, září 2006.
(5) Pešák, J.: Pneumoobstruction of the tracheobronchial tree as
a hypothetical cause of balbuties. Medical Hypotheses, 59 (4),
458-461, 2002.
(6) Pešák, J.: Patentová listina. Použití přípravku β2 sympatomimetika k omezení koktavosti. PV 31-03-2004. Úřad průmyslového
vlastnictví, Česká republika, Praha, 2004
(7) Pešák, J, aj.: Zmírňování koktavosti bronchodilatací β2 sympatomimetikem formoterolem. Časopis lékařů českých ISSN 00087335 148-2009.
Literature
(1) Guitar, B.: Stuttering. An Integrated Approach to its Treatment.
2th edition, Williams & Wilkins, Baltimore, USA, 1998.
(2) ICD-10. International Statistical Classification of Diseases and
Related Health Problems, World Health Organization, Ženeva
1992.
(3) Honová J., Pešák, J., Výzkumný záměr MŠMT MSM 1521000018
„Ověřování vlivu bronchodilatace na plynulost řeči u nezletilých
i dospělých s balbuties“; pokračování. Výzk. záměru MŠMT CEZ:
J14/98: N30000018 „Integrované studium hlasu a řeči“
52
META-ANALYTIC AND RESTING-STATE
FUNCTIONAL CONNECTIVITY OF THE
CLAUSTRUM
Pavel Hok1,2, Robert Opavský1,3, Petr Hluštík1,2, Zbyněk
Tüdös2,4
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc
1
2
University Hospital Olomouc
3
Department of Neurology, Sternberk Hospital, Sternberk
4
Department of Radiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc
Introduction: The claustrum anatomy is quite remarkable
for its reciprocal connections with almost all regions of the
cortex. Although a multimodal integrative and/or synchronising role has been previously suggested, its function remains
enigmatic so far. The present study had two main aims: First,
we employed the database driven approach to investigate the
task-dependent functional connectivity using meta-analytic
connectivity modelling (MACM). Second, we performed
a complementary resting-state (task-independent) functional
connectivity (RSFC) analysis of an sample of healthy subjects.
Methods: The regions of interest (ROIs) for both MACM
and RSFC were manually drawn in the left and right claustrum on a standard space template. For MACM, the ROIs
were input as seed regions into the BrainMap database
(http://BrainMap.Org)1. The significant areas of coactivation
were obtained using modified activation likelihood estimation (ALE) algorithm2. For RSFC, a dataset of 50 healthy
volunteers (25 males, average age 31.36) was downloaded
from the NKI/Rockland sample3. We employed seed-based general linear model analysis, as implemented in FSL
v5.0 (http://www.fmrib.ox.ac.uk/fsl)4. The modelled time-
OLOMOUC 15.–18. 10. 2014
-series were extracted from the preprocessed data in each
ROI. To account for head motion and physiological noise,
the model further included several vectors of nuisance signal.
Both MACM and RSFC maps were registered to a common
MNI152 standard space. Additionally, connectivity of the
putamen and insula was subtracted or regressed out in the
model to avoid false positives due to partial volume effect
and spatial filtering. Next, contrast analysis of resulting maps
for the left and right claustrum was performed to detect possible asymmetries. The resulting maps were thresholded at
corrected p < 0.05.
Results: Both MACM and RSFC have shown similar and
mainly symmetrical pattern of connectivity including the
contralateral claustrum, ventrolateral thalami, lentiform
nuclei, cerebellum, pons, bilateral precentral cortices (BA6),
supplementary motor area, insular and frontoparietal opercular cortices. At lower Z threshold, the RSFC maps resembled
a combination of several resting-state networks – including
task-positive, sensorimotor and salience networks, while
excluding mainly rostral frontal and ventral temporal cortices, and so-called default mode network located to posterior
cingulate, precuneous cortex, and lateral occipital cortices.
Moreover, some striking asymmetries were observed: left
claustrum connecting more to the left inferior frontal gyrus
(BA44), superior frontal gyrus and left thalamus. On the
other hand, the right claustrum showed stronger connections
to the right superior and inferior parietal lobule.
53
Conclusions: Our findings provide novel evidence for the
connectivity of the claustrum, suggesting a more specific role
in sensorimotor and task-positive systems.
References:
1. Laird, A.R., (2009) Front Neuroinformatics 3. doi:10.3389/neuro.11.023.2009
2. Eickhoff, S.B., (2012) Neuroimage 59, 2349–2361.
3. Nooner, K.B., et al. (2012). Front Neurosci 6. doi:10.3389/
fnins.2012.00152
4. Jenkinson, M., et al. (2012) Neuroimage 62, 782–790.
EEG 1
AUTOMATED SYSTEM FOR QUANTITATIVE
ANALYSIS OF THE EEG BACKGROUND.
Jombík P1, Spodniak P2.
1
2
Hosp Zvolen, Dept Neurol;
Tech Univ Zvolen
Objectives: This study presents an automated quantitative
EEG background analysis system in Microsoft Excel that re-
54
OLOMOUC 15.–18. 10. 2014
solves certain methodological problems in usual qualitative
assessments of properties of the EEG background.
Methods: EEG epochs without extra-cerebral signal artifacts
with duration of 2-8 s were subjected to further processing by
using an automated analysis system. The trends (identified
by the least square method) and the DC offsets (identified by
calculating the average value of the data row) were subtracted. The onsets and the ends of the data rows were smoothed
by applying the Hanning’s window and subjected to Fast
Fourier Transform (FFT). The power spectra over the band-pass of 0.5-45Hz were calculated. Both the means of the
spectral powers and the spectral powers of the major peaks
in the rough delta to gamma spectral bands and in the more
detailed narrower sub-bands (by splitting the delta into four;
theta into three; alpha into three; beta into four and gamma
into 3 sub-bands) were analyzed. In addition to the conventional topographic spectral band analysis, global coefficients
of the following indexes were calculated: the ratios of the
particular rough spectral powers, the diffused background
slowing, the spectral moments and their centers, the topographic spectral gradients and asymmetries in the peaks powers
and frequencies. The individual findings were compared with
the parameters which were based on provisional database of
76 normal adult EEG (52.16 y.; 15.95; 19-83; mean age; SD;
range).
Conclusions: The EEG analysis is based on assessment of
the properties of the background and the events. The detec-
tion of events which are blowing out from the background
is relatively easy and straightforward. However, an assessment of the background might be sometimes a difficult task
even for a trained EEG specialist. This system which is based on the commonly used Excel environment offers several
advantages. The main advantage is the possibility of the easy
accomplishment according to the needs of the user, and the
development of the EEG research.
References:
Gotman J, Skuce DR, Thompson CJ, Gloor P, Ives JR, Ray WF. Clinical applications of spectral analysis and extraction of features
from electroencephalograms with slow waves in adult patients.
Electroencephalogr Clin Neurophysiol. 1973 Sep; 35(3):225-35.
CLINICAL EVALUATION VERSUS
AUTOMATIC DETECTION OF
INTERICTAL EPILEPTIFORM
DISCHARGES – WHO CAN WE TRUST?
Janča R.1, Ježdík P.1, Čmejla R.1, Kršek P.2, Jiruška P.3, Marusič P.4
1
Department of Circuit theory, Faculty of Electrical engineering,
OLOMOUC 15.–18. 10. 2014
Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital
2
3
Medicine, Motol University Hospital
4
Objective. Interictal epileptiform discharges (IEDs) are
electrographic hallmark of epilepsy. Information about the
spatiotemporal distribution of IEDs in intracranial EEG is utilized to localize epileptogenic zone during the presurgical evaluation and plan the resection. Visual evaluation of long-term
multi-channel intracranial recordings is extremely difficult and
prone to bias. Clinicians usually assess only high-amplitude
(high signal to noise ratio) discharge and low-amplitude IEDs
can be overlooked or considered clinically insignificant. The
goal of our study was to develop reliable automatic IED detectors to facilitate analysis of long-term recordings and increase
the information yield of intracranial recordings.
Methods. Seven intracranial EEG recordings were randomly
selected from our database. Samples of five minutes duration
from fifteen high-rate IED channels (525 minutes in total)
were presented to three experienced EEG specialists for spike labelling. The readers independently reviewed the data
and classified IEDs into two groups: obvious and ambiguous.
The inter-reader agreement was evaluated and IEDs labelled
by at least two readers were considered as a gold standard
55
(GS). We have developed, tested and optimized novel IED
detector using GS datasets and compared its performance
with published detectors. Our detecting approach estimates
the signal envelope distribution to discriminate IEDs from
background activity.
Results. Readers together labelled 6,518 IEDs (53±21% obvious, 47±21% ambiguous). The reader’s maximal match
was 58% in pair and agreement of all three readers was only
30% (Cohen’s kappa 0.14±0.11). Detector’s performance
was characterized by sensitivity 91±12% and 8±7 false positives per min and per channel. Its performance was 1.4×
better than published detector. Examination of false positives
revealed that substantial proportion had shape of reminiscent
of IEDs, but with lower amplitude. More than 50% false positives were reclassified by readers as IEDs. In addition, regression analysis showed positive relationship between IEDs
marked by readers and number of false positives.
Conclusion. The inter-reader agreement in visual IED evaluation is poor. Even experienced readers can identify approximately 40% of IED, especially those with high signal-to-noise ratio. In contrast, automatic detector is 2.5× more
sensitive and can identify also low-amplitude IEDs. Areas
generating not only high- but also low-amplitude IEDs can
be crucial for epileptogenic zone localization.
56
OLOMOUC 15.–18. 10. 2014
IOM
PERIOPERATIVE MONITORING
OF COGNITIVE FUNCTIONS BY
EVENT-RELATED POTENTIALS AND
PSYCHOMETRIC TESTS
I. Holeckova1, J. Kletecka2, P. Brenkus3, P. Honzikova2, S.
Zidek1, J. Benes2
Dpt. of Neurosurgery
1
Dpt. of Anaesthesiology and Intensive Care
2
Dpt. of Neurology, The University Hospital and The Faculty of
Medicine in Plzen, Charles University, Czech Republic
3
Introduction. Postoperative cognitive dysfunction (POCD)
is well recognized, but poorly understood syndrome. The
role of used anaesthetics remains unclear. Neurophysiologic
method – auditory event-related potentials (ERPs) are widely
used for assessment of cognitive brain functions.
Objectives. To test the difference in occurrence of POCD
between patients undergoing sevoflurane and propofol
anaesthesia using standard psychometric tests and ERPs.
Methods. We present results of scheduled interim analysis
of the prospective randomized trial after inclusion of 30 pati-
ents undergoing lumbar discectomy. Patients were randomized to receive either sevoflurane (group S; n=18) or propofol
anaesthesia (group P ; n=12). Anaesthesia depth was controlled by BIS monitoring. POCD was assessed using modified
standard psychometric test battery and ERPs (wave N100
and P3) in defined time-points (preoperatively and postoperatively on day 1, 7 and 40). POCD was defined as a decline
of more than one standard deviation in three or more tests.
Results. ERPs analysis of the S group showed increase in
the latency (84.9±1.4 vs. 81.4±1, p=0.03) and decrease of
the amplitude (6.3±0.6 vs. 8.0±0.8, p<0.001) of the N100
wave on day 1 with normalization on day 7. P3a wave amplitude also in S group showed significant decrease on day
7 (6.2±0.8 vs. baseline 8.4±0.9; p=0.01) lasting till day 40
(6.3±0.9; p=0.004).
POCD using standard tests was diagnosed in 6 patients
(33 %) of S group versus 2 (17 %) in P, p=0.41.
Temporary occurrence of new POCD development did not
differ between groups (4, 5 and 4 pts. vs. 1, 1 and 0 pts.; on
day 1, 7 and 40 in groups S and P respectively; p=0.31). In the
S arm a significant decrease in Categorical Verbal Fluency
score (CVF) was observed on day 1 (13.7±0.8; p<0.001) and
7 (16.3±1.1; p=0.01) compared to baseline value (22.2±1.5)
with normalization on day 40. No differences in other tests
were observed.
OLOMOUC 15.–18. 10. 2014
Conclusions. ERPs analysis showed early auditory sensory
impairment and late cognitive decline after sevoflurane use,
however these changes were subclinical. POCD occurrence
was non-significantly more frequent among patients after
sevoflurane anaesthesia, possibly associated with short-term
semantic memory impairment assessed by CVF decline.
The study is supported by Charles University grant PRVOUK P36
and grant GACR P407/12/1525
INTRAOPERATIVE
NEUROPHYSIOLOGICAL MONITORING
OF BRAIN PERFUSION DURING
CARDIAC SURGERY IN PATIENTS WITH
ASYMPTOMATIC INTERNAL CAROTID
STENOSIS.
Ostrý S.1,2, Tesařík R.3, Leitgeb M.3
1
Dept. of Neurosurgery Hospital Budweis, Czech Republic.
Dept. of Neurosurgery, Charles University in Prague, Central Military Hospital – Military University Hospital Prague
2
3
Dept. of Cardiosurgery, Hospital Budweis, Czech Republic.
57
Introduction: Asymptomatic internal carotid (ICA) stenosis
is one of documented risk factors of perioperative ischemic
stroke (IS) in cardiac surgery. There is no strict consensus
in benefit of prophylactic carotid endarterectomy (CEA) in
asymptomatic ICA stenosis to reduce intraoperative IS. Median somatosensory evoked potentials (SEP) is reliable tool
for intraoperative neurophysiological monitoring (IONM) of
brain perfusion during CEA.
Aim of study: Determine safety of median SEP monitoring
in intraoperative IS prevention.
Material a Methods: From 1st Jan 2013 to 31st Aug 2014
were enrolled 26 patients (20 males (76.9%), 6 females
(23.1%) age range 59-84, average 71.9± 6.47 years). All patients underwent cardiosurgical procedure in extracorporal
perfusion (EC) with IONM of cerebral perfusion.
Inclusion criteria: ICA stenosis ≥ 50% on one or more sides,
asymptomatic > 6 months.
Unilateral stenosis was detected in 10 (38.5%), bilateral in
13 (50.0%), occlusion with contralateral stenosis was in 3
patients (11.5%).
IONM consisted of median SEP and brainstem auditory evoked potentials (BAEP), near infrared spectroscopy (NIRS)
were monitored synchronously. Warning and alarm were always directed at anaesthesiologist or perfusionist.
58
OLOMOUC 15.–18. 10. 2014
Significant changes were defined as: > 50% of N20/P25 amplitude decrease in SEP and/or “V” wave in BAEP and or
“V” latency prolongation > 1 ms. NIRS decrease ≤ 40.
Coronary bypass was performed in 22 patients (86.4%), aortic valve replacement in 10 (38.5%), mitral valve replacement in 6(23.1%). Cardiac compartments were opened in 17
cases (65.4%).
Results: SEP amplitude decrease was detected in 5 (19.2%).
In 4 of them (80%) was asymmetrical relevant to higher grade of ICA stenosis. Mean arterial pressure (MAP) increase
was most effective manoeuvre in all cases. Full SEP restoration (> 50% baseline amplitude) appeared in 3, partial in
remaining 2 patients.
Decrease of NIRS was recorded in 4 (15.4%) and always bilateral, symmetrical. Both NIRS and SEP decrease was only
marginal, and in 1 case only. BAEP changed nonsignificantly.
No new neurological deficit appeared in 25 (96.2%) within
24 hours. 1 patient could not be clinically evaluated.
3 patients (11.5%) died within 7 days (1- ileus, 2 circulation
failure). Perioperative IS was not recorded.
In all surviving 23 patients neither neurological deficit nor
TIA/IS within 3 months period after surgery.
Conclusion: Intraoperative brain hypoperfusion in SEP was
detected in about 19% of cases. MAP elevation caused in
SEP restitution. No false negative SEP changes were recorded.
No new neurological deficit developed during and after surgery.
NIRS changes were neither consistent with SEP changes nor
neurological outcome.
STRUCTURAL CONNECTIVITY OF
ELOQUENT SPEECH AREAS DEFINED
BY DIRECT CORTICAL STIMULATION
MAPPING
Pavel Hok1, Christian A. Kell2
1
Department of Neurology, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
Department of Neurology, Goethe University Frankfurt, Germany
2
Introduction: The awake intraoperative cortical mapping
using direct electric stimulation during neuropsychological
testing has become the preferred method to delineate the
highly variable speech areas in brain tumour patients. Interestingly, there was no clear relationship observed between
OLOMOUC 15.–18. 10. 2014
the gyrification and the regions involved in various language
tasks. In this pilot study, we employed preoperative diffusion
tensor imaging (DTI) to test whether eloquent cortex was better predicted by different structural connectivity rather than
by its relation to gyrification.
Methods: Four patients (3 males, average age 37) suffering
from primary brain tumour underwent pre-operative 3T MRI
scanning using a high resolution T1 MPRAGE and a single shell diffusion weighted imaging (DWI) sequence (60
directions, b=1000s/mm2, 2x2x2mm) and intraoperative
direct cortical electrical stimulation with a bipolar Ojemann
electrode during awake language mapping. After standard
preprocessing (FDT in FSL1), probabilistic fiber tracking
was performed on DWI data, using 5mm spheres around the
intraoperatively defined sites as cortical seeds (PROBTRACKX in FSL1). The resulting cortical projections were then
projected onto the coregistered and segmented individual
cortex (Freesurfer).
Results: A variety of stimulation-positive functional sites
was detected and compared to each other, including anomia,
counting, speech and motor arrest. The anomia sites were
found both in the pars triangularis and pars opercularis of
the inferior frontal gyrus. Even opercular anomia sites followed the connectivity pattern of triangular anomia sites and
had stronger connections to the rostral parts of the mesial
prefrontal cortex and pre-supplementary motor area (pre-
59
-SMA) than to the precentral gyrus and SMA proper, as
opposed to opercular speech or counting arrest sites which
also connected more strongly to more posterior parts of the
brain, mostly posterior temporal cortex2. Thus, even adjacent sites on the same gyrus that differed in function showed
dissociable structural connectivity.
OLOMOUC 15.–18. 10. 2014
Epilepsie 2
PRACTICAL VALUE OF QUANTITATIVE
EEG IN EPILEPSY SURGERY PLANNING
Conclusions: Our results suggest that structure-function relationships are more evident between function and structural
connectivity than between function and gyrification.
Pavel Kršek1, Radek Janča2, Petr Ježdík2, Tomáš Havel2, Roman Čmejla2, Vladimir Komárek1, Michal Tichý3, Petr Marusič4, Přemysl Jiruška5
References:
1
1. Behrens et al. (2007) NeuroImage 34: 144-155
2
2. Matsumoto et al. (2004) Brain 127: 2316-2330
Acknowledgement:
This study was supported by the German Research Foundation and
the European Union
Department of Pediatric Neurology,
Department of Circuit theory, Faculty of Electrical Engineering,
Department of Neurosurgery,
3
Medicine, Motol University Hospital, Prague
4
5
Objective. To assess whether available algorithms of quantitative EEG (qEEG) could practically help in localizing epileptogenic zone (EZ) and modify surgical planning in patients with focal intractable epilepsy.
Methods. We will present a case report of a 7-year-old boy
with catastrophic epilepsy caused by focal cortical dysplasia
located in the operculo-insular region of the right hemisphe-
60
re. Due to the challenging localization of the presumed EZ,
uncertain surgical borders and expected significant risks of
the resection, the patient was stereotactically implanted with
oblique depth electrodes. Intracranial EEG (iEEG) signal
was analyzed using different qEEG methods. Our originally
developed interictal epileptiform discharges (IED) detecting
algorithm, which also extracts repetitive propagation patterns, was applied to localize sources of IED. We also used
own network connectivity algorithm to analyze ictal (seizure) iEEG activity in detail. Employing results of qEEG analyses, 2D and 3D dynamic reconstructions of both interictal
and ictal iEEG epileptiform changes were created and used
to guide surgical approach.
Results. Both qEEG algorithms clearly proved the EZ localization in the dorso-caudal insular cortex of the right hemisphere and demonstrated sparing of initially suspected
frontal opercular area. The dorso-caudal insular cortex generated 89% of IED; remaining 11% IED originated from
the primary motor cortex. Surgical approach was adjusted to
this qEEG-based hypothesis. Oblique depth electrodes were
preserved intraoperatively to help precise targeting of the lesion. Continuous intraoperative motor-evoked potential monitoring was used to preserve motor functions. The boy has
been followed for more than one year postoperatively. He
is seizure-free with no motor deficit; with normal cognitive
functions.
OLOMOUC 15.–18. 10. 2014
Conclusions. The case report demonstrates that currently available qEEG methods could help in guiding resective
epilepsy surgery in complicated patients indicated for iEEG
studies. We suggest our approach could increase patients’
chance to obtain seizure-free outcomes without new deficits
and thus ultimately improve their quality of life.
Supported by MH CZ–DRO, University Hospital Motol, Prague,
Czech Republic 00064203 and IGA NT/11460-4.
INFLUENCE OF DATA PROCESSING
PIPELINES ON EEG-FMRI RESULTS IN
PATIENTS WITH EPILEPSY
Michal Mikl1*, Radek Mareček1, Eva Janoušová2, Tomáš
Slavíček3, Marek Bartoň1, Milan Brázdil4,5
1
Multimodal And Functional Neuroimaging Research Group,
2
Institute of Biostatistics and Analysis, Masaryk University, Brno,
Czech Republic
3
Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Czech Rep.
61
4
Brno Epilepsy Centre, First Department of Neurology, Saint
Anne’s University Hospital and Masaryk University, Brno
5
Simultaneous EEG-fMRI is increasingly used for the noninvasive pre-surgical evaluation of epileptic patients to localize
the epileptogenic zone. In this retrospective study of EEG-fMRI data in patients with pharmacoresistant epilepsy, we
compared a wide range of data processing strategies using
validation with resection masks after successful epilepsy surgery. The aims of this study were to find how various data
processing strategies influence EEG-fMRI results, and to
identify the best approach for data processing.
Thirteen subjects (9 F, 4 M) with pharmacoresistant epilepsy
and good outcome after epilepsy surgery were included in the
study. Simultaneous EEG-fMRI data (1.5T scanner) was acquired before the surgery (300 scans per session, TR = 3s). The
position of interictal discharges (IED) was marked and used as
onsets for event-related regressors in statistical model. SPM8
software was used for data processing. In total, 240 statistical
analyses were calculated for each subject comprising all possible combinations of the used variants of preprocessing and
GLM settings. The resection mask was created individually for
each patient using clinical MR images acquired 3 months after
the surgery. Several parameters (e.g. sensitivity, cosine criteri-
62
OLOMOUC 15.–18. 10. 2014
on) were calculated for each dataset and processing pipeline to
evaluate the concordance between spike-informed EEG-fMRI
results and the resection mask. Multivariate statistical analysis
was performed in SPSS software.
We found that the preprocessing type (mainly basic pipeline
vs. correction for cardiac artifact) does not affect the results.
The study revealed two main findings. The first is the optimal
processing pipeline – only canonical HRF as a basis function,
IED stimulation time series shifted 2 s earlier than positions
from EEG description, and massive filtering of artifact (24
movement regressors, signals from white matter and CSF,
and global signal). The second finding is related to a more
general understanding of the influence of various processing
options on results. The superiority of canonical HRF over
more flexible basis functions is probably due to our concordance measure, which is based on a single epileptic focus
represented with a resection mask, and some type of similarity between the activation map and the mask. The finding of
earlier BOLD responses is in concordance with the predominantly prespiking character of the BOLD response presented
in previous studies.
OLOMOUC 15.–18. 10. 2014
IMPORTANCE OF WEAK CONNECTIONS
IN FUNCTIONAL NETWORK ANALYSIS
OF LEFT TLE
connections. For both representations we computed path length, clustering coefficient, connectivity strength, and betweenness centrality measures and evaluated group differences by
Mann-Whitney U test.
Bujnošková E.1, J. Fousek1, R. Mareček2, I. Rektor2,3
By weighted approach, we observed the significantly (FDR
corr.) higher normalized clustering coefficient and higher
normalized characteristic path length in patient group that suggest the shift of the network topology toward more regular
structure. Together with increased global betweenness centrality, it leads us to an assumption that the patient network
forms densely connected clusters that are mutually connected
only by a small number of links, whereas the control network
exhibits more distributed and balanced pattern of topology.
The most striking difference between groups is in connectivity strength which is significantly lower in left TLE group.
These results, however, could not be observed in binary representation of connectivity. The increases in characteristic
path length and global clustering coefficient were not significant after FDR correction (p-values 0.03 and 0.14) and
only a trend towards lattice topology can be concluded. Also
just a trend to increased betweenness centrality (p = 0.03)
in patient group was seen, no change in connection strength
was found.
1
Faculty of Informatics at Masaryk University, Brno
2
Research group Multimodal and Functional Neuroimaging, Central European Institute of Technology (CEITEC), Brno
3
Brain and Mind Research Programme, Central European Institute
of Technology (CEITEC), Brno
Brain can be described as a complex network and its structure can be changed in disease [1]. The analysis based on graph
theory is a well established tool for quantification of changes
in network topology [2,3]; so far the binary representation
of connectivity network has been very popular: it preserves
a chosen percentage of the strongest connections, thus simplifies analysis and interpretations of results. This approach,
however, discards information about weak connections and
weighted representation comes into use. We aim to examine
differences in results from both approaches.
We used resting state fMRI data from 9 left temporal lobe
epilepsy (TLE) patients and 20 controls. We extracted matrices of functional connectivity based on Pearson correlations
between representatives from regions defined by AAL atlas
[4], in case of binary approach we used 15% of the strongest
Our findings support other studies showing that network topology in left temporal lobe epilepsy shifts towards regular
structure [3]. This, combined with changes in betweenness
63
centrality and connection strength, allows us to provide better specification of network topology in left TLE patients.
We stress that the difference between groups lies especially
in low correlations which is the reason why the analysis based on binary representation failed to find statistically significant changes.
[1] Rubinov, M., and O. Sporns. „Complex network measures of
brain connectivity: uses and interpretations.“ Neuroimage 52.3
(2010): 1059-1069.
[2] Tijms, B.M., et al. „Alzheimer‘s disease: connecting findings
from graph theoretical studies of brain networks.“ Neurobiology
of aging 34.8 (2013): 2023-2036.
[3] Diessen, E., et al. „Functional and structural brain networks in
epilepsy: What have we learned?.“ Epilepsia 54.11 (2013): 18551865.
[4] Tzourio-Mazoyer, N., et al. „Automated anatomical labeling of
activations in SPM using a macroscopic anatomical parcellation
of the MNI MRI single-subject brain.“ Neuroimage 15.1 (2002):
273-289.
OLOMOUC 15.–18. 10. 2014
THE EFFECT OF REPETITIVE
TRANSCRANIAL MAGNETIC
STIMULATION ON ATTENTION AND
PSYCHOMOTOR SPEED IN PATIENTS
WITH MILD COGNITIVE IMPAIRMENT
AND EARLY ALZHEIMER’S DISEASE
Anderkova Lubomira1,2, Eliasova Ilona1,2, Marecek Radek1,2,
Rektorova Irena1,2
First Department of Neurology, St. Anne‘s University Hospital
and School of Medicine, Masaryk University, Brno, Czech Republic
1
2
Brain and Mind Research Program, Central European Institute
of Technology, CEITEC MU, Masaryk University, Brno, Czech
Republic
Introduction: Repetitive transcranial magnetic stimulation
(rTMS) is a noninvasive tool to study and modulate cortical
plasticity and brain processes in healthy and diseased brain.
Study objectives
The aim of this study was to investigate the effects of one
session of high-frequency rTMS on cognitive functions in
64
patients with mild cognitive impairment (MCI) and early
stages of Alzheimer’s disease (AD). Based on our pilot study
results (Eliasova et al. 2014) we were particularly interested
in modulating attention and psychomotor speed domain by
applying rTMS over the right inferior frontal gyrus (IFG) and
the right superior temporal gyrus (STG).
Methods: Altogether 20 right-handed patients (11 women, 9
men; age 73.0 ± 6.9 years; 12 mild AD, 8 MCI) participated
in the placebo-controlled study. Each patient received 3 sessions of 10 Hz rTMS applied over the IFG, STG and vertex
(a control stimulation site). A frameless stereotaxy was used
for the coil navigation. A total of 2250 stimuli were delivered
per session at 90% intensity of resting motor threshold. The
order of stimulation sites was randomized. The Trail making
test (TMT) and the Stroop test (ST) were used to evaluate
attention and psychomotor speed prior to and immediately
after each session. The Wilcoxon paired test and Linear mixed models were used for data analyses.
Results: rTMS of both IFG and STG induced significant improvement in the Word part of the ST (Wilcoxon paired test;
p=0.023 and 0.033, respectively), while the IFG stimulation
induced additional enhancement in the TMT A and B (Wilcoxon paired test; p = 0.002 and 0.005, respectively). When
controlling for placebo effects improvement in the ST (Word
part) remained significant after both IFG and STG stimulation.
OLOMOUC 15.–18. 10. 2014
Conclusions: rTMS of the right IFG and the right STG enhanced psychomotor speed and attention in patients with early stages of AD and may thus have a therapeutic potential
that has to be further tested using a multiple-sessions rTMS
protocol.
Reference
Eliasova I, Anderkova L, Marecek R, Rektorova I. Non-invasive
brain stimulation of the right inferior frontal gyrus may improve
attention in early Alzheimer’s disease: A pilot study. J Neurol Sci,
2014, doi:10.1016/j.jns.2014.08.036.
PREDICTION OF COGNITIVE CHANGES
IN PATIENTS WITH PARKINSON‘S
DISEASE AFTER DBS STN WITH THE USE
OF P300 COGNITIVE EVENT RELATED
POTENTIAL
M. Baláž, A. Hlučková, J. Chrastina, I. Rektor
Masaryk University, Movement Disorders Centre, Department of
Neurology, St. Anne’s University Hospital and School of Medicine, Brno
65
Central European Institute of Technology - CEITEC, Neuroscience Centre, Brno,
Conclusion: Scalp P300 can be proposed as a tool for selection of suitable candidates for the DBS STN surgery in PD.
Objective: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective long-term treatment for
motor symptoms in advanced Parkinson’s disease (PD). However, it is evident that at least in some patients the change
in cognitive functions after STN-DBS may have a clinical
importance. Thorough neuropsychological examination is an
established part of preoperative assessment of candidates for
DBS surgery. We studied whether scalp P300 wave can be
used as an additional tool that could improve the selection
process and predict the cognitive decline after the procedure.
Key words: Parkinson’s disease; DBS; subthalamic nucleus,
P300, event-related potentials
Patients and methods: 30 patients with Parkinson’s disease
who had been implanted with DBS STN were included in
the pilot study. They were examined by a neuropsychologist
before the DBS and a year after the DBS. The latencies and
amplitudes of P300 wave were measured before the operation and again one year after the DBS STN.
Martina Bočková1,2, Jan Chládek1,3, Pavel Jurák3, Josef Halámek3, Steven Z Rapcsak5, Marek Baláž1,2, Jan Chrastina1,4,
Ivan Rektor1,2
Results: We found indirect correlation between latencies of
preoperative P300 and neuropsychological status 1 year after
the operation. We observed that patients with longer latencies of preoperative P300 tended to have more psychiatric side
effects and worse neuropsychological performance one year
after the DBS.
66
OLOMOUC 15.–18. 10. 2014
ALPHA AND BETA POWER DECREASE
DURING ENHANCED COGNITIVE
EFFORT IN THE BASAL GANGLIA: AN
INTRACEREBRAL RECORDING STUDY.
Central European Institute of Technology (CEITEC), Brain and
Mind Research Programme, Masaryk University, Brno, Czech
Republic
1
Movement disorders centre, First Department of Neurology, Masaryk University, St. Anne’s Hospital, Brno, Czech Republic
2
3
Institute of Scientific Instruments of the Academy of Sciences of
the Czech Republic, v.v.i., Brno, Czech Republic
4
Department of Neurosurgery, Masaryk University, St. Anne’s
Hospital, Brno, Czech Republic
5
Department of Neurology, University of Arizona, Tucson, USA
Purpose: Cognitive adverse effects may accompany deep
brain stimulation (DBS) treatment, as the basal ganglia have
influence on widespread neocortical networks. The aim of
this study was to investigate how complex motor-cognitive
activities are processed in the subthalamic nucleus (STN)
and internal globus pallidum (GPi).
Methods: Dystonia patients implanted with GPi-DBS
electrodes (n=5), and individuals with Parkinson´s disease
(PD) (n=4) or essential tremor (n=1) with STN-DBS electrodes performed two tasks involving the writing of single letters: 1. copying letters from a monitor; and 2. writing of any
letter other than that appearing on the monitor. The cognitive
load of the second task was increased relative to the first. Intracranial recordings of task-related oscillatory changes were
assessed and compared.
Results: Local event-related alpha and beta desynchronization (ERD) were more expressed during the second task while
the lower gamma synchronization (ERS) decreased regardless of the basal ganglia structure from which recordings were
obtained or the clinical diagnosis. Task-related ERD differences recorded from the language-dominant left hemisphere correlated with a behavioural (RT) measure of cognitive
effort. ERD changes declined after levodopa intake in PD
patients.
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Conclusions: The STN and Gpi participate in cognitive networks. Alpha and beta ERD seems to be essential during
processing complex motor-cognitive tasks and increase with
enhanced cognitive effort.
Posterová sekce
APPLICATION OF EYE TRACKING IN
NEUROSCIENCE
Doležal J.1, Fabian V.2
1
2
Medicton Group, Inc.
Introduction: Eye tracking is a technology using cameras
to record and analyze eye movements and gaze patterns, therefore providing insight into both cognitive and physiological processing of visual information. Neurological problems
frequently affect the way visual information is processed,
which then reversely affect the eye movements. While the
idea of eye tracking exists for a long time, recent technological advances enable more precise measurement, automated
evaluation and make the technology broadly available.
67
Applications: Specific learning disabilities such as dyslexia are often first diagnosed late due to bad reading skills at
school. The eye tracking can be used for screening in preschool age even with children who cannot yet read by easier
tasks: e.g. the well known non-verbal Pavlidis task, the gravity effect or by simple smooth stimuli movement tracking.
Similarly, schizophrenia is associated with wide spectrum of
cognitive impairments. The eye tracking can be used with
smooth stimuli movement tracking or also in conjunction
with the Rorschach test where it can provide additional information channel for examining psychologist. Other applications of eye tracking include early detection of Alzheimer
disease, Autistic spectrum disorder (ASD), and attention
deficit hyperactivity disorder (ADHD). Eye tracking is also
applicable in the field of assistive technologies where the eye
movements serve as output channel, and in other non-medical applications.
Ongoing study: We are currently evaluating a study on early
dyslexia detection. Six special schools with preschool classes
for children with learning and other disabilities participate in
the study. Total of 384 children aging from 6 to 11 years were
recorded, of which 33 were diagnosed specifically with dyslexia. Preliminary results suggest differences in the Pavlidis
task.
Conclusion: The contribution presents possibilities eye tracking technologies offer for specialized medical examinations
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and objective evaluation of the measured data. It has been
proven in several applications that eye tracking can be successively used both in diagnostic and therapeutical applications. The ongoing study is being made to develop practical
application for early dyslexia detection, perform clinical evaluation, and certification of both the method and recording
equipment.
DIFFERENCES OF EEG SIGNAL
BETWEEN GIFTED AND AVERAGE
ADOLESCENTS
Karla Štěpánová1, Michal Vavrečka1, Jaroslava Durdiaková2,
Lenka Lhotská1
BioDat group, Department of cybernetics, FEL ČVUT, Czech republic
1
Department of Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
2
The mental rotation task (Shepard and Metzler, 1971) is a
standard cognitive task and a huge amount of research has
been done comparing reaction times and error rates between
different groups of people. O‘Boyle et al. (2005) in their neu-
roimaging study demonstrated that mathematically gifted
male adolescents engage different brain structures than those
avarage gifted when performing 3D mental rotation.
The purpose of this study was to observe differences between gifted and average adolescents during both 2D and
3D mental rotation task. We recorded and analyzed 16 adolescents (10 boys, 6 girls) with IQ>130 and 10 adolescents
with average IQ (<90,110>), all 15 - 18 years old. From the
subsequent EEG signal analysis we were able to identify
brain structures that discriminates between mathematically
gifted and average ability. Together with the EEG signal we
measured reaction times and error rates and evaluated them.
The significant difference between experimental groups was
detected in both reaction times and error rates. After finishing
the experiment subjects performed Raven intelligence test
and filled out psychological questionnaires (autistic, systematizing and empathizing quotient) and questionnaire with
factual, self-evaluation questions and questions about used
strategy. Finally, the values from questionnaires were correlated with the EEG signal.
We acknowledge the support of SGS grant “New approaches
to collection, evaluation and utilization of biological data II”,
No. SGS13/203/OHK3/3T/13.
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CEREBELLAR ACTIVITY IN CERVICAL
DYSTONIA DURING A MOTOR TIMING
TASK: AN FMRI STUDY
Pavel Filip1,2, Cécile Gallea3, Eric Bertasi3, Traian Popa3, Marek Bartoň4, Radek Mareček4, Ovidiu V. Lungu5,6, Stéphane
Lehéricy3, Martin Bareš1,2
Central European Institute of Technology, CEITEC MU, Behavioral and Social Neuroscience Research Group, Masaryk University, Brno, Czech Republic
1
First Department of Neurology, Faculty of Medicine, Masaryk
University and St. Anne’s Teaching Hospital, Brno, Czech Republic
2
Centre de NeuroImagerie de Recherche—CENIR, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
3
Central European Institute of Technology, CEITEC MU, Research group Multimodal and Functional Neuroimaging, Masaryk University, Brno, Czech Republic
4
Department of Psychiatry, Université de Montréal, Montréal,
Québec, Canada
5
Functional Neuroimaging Unit, Research Center of the Geriatric Institute affiliated with the Université de Montréal, Montréal,
Québec, Canada
6
69
Question: Dystonia research has recently started to turn towards a new neural network node presumably playing a significant role in its pathophysiology – cerebellum. Even in
the absence of traditional neurology signs of cerebellar dysfunction in most dystonia patients, more subtle indications of
cerebellar abnormities may still be found. In preliminary data
of our fMRI study, we are presenting compelling evidence of
its dysfunction in cervical dystonia patients.
Methods: Functional magnetic resonance imaging has heretofore been performed in 10 patients and 10 healthy individuals during interception of a moving target with simple button
pushing – a task, known to engage cerebellum, involving
complex predictive motor timing abilities, as the subjects has
to react in advance according to the speed of the target to
successfully intercept it.
Results: In addition to statistically significantly lower hit ratios than the healthy controls, cervical dystonia patients had
substantial differences in activations during the movement
estimation and motor timing in preparation for reaction button pressing: there was lower activation in the ipsilateral cerebellar lobule VI and VII and in contralateral medial
prefrontal cortex.
Conclusions: Our results suggest that the cervical dystonia
patients suffer from impairment of predictive motor timing
– dysfunction presumably directly attributable to changes in
cerebellar activation.
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fMRI 2
DEALING WITH NOISE IN
PSYCHOPHYSIOLOGICAL INTERACTION
ANALYSIS
M. Barton1, R. Marecek1, I.Rektor1, M. Mikl1
1
CEITEC MU, Multimodal and Functional Neuroimaging Research Group
Background: In some fields of fMRI data analysis, it is
apparent that a correct methodology is crucial to achieving
meaningful results. This paper provides a first quantitative
evaluation of the effects of different preprocessing and noise
filtration strategies on the psychophysiological interactions
(PPI) – method for analysis of fMRI data [1], where noise
management is not yet established.
Materials and Methods: To assess these effects, both real
fMRI data and simulated fMRI data were used. Two regions of interest (ROIs) were chosen for the PPI analysis on
the basis of their engagement during the task. PPI terms
were computed and used in a general linear model (GLM);
group-level analyses followed. This first-level PPI analysis
pipeline was performed for 32 different preprocessing and
analysis settings, which included either data filtration with
RETROICOR [2] or no such filtration; different filtration of
the ROI “seed” signal with a nuisance data-driven time series; and the involvement of these data-driven time series in
the subsequent PPI GLM analysis [3]. The extent of the statistically significant results was quantified at the group level
using simple descriptive statistics.
Conclusion: We conclude that different approaches for dealing with noise in PPI analysis yield appreciably different results. We definitely recommend the usage of RETROICOR.
Filtering the ROI signal with data-driven signals and adding
these signals to the GLM for assessing the PPI effects is apparently influential, but it is not clear whether their usage improves results in all cases.
References
[1] Friston, K.J., Buechel, C., Fink, G.R., Morris, J., Rolls, E., Dolan, R.J. (1997) Psychophysiological and modulatory interactions
in neuroimaging. Neuroimage, 6:218-29.
[2] Glover, G.H., Li, T.Q., Ress, D. (2000) Image-based method for
retrospective correction of physiological motion effects in fMRI:
RETROICOR. Magnetic Resonance in Medicine, 44:162-167.
[3] Weissenbacher, A., Kasess, C., Gerstl, F., Lanzenberger, R.,
Moser, E., Windischberger, C. (2009) Correlations and anticorrelations in resting-state functional connectivity MRI: a quantitative comparison of preprocessing strategies. Neuroimage,
47:1408-16.
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A NOVEL COGNITIVE FMRI TASK
TO ASSESS BRAIN MECHANISMS
UNDERLYING VISUAL PROCESSING AND
ATTENTION
Elfmarková N1,2, Mareček R1,2, Rapcsak S3, Rektorová I1,2
Brain and Mind Research Programme, Central European Institute
of Technology, CEITEC MU, Masaryk University, Brno, Czech
Republic,
1
First Department of Neurology, School of Medicine, Masaryk
University and St. Anne’s Hospital, Brno, Czech Republic,
2
Department of Neurology, University of Arizona, Tucson, USA.
3
Introduction: Visual processing and attentional deficits can
be found in early Alzheimer‘s disease (AD).
Study objectives: We aimed at developing a visual cognitive
task to study brain mechanisms underlying visual processing
in early AD using functional MRI (fMRI). To achieve our
goal we developed a novel visual object matching task using
conventional and unconventional (spatially rotated) views of
object pairs. Here we present the fMRI results of a pilot study
performed in healthy subjects (HS).
Methods: Twenty-two right-handed HS (11 men; age
25.3±2.8 years) performed a cognitive task in a 1.5T MR
scanner. The task consisted of 60 pairs of emotionally neutral
71
images and 30 pairs of dots with a symbol placed on the right
or left side (a control task). Participants viewed successive
paired images, separated by a visual mask. The second image
of each pair was either: same (identical) as the first image
(canonical condition 1); different in identity (canonical condition 2); same as the first image but spatially rotated (unconventional condition 3); different in identity and spatially
rotated (unconventional condition 4). Participants were instructed to respond as quickly as possible by pressing a YES
(left) button if the second object of the paired images was the
same as the first object (regardless of spatial orientation) or
by pressing NO (right) button if they were different. In the
control task participants responded with buttons depending
on the side of a dot symbol placement. fMRI data were processed using SPM8 and the standard pipeline. The significance level was set to p<0.05 FWE corrected.
Results: At the group level, we found major activation of bilateral temporo-occipital areas, precuneus and inferior frontal gyri during the canonical conditions as compared to the
control task. The unconventional conditions revealed additional activation of the posterior parietal areas including the
superior parietal lobule and intraparietal sulcus as compared
to the canonical conditions.
Conclusion: In the visual object matching task with conventional views of objects we observed major engagement
of the ventral visual pathway. The task with spatially uncon-
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ventional views of objects revealed additional recruitment
of the dorsal visual pathway and the dorsal attentional network which is involved in the top-down attentional control
of visual processing. Our fMRI paradigm shows promise for
assessing task-dependent attentional modulation of visual
processing in early AD.
References:
Schendan, H. E., Stern, Ch. E. (2008). Where Vision Meets Memory: Prefrontal-Posterior Networks for Visual Object Constancy during Categorization and Recognition. Cerebral Cortex;
18:1695-1711.
Vincent, J. L., Kahn, I., Snyder, A. Z., Raichle, M. E., Buckner,
R. L. (2008). Evidence for a Frontoparietal Control System Revealed by Intrinsic Functional Connectivity. J Neurophysiol;
100:3328–3342.
COULD IT BE POSSSIBLE TO
DISTINGUISH BENDING AND CROSSING
FIBERS IN DIFFUSION MRI DATA?
René Labounek1, Michal Mikl2, Roman Jakubíček1, Jiří
Chmelík1, Jiří Jan1
1
Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology,
Czech Republic
2
After diffusion tensor imaging (DTI) model [1], several approaches which are able to detect two or more crossing fibers
in diffusion MRI (dMRI) data have been invented (e.g. Q-ball imaging, ball and stick model) [2], [3]. After that, some
fiber bundles which had not been seen with DTI model were
suddenly observed (e.g. in corpus callosum). Although it
brought an improvement it seems that about 50% of detected fiber bundles are false positive results after tractography
[4]. One crucial problem is that tractography cannot decide
if the bundles are crossing or bending because models are
not estimating bending-tensor. For 2 crossing fibers, the tractography algorithm can trace from one point to three different places. For 2 bending fibers, there is only one possible
way. We would like to introduce how the difference between
dMRI data coming from crossing or bending fibers could
be detected. Imagine a population of water molecules in the
centre of crossing or bending and some applied gradient of
diffusion measurement. For crossing fibers, the population of
molecules can diffuse in all directions of fiber spreading, thus
the phase of molecules can be affected by the whole gradient range. Contrary for one bending fiber, the population can
diffuse only in directions of the fiber, thus the phase can be
affected only by the narrower gradient range. It applies simi-
OLOMOUC 15.–18. 10. 2014
larly for second bended fiber. From this point of view, phase
distributions should differ for crossing and bending fibers
respectively also resulting dMRI data should differ. For this
statement testing, the dMRI data simulator which generates
dMRI data based on Brownian motion of water molecules
inside and outside axons per one voxel volume was created.
Although there is several technical problems and aspects
(e.g. periodic character of gradient space phase distribution)
we are looking for sequence settings of dMRI measurement
where the dMRI data would be statistically significantly different for crossing and bending fiber geometries.
Acknowledgement
Computational resources were provided by the MetaCentrum
under the program LM2010005 and the CERIT-SC under the
program Centre CERIT Scientific Cloud, part of the Operational
Program Research and Development for Innovations, Reg. no.
CZ.1.05/3.2.00/08.0144.
References
[1] P. J. Basser, J. Mattiello, and D. LeBihan, “MR diffusion tensor spectroscopy and imaging,” Biophys. J., vol. 66, no. 1, pp.
259–67, Jan. 1994.
[2] D. S. Tuch, “Q-ball imaging.,” Magn. Reson. Med., vol. 52, no.
6, pp. 1358–72, Dec. 2004.
[3] T. E. J. Behrens, M. W. Woolrich, M. Jenkinson, H. Johansen-Berg, R. G. Nunes, S. Clare, P. M. Matthews, J. M. Brady, and
73
S. M. Smith, “Characterization and propagation of uncertainty in
diffusion-weighted MR imaging.,” Magn. Reson. Med., vol. 50,
no. 5, pp. 1077–88, Nov. 2003.
[4] O. Ciccarelli, M. Catani, H. Johansen-berg, C. Clark, and A.
Thompson, “Diffusion-based tractography in neurological disorders: concepts, applications, and future developments,” Lancet
Neurol, vol. 7, pp. 715–727, 2008.
signals
b. Heuristic features extraction based on physician’s point
of view
c. Extraction, selection, reduction and features standardization
d.Application of PCA - Principal Component Analysis
and ICA- Independent Component Analysis (artefacts
rejection]
Workshop: Automatická klasifikace
EEG grafoelementů
3. Supervised and non-supervised learning classical and fuzzy.
AUTOMATIC CLASSIFICATION OF EEG
GRAPHOELEMENTS (WORKSHOP)
c.Fuzzy sets for improving the homogeneity classes of
EEG segments (fuzzy c-means, fuzzy k-NN)
Vladimír Krajča, Svojmil Petránek, Jitka Mohylová, Hana
Schaabová, Václava Sedlmajerová
Outline
1. Motivation, why and which types of EEG graphoelements
to classify automatically
2. Discriminative features extraction
a. Multichannel adaptive segmentation of non-stationary
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OLOMOUC 15.–18. 10. 2014
a. Statistical pattern recognition, k-NN, k-means
b. Artificial neural networks, multilayer perceptron
4. Semi-automatic extraction of prototypes from original
EEG recordings, pre-processing by cluster analysis in the
learning phase (prototypes gathering), involving of expert
into the process of etalons extraction
5. Graphic visualization of results
a. Color identification of significant graphoelements
b. Temporal profiles - graphs of segments membership in
EEG classes in the course of time
c. Automated processing of neonatal temporal profiles
(sleep stages detection)
d. Statistical diagrams of percentual EEG graphoelements
occurrence
6. Applications, case studies
a. Automatic detection and classification of epileptic graphoelements for long-term EEG monitoring
b. Automatic detection of sleep stage changes in neonatal
EEG, statistics of quiet and active sleep
c. Practical examples of etalons extraction
NF „Resting State“
FMRI FOR STUDY OF BRAIN RESTING
STATE NETWORKS IN PATIENTS WITH
DEGENERATIVE BRAIN DISEASES
Rektorová I1,3, Mikl M2, Krajčovičová L1,3, Nováková M1,
Elfmarková N1, Gajdoš M2, Mareček R2
OLOMOUC 15.–18. 10. 2014
Applied Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech
Republic
1
Multimodal and Functional Imaging Laboratory, CEITEC - Central European Institute of Technology, Masaryk University, Brno,
Czech Republic
2
First Department of Neurology, School of Medicine, Masaryk
University and St. Anne’s Hospital, Brno, Czech Republic
3
Resting-state networks (RSNs) are characterized by organized basal activity during rest and by low-frequency signal
fluctuations that can be studied by fMRI. To date, several
RSNs have been consistently reported, including the task-positive networks (e.g., the primary motor, visual and auditory
network, the left and right fronto-parietal RSNs, and the extrastriate visual RSN) and the default mode network (DMN).
Functional connections of these RSNs tend to be strongly
related to structural white matter connections, suggesting the
existence of an underlying structural core of functional connectivity networks in the human brain. Several hundred studies are now available that address integrity of resting connectivity in patients with Alzheimer’s disease (AD) and mild
cognitive impairment (MCI), as well as preclinical at-risk
subjects. Most studies focus on the default mode network
(DMN), a system of specific brain areas showing strong connected resting activity that attenuates during goal-directed
behavior. The extent of intrinsic brain activity tends to be
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OLOMOUC 15.–18. 10. 2014
strongly correlated with cognitive processes and is specifically disrupted in AD and MCI patients and at-risk subjects,
with changes seeming to evolve during the transition between the disease stages.
INTER-AREAL FRONTAL LOBE
COMMUNICATION DURING REST:
A DEPTH EEG CONNECTIVITY STUDY
Regarding Parkinson’s disease (PD) and PD with cognitive impairment the data on changes in the DMN and other
RSNs remain rather conflicting and are probably related to
the phenotypic and pathological heterogeneity of the disease. The DMN disturbances in PD may be linked both to the
dopamine deficiency (that can be at least partially reversed
by dopaminergic medication) and to cognitive dysfunctions.
The lecture will focus on the DMN and other RSNs results
as assessed by fMRI, particularly in PD and early AD. The
impact of dopaminergic and cholinergic medication will also
be discussed.
Lucie Šimová¹, Josef Halámek³, Pavel Jurák³, Jan Fousek¹,4,
Petr Klimeš³, Ivan Rektor¹ʼ²
¹ Multimodal and Functional Imaging Research Group, CEITEC
² Department of Neurology, Masaryk University, St. Anna’s Hospital, Pekařská 53, 656 91 Brno, Czech Republic
³ Institute of Scientific Instruments, Academy of Sciences of the
Czech Republic, Brno, Czech Republic
Department of Computer Systems and Communications, Faculty
of Informatics, Masaryk University, Brno, Czech Republic
4
Purpose: This study investigated functional connectivity in
the human limbic system, frontal and temporal lobe and their
relationship in pharmacoresistant patients with temporal lobe
epilepsy (TLE). We worked with interictal recordings in resting state and investigated whether there exists a relationship
between specific brain structures and frequency bands.
Methods: We studied five pharmacoresistant patients with
TLE, who were candidates for surgery and had established deep
electrodes in the pre-surgery examination (the detection of epileptic zone). The deep electrode recordings from epileptic zones
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and non-epileptic structures of the brain we divided into eleven
areas based on their anatomical locations which are cross correlated with each other and we identified the relationship between
them. We worked with interictal recordings in resting state. We
considered a significant correlation to be a correlation value bigger than +/-0.5 and lasts longer than 30 percent of 10-minute
interval. We complemented correlation with graphs (tentative
graphical views of correlations) and coherence.
Pittau F, Grova C, Moeller F, Dubeau F, Gotman J. Patterns of altered functional connectivity in mesial temporal lobe epilepsy.
Epilepsia 2012; 53(6):1013-23.
Results: In the tested structures the link occurred predominantly in alpha. It was shown that there exist the relationship
between specific structures and particular frequency bands.
We also discovered that this relationship wasn’t affected by
epilepsy.
COMPARISON OF CANONICAL
CORRELATION ANALYSIS AND PEARSON
CORRELATION IN RESTING STATE
FMRI IN PATIENTS WITH PARKINSON’S
DISEASE
Conclusions: Interareal communication within the frontal
lobe during rest appears to be structured and complex. The
resting state comprises ongoing communications on various
levels: the whole brain, interlobar, regional and subregional
levels. The hub structures known to assure the large scale
communication in the RSNs have the hub properties also in
interlobar and regional interactions. While the very slow oscillation on the brain level have been largely studied by the
RSN fMRI, the more rapid lobar and sublobar communications are not well understood and need further research.
References
Buzsáki G, Draguhn A. Neuronal oscillations in cortical networks.
Science 2004;304(5679):1926-9.
Wu CW, Gu H, Lu H, Stein EA, Chen JH, Yang Y. Frequency specificity of functional connectivity in brain networks. Neuroimage
2008;42(3):1047-55.
M, Gajdoš1; M, Mračková1; N, Elfmarková1; I, Rektorová1;
M, Mikl1
1 CEITEC MU and LF MU, Masaryk University, Brno
Introduction: In many fMRI studies of functional connectivity, researchers need to select representative signal of region
of interest (ROI). Usual approach is to compute mean or first
eigenvector of ROI voxels and use it to calculate Pearson correlation (PC). In this abstract we compare this usual practice
with extended technique using more eigenvectors and canonical correlation analysis (CCA).
77
Methods: We used resting-state data from 18 PD patients,
two sessions for each subject, first in off state, second in on
state (after L-dopa medication). Dataset was acquired using
1.5T MR scanner Siemens Symphony, 150 scans, TR=3.0 s.
Data were preprocessed in SPM8 - unwarped, slice timing
corrected, spatially normalized and smoothed using 5mm
kernel. Masks of individually segmented gray matter were
applied. Then we used AAL parcelation and performed PCA
on each region. First eigenvectors were used for PC analysis
and every eigenvector above 10% explained variability entered CCA. To find AAL regions influenced by medication,
t-tests were performed on differences between first and second session both using PC and CCA coefficients.
dence that CCA is able to find differences between datasets
albeit on uncorrected level. These differences can represent
effect of L-dopa medication on functional connectivity network. CCA could reveal information, that remains hidden
for PC analysis and for assessment of functional connectivity
it could be useful to combine information from both methods
– CCA and PC.
Results: CCA identified 107 and PC 206 significant changes in
correlation between AAL regions (p<0.05 uncorrected). Only
5 significant changes were identical for CCA and PC. Mean
CCA correlation was 0.58, mean PC correlation was 0.22.
EEG 2
Conclusion: PC and CCA are statistical methods quantifying
information about similarity of signals. Although CCA is not
commonly used in fMRI, we performed it as extension of
PC, because we want to exploit more variability from data
than PC can. Mean CCA correlation on group level is significantly higher than PC correlation. CCA evaluates greatest
correlation obtained by linear combination of eigenvectors
between every two regions. Therefore CCA contains stronger
correlations than PC. Statistically significant results are evi-
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Thanks to Grant GA14-33143S from GACR for funding.
INITIATIVES AND PROJECTS
FOR COLLABORATION IN
NEUROINFORMATICS
Roman Mouček1,2, Petr Ježek1,2, Pavel Mautner1,2
1
New Technologies for the Information Society, Faculty of
Applied Sciences, University of West Bohemia, Univerzitní 8,
306 14 Plzeň, Czech Republic
2
Department of Computer Science and Engineering, Faculty of
Applied Sciences, University of West Bohemia, Univerzitní 8,
306 14 Plzeň, Czech Republic
Sharing of electrophysiology data, related metadata, processing methods and workflows is one of the crucial tasks in
neuroinformatics. International Neuroinformatics Coordinating Facility (INCF) develops and maintains computational
infrastructure for neuroscientists and INCF Programs address infrastructural issues of high importance to the neuroscience community. The INCF program “Standard for data sharing – Electrophysiology Task Force” deals with collection
of requirements for developing the data format that could be
accepted and widely shared within the community. To enable collaboration through the sharing of neuroscience data,
INCF also introduced the INCF Dataspace that associates
data sources in a distributed system based on iRods solution.
The Czech National Node for Neuroinformatics (CNNN) is
currently focused on two main topics. The first one deals with
higher reliability of interactions of human subjects, artificial
systems and their alliances. Theoretical knowledge is applied
in transportation area; relations between the components of
the EEG alpha rhythm and attention levels of relevant subjects are investigated. The Node also continues in building of
complex hardware and software infrastructure for research in
electrophysiology. A catalog server connected to INCF Dataspace and a node server for EEG/ERP domain (a subnode of
the catalog server) were established. The Node members also
work in an international group developing the Ontology for
describing Experimental Neurophysiology (OEN).
OLOMOUC 15.–18. 10. 2014
The EEG/ERP Portal (EEGBase) is a web-based system that
enables researchers to store, manage, share, and process data
and metadata from EEG/ERP experiments [1]. The portal
also enables users to work in research groups, define metadata, and run methods for discrete signal processing. Users
may have different roles in the system and the related level
of authority. The EEG/ERP Portal was registered as a neuroscience resource within the Neuroscience Information Framework (NIF); direct access to the services implemented in
the EEG/ERP Portal is ensured through the NIF interface.
Off-line and mobile versions of the portal are also available.
A programmable hardware stimulator that allows users to
create various experiments and use the combined stimulation (acoustic and visual) was designed and developed. The
stimulator is portable and can be connected to conventional
equipment.
Acknowledgments:
The work was supported by the European Regional Development Fund (ERDF), Project “NTIS - New Technologies
for Information Society”, European Centre of Excellence,
CZ.1.05/1.1.00/02.0090.
[1] EEG/ERP Portal (EEGBase). (2014). Available online at: http://
eegdatabase.kiv.zcu.cz/
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NON-LINEAR ANALYSIS OF NEWBORN
EEG
Radisavljevic Djordjevic V., Lhotska L., Gerla V., Krajca V.,
Paul K.
Introduction: Electroencephalography (EEG) is the measurement of brain electrical activity by means of electrodes
positioned on the scalp, which has many important applications in medicine. From one side, visual inspection of EEG
signal by neurologists is time consuming, tedious, based on
the previous experience and subjective. From the other side,
automated classification of EEG signals is very difficult task,
as these signals can be noisy and especially when they are
recorded during a long time period. In most cases, the agreement of an automatic method with visual analysis is a basis
criterion for its acceptance. Today, as well as in the previous
decade, a variety of signal processing techniques is being
applied on EEG data.
Methods: In this contribution we present briefly a comprehensive methodology for automatic recognition of behavioral
states in neonatal sleep EEG. The methodology is based on
segmentation, comprehensive feature extraction and classification of signal segments by supervised learning techniques.
The attention was focused on data representation stage in
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the multistage processing system, namely representation of
signal by extracted features. This stage is very important in
the analysis of EEG signals in the computational data processing, as it directly affects the classification accuracy. Specifically extracted nonlinear features, whose classification
potential was tested, were Hurst exponent and approximate
entropy, calculated both for the raw signal and signal after
the application of wavelet transform. The methodology was
optimized for EEG signal processing in the field of sleep studies in newborns and verified on real clinical neonatal data.
Conclusions: Based on the obtained results, it can be concluded that the Hurst exponent can be used in the field of neonatal sleep EEG analysis, as it can differentiate well between
quiet and active sleep stages. The combination of wavelet
transform and approximate entropy were used for the first
time in the proposed system for the classification of sleep
stages in newborns. The results show that this approach can
be used for neonatal sleep EEG analysis, as it provides high
classification accuracy. Thus this work provides a reference
for enhancing the differentiation of individual neurological
states and for the improvement of existing approaches.
METHODS OF HIGH FREQUENCY
OSCILLATIONS DETECTION:
ADVANTAGES AND DISADVANTAGES
Balach J. , Havel T. , Janča R. , Ježdík P. , Čmejla R. , Kršek
P.2, Marusič P.3, Jiruška P.4
1
1
1
1
1
1
Czech Technical University in Prague, Faculty of Electrical Engineering, Technicka 6, Prague 6, Czech Republic
2
Charles University in Prague, 2nd Faculty of Medicine, Motol University Hospital, Department of Paediatric Neurology,
U Uvalu 84, Prague 5, Czech Republic
3
Charles University in Prague, 2nd Faculty of Medicine, Motol
University Hospital, Department of Neurology, U Uvalu 84, Prague 5, Czech Republic
4
Institute of Physiology, Academy of Sciences of Czech Republic,
Department of Developmental Epileptology, Videnska 1083, Prague 4, Czech Republic
Background: High frequency oscillations (HFOs) represent
new electrographic marker of epileptogenic tissue and they
are considered as a surrogate marker of seizure onset and epileptogenic zones. HFOs are recorded mainly in intracranial
recordings. Visual analysis of HFOs in long-term recordings
is extremely difficult due to the low signal-to-noise ratio of
HFOs. Successful integration of HFOs into presurgical evaluation requires development of reliable methods of automa-
OLOMOUC 15.–18. 10. 2014
tic HFO detection and quantification. We aimed to examine
performance of three new HFO detecting algorithms and
compared their performance with published detectors.
Methods: We implemented three published detectors which
utilize RMS, line length or Hilbert transform approach to
detect HFOs. We have developed additional three types of
detectors which utilize short time energy estimation, Hilbert
envelope and Bayesian evidence. All HFO detecting algorithms were applied to gold standard datasets and their performance quantified.
Results: Line length and Hilbert detectors detected the
highest number of HFOs. The lowest number of the detections was achieved by RMS and energy estimating detectors.
According to the results, the detectors can be divided into
two groups. One group is characterized by high sensitivity.
These algorithms detect nearly all the labeled HFOs events,
but suffer from the high false positive detection rate. Second
group of detectors have high positive prediction value but lower sensitivity. Our Hilbert envelope detector demonstrated
the best performance of all evaluated detectors.
Conclusions: To improve the performance of detectors with
high sensitivity will require to develop additional post-processing steps to remove the majority of false detections.
Meanwhile detectors with low sensitivity will detect only
high-amplitude HFOs. Future selection of the most appro-
81
priate algorithm for HFO detection in intracranial recordings
will require detail understanding of the clinical significance
of low-amplitude HFOs and major sources of false positive
detections.
FALSE VISUAL MISMATCH NEGATIVITY
Jan Kremláček, Miroslav Kuba, Zuzana Kubová, Jana Szanyi, Jana Langrová, František Vít
Dept. of pathological physiology, Charles University in Prague,
Faculty of Medicine in Hradec Kralove
Recording of the visual mismatch negativity (vMMN) requires building of a visual temporal regularity using standard
stimuli and afterwards interrupting of such regularity by a
deviant stimulus. However, for the veridical vMMN it is necessary to control subject’s attention by a task, because the
attentional modulation might elicit a similar event related re-
82
OLOMOUC 15.–18. 10. 2014
sponse (ERP) as the vMMN. In this contribution we point out
an important and unexpected interaction between the attentional task and the regularity violation.
We presented standard/deviant stimuli (a moving grating) in
periphery of the visual field and targets/non-targets (numbers) stimuli in the central part of the visual field. Targets
were presented randomly with preceding 2, 3 or 4 non-target
stimuli (so the time between targets was randomly selected in
the interval of 2460 to 4100 ms. Subjects (aged 21–61 years,
3 females) pressed a button when they spot the target. To
make the recording session as short as possible the target was
presented immediately (400 ms) after each deviant; this way
deviants were unpredictable and also uninterrupted by a slow
response to the target. ERPs were recorded from 68 unipolar
electrodes, (four EOG channels) with the right earlobe as a
reference.
In results we observed a statistically significant vMMN-like
response in the interval of 150 to 250 ms. This response, however, exhibited unexpected features, as its localisation was
in the central area with prevalence to the left hemisphere (all
subjects responded by the right hand) and it was absent in recordings where the subjects’ response was not required. Further, we observed difference in a linear trend of the ERPs to
standard/deviant stimuli. All these signs supported evidence
that the vMMN-like potential was a false vMMN created by
superposition of a preparatory potential for the target detec-
tion (the early readiness potential – Bereitschafts Potential)
and the deviant response.
The presented stimulation scheme with a randomised appearance of the deviant stimulus and the attentional task caused
the false vMMN because the subjects’ expectation of the target stimulus resulted in the readiness potential, which precedes the behavioural response even couple of seconds before
subjects’ reaction. Due to a suboptimal design, this preceding
response was superimposed in a greater extent over the deviant response than over the standard one.
The linear character of the readiness potential, however,
allows its extraction from the ERP and identification of the
veridical vMMN (Kremláček J, et al. Visual mismatch negativity in the dorsal stream is independent of concurrent visual
task difficulty. Front Hum Neurosci 2013;1–7).
Supported by P37/07 (PRVOUK) program of Charles University.
OLOMOUC 15.–18. 10. 2014
IS NUCLEUS SUBTHALAMICUS
INVOLVED IN THINKING? SEPARATION
OF CONSCIOUS AND SUBCONSCIOUS
COGNITION COMPONENT IN THE
SUBTHALAMIC NUCLEUS USING P300
AND MMN PROTOCOLS.
Eduard Minks1, Pavel Jurák3,4, Jan Chládek2,3, Zuzana Hummelová1, Josef Halámek3,4, Alexandra Minksová, Martin
Bareš1,2
1
First Department of Neurology, Faculty of Medicine, Masaryk
University and St. Anne’s Hospital, Brno, Czech Republic
2
Central European Institute of Technology, Masaryk University
– CEITEC MU, Behavioral and Social Neuroscience Research
Group, Brno, Czech Republic
3
Institute of Scientific Instruments of the Academy of Sciences,
4
ICRC – International Clinical Research Center, St. Anne‘s Hospital, Brno, Czech Republic
Introduction: P300 wave is considered a correlate of cognitive process and an oddball paradigm is used for its recording. MMN (Mismatch negativity) is considered a correlation of automatic sensory memory on a subconscious level and
also a reflection of subconscious primitive sensory intelligen-
83
ce. When the MMN is recorded the same protocol as P300
paradigm is used, only with the difference that the proband
pays no attention to the stimuli. The aim of this study was to
compare evoked potentials from the P300 paradigm against
MMN paradigm, both recorded in the subthalamic nucleus
(STN) and thus electrophysiologically isolate conscious cognition component in this structure.
Methods: We included 3 patients (2 of whom were women)
with Parkinson‘s disease and recorded the evoked potentials using protocols P300 and MMN during installation of
DBS (Deep brain stimulation). The average age of the patients was 59 ± 8 years, disease duration 9 ± 3 years. The
electrodes were implanted into the STN bilaterally and each
wore four contacts on the left and on the right side (L1,2,3,4
and R1,2,3,4). We were interested in local potentials – in signal from the connection of contacts to each other on one intracerebral electrode (on each side 3 bipolar montages were
monitored: L1-2, L2-3, L3-4, R1-2, R2-3, R3-4). We were
interested in the latency of 200 to 400 ms - thus in the area of
cognitive responses P300.
Results: When the averaged signal of infrequent stimuli between P300 and MMN paradigm was compared a significant
difference between them in each left and right electrode at
least in one montage was found. The same we found when
comparing averaged frequent answers. There was also a statistically significant difference between the evoked potentials
84
OLOMOUC 15.–18. 10. 2014
obtained during P300 paradigm and MMN paradigm.
Conclusion and Discussion: The difference between evoked potentials of MMN and P300 protocols in latency of 200400 ms suggests that STN is involved in conscious cognitive
processes at the time of stimuli application. Thus the thinking
– at a given time – is not a function of the brain cortex only.
What component of the cognitive processes STN does represent cannot be exactly specified. Although oddball paradigm
is very simple, during this paradigm the patient uses a variety
of cognitive functions – attention, executive function, working memory, calculation and proper level of motivation is
necessary too.
Workshop: Automatická klasifikace
EEG grafoelementů
AUTOMATIC CLASSIFICATION OF EEG
GRAPHOELEMENTS (WORKSHOP)
Vladimír Krajča, Svojmil Petránek, Jitka Mohylová, Hana
Schaabová, Václava Sedlmajerová
Outline
1. Motivation, why and which types of EEG graphoelements
to classify automatically
2. Discriminative features extraction
a. Multichannel adaptive segmentation of non-stationary
signals
b. Heuristic features extraction based on physician’s point
of view
c. Extraction, selection, reduction and features standardization
d.Application of PCA - Principal Component Analysis
and ICA- Independent Component Analysis (artefacts
rejection]
OLOMOUC 15.–18. 10. 2014
3. Supervised and non-supervised learning classical and fuzzy.
a. Statistical pattern recognition, k-NN, k-means
b. Artificial neural networks, multilayer perceptron
c.Fuzzy sets for improving the homogeneity classes of
EEG segments (fuzzy c-means, fuzzy k-NN)
4. Semi-automatic extraction of prototypes from original
EEG recordings, pre-processing by cluster analysis in the
learning phase (prototypes gathering), involving of expert
into the process of etalons extraction
5. Graphic visualization of results
a. Color identification of significant graphoelements
b. Temporal profiles - graphs of segments membership in
EEG classes in the course of time
c. Automated processing of neonatal temporal profiles
(sleep stages detection)
d. Statistical diagrams of percentual EEG graphoelements
occurrence
6. Applications, case studies
a. Automatic detection and classification of epileptic graphoelements for long-term EEG monitoring
b. Automatic detection of sleep stage changes in neonatal
EEG, statistics of quiet and active sleep
c. Practical examples of etalons extraction
85
86
OLOMOUC 15.–18. 10. 2014
GENZYME
61. SPOLEČNÝ
SJEZD ČESKÉ A SLOVENSKÉ SPOLEČNOSTI PRO NEUROFYZIOLOGII
Inovace
v neurologii
Biotechnologie v neurologii
OLOMOUC 15.–18. 10. 2014
Organizátoři děkují za laskavé přispění následujícím firmám:
e léky na vzácná střádavá
a nově se zaměřujeme
erózy.
litu života
Generální partneři
Genzyme, a Sanoﬁ company, Evropská 846/176a, 160 00 Praha 6
20 233 086 111, fax: +420 233 086 222, e-mail: [email protected]
Zlatí partneři
Partneři
MUDr. Pavel Čelakovský
Lékařská elektronika
Špičkové neurofyziologické přístroje světových
výrobců - jistota pro zdravotníky,
bezpečí pro pacienty.
Skalní 10, 152 00 Praha 5 | tel.: 251 814 483 | fax: 251 814 484
mobilní tel.: 602 202 271 | e-mail: [email protected] | www.drcel.cz
Mediální partneři
87
Oranžová: CMYK 0-72-100-0
Šedá: CMYK 0-0-0-75
Oranžová: PMS 021
Šedá: PMS 7545
Šedá: CMYK 0-0-0-75
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České a slovenské spoleČnosti pro klinickou neurofyziologii

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