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Magnetoencephalography (MEG) data is subject to many sources of environmental noise, and interference rejection is a necessary step in the processing of MEG data. Large amplitude interference caused by sources near the brain have been common in clinical settings and are difficult to reject. Artifact from vagal nerve stimulators (VNS) is a prototypical example. In this study, we describe a novel MEG interference rejection algorithm called dual signal subspace projection (DSSP), and evaluate its performance in clinical MEG data from people with epilepsy and implanted VNS. The performance of DSSP was evaluated in a retrospective cohort study of patients with epilepsy and VNS who had MEG scans for source localization of interictal epileptiform discharges. DSSP was applied to the MEG data and compared with benchmark for performance. We evaluated the clinical impact of interference rejection based on human expert detection and estimation of the location and time-course of interictal spikes, using an empirical Bayesian source reconstruction algorithm (Champagne). Clinical recordings, after DSSP processing, became more readable and a greater number of interictal epileptic spikes could be clearly identified. Source localization results of interictal spikes also significantly improved from those achieved before DSSP processing, including meaningful estimates of activity time courses. Therefore, DSSP is a valuable novel interference rejection algorithm that can be successfully deployed for the removal of strong artifacts and interferences in MEG., (Copyright © 2018. Published by Elsevier Inc.)

Objective: Focal cortical dysplasias (FCDs) often cause pharmacoresistant epilepsy, and surgical resection can lead to seizure-freedom. Magnetic resonance imaging (MRI) and positron emission tomography (PET) play complementary roles in FCD identification/localization; nevertheless, many FCDs are small or subtle, and difficult to find on routine radiological inspection. We aimed to automatically detect subtle or visually-unidentifiable FCDs by building a classifier based on an optimized cortical surface sampling of combined MRI and PET features., Methods: Cortical surfaces of 28 patients with histopathologically-proven FCDs were extracted. Morphology and intensity-based features characterizing FCD lesions were calculated vertex-wise on each cortical surface, and fed to a 2-step (Support Vector Machine and patch-based) classifier. Classifier performance was assessed compared to manual lesion labels., Results: Our classifier using combined feature selections from MRI and PET outperformed both quantitative MRI and multimodal visual analysis in FCD detection (93% vs 82% vs 68%). No false positives were identified in the controls, whereas 3.4% of the vertices outside FCD lesions were also classified to be lesional ("extralesional clusters"). Patients with type I or IIa FCDs displayed a higher prevalence of extralesional clusters at an intermediate distance to the FCD lesions compared to type IIb FCDs (p < 0.05). The former had a correspondingly lower chance of positive surgical outcome (71% vs 91%)., Conclusions: Machine learning with multimodal feature sampling can improve FCD detection. The spread of extralesional clusters characterize different FCD subtypes, and may represent structurally or functionally abnormal tissue on a microscopic scale, with implications for surgical outcomes., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: Periventricular nodular heterotopia (PVNH) is a malformation of cortical development due to impaired neuronal migration resulting in the formation of nodular masses of neurons and glial cells in close proximity to the ventricular walls. We report the clinical characteristics of the largest case series of FLNA-negative patients with seizures and bilateral periventricular heterotopia., Methods: Participants were recruited through the Epilepsy Phenome/Genome Project (EPGP), a multicenter collaborative effort to collect detailed phenotypic data and DNA on a large number of individuals with epilepsy, including a cohort with symptomatic epilepsy related to PVNH. Included subjects had epilepsy, and MRI confirmed bilateral PVNH. Magnetic resonance imaging studies were visually and quantitatively reviewed to investigate the topographic extent of PVNH, symmetry, and laterality., Key Findings: We analyzed data on 71 patients with bilateral PVNH. The incidence of febrile seizures was 16.6%. There was at least one other family member with epilepsy in 36.9% of this population. Developmental delay was present in 21.8%. Focal onset seizures were the most common type of seizure presentation (79.3%). High heterotopia burden was strongly associated with female gender and trigonal nodular localization. There was no evidence for differences in brain volume between PVNH subjects and controls. No relationship was observed between heterotopic volume and gender, developmental delay, location of PVNH, ventricular or cerebellar abnormalities, laterality of seizure onset, age at seizure onset, and duration of epilepsy., Significance: A direct correlation was observed between high heterotopia burden, female gender, and trigonal location in this large cohort of FLNA-negative bilateral PVNH patients with epilepsy. Quantitative MRI measurements indicated that this correlation is based on the diffuse nature of the heterotopic nodules rather than on the total volume of abnormal heterotopic tissue., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Magnetoencephalography (MEG) is an important tool in the presurgical evaluation of patients with medically refractory epilepsy. The appropriate utilization and interpretation of MEG studies can increase the proportion of patients who may be able to further pursue surgical evaluation, refine surgical planning, and potentially increase the probability of seizure freedom after surgery. The aim of this paper is to provide the reader with a comprehensive but accessible guide to MEG, with particular emphasis on acquiring a working knowledge of MEG analysis, identifying patient groups that are most likely to benefit, and clarifying the limitations of this technology., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Summarizing the podium discussion at the AES 2009, strengths and limitations of magnetoencephalography (MEG) are discussed with regard to basic methodological and clinical aspects in routine screening and presurgical evaluation of patients with epilepsies. Current literature and example cases are used to illustrate MEG contribution to clinical decision making, specifically whether a patient with pharmacoresistant epilepsy can move forward to epilepsy surgery. The main conclusion is that the largest role of MEG, as presently performed in the clinical environment, is to increase the number of patients who can go on to surgery, while it should not be used to deny surgery to any patient., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The purpose of the study was to compare figural and spatial memory in patients with left (LTLE, n=56) and right (RTLE, n=48) temporal lobe epilepsy using J.I. Breier and colleagues' (J Int Neuropsychol Soc 1996;2:535-40) figural/spatial scoring method for the Rey Osterrieth Complex Figure Test (RCFT). The study also examined the association between figural and spatial components of the RCFT, temporal lobe laterality, and hippocampal structure (MRI hippocampal volumes and neuropathology ratings). Neither immediate or delayed trial figural and spatial memory scores were associated with seizure laterality or hippocampal pathology ratings. Immediate and delayed recall scores were not associated with right hippocampal volume. However, modestly positive correlations were found between left hippocampal volume and RCFT delayed recall scores. Similar to recent work (A.C. Kneebone et al., J Int Neuropsychol Soc 2007;13:664-71), stronger associations were related to left temporal lobe function. This study provides further evidence for the lack of sensitivity of the RCFT as a surrogate measure of right temporal lobe memory function.

Purpose: Reliable change indices (RCIs) and standardized regression-based (SRB) change score norms were calculated for a measure of self-reported cognitive function, the Multiple Abilities Self-Report Questionnaire (MASQ), in patients with complex partial seizures. Establishment of such standardized change scores could be useful in determining the magnitude and direction of self-appraised cognitive change after epilepsy surgery or other treatment interventions. The primary study objective was to calculate RCI and SRB values for the MASQ. A secondary objective was to report SRB change scores in patients who had undergone anterior temporal lobectomy (ATL) and to assess relationships between self-reported cognitive change, seizure outcome, objective memory test performance, and mood., Methods: The MASQ was administered to 36 patients with complex partial seizures on two occasions (mean test-retest interval, 6 months). This group did not have major psychopathology and were on stable antiepileptic drugs. RCI and SRB change scores were calculated. Adjustments for baseline ratings, age, education, gender, age at seizure onset, and seizure duration were made with the SRB method. A confidence interval cutoff score (90% level) was calculated for the five MASQ cognitive domains (Language, Visual Perception, Verbal Memory, Visual-Spatial Memory, Attention/Concentration). MASQ SRB scores were computed for a second sample of 50 patients who had undergone ATL., Results: Test-retest reliabilities for the MASQ domains ranged from a low of 0.63 (Attention/Concentration) to a high of 0.87 (total score). Baseline MASQ score was the single largest contributor to the regression equations. Left and right ATL groups demonstrated similar magnitudes of self-reported cognitive change across all five MASQ domains. Individual base rate change distributions were similar across four of the five domains. with a higher proportion of right ATL patients reporting worsening attention function. Both postoperative mood and SRB-based verbal memory outcome were significantly correlated to self-reported cognitive change in the patients who had undergone ATL., Conclusions: SRB methodology provides a standardized technique with which to establish patient perception of cognitive change and may be of use when examining change across individual- and group-level ratings of cognitive functioning in clinical and research settings. These techniques also provide a common metric for direct comparison between subjective self-report ratings of cognitive function and objective cognitive test instruments.

Purpose: Previous studies have shown that structural integrity (i.e., presence/absence of mesial temporal sclerosis (MTS)) of the left mesial temporal lobe is associated with verbal memory outcome following left anterior temporal lobectomy (ATL). However, the functional integrity of the left temporal lobe, as exemplified by preoperative verbal memory performance, has also been associated with verbal memory outcome following surgery. We investigated the risk of verbal memory loss in patients with known structural abnormality (i.e., left mesial temporal sclerosis by MRI) and normal preoperative verbal memory performance who undergo left ATL., Methods: Seventeen patients with left temporal lobe epilepsy, MRI-based exclusive left MTS, and normal preoperative verbal memory were identified. Normal verbal memory was defined as performance on both Acquisition (learning across trials 1-5) and Retrieval (long delayed free recall) portions of the California Verbal Learning Test (CVLT) above a T score of 40 (>16%ile). Postoperative verbal memory outcome was established by incorporating standardized regression-based (SRB) change scores., Results: Postoperative declines across both CVLT Retrieval T scores and Acquisition T scores (average 20% and average 15% declines from baseline scores, respectively) were measured for the group. The average CVLT Retrieval SRB change score was -2.5, and the average CVLT Acquisition SRB change score was -1.0. A larger proportion of patients demonstrated postoperative declines on Retrieval scores than Acquisition scores (64.7% vs 17.6%, respectively)., Conclusions: Even in the presence of left MTS, patients exhibiting normal presurgical verbal memory are at risk for verbal memory declines following ATL. These results suggest that the functional integrity of the left mesial temporal lobe may play an important role in the verbal memory outcome in this patient group.

Self-report of cognitive functioning using the Multiple Abilities Self-Report Questionnaire (MASQ) was examined in 57 left (LTLE) and 36 right (RTLE) temporal lobe epilepsy patients. The MASQ is a 38-item self-report measure assessing five domains of self-perceived cognitive functioning: Language, Visual-Perceptual Abilities, Verbal Memory, Visual-Spatial Memory, and Attention/Concentration. Overall, LTLE patients self-reported more cognitive difficulties across all domains. Language was the only domain to emerge as a robust indicator of seizure lateralization (LTLE patients reporting more problems). Neuropsychological test performance did not emerge as a significant predictor for any domain, whereas measures of psychosocial and emotional functioning accounted for a significant but modest amount of variance in all of them. The results suggest caution in using such self-report measures as an ecological extension of objective testing, but suggest a role in assessing self-appraisal of deficits.

Multiple epiphyseal dysplasia (MED) and pseudoachondroplasia (PSACH) are autosomal dominant chondrodysplasias that have similar phenotypes at both clinical and cytological levels. With the recent mapping of PSACH and one form of MED (EDM1) to the pericentromeric region of chromosome 19, it is likely that the disease mutations are allelic. D19S212 and D19S215, genetic markers flanking the EDM1/PSACH locus, have been localized in a chromosome 19 physical map consisting of cosmid contigs ordered by high-resolution FISH. These two markers define an interval of approximately 3.1 Mb at the 19p13.1-p12 boundary. With as many as five informative crossovers within the D19S212-D19S215 interval in one family with EDM1 and one family with a mild form of PSACH, recombination mapping at greater resolution was undertaken. From cosmid contigs physically mapped within the D19S212-D19S215 interval, four new dinucleotide repeat polymorphisms have been identified. Analysis of recombinant haplotypes in the two families has narrowed the possible location of the EDM1/PSACH gene to an interval of approximately 600 kb.

The genomic structure of the D20S16 locus has been evaluated using genetic and physical methods. D20S16, originally detected with the probe CRI-L1214, is a highly informative, complex restriction fragment length polymorphism consisting of two separate allelic systems. The allelic systems have the characteristics of conventional VNTR polymorphisms and are separated by recombination (theta = 0.02, Zmax = 74.82), as demonstrated in family studies. Most of these recombination events are meiotic crossovers and are maternal in origin, but two, including deletion of the locus in a cell line from a CEPH family member, occur without evidence for exchange of flanking markers. DNA sequence analysis suggests that the basis of the polymorphism is variable numbers of a 98-bp sequence tandemly repeated with 87 to 90% sequence similarity between repeats. The 98-bp repeat is a dimer of 49 bp sequence with 45 to 98% identity between the elements. In addition, nonpolymorphic genomic sequences adjacent to the polymorphic 98-bp repeat tracts are also repeated but are not polymorphic, i.e., show no individual to individual variation. Restriction enzyme mapping of cosmids containing the CRI-L1214 sequence suggests that there are multiple interspersed repeats of the CRI-L1214 sequence on chromosome 20. The results of dual-color fluorescence in situ hybridization experiments with interphase nuclei are also consistent with multiple repeats of an interspersed sequence on chromosome 20.

Bullous pemphigoid antigens (BPAGs) are defined as autoantigens in a blistering skin disease, bullous pemphigoid. Two of the BPAGs, a 230-kD (BPAG1) and a 180-kD (BPAG2) protein, have been localized to hemidesmosomes, attachment structures at the basal keratinocyte-basement membrane interphase. We have recently cloned cDNAs corresponding to human BPAG1 and BPAG2, and mapped the corresponding genes to human chromosomes 6p and 10q, respectively. These cDNAs have now been used in a search for RFLPs in the corresponding genes. Southern hybridizations of genomic DNA from normal unrelated individuals with a BPAG1 cDNA detected an informative MspI RFLP, and similar hybridizations with a BPAG2 cDNA revealed an informative TaqI RFLP. These RFLPs were applied to a large kindred with epidermolysis bullosa simplex (EBS), generalized (Koebner) type, consisting of 14 affected and 12 unaffected individuals in three generations. Linkage analysis excluded the EBS locus in this pedigree approximately 9 cM and approximately 5 cM on either side of the BPAG1 and BPAG2 loci, respectively, when a lod score of -2.0 was taken as the limit of exclusion. This study demonstrates that mutations in the BPAG1 or BPAG2 genes are not the primary genetic defect in this family with EBS.

Bullous pemphigoid antigen (BPAG1), an integral component of the cutaneous basement membrane zone, serves as autoantigen in a blistering disease, bullous pemphigoid. In this study, we have generated cDNAs corresponding to human BPAG1 sequences. Two cDNAs, a 0.45-kb PCR product synthesized with human keratinocyte RNA as template and a 2.2-kb cDNA isolated from human keratinocyte lambda gt11 library, were utilized for chromosomal in situ hybridizations to establish the genomic location of the BPAG1 gene. Metaphase chromosomes of phytohemagglutinin-stimulated human peripheral blood leukocytes were examined by hybridizations with 3H-labeled cDNAs, and the chromosomes were identified by R-banding (fluorochrome-photolysis-Giemsa method). The results indicated that the human BPAG1 gene is at locus 6p11-6p12. This conclusion was supported by hybridizations with a panel of human X rodent hybrid cell DNA, which indicated concordance with human chromosome 6. Because different genes encoding human basement membrane components have been mapped previously to chromosomes other than 6, the results further indicate that human basement membrane zone genes are widely dispersed within the human genome.

pCRI-S232 (DXS278) is a 7-kb genomic sequence that hybridizes to multiple polymorphic X-linked restriction fragments on standard Southern analysis. Physical mapping of pCRI-S232 by pulsed-field gel electrophoresis (PFGE) suggests that a sequence in S232 is repeated in multiple X-chromosomal regions in normal individuals. Steroid sulfatase (STS) and DXS237 each hybridize to two of six X-linked SfiI fragments detected by S232. Two independent familial STS deletions, one of which is associated with a phenotype of ichthyosis plus ocular albinism (XI/OA1) and the other with nystagmus plus Rud syndrome, lack some but not all of the normal S232 PFGE fragments. We isolated a DNA fragment, E25B1.8, from a cosmid that contains S232. E25B1.8 detects a subset of the S232 polymorphic fragments on standard Southern blots plus new constant fragments; some, but not all, of the E25B1.8-hybridizing fragments are deleted in the XI/OA1 and Rud syndrome/nystagmus males. The simpler, but highly informative, polymorphism detected by E25B1.8 (DXS452) also eliminates an "intralocus" recombination seen with S232. We conclude that (1) males with STS deletions and complex phenotypes are partially deleted for DXS278, (2) DXS237 and part of DXS278 lie within 800 kb of STS, and (3) a repeat sequence within or around pCRI-S232 is probably located in multiple X-chromosomal locations spanning at least 2-3 Mb.

Laminin, an integral component of basement membranes, consists of three subunit polypeptides, A, B1, and B2 chains. We have recently isolated cDNAs corresponding to human laminin A chain. These cDNAs were utilized for chromosomal in situ hybridizations to establish the genomic location of the laminin A chain gene. Metaphase chromosomes of PHA-stimulated human peripheral blood leukocytes were examined by in situ hybridization with 3H-labeled cDNAs, and the chromosomes were identified by R-banding (fluorochrome-photolysis-Giemsa method). The results indicated that the human laminin A chain is at locus 18p11.3. Since human laminin B1 and B2 chain genes have been previously mapped to chromosomes 7 and 1, respectively, the results indicate that genes encoding human laminin chains reside in separate chromosomes.