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Electrical impedance tomography (EIT) could provide images of fast neural activity in the adult human brain with a resolution of 1 ms and 1 mm by imaging impedance changes which occur as ion channels open during neuronal depolarization. The largest changes occur at dc and decrease rapidly over 100 Hz. Evoked potentials occur in this bandwidth and may cause artefactual apparent impedance changes if altered by the impedance measuring current. These were characterized during the compound action potential in the walking leg nerves of Cancer pagurus, placed on Ag/AgCl hook electrodes, to identify how to avoid artefactual changes during brain EIT. Artefact-free impedance changes (δZ) decreased with frequency from −0.045 ± 0.01% at 225 Hz to −0.02 ± 0.01% at 1025 Hz (mean ± 1 SD, n = 24 in 12 nerves) which matched changes predicted by a finite element model. Artefactual δZ reached c.300% and 50% of the genuine membrane impedance change at 225 Hz and 600 Hz respectively but decreased with frequency of the applied current and was negligible above 1 kHz. The proportional amplitude (δZ (%)) of the artefact did not vary significantly with the amplitude of injected current of 5–20 µA pp. but decreased significantly from −0.09 ± 0.024 to −0.03 ± 0.023% with phase of 0 to 45°. For fast neural EIT of evoked activity in the brain, artefacts may arise with applied current of >10 µA. Independence of δZ with respect to phase but not the amplitude of applied current controls for them; they can be minimized by randomizing the phase of the applied measuring current and excluded by recording at >1 kHz.

Objective. In electroencephalography (EEG) measurements, the signal of each recording electrode is contrasted with a reference electrode or a combination of electrodes. The estimation of a neutral reference is a long-standing issue in EEG data analysis, which has motivated the proposal of different re-referencing methods, among which linked-mastoid re-referencing (LMR), average re-referencing (AR) and reference electrode standardization technique (REST). In this study we quantitatively assessed the extent to which the use of a high-density montage and a realistic head model can impact on the optimal estimation of a neutral reference for EEG recordings. Approach. Using simulated recordings generated by projecting specific source activity over the sensors, we assessed to what extent AR, REST and LMR may distort the scalp topography. We examined the impact electrode coverage has on AR and REST, and how accurate the REST reconstruction is for realistic and less realistic (three-layer and single-layer spherical) head models, and with possible uncertainty in the electrode positions. We assessed LMR, AR and REST also in the presence of typical EEG artifacts that are mixed in the recordings. Finally, we applied them to real EEG data collected in a target detection experiment to corroborate our findings on simulated data. Main results. Both AR and REST have relatively low reconstruction errors compared to LMR, and that REST is less sensitive than AR and LMR to artifacts mixed in the EEG data. For both AR and REST, high electrode density yields low re-referencing reconstruction errors. A realistic head model is critical for REST, leading to a more accurate estimate of a neutral reference compared to spherical head models. With a low-density montage, REST shows a more reliable reconstruction than AR either with a realistic or a three-layer spherical head model. Conversely, with a high-density montage AR yields better results unless precise information on electrode positions is available. Significance. Our study is the first to quantitatively assess the performance of EEG re-referencing techniques in relation to the use of a high-density montage and a realistic head model. We hope our study will help researchers in the choice of the most effective re-referencing approach for their EEG studies., Journal of Neural Engineering, 12 (5), ISSN:1741-2560, ISSN:1741-2552

Background: Multifocal motor neuropathy with conduction block (MMN) can be mistaken for motor neurone disease or other lower motor neurone syndromes, but is treatable with intravenous immunoglobulin (IvIg). Formal electrophysiological criteria for conduction block (CB) are so stringent that substantial numbers of patients may miss out on appropriate treatment. Methods: Electrophysiological data were collected from 10 healthy volunteers and compared to data from 10 patients who satisfied the clinical criteria for MMN and who responded to IvIg. This produced a definition of CB in MMN patients which was compared with existing definitions to assess “miss rates”. Results: Mean values for compound muscle action potential area, amplitude, and duration were calculated in normal subjects. Results beyond 3 SD of their respective means were considered abnormal. Using these criteria, CB in the context of MMN was defined as a reduction in negative peak area >23% along a distal nerve segment or >29% across a proximal segment; or a reduction in amplitude >32% across a distal segment or >33% across a proximal segment. All IvIg responsive patients had at least one nerve segment showing such CB. Employing some criteria from the literature would have denied treatment to over 30% of responsive patients. Conclusion: In the clinical setting of suspected MMN, less stringent criteria for CB can improve the diagnosis of this treatable disorder. Exclusions on grounds of temporal dispersion may be over-restrictive. A little over one third of CBs occur proximally.

Objective: To clarify age related changes in the clinicopathological features of hereditary neuropathy with liability to pressure palsy (HNPP) in Japanese patients with deletion of 17p11.2, particularly concerning axonal abnormalities. Methods: Forty eight proband patients from 48 HNPP families were assessed as to clinical, electrophysiological, and histopathological features, including age associated changes beyond those in controls. Results: Motor conduction studies showed age associated deterioration of compound muscle action potentials in nerves vulnerable to repetitive compression (median, ulnar, and peroneal nerves), but not in others such as the tibial nerve. Sensory conduction studies revealed more profound reduction of action potentials than motor studies with little age related change. Large myelinated fibre loss was seen in the sural nerve irrespective of age at examination. Conclusions: Irreversible axonal damage may occur at entrapment sites in motor nerves in HNPP patients, progressing with aging. Sensory nerves may show more profound axonal abnormality, but without age association. The electrophysiological features of HNPP are presumed to be a mixture of abnormalities occurring from early in life and acquired features caused by repetitive insults at entrapment sites. Unlike Charcot-Marie-Tooth disease type 1A, age associated axonal damage may not occur unless the nerves are subjected to compression.

Background: Multifocal motor neuropathy with conduction block (MMN) is a treatable disorder that can be mistaken for other lower motor neurone syndromes. Existing electrophysiological diagnostic criteria for MMN are restrictive. In particular, many are cautious about diagnosing conduction block (CB) in the presence of abnormal temporal dispersion (TD). Objective: To study the significance of TD in MMN, its relationship to CB in intravenous immunoglobulin (IvIg) responsive patients, and its utility in detecting a treatment response. Methods: We compared pre- and post-treatment changes in CB and TD in nine patients who satisfied clinical and electrophysiological criteria for MMN and responded to IvIg. Results: TD improved in one or more nerve segments in eight of nine patients tested. There was marked improvement in 65% of all nerve segments, and 60% of those segments with CB. By comparison, significant improvement in CB occurred in only 33% of segments. Of segments with significantly better CB after treatment, all but one showed similar improvements in TD. Such changes were not related to the degree of TD before treatment, being seen in segments with abnormal as well as normal TD. There was no correlation between improvements seen in TD and CB. Conclusion: We believe that TD should be considered an inherent feature of MMN. Improvement in TD is an independent marker of electrophysiological improvement in this disorder and is likely to be more useful than CB. When MMN is clinically suspected, the use of stringent criteria for CB in the presence of TD should be avoided.