Our scientific work can be seen in the context of "Connectomics". EEG and functional MRI are the main tools of our research. Please also relate to our Multimodal Imaging Group.
Quantification of impaired conscious awareness
fMRI signal changes in response to epileptiform EEG discharges during temporal lobe and absence seizures
We aim to develop an EEG-based bed-side test for the objective assessment of conscious awareness. Impaired conscious awareness has important practical consequences for people living with epilepsy. Recent pathophysiologic studies show that seizures with an impaired level of conscious awareness always affect widespread cortical networks and subcortical arousal systems. In light of these findings and their clinical significance, the International League Against Epilepsy (ILAE) has revised their classification system, which now includes awareness as one dimension in the classification of seizures (Fisher et al., 2017; Scheffer et al., 2017). However, as of yet, a bed side test for the objective assessment of conscious awareness does not exist. We aim to develop electroencephalography (EEG) as a measurement tool for conscious awareness.
Temporal lobe epilepsy (TLE) can be conceptualized as a network disease. The network can be characterized by inter-regional functional connectivity, i.e., blood oxygen level-dependent (BOLD) signal correlations between any two regions. However, functional connectivity is not constant over time, thus computing correlation at a given time and then at some later time could give different results (non-stationarity).
BOLD signal variance in patients with temporal lobe epilepsy in the hippocampi is higher than in controls (colorbar indicates p-value thresholded at p <0.001 fordisplay, clusters survive family-wise error correction at p <0.05).
We hypothesized (1) that non-stationarities can be induced by epilepsy (e.g., interictal epileptic activity) increasing local signal variance and that (2) these transient events contribute to fluctuations in connectivity leading to pathological functioning, i.e., TLE semiology. We analyzed fMRI data from 27 patients with TLE and 22 healthy controls. Testing hypothesis (1), we identified brain regions where the BOLD signal variance was significantly greater in TLE than in controls: the temporal pole - including the hippocampus. Taking the latter as the seed region and testing hypothesis (2), we calculated the time-varying inter-regional correlation values (dynamic functional connectivity) to other brain regions and found greater connectivity variance in the TLE than the control group mainly in the precuneus, the supplementary and sensorimotor, and the frontal cortices. We conclude that the highest BOLD signal variance in the hippocampi is highly suggestive of a specific epilepsy-related effect. The altered connectivity dynamics in TLE patients might help to explain the hallmark semiological features of dyscognitive seizures including impaired consciousness (precuneus, frontal cortex), sensory disturbance, and motor automatisms (sensorimotor cortices, supplementary motor cortex). Accounting for the non-stationarity and state-dependence of functional connectivity are a prerequisite in the search for potential connectivity-derived biomarkers in TLE.
Significantly greater varianceof hippocampal dynamic functional connectivity in patients with temporal lobe epilepsy (here: seed in left hippocampus) than in healthy controls (colorbar indicates p-value thresholded at p <0.001 fordisplay, clusters survive family-wise error correction at p <0.05).
Epilepsy and Neuroimmunology
We collaborate with our local neuroimmunology group. In our current work we investigate the potential role of immunologic processes in new-onset epilepsies manifesting with status epilepticus.
Arbeitsgruppen der Neurologie an der Christian-Albrechts-Universität zu Kiel
