title: Multimodal effective connectivity analysis reveals seizure focus and propagation in musicogenic epilepsy.
abstract: Dynamic causal modeling (DCM) is a method to non-invasively assess effective connectivity between brain regions. 'Musicogenic epilepsy' is a rare reflex epilepsy syndrome in which seizures can be elicited by musical stimuli and thus represents a unique possibility to investigate complex human brain networks and test connectivity analysis tools. We investigated effective connectivity in a case of musicogenic epilepsy using DCM for fMRI, high-density (hd-) EEG and MEG and validated results with intracranial EEG recordings. A patient with musicogenic seizures was examined using hd-EEG/fMRI and simultaneous '256-channel hd-EEG'/'whole head MEG' to characterize the epileptogenic focus and propagation effects using source analysis techniques and DCM. Results were validated with invasive EEG recordings. We recorded one seizure with hd-EEG/fMRI and four auras with hd-EEG/MEG. During the seizures, increases of activity could be observed in the right mesial temporal region as well as bilateral mesial frontal regions. Effective connectivity analysis of fMRI and hd-EEG/MEG indicated that right mesial temporal neuronal activity drives changes in the frontal areas consistently in all three modalities, which was confirmed by the results of invasive EEG recordings. Seizures thus seem to originate in the right mesial temporal lobe and propagate to mesial frontal regions. Using DCM for fMRI, hd-EEG and MEG we were able to correctly localize focus and propagation of epileptic activity and thereby characterize the underlying epileptic network in a patient with musicogenic epilepsy. The concordance between all three functional modalities validated by invasive monitoring is noteworthy, both for epileptic activity spread as well as for effective connectivity analysis in general.
authors: Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany; MEG Center, University of Tuebingen, Tuebingen, Germany. Electronic address: silke.klamer@uni-tuebingen.de.
authors: Silke
authors: S
authors: Klamer
authors: Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.
authors: Sabine
authors: S
authors: Rona
authors: Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany; MEG Center, University of Tuebingen, Tuebingen, Germany.
authors: Adham
authors: A
authors: Elshahabi
authors: Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany; Werner Reichardt Centre for Integrative Neuroscience, Tuebingen, Germany.
authors: Holger
authors: H
authors: Lerche
authors: MEG Center, University of Tuebingen, Tuebingen, Germany; Werner Reichardt Centre for Integrative Neuroscience, Tuebingen, Germany; CIMeC, Center for Mind/Brain Sciences, University of Trento, Trento, Italy.
authors: Christoph
authors: C
authors: Braun
authors: Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.
authors: Jürgen
authors: J
authors: Honegger
authors: Department of Biomedical Magnetic Resonance, University of Tuebingen, Tuebingen, Germany.
authors: Michael
authors: M
authors: Erb
authors: Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany; Werner Reichardt Centre for Integrative Neuroscience, Tuebingen, Germany.
authors: Niels K
authors: NK
authors: Focke
mesh_terms: D000465:Algorithms; D015984:Causality; D003690:Deja Vu / Q000523:psychology; D004569:Electroencephalography; D020195:Epilepsy, Reflex / Q000523:psychology*; D005625:Frontal Lobe / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D015225:Magnetoencephalography; D008297:Male; D008959:Models, Neurological; D064847:Multimodal Imaging / Q000379:methods*; D009146:Music / Q000523:psychology*; D009434:Neural Pathways / Q000473:pathology / Q000503:physiopathology; D059906:Neuroimaging / Q000379:methods*; D012640:Seizures / Q000503:physiopathology; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology; D055815:Young Adult
keywords: Dynamic causal modeling; Effective connectivity; High-density EEG; MEG; Musicogenic epilepsy; fMRI