Significance:Understanding the brain's complex functions requires multimodal approaches that combine data from various neuroimaging techniques. Functional near-infrared spectroscopy (fNIRS) offers valuable insights into hemodynamic responses, complementing other modalities such as electroencephalography (EEG), magnetoencephalography (MEG), and magnetic resonance imaging. However, there is a lack of comprehensive and accessible toolboxes able to integrate fNIRS advanced analyses with other modalities. NIRSTORM addresses this gap by offering a unified platform for multimodal neuroimaging analysis. Aim:NIRSTORM aims to provide a user-friendly and comprehensive environment for multimodal analysis while supporting the entire fNIRS analysis pipeline, from experiment planning to the reconstruction of hemodynamic fluctuations on the cortex. Approach:Developed in MATLAB®, NIRSTORM operates as a Brainstorm plugin, enhancing Brainstorm's capabilities for analyzing fNIRS data. Brainstorm is a widely used, GUI-based software originally designed for statistical analysis and source imaging of EEG and MEG data. Results:NIRSTORM supports conventional fNIRS preprocessing and statistical analyses while introducing new advanced features such as optimal montage for planning optode placement and maximum entropy on the mean (MEM) for reconstructing hemodynamic fluctuations on the cortical surface. Conclusion:As an open-access and user-friendly plugin, NIRSTORM extends Brainstorm's functionality to fNIRS, bridging the gap between EEG/MEG and hemodynamic analyses.

Although rapid eye movement (REM) sleep is often thought of as a singular state, it consists of two substates, phasic and tonic REM, defined by the presence (respectively absence) of bursts of rapid eye movements. These two substates have distinct EEG signatures and functional properties. However, whether they exhibit regional specificities remains unknown. Using intracranial EEG recordings from 31 patients, we analyzed expert-labeled segments from tonic and phasic REM and contrasted them with wakefulness segments. We assessed the spectral and connectivity content of these segments using Welch's method to estimate power spectral density and the phase locking value to assess functional connectivity. Overall, we found a widespread power gradient between low and high frequencies (p < 0.05, Cohen's d = 0.17 ± 0.20), with tonic REM being dominated by lower frequencies (p < 0.01, d = 0.18 ± 0.08), and phasic REM by higher frequencies (p < 0.01, d = 0.18 ± 0.19). However, some regions, such as the occipito-temporal areas as well as medial frontal regions, exhibit opposite trends. Connectivity was overall higher in all bands except in the low and high ripple frequency bands in most networks during tonic REM (p < 0.01, d = 0.08 ± 0.09) compared to phasic REM. Yet, functional connections involving the visual network were always stronger during phasic REM when compared to tonic REM. These findings highlight the spatiotemporal heterogeneity of REM sleep which is consistent with the concept of focal sleep in humans.

Temporal lobe epilepsy (TLE) is the most common pharmacoresistant epilepsy in adults, yet few patients receive curative surgery due to diagnostic and prognostic uncertainty. In a multicenter cohort, we analyzed multimodal MRI and clinical data from 282 TLE patients, 298 healthy controls, and 45 disease controls. Patient-specific deviations from typical lifespan trajectories of intrinsic brain function were mapped using normative modeling. Regional functional alterations were heterogeneous but overlapped most in the mesiotemporal cortex. Connectome-based simulations revealed abnormality spread followed structural network architecture, highlighting the hippocampus as well as paralimbic and medial default-mode regions as epicenters. Multimodal integration implicated superficial white-matter microstructural alterations as a key contributor. Supervised models achieved AUCs of 0.77 for distinguishing TLE from disease controls, 0.74 for lateralizing seizure focus, and 0.64 for predicting postsurgical seizure freedom; greater contralateral temporal deviations predicted poorer outcomes. These findings support individualized functional biomarkers for precision presurgical care in focal epilepsy.

OBJECTIVE:Epilepsy surgery needs predictive features that are easily implemented in clinical practice. Previous studies are limited by small sample sizes, lack of external validation, and complex computational approaches. We aimed to identify and validate visually stereo-electroencephalography (SEEG) features with the highest predictive value for surgical outcome, and assess the reliability of their visual extraction. METHODS:We included 177 patients with drug-resistant epilepsy who underwent SEEG-guided surgery at 4 epilepsy centers. We assessed the predictive performance of 10 SEEG features from various SEEG periods for surgical outcome, using the area under the receiver operating characteristic curve, and considering resected channels and surgical outcome as the gold standard. Findings were validated externally using balanced accuracy. Six experts, blinded to outcome, evaluated the visual reliability of the optimal feature using interrater reliability, percentage agreement (standard deviation ± SD) and Gwet's kappa (κ ± SD). RESULTS:The derivation cohort comprised 100 consecutive patients, each with at least 1-year of postoperative follow up (40% temporal lobe epilepsy; 42% Engel Ia). Spatial co-occurrence of gamma spikes and preictal spikes emerged as the optimal predictive feature of surgical outcome (area under the receiver operating characteristic curve 0.82). Applying the optimized threshold from the derivation cohort, external validation in 2 datasets showed similar performances (balanced accuracy 69.2% and 73.2%). Expert interrater reliability for gamma spikes (percentage agreement, 96% ± 2%; κ, 0.63 ± 0.16) and preictal spikes (percentage agreement, 92% ± 2%; κ, 0.65 ± 0.18) were substantial. INTERPRETATION:Spatial co-occurrence of gamma spikes and preictal spikes predicts surgical outcome. These visually identifiable features may reduce the burden of SEEG analysis by reducing analysis time, and improve outcome by guiding surgical resection margins. ANN NEUROL 2025;98:547-560.

Morning awakening is part of everyday life. Surprisingly, information remains scarce on its underlying neurophysiological correlates. Here simultaneous polysomnography and stereo-electroencephalography recordings from 18 patients are used to assess the spectral and connectivity content of the process of awakening at a local level 15 min before and after the awakening. Awakenings from non-rapid eye movement sleep are accompanied by a widespread increase in ripple (>80 Hz) power in the fronto-temporal and parieto-insular regions, with connectivity showing an almost exclusive increase in the ripple band in the somatomotor, default, dorsal attention, and frontoparietal networks. Awakenings from rapid eye movement sleep are characterized by a widespread and almost exclusive increase in the ripple band in all available brain lobes, and connectivity increases mainly in the low ripple band in the limbic system as well as the default, dorsal attention, somatomotor, and frontoparietal networks.

ObjectiveIncreasing evidence suggests that the seizure-onset pattern (SOP) in stereo-electroencephalography (SEEG) is important for localizing the “true” seizure onset. Specifically, SOPs with low-voltage fast activity (LVFA) are associated with seizure-free outcome (Engel I). However, several classifications and various terms corresponding to the same pattern have been reported, challenging its use in clinical practice.MethodFollowing the Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) guideline , we performed a systematic review of studies describing SOPs along with accompanying figures depicting the reported SOP in SEEG.ResultsOf 1799 studies, 22 met the selection criteria. Among the various SOP patterns, we observed that the terminology for low frequency periodic spikes exhibited the most variability, whereas LVFA is the most frequently used term of this pattern. Some SOP terms were inconsistent with standard EEG terminology. Finally, there was a significant but weak association between presence of LVFA and seizure-free outcome.ConclusionDivergent terms were used to describe the same SOPs and some of these terms showed inconsistencies with the standard EEG terminology. Additionally, our meta-analysis confirmed the link between patterns with LVFA and seizure-free outcomes. However, this association was not strong.SignificanceThese results underline the need for standardization of SEEG terminology.

Decrease in cognitive performance after sleep deprivation followed by recovery after sleep suggests its key role, and especially non-rapid eye movement (NREM) sleep, in the maintenance of cognition. It remains unknown whether brain network reorganization in NREM sleep stages N2 and N3 can uniquely be mapped onto individual differences in cognitive performance after a recovery nap following sleep deprivation. Using resting state functional magnetic resonance imaging (fMRI), we quantified the integration and segregation of brain networks during NREM sleep stages N2 and N3 while participants took a 1-hour nap following 24-hour sleep deprivation, compared to well-rested wakefulness. Here, we advance a new analytic framework called the hierarchical segregation index (HSI) to quantify network segregation across spatial scales, from whole-brain to the voxel level, by identifying spatio-temporally overlapping large-scale networks and the corresponding voxel-to-region hierarchy. Our results show that network segregation increased in the default mode, dorsal attention and somatomotor networks during NREM sleep compared to wakefulness. Segregation within the visual, limbic, and executive control networks exhibited N2 versus N3 sleep-specific voxel-level patterns. More segregation during N3 was associated with worse recovery of working memory, executive attention, and psychomotor vigilance after the nap. The level of spatial resolution of network segregation varied among brain regions and was associated with the recovery of performance in distinct cognitive tasks. We demonstrated the sensitivity and reliability of voxel-level HSI to provide key insights into within-region variation, suggesting a mechanistic understanding of how NREM sleep replenishes cognition after sleep deprivation.

Simultaneous recording of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) is a widely used non-invasive neuroimaging technique in sleep studies. However, EEG data are strongly influenced by two types of MRI-related artefacts: gradient artefacts (GA) and ballistocardiogram artefacts (BCG). If artefacts correction is suboptimal, the BCG obscures the EEG signals below 20Hz and could make it difficult to investigate sleep oscillations, especially sleep spindles, sleep specific oscillations occurring within 11-16Hz frequency band. We previously demonstrated the utility of beamforming spatial filtering in correcting MRI-related artefacts on EEG. Here, we investigated the use of beamforming spatial filtering for improving the detection of EEG oscillations during sleep, in particular, 1) to accurately estimate single-event spindle EEG power changes, and 2) to demonstrate the potential improvement of fMRI general linear model (GLM) analysis when involving such additional EEG information. We analysed EEG-fMRI data acquired during a recovery nap after sleep deprivation in 20 young healthy participants (12 females, 8 males, age=21.3+/-2.5 years). Based on spindle events (onset and duration) detected by trained sleep scorers on BCG corrected EEG signals through a conventional average artefact subtraction (AAS) method, we compared four different EEG processing steps: non-BCG corrected; AAS BCG corrected; beamforming BCG corrected; beamforming+AAS BCG corrected. These processing steps consist of non-BCG corrected and AAS BCG corrected considered either at the sensor level or at the source-level (after beamformer localization) to evaluate the impact of the BCG artefact on the detection of spindle activity. Then we further investigated four different fMRI GLM approaches using 1) the spindle onset and duration (GLM1), 2) spindle onset, duration, and parametric modulation of single-spindle power change from the Cz electrode of the AAS BCG corrected data (GLM2), 3) spindle onset, duration, and parametric modulation of single-spindle power change from the beamforming+AAS BCG corrected (GLM3) and 4) spindle onset, duration, and parametric modulation of single-spindle power change from the beamforming BCG corrected data (GLM4). We found that the beamforming approach did not only attenuate the BCG artefacts, but also recovered sleep spindle activity occurring during NREM sleep. Furthermore, this beamforming approach allowed us to accurately estimate single-event power change of each spindle in the source space when compared to the channel level analysis, and therefore to further improve the specificity of fMRI GLM analysis, better localizing the recruited brain regions during spindles. Our findings show the benefit of applying beamforming source imaging technique to EEG-fMRI acquired during sleep. We demonstrate that this approach would be beneficial especially for long EEG-fMRI data acquisitions (i.e., sleep, resting-state), when the BCG correction becomes problematic due to inherent dynamic changes of heart rates. Our findings extend previous work regarding the application of the source imaging to the sleep EEG-fMRI. Combining with this advanced methodology and analysis, sleep EEG-fMRI will help us better understand the functional roles of human sleep. ### Competing Interest Statement The authors have declared no competing interest.

OBJECTIVE:The use of electrical source imaging (ESI) in assessing the source of interictal epileptic discharges (IEDs) is gaining increasing popularity in presurgical work-up of patients with drug-resistant focal epilepsy. While vigilance affects the ability to locate IEDs and identify the epileptogenic zone, we know little about its impact on ESI. METHODS:We studied overnight high-density electroencephalography recordings in focal drug-resistant epilepsy. IEDs were marked visually in each vigilance state, and examined in the sensor and source space. ESIs were calculated and compared between all vigilance states and the clinical ground truth. Two conditions were considered within each vigilance state, an unequalized and an equalized number of IEDs. RESULTS:The number, amplitude, and duration of IEDs were affected by the vigilance state, with N3 sleep presenting the highest number, amplitude, and duration for both conditions (P < 0.001), while signal-to-noise ratio only differed in the unequalized condition (P < 0.001). The vigilance state did not affect channel involvement (P > 0.05). ESI maps showed no differences in distance, quality, extent, or maxima distances compared to the clinical ground truth for both conditions (P > 0.05). Only when an absolute reference (wakefulness) was used, the channel involvement (P < 0.05) and ESI source extent (P < 0.01) were impacted during rapid-eye-movement (REM) sleep. Clustering of amplitude-sensitive and -insensitive ESI maps pointed to amplitude rather than the spatial profile as the driver (P < 0.05). INTERPRETATION:IED ESI results are stable across vigilance states, including REM sleep, if controlled for amplitude and IED number. ESI is thus stable and invariant to the vigilance state.

Electro/Magneto-EncephaloGraphy (EEG/MEG) source imaging (EMSI) of epileptic activity from deep generators is often challenging due to the higher sensitivity of EEG/MEG to superficial regions and to the spatial configuration of subcortical structures. We previously demonstrated the ability of the coherent Maximum Entropy on the Mean (cMEM) method to accurately localize the superficial cortical generators and their spatial extent. Here, we propose a depth-weighted adaptation of cMEM to localize deep generators more accurately. These methods were evaluated using realistic MEG/high-density EEG (HD-EEG) simulations of epileptic activity and actual MEG/HD-EEG recordings from patients with focal epilepsy. We incorporated depth-weighting within the MEM framework to compensate for its preference for superficial generators. We also included a mesh of both hippocampi, as an additional deep structure in the source model. We generated 5400 realistic simulations of interictal epileptic discharges for MEG and HD-EEG involving a wide range of spatial extents and signal-to-noise ratio (SNR) levels, before investigating EMSI on clinical HD-EEG in 16 patients and MEG in 14 patients. Clinical interictal epileptic discharges were marked by visual inspection. We applied three EMSI methods: cMEM, depth-weighted cMEM and depth-weighted minimum norm estimate (MNE). The ground truth was defined as the true simulated generator or as a drawn region based on clinical information available for patients. For deep sources, depth-weighted cMEM improved the localization when compared to cMEM and depth-weighted MNE, whereas depth-weighted cMEM did not deteriorate localization accuracy for superficial regions. For patients' data, we observed improvement in localization for deep sources, especially for the patients with mesial temporal epilepsy, for which cMEM failed to reconstruct the initial generator in the hippocampus. Depth weighting was more crucial for MEG (gradiometers) than for HD-EEG. Similar findings were found when considering depth weighting for the wavelet extension of MEM. In conclusion, depth-weighted cMEM improved the localization of deep sources without or with minimal deterioration of the localization of the superficial sources. This was demonstrated using extensive simulations with MEG and HD-EEG and clinical MEG and HD-EEG for epilepsy patients.

Background: Magnetoencephalography (MEG) is a widely used non-invasive tool to estimate brain activity with high temporal resolution. However, due to the ill-posed nature of the MEG source imaging (MSI) problem, the ability of MSI to identify accurately underlying brain sources along the cortical surface is still uncertain and requires validation.Method: We validated the ability of MSI to estimate the background resting state activity of 45 healthy participants by comparing it to the intracranial EEG (iEEG) atlas ( https://mni-open-ieegatlas.research.mcgill.ca/ ). First, we applied wavelet-based Maximum Entropy on the Mean (wMEM) as an MSI technique. Next, we converted MEG source maps into intracranial space by applying a forward model to the MEG-reconstructed source maps, and estimated virtual iEEG (ViEEG) potentials on each iEEG channel location; we finally quantitatively compared those with actual iEEG signals from the atlas for 38 regions of interest in the canonical frequency bands.Results: The MEG spectra were more accurately estimated in the lateral regions compared to the medial regions. The regions with higher amplitude in the ViEEG than in the iEEG were more accurately recovered. In the deep regions, MEG-estimated amplitudes were largely underestimated and the spectra were poorly recovered. Over-all, our wMEM results were similar to those obtained with minimum norm or beamformer source localization. Moreover, the MEG largely overestimated oscillatory peaks in the alpha band, especially in the anterior and deep regions. This is possibly due to higher phase synchronization of alpha oscillations over extended regions, exceed-ing the spatial sensitivity of iEEG but detected by MEG. Importantly, we found that MEG-estimated spectra were more comparable to spectra from the iEEG atlas after the aperiodic components were removed.Conclusion: This study identifies brain regions and frequencies for which MEG source analysis is likely to be reliable, a promising step towards resolving the uncertainty in recovering intracerebral activity from non-invasive MEG studies.

Since the discovery of the human electroencephalogram (EEG), neurophysiology techniques have become indispensable tools in our armamentarium to localize epileptic seizures. New signal analysis techniques and the prospects of artificial intelligence and big data will offer unprecedented opportunities to further advance the field in the near future, ultimately resulting in improved quality of life for many patients with drug-resistant epilepsy. This article summarizes selected presentations from Day 1 of the two-day symposium "Neurophysiology, Neuropsychology, Epilepsy, 2022: Hills We Have Climbed and the Hills Ahead". Day 1 was dedicated to highlighting and honoring the work of Dr. Jean Gotman, a pioneer in EEG, intracranial EEG, simultaneous EEG/ functional magnetic resonance imaging, and signal analysis of epilepsy. The program focused on two main research directions of Dr. Gotman, and was dedicated to "High-frequency oscillations, a new biomarker of epilepsy" and "Probing the epileptic focus from inside and outside". All talks were presented by colleagues and former trainees of Dr. Gotman. The extended summaries provide an overview of historical and current work in the neurophysiology of epilepsy with emphasis on novel EEG biomarkers of epilepsy and source imaging and concluded with an outlook on the future of epilepsy research, and what is needed to bring the field to the next level.

Objective: High-density (HD) electroencephalography (EEG) is increasingly used in presurgical epilepsy evaluation, but it is demanding in time and resources. To overcome these issues, we compared EEG source imaging (ESI) solutions with a targeted density and HD-EEG montage.Methods: HD-EEGs from patients undergoing presurgical evaluation were analyzed. A low-density recording was created by selecting the 25 electrodes of a standard montage from the 83 electrodes of the HD-EEG and adding 8-11 electrodes around the electrode with the highest amplitude interictal epileptiform discharges. The ESI solution from this "targeted" montage was compared to that from the HD-EEG using the distance between peak vertices, sublobar concordance and a qualitative similarity measure.Results: Fifty-eight foci of forty-three patients were included. The median distance between the peak ver-tices of the two montages was 13.2 mm, irrespective of focus' location. Tangential generators (n = 5/58) showed a higher distance than radial generators (p = 0.04). We found sublobar concordance in 54/58 of the foci (93%). Map similarity, assessed by an epileptologist, had a median score of 4/5. Conclusions: ESI solutions obtained from a targeted density montage show high concordance with those calculated from HD-EEG.Significance: Requiring significantly fewer electrodes, targeted density EEG allows obtaining similar ESI solutions as traditional HD-EEG montage.(c) 2023 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.