Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-15T23:29:24.376Z Has data issue: false hasContentIssue false

Multimodal Imaging in Psychiatry: The Electroencephalogram as a Complement to Other Modalities

Published online by Cambridge University Press:  07 November 2014


The use of different imaging modalities provides the clinician and researcher with different views of anatomy and physiology at unprecedented levels of detail. Multimodal imaging allows for noninvasive measurement of structure and function in humans during complex behavior, and thus provides information about the inner workings of the brain previously unavailable. The present paper examines the various imaging techniques available, and describes their application to the clinic—in the case of epilepsy—and to research—in the case of schizophrenia. Because the electroen-cephalogram has a dynamic response in milliseconds, it provides the best temporal sensitivity of functional measures of brain activity. When coupled with high-resolution magnetic resonance imaging measures of brain structure, this multimodal approach provides a powerful tool for understanding brain activity. Clinically, the use of multimodal imaging has provided greater precision in localization of the epileptogenic focus. For researchers attempting to determine the underlying causes of schizophrenia, the use of multimodal imaging has helped lead the field away from a specific lesion view to a more distributed system abnormality view of this disorder.

Feature Articles
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



1. Rauch, SL, Renshaw, PF. Clinical neuroimaging in psychiatry. Harv Rev Psychiatry. 1995; 2: 297312.Google Scholar
2. Sokoloff, L. Cerebral circulation, energy metabolism, and protein synthesis: general characteristics and principles of measurement. In: Phelps, M, Mazziotta, J, Schelbert, H, eds. Positron Emission Tomography and Autoradiography: Principles and Applications for the Brain and Heart. New York, NY: Raven Press; 1986: 171.Google Scholar
3. Raichle, ME. Behind the scenes of functional brain imaging: a historical and physiological perspective. Proc Natl Acad Sci. USA. 1998; 95: 765772.CrossRefGoogle ScholarPubMed
4. Rosen, BR, Buckner, RL, Dale, AM. Event-related functional MRI: past, present, and future. Proc Natl Acad Sci. USA. 1998; 95: 773780.Google Scholar
5. Krings, T, Chiappa, KH, Cuffin, BN, Buchbinder, BR, Cosgrove, GR. Accuracy of electroencephalographic localization of epileptiform activities associated with focal brain lesions. Ann Neurol. 1998; 44: 7686.CrossRefGoogle ScholarPubMed
6. King, D, Spencer, SS, McCarthy, G, Spencer, DD. Surface and depth EEG findings in patients with hippocampal atrophy. Neurology. 1997; 48: 13631367.Google Scholar
7. Knowlton, RC, Laxer, KD, Ende, G et al. , Presurgical multimodal neuroimaging in electroencephalographic lateralized temporal lobe epilepsy. Ann Neurol. 1997; 42: 829837.Google Scholar
8. Koutroumanidis, M, Binnie, CD, Elwes, RDC et al. , Interictal regional slow activity in temporal lobe epilepsy correlates with lateral temporal hypometabolism as imaged with 18FDG PET: neurophysiological and metabolic implications. J Neurol Neuwsurg Psychiatry. 1998; 65: 170176.Google Scholar
9. Mukahira, K, Oguni, H, Awaya, Y et al. , Study on surgical treatment of intractable childhood epilepsy. Brain Dev. 1998; 20: 154164.Google Scholar
10. O'Brien, TJ, So, EL, Mullan, BP et al. , Subtraction ictal SPECT co-registered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus. Neurology. 1998; 50: 445454.CrossRefGoogle ScholarPubMed
11. Baumgartner, C, Podreka, I, Olbrich, A et al. , Epileptic negative myoclonus: an EEG-single-photon emission CT study indicating involvement of premotor cortex. Neurology. 1996; 46: 753758.Google Scholar
12. Manganotti, P, Zanette, G, Beltramello, A et al. , Spike topography and functional magnetic resonance imaging (fMRI) in benign rolandic epilepsy with spikes evoked by tapping stimulation. Electroencephalogr Clin Neurophysiol. 1998; 107: 8892.Google Scholar
13. Johnstone, EC, Crow, TJ, Frith, CD et al. , Cerebral ventricular size and cognitive impairment in chronic schizophrenia. Lancet. 1976; 2: 924926.Google Scholar
14. Gur, RE, Pearlson, GD. Neuroimaging in schizophrenia research. Schizophr Bull. 1993; 19: 337353.Google Scholar
15. McCarley, RW, Hsiao, J, Freedman, R, Pfefferbaum, A, Donchin, E. Neuroimaging and the cognitive neuroscience of schizophrenia. Schizophr Bull. 1996; 22: 703726.Google Scholar
16. Andreasen, NC. Linking mind and brain in the study of mental illness: a project for a scientific psychopathology. Science. 1997; 275: 15861592.Google Scholar
17. Buckley, PF. Structural brain imaging in schizophrenia. Psychiatr Clin North Am. 1998; 21: 7792.Google Scholar
18. Frith, C, Dolan, RJ. Images of psychopathology. Curr Opin Neurobiol. 1998; 8: 259262.Google Scholar
19. Selemon, LD, Rajkowska, G, Goldman-Rakic, PS. Abnormally high neuronal density in the schizophrenic cortex. Arch Gen Psychiatry. 1995; 52: 805818.Google Scholar
20. McClure, RJ, Keshavan, MS, Pettegrew, JW. Chemical and physiologic brain imaging in schizophrenia. Psychiatr Clin North Am. 1998; 21: 93122.Google Scholar
21. Weinberger, DR, Berman, KF, Zee, RF. Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia: I. Regional cerebral blood flow evidence. Arch Gen Psychiatry. 1986; 43: 114125.Google Scholar
22. Saunders, RC, Kolachana, BS, Bachevalier, J, Weinberger, DR. Neonatal lesions of the medial temporal lobe disrupt prefrontal cortical regulation of striatal dopamine. Nature. 1998; 393: 169171.Google Scholar
23. Schlaepfer, TE, Harris, GJ, Tien, AY et al. , Decreased regional cortical gray matter volume in schizophrenia. Am J Psychiatry. 1994; 151: 842848.Google Scholar
24. Pearlson, GD, Barta, PE, Powers, RE et al. , Medial and superior temporal gyral volumes and cerebral asymmetry in schizophrenia versus bipolar disorder. Biol Psychiatry. 1997; 41: 114.Google Scholar
25. McCarley, RW, Wible, C, Frumin, M et al. , MRI anatomy of schizophrenia. Biol Psychiatry. In Press.Google Scholar
26. Grunze, HCR, Rainnie, DG, Hasselmo, ME et al. , NMDA-dependent modulation of CAl local circuit inhibition. J Neurosci. 1996; 16: 20342043.Google Scholar
27. Buchsbaum, MS, Hazlett, EA. Functional brain imaging and aging in schizophrenia. Schizophr Res. 1997; 27: 129141.Google Scholar
28. Buchsbaum, MS, Tang, CY, Peled, S et al. , MRI white matter diffusion anisotropy and PET metabolic rate in schizophrenia. Neuwreport. 1998; 9: 425430.Google Scholar
29. Kinderman, SS, Karirni, A, Symonds, L, Brown, GG, Jeste, DV. Review of functional magnetic imaging in schizophrenia. Schizophr Res. 1997; 27: 143156.Google Scholar
30. Volz, HP, Gaser, C, Hager, F et al. , Brain activation during cognitive stimulation with the Wisconsin Cart Sorting Test—a functional MRI study on healthy volunteers and schizophrenics. Psychiatry Res. 1997; 75: 145157.Google Scholar
31. Barta, PE, Pearlson, GD, Powers, RE, Richards, SS, Tune, LE. Auditory hallucinations and smaller superior temporal gyral volume in schizophrenia. Am J Psychiatry. 1990; 147: 12571462.Google ScholarPubMed
32. Shenton, ME, Kikinis, R, McCarley, RW et al. , Left temporal lobe abnormalities in schizophrenia and thought disorder: a quantitative MRI study. N Engl J Med. 1992; 327: 604612.Google Scholar
33. Wright, IC, McGuire, PK, Poline, JB et al. , A voxel-based method for the statistical analysis of grey and white matter density applied to schizophrenia. Newvimage. 1995; 2: 244252.Google Scholar
34. Chua, SE, Wright, IC, Poline, JB et al. , Grey matter correlates of syndromes in schizophrenia: a semi-automated analysis of structural magnetic resonance images. Br J Psychiatry. 1997; 170: 406410.Google Scholar
35. Roth, WT, Cannon, E. Some features of the auditory evoked response in schizophrenics. Arch Gen Psychiatry. 1972; 27: 466471.Google Scholar
36. Begleiter, H, Porgesz, B. The P300 component of the event-related brain potential in psychiatric patients. In: Cracco, R, Bodis-Wollender, I, eds. Evoked Potentials. New York, NY: Alan R. Liss; 1986: 529535.Google Scholar
37. Pritchard, WS. Cognitive event-related potential correlates of schizophrenia. Psychol Bull. 1986; 100: 4366.CrossRefGoogle ScholarPubMed
38. Duncan, CC. Event-related brain potentials: a window on information processes in schizophrenia. Schizophr Bull. 1988; 14: 199203.Google Scholar
39. Ford, JM, White, PM, Csemansky, JG, Faustman, WO, Roth, WT, Pfefferbaum, A. ERPs in schizophrenia: effects of antipsychotic medication. Bid Psychiatry. 1994; 36: 153170.Google Scholar
40. Rao, KMJ, Ananthnarayanan, CV, Gangadhar, BN, Janakiramaiah, N. Smaller auditory P300 amplitude in schizophrenics in remission. Neuropsychobiology. 1995; 32: 171174.Google Scholar
41. Maeda, H, Merita, K, Kawamura, N, Nakazawa, Y. Amplitude and area of the auditory P300 recorded with eyes open reflect remission of schizophrenia. Biol Psychiatry. 1996; 39: 743746.Google Scholar
42. Egan, MF, Duncan, CC, Suddath, RL, Kirch, DG, Mirsky, AF, Wyatt, RJ. Event-related potential abnormalities correlate with structural brain alterations and clinical features in patients with chronic schizophrenia. Schizophr Res. 1994; 11: 259271.Google Scholar
43. McCarley, RW, Shenton, ME, O'Donnefl, BF et al. , Auditory P300 abnormalities and left posterior superior temporal gyms reduction in schizophrenia. Arch Gen Psychiatry. 1993; 50: 190197.Google Scholar
44. Morstyn, R, Duffy, F, McCarley, RW. Altered P300 topography in schizophrenia. Arch Gen Psychiatry. 1983; 40: 729734.Google Scholar
45. O'Donnell, BF, Shenton, ME, McCarley, RW et al. , The auditory N2 component in schizophrenia: relationship to MRI temporal lobe gray matter and to other ERP abnormalities. Biol Psychiatry. 1993; 34: 2640.CrossRefGoogle ScholarPubMed
46. Salisbury, DF, Shenton, ME, Sherwood, AR et al. , First episode schizophrenic psychosis differs from first episode affective psychosis and controls in P300 amplitude over left temporal lobe. Arch Gen Psychiatry. 1998; 55: 173180.CrossRefGoogle ScholarPubMed
47. Salisbury, DF, Shenton, ME, McCarley, RW. P300 topography differs in schizophrenia and manic psychosis. Biol Psychiatry. 1999; 45: 98106.Google Scholar
48. Hirayasu, Y, Shenton, ME, Salisbury, DF et al. , First episode schizophrenia differs from first episode affective disorder and a normal comparison group in left temporal lobe MRI volume reductions. Am J Psychiatry. 1998; 155: 13841391.Google Scholar
49. Hirayasu, Y, Shenton, ME, Salisbury, DF et al. , MRI and ERP abnormalities in first episode psychosis. Biol Psychiatry. 1997; 41s: 60S.Google Scholar
50. Naatanen, R, Gaillard, AWK, Mantysalo, S. Early selective-attention effect on evoked potential reinterpreted. Acta Psychol. 1978; 42: 313329.Google Scholar
51. Naatanen, R, Gaillard, AWK. The N2 deflection of ERP and the orienting reflex. In: Gaillard, AWK, Ritter, W, eds. EEG Correlates of Information Processing: Theoretical Issues. Amsterdam, The Netherlands: North Holland; 1983: 119141.Google Scholar
52. Naatanen, R. The role of attention in auditory information processing as revealed by event-related potentials and other measures of cognitive function. Behav Brain Sci. 1990; 13: 201288.Google Scholar
53. Alho, K, Paavilainen, P, Reinikainen, K et al. , Separability of different negative components of the event-related potential associated with auditory stimulus processing. Psychophysiohgy. 1986; 23: 613623.Google Scholar
54. Hari, R, Hamalainen, M, Ilmoniemi, R et al. , Responses of the primary auditory cortex to pitch changes in a sequence of tone pips: neuromagnetic recordings in man. Neurosci Lett. 1984; 50: 127132.CrossRefGoogle Scholar
55. Kropotov, JD, Naatanen, R, Sevostianov, AV, Alho, K, Rinikainen, K, Kropotova, OV. Mismatch negativity to auditory stimulus change recorded directly from the human temporal cortex. Psychophysiobgy. 1995; 32: 418422.Google Scholar
56. Scherg, M, Vajsar, J, Picton, T. A source analysis of human auditory evoked potentials. J Cogn Neurosci. 1989; 1: 336355.Google Scholar
57. Tiitinen, H, Alho, K, Huotilainen, M et al. , Tonotopic auditory cortex and the magnetoencephalographic (MEG) equivalent of the mismatch negativity. Psychophysiology. 1993; 30: 537540.Google Scholar
58. Hirayasu, Y, Potts, GF, O'Donnell, BF et al. , Auditory mismatch negativity in schizophrenia: topographic evaluation with a high-density recording montage. Am J Psychiatry. 1998; 155: 12811284.CrossRefGoogle ScholarPubMed
59. Picton, T. Human steady-state responses: the music of the hemispheres. Evoked Potential International Congress XII. 1998: 01S-01S.Google Scholar
60. Kwon, JS, O'Donnell, BF, Wallenstein, GV et al. , Delayed synchronization of auditory 40 Hz response in schizophrenia. Evoked Potential International Congress XII. 1998: 01S-04S.Google Scholar
61. Benes, F. Is there a neuroanatomical basis for schizophrenia? An old question revisited. Neuroscientist. 1995; 1: 104115.Google Scholar
62. Snyder, SH. Phencyclidine. Nature. 1980; 285: 355356.Google Scholar
63. Javitt, DC, Zukin, SR. Recent advances in the phencyclidine model of schizophrenia. Am J Psychiatry. 1991; 148: 13011308.Google ScholarPubMed
64. McCarley, RW, Faux, SF, Shenton, ME, Nestor, PG, Adams, J. Event-related potentials in schizophrenia: their biological and clinical correlates and a new model of schizophrenic pathophysiology. Schizophr Res. 1991; 4: 209231.Google Scholar
65. Tsai, G, van Kammen, DP, Chen, S, Kelley, ME, Grier, A, Coyle, JT. Glutamatergic neurotransmission involves structural and clinical deficits of schizophrenia. Biol Psychiatry. 1998; 44: 667674.Google Scholar