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Magnetoencephalography
Malcolm Proudfoot,1,2
Mark W Woolrich,2
Anna C Nobre,2
Martin R Turner1
1
Nuffield Department of Clinical
Neurosciences, University of
Oxford, UK
2
Oxford Centre for Human Brain
Activity, University of Oxford, UK
Correspondence to
Dr Martin Turner, Nuffield
Department of Clinical
Neurosciences, West Wing
Level 3, John Radcliffe Hospital,
Oxford OX3 9DU, UK;
martin.turner@ndcn.ox.ac.uk
To cite: Proudfoot M,
Woolrich MW, Nobre AC,
et al. Pract Neurol Published
Online First: [please include
Day Month Year]
doi:10.1136/practneurol-
2013-000768
INTRODUCTION
The understanding of brain function is
moving rapidly towards a systems-level,
network-based approach. It is now as naive
to talk simplistically about what a particu-
lar area of the brain ‘does’, as it was for
Franz Joseph Gall (1758–1828) to link
its performance to the thickness of the
overlying skull. Magnetoencephalography
(MEG) is a rapidly developing and unique
tool for the study of brain function, in
particular the underlying oscillations in
neuronal activity that appear to be funda-
mental (box 1), with real-time resolution
and potential for application across a range
of brain disorders. We provide a brief
overview of the technology, broad
approaches to data analysis, and aspirations
for its application to the study of
neurodegeneration.
FUNCTIONAL BRAIN IMAGING SO FAR
Structural MR imaging of the brain and
spinal cord has revolutionised the accur-
acy of diagnosis in common conditions,
such as stroke, and greatly expanded the
taxonomy of neurological disorders.
Advanced applications of MRI now allow
the assessment of white matter tract
integrity (diffusion-tensor imaging),
regional grey matter volume (voxel-based
morphometry), and cortical thickness
(surface-based morphometry). These
techniques enable the non-invasive and
rapid quantification of structure at a
given time point, but it is clear that the
brain cannot be understood in terms of
structure alone. Functional MRI (fMRI),
based on blood oxygen-level-dependent
(BOLD) image contrast, can achieve
almost submillimetre accuracy in the
spatial localisation of neuronal activity.
However, this relatively high spatial reso-
lution is not matched in temporal accur-
acy, in essence because the relatively slow
speed of haemodynamic changes in
response to neuronal activity fundamen-
tally limits the temporal detail that can be
extracted to a timescale of seconds.
When one considers the multiple synaptic
transmissions and physical distance
covered by brain activity within this time
frame, it is quickly appreciated that this
technology is limited in its ability to
deliver a systems-level understanding of
brain function if used in isolation.
THE UNIQUE ADVANTAGES OF MEG
Ever since the pioneering EEG recordings
made by German neurologist Hans
Berger (1873–1941), it has been possible
to identify the self-generated oscillatory
activity of neuronal ensembles and cat-
egorise frequency bands with increasing
accuracy. Electrical potential changes
related to brain activity measured at the
scalp by EEG are fundamentally limited
Box 1 An introduction to neuronal
oscillations
▸ Neuronal oscillatory activity is continu-
ous, but fluctuations in power and
timing allow rapid alteration in com-
munication strength within existing
structural network architecture, far
faster than synaptic modification.1
▸ Two distinct cerebral regions can facili-
tate preferential information exchange
by synchronising their rhythmic behav-
iour; the γ band (40–80 Hz), in particu-
lar, facilitates this process, but is also
modulated ‘top-down’ by lower fre-
quencies such as θ (4–7 Hz), reflecting
factors, such as arousal states.
▸ α Rhythms (8–13 Hz), so prominent in
the occipital cortex upon eye closure,
reflect more than just an ‘idling’ rhythm
but also contribute to active allocation
of attentional resources and suppress
irrelevant sensory information.2
▸ The influential theory ‘Communication
through Coherence’ developed by
Fries,3
builds on existing models of
‘binding by synchronisation’ that may
underpin selective attention, a key func-
tion in prioritising neural events to
guide awareness and action.4
HOW TO UNDERSTAND IT
Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768 1
by the distortive effects of the intervening structures,
which severely hamper efforts to localise the signal
source precisely. MEG, instead, measures the magnetic
field changes induced by intracellular current flow, the
generation of which obeys the ‘right-hand rule’ in the
application of Ampère’s law. Unlike EEG measures,
these pass through dura, skull and scalp relatively
unaltered. The technique, therefore, offers a safe,
non-invasive method to ‘listen’ in to brain activity at
rest and during simple tasks, which from the subject’s
perspective, despite measuring at several hundred
channels, is painless and quick to set up.
Mathematical modelling of these data then enables
localisation of sources while uniquely maintaining
sampling frequencies up to several thousand times per
second. Compared to fMRI’s temporal resolution of,
at best, several hundred milliseconds, MEG can
resolve events with millisecond precision.
HOW IT WORKS
The neuronal activity captured by MEG is not, as
perhaps expected, generated by the (too brief) axonal
action potentials of pyramidal cells, but rather by the
net contributions of excitatory and inhibitory den-
dritic postsynaptic potentials. This current flow
through the apical dendrites (represented as a
‘dipole’) generates a magnetic field that projects radi-
ally; thus, MEG excels at detecting dipoles arranged
in a tangential orientation to the skull. Fortunately,
the extensively folded sulci of the human cortex
promote that orientation for the majority of cortical
microcolumns (figure 1). However, MEG is less sensi-
tive to deeper (including subcortical) sources, as mag-
netic field change decreases rapidly with distance.
Compared with a standard clinical MR scanner
magnet strength of 1.5 Tesla, the strength of the
signals detected by MEG are 1014
orders smaller
(figure 2). It has been compared with hearing a pin
drop at a rock concert. The smallest measurable mag-
netic field changes are thought to be produced by sim-
ultaneously active arrays of approximately 50 000
pyramidal cells, which in theory covers a cortical
surface area of 0.9 mm diameter. It is increasingly
recognised that modulation of self-generated oscilla-
tory activity is a principal mechanism by which geo-
graphically distant network regions interact,6
thus, a
brain-wide imaging technique with high temporal sen-
sitivity is a prerequisite for interrogation.
The ability to detect endogenously generated mag-
netic fields was realised in the 1960s by physicist
David Cohen at Massachusetts Institute of
Technology, who furthered the then recent discovery
of ‘magnetocardiography’ by applying a magnetically
shielded room to remove the overwhelming noise of
the Earth’s magnetic field (figure 3). He could then
measure the even smaller magnetoencephalographic
signal by making use of superconducting loops super-
conducting quantum interference device (SQUIDs),
developed by his collaborator James Zimmerman. At
very low temperatures, SQUIDs are extremely sensi-
tive to magnetic field change, which can be recorded
and converted into digital signal (‘quantisation’).
Sensor arrays have evolved to provide whole-head
coverage via a helmet containing more than 300
Figure 2 Magnetic field strength density measured in
femtotesla (fT), highlighting the exquisite sensitivity of the
SQUIDs used in magnetoencephalography.
Figure 1 The organisation of cortical microcolumns within the
sulcal bank, tangentially orientated to the skull, allows their
detection with magnetoencephalography since their induced
magnetic fields will project beyond the skull surface. Conversely,
apical dendrites orientated perpendicularly to the skull, as
found at the gyral crown, are better detected by EEG. (From
Hansen et al5
).
HOW TO UNDERSTAND IT
2 Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768
sensor sites, enveloped in a ‘dewar’ of cooling liquid
helium. The subject’s head is positioned underneath
the helmet (figure 4) and it is possible to acquire EEG
recordings simultaneously if desired. In the future,
MEG may include atomic sensors, which still exploit
the principle of quantum tunnelling of pairs of elec-
trons, but obviate the need for cryogenic
temperatures.7
THE ACQUISITION
The sensor design itself has evolved to meet some of
the localisation challenges by using more than one
pick-up coil in series. A single ‘magnetometer’ coil
measures any orthogonal magnetic field. Pairs of coils
place closed together and wound in opposite direc-
tions are also used to measure gradients in the mag-
netic field over space. These ‘gradiometers’ are
particularly sensitive to a gradient in magnetism from
nearby (ie, neuronal) sources, but subtract out signal
from distant external (and thus artefactual) sources, as
these appear similar to both coils.
Electromagnetic signals are also generated by move-
ment of the head or eyes (including blinking), skeletal
and cardiac muscle electromagnetic activity. The
sensors, therefore, also pick up this physiological
noise, unrelated to brain activity. Interference from
dental amalgam, metal zippers, jewellery, and bra fas-
teners is also significant and avoided by pre-scan
screens if possible. Head location must be calculated
relative to the SQUID sensors, since the helmet is not
a tight fit. This is achieved by using small magnetic
coils attached to anatomical landmarks to localise the
subject’s head position in the MEG scanner, and these
can also be used to enable continuous motion correc-
tion. However, it is also important to maximise
subject comfort to discourage excess head movement.
Considerable care must also be taken in ensuring
that all stimulus presentation and response devices
within the magnetically shielded room are themselves
electromagnetically silent. Experimental tasks are typ-
ically designed to avoid eye movements during rele-
vant measurement periods in order to minimise
artefact, but remaining eye movements and blinks can
still be identified with a combination of surface
electro-oculography and infrared eye tracking. An
ECG is typically also recorded to enable identification
and subsequent exclusion of cardiac electrical activity,
which can otherwise create large contaminating arte-
facts in the MEG signal. There are comprehensive
expert consensus guidelines aiming to harmonise
MEG experimental strategies across sites8
in an effort
to improve reproducibility.
THE ANALYSIS
MEG analysis involves enormous datasets that require
vast computer processing power to manipulate them.
Having overcome the initial difficulties in artefact
identification, MEG data analysis still involves consid-
erable complexity. The fundamental issue is that of
the ‘inverse problem’. This concept, in relation to
MEG, summarises the challenge of precisely localising
in three dimensional (3D) space the underlying neural
sources of a magnetic recording. In reality, there may
be many equally plausible combinations of neural
sources, and thus, without additional constraints the
solution is not unique. Yet, this is a challenge our own
brains overcome daily by using constraints that reflect
Figure 3 After 4 s of raw magnetoencephalography data (two
channels contain obvious artefacts), the door to the
magnetically shielded room is opened during recording. The
interference caused by external magnetic fields highlights why
effective room shielding is essential.
Figure 4 A MEG recording session at OHBA, eyetracker device
shown in foreground.
HOW TO UNDERSTAND IT
Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768 3
sensible prior assumptions, for example in deciding if
a visual object is small and close, or large and far
away. We have existing expectations about object size
to guide us.
Methods to solve the inverse problem, therefore,
need to make additional assumptions, such as the
brain activity being spatially sparse or smooth. The
appropriate assumptions to make are often directed
by the particular experimental protocol and expected
findings. A given paradigm may seek to identify differ-
ential brain activity during a rudimentary sensory
stimulation task, in which case the localisation model
might assume that a small number of dipole sources
could account for the difference in signal production
(ie, the brain activity is sparse). Alternatively, for
example during cognitive tasks, there is a wide net of
possible sources in the brain to consider, and we need
more advanced modelling techniques. This includes
approaches that assume the brain activity is smooth
and sparse,9
and also constrained to a 3D map of the
patient’s own cortical mantle (obtained during a sub-
sequent structural MRI). A common approach for
representing these various assumptions is to use priors
in powerful Bayesian algorithms. A popular alternative
to overcome the inverse problem is to use beamform-
ing. This method, originally developed for use in
radar arrays, corresponds to an adaptive spatial filter
designed to extract the origins of a signal from some
prespecified spatial location.10
MEG data in either ‘sensor space’ (presented as
data recorded across the distribution of the sensors)
or ‘source space’ (reconstructed to a 3D model of
brain sources) offer a wealth of analysis possibilities
and selected features that can relate to a particular
clinical question (figure 5).
For example, it is possible to analyse the data time-
locked to experimental events in terms of event-related
fields (ERF, the MEG analogue of event-related poten-
tials), such as the mismatch negativity abnormalities
described in dyslexia.11
Additionally, MEG is
particularly powerful at investigating oscillatory brain
activity by using ‘Fourier transformations’, or related
transforms, such as Wavelet or Hilbert, to describe the
signal in terms of how it oscillates in different fre-
quency bands over time. These frequency bands show
meaningful changes in power or synchronisation of
ongoing oscillatory activity at behaviourally relevant
time points, and can also form the basis of functional
connectivity measurements (correlated changes over
time) between different brain regions captured in
MEG data12
(figure 6).
THE APPLICATIONS AND POTENTIAL OF MEG
MEG has found early clinical application in epileptic
source localisation, in particular for the planning of
subsequent surgery, and shows close correlation to
invasive studies of cortical activity.13
In a new era,
MEG applications are no longer limited to description
of relatively fundamental neurophysiology, but have
instead begun to describe whole-brain activity at the
network-level during the so-called resting state14
(figure 7) as well as task performance.15
This approach has been pioneered by fMRI,16
but
MEG now validates these findings in eliminating arte-
factual explanations based solely on correlated patterns
of vascular activity. MEG also offers the possibility of
decomposing the time-course of communication
between ‘nodes’ in such networks, assessing their func-
tionality during task activity, and indeed describing
their dysfunction during neurodegenerative disease,17
with the ultimate hope of developing sensitive pharma-
codynamic markers of therapeutic response. MEG
also offers information complementary to fMRI; the
uncertain impact of disease on the time course of the
BOLD haemodynamic response function encourages
multimodal data acquisition during brain activation (by
Figure 5 Sensor space MEG data (A) presented as a two
dimensional (2D) topographic map of contrasted α (8–12 Hz)
activity in a visual attention task (data concatenated from 38
subjects). α power is lower in the contralateral (attending)
hemisphere. MEG data reconstructed into source space (B) with
a beamformer approach and presented on a 3D cortical map.
Figure 6 Time–frequency plot from posterior sensors
following presentation of a visual stimulus (multiple subjects
combined). Increased power is noted in θ followed shortly by γ.
Desynchronisation instead occurs in α and β bands. Vertical lines
denote stimulus onset/offset.
HOW TO UNDERSTAND IT
4 Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768
necessity non-concurrent, as MEG and fMRI cannot
be acquired simultaneously).18
MEG correlates of neurodegeneration
Focal slowing in temporoparietal regions was an
expected finding in early MEG studies of Alzheimer’s
disease, and was furthermore correlated with cogni-
tive measures.19
Attempts to model the source of
spontaneous α band activity also noted an anterior
shift from parieto-occipital regions to predominantly
temporal-lobe generators in Alzheimer’s disease versus
controls; this was interpreted to reflect somehow a
loss of cholinergic transmission.20
Another study pro-
vided more convincing evidence that described left
temporal MEG activity deficits, which correlated with
ipsilateral hippocampal atrophy and behavioural
measures.21
Surface EEG had already described abnormalities in
preattentive auditory processing of deviant tones in
neurodegenerative disease. These excessive evoked
response potential (ERP) abnormalities, perhaps
reflecting a failure to inhibit or adapt to irrelevant
stimuli, were convincingly replicated and localised in
MEG studies of Parkinson’s disease,22
Alzheimer’s
disease23
and amyotrophic lateral sclerosis.24
Subjects with Parkinson’s disease, even without
dementia, also show widespread oscillatory slowing.25
Furthermore, in combination with invasive local
recordings, MEG identified a dopamine-responsive
long-distance network operating in the β band that
showed coherence between prefrontal cortex and sub-
thalamic nuclei, in contrast to a spatially and spec-
trally distinct network in the α band connecting
brainstem with temporoparietal cortex.26
Global resting-state networks in neurodegeneration
A growing number of MEG studies have described
neurodegenerative alteration to functional connectiv-
ity during resting-state recordings, complementing
findings from fMRI. Resting-state networks describe
Figure 7 Comparison of resting-state networks identified from magnetoencephalography and fMRI data independently. (A) Default
mode network, (B) left lateral frontoparietal network, (C) right lateral frontoparietal network, (D) sensorimotor network. (Adapted
from Brookes et al14
).
HOW TO UNDERSTAND IT
Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768 5
the temporally coordinated, but often anatomically
disparate, spontaneous fluctuations in brain activity
that are present even at rest within distinct functional
brain networks.27
Although such networks are obvi-
ously engaged during relevant task activity, study of
resting-state networks is particularly appealing within
patient populations as impaired task performance is
no longer a possible confounding factor.
Alzheimer’s disease has been most frequently scruti-
nised using resting-state measures. A study of 18
patients (mean Mini-Mental State Examination Score
19.2) noted a loss of long-distance interhemispheric
connectivity (measured as synchronisation likelihood)
within the α and β bands. This correlated with cogni-
tive impairment and was not consequent to anticholi-
nesterase treatment.28
A repeat study focused on the
modular organisation of resting-state networks
(decomposed into functional subnetworks), and noted
Alzheimer’s disease to cause decrement of intermodu-
lar connectivity but also intramodular damage
restricted to certain cortical regions.29
Such graph-theory concepts could, in principle, be
employed to transfer descriptions of a ‘connectome’
(our unique neural fingerprint that defines us as indivi-
duals) across different modalities, including fMRI and
diffusion tensor imaging (DTI) studies.30
However,
results from these connectivity studies often conflict,
perhaps reflecting differing population samples, but also
implying a mismatch between functional and structural
connection strength,31
which may hint at underlying
pathological mechanisms, such as interneuronal dys-
function in amyotrophic lateral sclerosis.32
Oscillatory signatures in neurodegeneration
The suitability of MEG to capture neuronal activity
during relevant motor or cognitive tasks has encour-
aged parallel investigation of induced changes in oscil-
latory activity—perturbations of spontaneous brain
activity patterns are fundamental to all our experi-
ences, decisions and actions.1
A block-design study of
patients with Alzheimer’s disease or dementia with
Lewy bodies contrasted their cortical spectral power
during periods of either rest or repeated auditory
attention tasks. In both conditions, there were large
group differences from anterior sensors in a 3–7 Hz θ
band.33
An event-related experimental design was
used to study visual working memory tasks attempted
by Alzheimer’s disease and vascular dementia
patients.34
Those dementia subjects still able to com-
plete the task successfully demonstrated (against con-
trols) significantly delayed and stronger amplitude α
desynchronisation during the task epochs (albeit with
limited topographical localisation), in keeping with
the comparatively higher burden of cognitive process.
Task-based MEG recordings of 12 subjects with fron-
totemporal dementia were compared with controls,
while making categorical semantic judgements about
visually presented objects. There was an early
difference in temporoparietal cortex activity followed
by a later reduction in frontoparietal activity in each
task epoch, interpreted as corresponding to semantic
information processing and subsequent action selec-
tion.35
This result highlights the high temporal reso-
lution achievable in MEG recordings such that
component parts of a rapid cognitive task can be distin-
guished with confidence in time and anatomical space.
Even swallowing has proved to be an informative
motor task in the study of neurodegenerative disease
with MEG. An investigation of Parkinson’s disease sub-
jects with and without dysphagia found evidence for
compensatory adaptive cerebral changes to involve
wider cortical regions.36
The same researchers have
noted right hemispheric lateralisation of swallow-related
activity in amyotrophic lateral sclerosis37
and Kennedy’s
syndrome,38
perhaps reflecting plasticity in the face of
progressive neurodegeneration.
Biomarker potential
MEG has been used to predict whether subjects were
more likely to progress to clinically defined
Alzheimer’s disease on the basis of more widespread
power changes during a memory task, in a study of a
small number of subjects with minimal cognitive
impairment.39
A larger (117 Alzheimer’s disease sub-
jects) multicentre MEG study was subsequently per-
formed; 1 min of resting-state data was sufficient to
detect increased functional connectivity.40
Ten-month
interval assessment of 31 subjects detailed progressive
abnormalities, correlating with worsening neuropsy-
chometry. A longitudinal study of Parkinson’s disease
showed progressive slowing of oscillatory activity over
a 4-year follow-up period in 59 initially non-
demented Parkinson’s disease subjects.41
These
changes were particularly associated with mild cogni-
tive decline and, furthermore, MEG signals, above
and beyond neuropsychometry, predicted subsequent
conversion to Parkinson’s disease dementia, as borne
out at the 7-year follow-up time point.42
CONCLUSION
In combination with the increasingly high structural
resolution offered by MRI, MEG has unique potential
as part of a multimodal approach to brain disorders
that is sensitive to time as well as space. It seems clear
from presymptomatic studies across a range of neuro-
degenerative disorders, that the earliest events occur
many years, possibly decades, before the onset of
symptoms. Primary prevention of neurodegeneration
will require sensitivity to very subtle changes in brain
activity that seem likely to operate at the network
level.43
As well as studying the patterns of brain activ-
ity in the resting state, cognitive or motor MEG-based
tasks could reveal key pathological or compensatory
patterns of activity that might form the basis for early
intervention, including pharmacodynamic biomarkers
of therapeutic intervention.
HOW TO UNDERSTAND IT
6 Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768
Key points
▸ Magnetoencephalography (MEG) is non-invasive, safe
and comfortable.
▸ MEG offers unsurpassed temporal resolution; it can
probe neuronal oscillation activity that is fundamen-
tal to brain function in health and disease.
▸ Modern MEG systems include several hundred
distortion-free sensors surrounding the head to
provide high spatial precision over superficial cortical
areas.
▸ MEG analysis describes in vivo function of whole
brain networks in real time, and has the potential to
detect the very earliest changes in neurodegenerative
disorders and assess preventative therapies of the
future.
Acknowledgements We thank George Wallis, OHBA, for
providing figures 5 and 6.
Contributors MP drafted the manuscript. MWWedited the
manuscript. KN edited the manuscript. MRT conceived and
edited the manuscript, and is guarantor of the content.
Funding This work was support by the Wellcome Trust
(092753), the National Institute for Health Research (NIHR)
Oxford Biomedical Research Centre (BRC) based at Oxford
University Hospitals and by an MRC UK MEG Partnership
Grant, MR/K005464/1. MP receives funding from The
Guarantors of Brain and the Oxford BRC. MRT receives
funding from the Medical Research Council and Motor
Neurone Disease Association UK Lady Edith Wolfson
Fellowship (MR/K01014X/1).
Competing interests None.
Provenance and peer review Not commissioned; externally
peer reviewed. This paper was reviewed by Khalid Hamandi,
Cardiff, UK.
Open Access This is an Open Access article distributed in
accordance with the terms of the Creative Commons
Attribution (CC BY 3.0) license, which permits others to
distribute, remix, adapt and build upon this work, for
commercial use, provided the original work is properly cited.
See: http://creativecommons.org/licenses/by/3.0/
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37 Teismann IK, Warnecke T, Suntrup S, et al. Cortical processing
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HOW TO UNDERSTAND IT
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Magnetoencephalography

  • 1. Magnetoencephalography Malcolm Proudfoot,1,2 Mark W Woolrich,2 Anna C Nobre,2 Martin R Turner1 1 Nuffield Department of Clinical Neurosciences, University of Oxford, UK 2 Oxford Centre for Human Brain Activity, University of Oxford, UK Correspondence to Dr Martin Turner, Nuffield Department of Clinical Neurosciences, West Wing Level 3, John Radcliffe Hospital, Oxford OX3 9DU, UK; martin.turner@ndcn.ox.ac.uk To cite: Proudfoot M, Woolrich MW, Nobre AC, et al. Pract Neurol Published Online First: [please include Day Month Year] doi:10.1136/practneurol- 2013-000768 INTRODUCTION The understanding of brain function is moving rapidly towards a systems-level, network-based approach. It is now as naive to talk simplistically about what a particu- lar area of the brain ‘does’, as it was for Franz Joseph Gall (1758–1828) to link its performance to the thickness of the overlying skull. Magnetoencephalography (MEG) is a rapidly developing and unique tool for the study of brain function, in particular the underlying oscillations in neuronal activity that appear to be funda- mental (box 1), with real-time resolution and potential for application across a range of brain disorders. We provide a brief overview of the technology, broad approaches to data analysis, and aspirations for its application to the study of neurodegeneration. FUNCTIONAL BRAIN IMAGING SO FAR Structural MR imaging of the brain and spinal cord has revolutionised the accur- acy of diagnosis in common conditions, such as stroke, and greatly expanded the taxonomy of neurological disorders. Advanced applications of MRI now allow the assessment of white matter tract integrity (diffusion-tensor imaging), regional grey matter volume (voxel-based morphometry), and cortical thickness (surface-based morphometry). These techniques enable the non-invasive and rapid quantification of structure at a given time point, but it is clear that the brain cannot be understood in terms of structure alone. Functional MRI (fMRI), based on blood oxygen-level-dependent (BOLD) image contrast, can achieve almost submillimetre accuracy in the spatial localisation of neuronal activity. However, this relatively high spatial reso- lution is not matched in temporal accur- acy, in essence because the relatively slow speed of haemodynamic changes in response to neuronal activity fundamen- tally limits the temporal detail that can be extracted to a timescale of seconds. When one considers the multiple synaptic transmissions and physical distance covered by brain activity within this time frame, it is quickly appreciated that this technology is limited in its ability to deliver a systems-level understanding of brain function if used in isolation. THE UNIQUE ADVANTAGES OF MEG Ever since the pioneering EEG recordings made by German neurologist Hans Berger (1873–1941), it has been possible to identify the self-generated oscillatory activity of neuronal ensembles and cat- egorise frequency bands with increasing accuracy. Electrical potential changes related to brain activity measured at the scalp by EEG are fundamentally limited Box 1 An introduction to neuronal oscillations ▸ Neuronal oscillatory activity is continu- ous, but fluctuations in power and timing allow rapid alteration in com- munication strength within existing structural network architecture, far faster than synaptic modification.1 ▸ Two distinct cerebral regions can facili- tate preferential information exchange by synchronising their rhythmic behav- iour; the γ band (40–80 Hz), in particu- lar, facilitates this process, but is also modulated ‘top-down’ by lower fre- quencies such as θ (4–7 Hz), reflecting factors, such as arousal states. ▸ α Rhythms (8–13 Hz), so prominent in the occipital cortex upon eye closure, reflect more than just an ‘idling’ rhythm but also contribute to active allocation of attentional resources and suppress irrelevant sensory information.2 ▸ The influential theory ‘Communication through Coherence’ developed by Fries,3 builds on existing models of ‘binding by synchronisation’ that may underpin selective attention, a key func- tion in prioritising neural events to guide awareness and action.4 HOW TO UNDERSTAND IT Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768 1
  • 2. by the distortive effects of the intervening structures, which severely hamper efforts to localise the signal source precisely. MEG, instead, measures the magnetic field changes induced by intracellular current flow, the generation of which obeys the ‘right-hand rule’ in the application of Ampère’s law. Unlike EEG measures, these pass through dura, skull and scalp relatively unaltered. The technique, therefore, offers a safe, non-invasive method to ‘listen’ in to brain activity at rest and during simple tasks, which from the subject’s perspective, despite measuring at several hundred channels, is painless and quick to set up. Mathematical modelling of these data then enables localisation of sources while uniquely maintaining sampling frequencies up to several thousand times per second. Compared to fMRI’s temporal resolution of, at best, several hundred milliseconds, MEG can resolve events with millisecond precision. HOW IT WORKS The neuronal activity captured by MEG is not, as perhaps expected, generated by the (too brief) axonal action potentials of pyramidal cells, but rather by the net contributions of excitatory and inhibitory den- dritic postsynaptic potentials. This current flow through the apical dendrites (represented as a ‘dipole’) generates a magnetic field that projects radi- ally; thus, MEG excels at detecting dipoles arranged in a tangential orientation to the skull. Fortunately, the extensively folded sulci of the human cortex promote that orientation for the majority of cortical microcolumns (figure 1). However, MEG is less sensi- tive to deeper (including subcortical) sources, as mag- netic field change decreases rapidly with distance. Compared with a standard clinical MR scanner magnet strength of 1.5 Tesla, the strength of the signals detected by MEG are 1014 orders smaller (figure 2). It has been compared with hearing a pin drop at a rock concert. The smallest measurable mag- netic field changes are thought to be produced by sim- ultaneously active arrays of approximately 50 000 pyramidal cells, which in theory covers a cortical surface area of 0.9 mm diameter. It is increasingly recognised that modulation of self-generated oscilla- tory activity is a principal mechanism by which geo- graphically distant network regions interact,6 thus, a brain-wide imaging technique with high temporal sen- sitivity is a prerequisite for interrogation. The ability to detect endogenously generated mag- netic fields was realised in the 1960s by physicist David Cohen at Massachusetts Institute of Technology, who furthered the then recent discovery of ‘magnetocardiography’ by applying a magnetically shielded room to remove the overwhelming noise of the Earth’s magnetic field (figure 3). He could then measure the even smaller magnetoencephalographic signal by making use of superconducting loops super- conducting quantum interference device (SQUIDs), developed by his collaborator James Zimmerman. At very low temperatures, SQUIDs are extremely sensi- tive to magnetic field change, which can be recorded and converted into digital signal (‘quantisation’). Sensor arrays have evolved to provide whole-head coverage via a helmet containing more than 300 Figure 2 Magnetic field strength density measured in femtotesla (fT), highlighting the exquisite sensitivity of the SQUIDs used in magnetoencephalography. Figure 1 The organisation of cortical microcolumns within the sulcal bank, tangentially orientated to the skull, allows their detection with magnetoencephalography since their induced magnetic fields will project beyond the skull surface. Conversely, apical dendrites orientated perpendicularly to the skull, as found at the gyral crown, are better detected by EEG. (From Hansen et al5 ). HOW TO UNDERSTAND IT 2 Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768
  • 3. sensor sites, enveloped in a ‘dewar’ of cooling liquid helium. The subject’s head is positioned underneath the helmet (figure 4) and it is possible to acquire EEG recordings simultaneously if desired. In the future, MEG may include atomic sensors, which still exploit the principle of quantum tunnelling of pairs of elec- trons, but obviate the need for cryogenic temperatures.7 THE ACQUISITION The sensor design itself has evolved to meet some of the localisation challenges by using more than one pick-up coil in series. A single ‘magnetometer’ coil measures any orthogonal magnetic field. Pairs of coils place closed together and wound in opposite direc- tions are also used to measure gradients in the mag- netic field over space. These ‘gradiometers’ are particularly sensitive to a gradient in magnetism from nearby (ie, neuronal) sources, but subtract out signal from distant external (and thus artefactual) sources, as these appear similar to both coils. Electromagnetic signals are also generated by move- ment of the head or eyes (including blinking), skeletal and cardiac muscle electromagnetic activity. The sensors, therefore, also pick up this physiological noise, unrelated to brain activity. Interference from dental amalgam, metal zippers, jewellery, and bra fas- teners is also significant and avoided by pre-scan screens if possible. Head location must be calculated relative to the SQUID sensors, since the helmet is not a tight fit. This is achieved by using small magnetic coils attached to anatomical landmarks to localise the subject’s head position in the MEG scanner, and these can also be used to enable continuous motion correc- tion. However, it is also important to maximise subject comfort to discourage excess head movement. Considerable care must also be taken in ensuring that all stimulus presentation and response devices within the magnetically shielded room are themselves electromagnetically silent. Experimental tasks are typ- ically designed to avoid eye movements during rele- vant measurement periods in order to minimise artefact, but remaining eye movements and blinks can still be identified with a combination of surface electro-oculography and infrared eye tracking. An ECG is typically also recorded to enable identification and subsequent exclusion of cardiac electrical activity, which can otherwise create large contaminating arte- facts in the MEG signal. There are comprehensive expert consensus guidelines aiming to harmonise MEG experimental strategies across sites8 in an effort to improve reproducibility. THE ANALYSIS MEG analysis involves enormous datasets that require vast computer processing power to manipulate them. Having overcome the initial difficulties in artefact identification, MEG data analysis still involves consid- erable complexity. The fundamental issue is that of the ‘inverse problem’. This concept, in relation to MEG, summarises the challenge of precisely localising in three dimensional (3D) space the underlying neural sources of a magnetic recording. In reality, there may be many equally plausible combinations of neural sources, and thus, without additional constraints the solution is not unique. Yet, this is a challenge our own brains overcome daily by using constraints that reflect Figure 3 After 4 s of raw magnetoencephalography data (two channels contain obvious artefacts), the door to the magnetically shielded room is opened during recording. The interference caused by external magnetic fields highlights why effective room shielding is essential. Figure 4 A MEG recording session at OHBA, eyetracker device shown in foreground. HOW TO UNDERSTAND IT Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768 3
  • 4. sensible prior assumptions, for example in deciding if a visual object is small and close, or large and far away. We have existing expectations about object size to guide us. Methods to solve the inverse problem, therefore, need to make additional assumptions, such as the brain activity being spatially sparse or smooth. The appropriate assumptions to make are often directed by the particular experimental protocol and expected findings. A given paradigm may seek to identify differ- ential brain activity during a rudimentary sensory stimulation task, in which case the localisation model might assume that a small number of dipole sources could account for the difference in signal production (ie, the brain activity is sparse). Alternatively, for example during cognitive tasks, there is a wide net of possible sources in the brain to consider, and we need more advanced modelling techniques. This includes approaches that assume the brain activity is smooth and sparse,9 and also constrained to a 3D map of the patient’s own cortical mantle (obtained during a sub- sequent structural MRI). A common approach for representing these various assumptions is to use priors in powerful Bayesian algorithms. A popular alternative to overcome the inverse problem is to use beamform- ing. This method, originally developed for use in radar arrays, corresponds to an adaptive spatial filter designed to extract the origins of a signal from some prespecified spatial location.10 MEG data in either ‘sensor space’ (presented as data recorded across the distribution of the sensors) or ‘source space’ (reconstructed to a 3D model of brain sources) offer a wealth of analysis possibilities and selected features that can relate to a particular clinical question (figure 5). For example, it is possible to analyse the data time- locked to experimental events in terms of event-related fields (ERF, the MEG analogue of event-related poten- tials), such as the mismatch negativity abnormalities described in dyslexia.11 Additionally, MEG is particularly powerful at investigating oscillatory brain activity by using ‘Fourier transformations’, or related transforms, such as Wavelet or Hilbert, to describe the signal in terms of how it oscillates in different fre- quency bands over time. These frequency bands show meaningful changes in power or synchronisation of ongoing oscillatory activity at behaviourally relevant time points, and can also form the basis of functional connectivity measurements (correlated changes over time) between different brain regions captured in MEG data12 (figure 6). THE APPLICATIONS AND POTENTIAL OF MEG MEG has found early clinical application in epileptic source localisation, in particular for the planning of subsequent surgery, and shows close correlation to invasive studies of cortical activity.13 In a new era, MEG applications are no longer limited to description of relatively fundamental neurophysiology, but have instead begun to describe whole-brain activity at the network-level during the so-called resting state14 (figure 7) as well as task performance.15 This approach has been pioneered by fMRI,16 but MEG now validates these findings in eliminating arte- factual explanations based solely on correlated patterns of vascular activity. MEG also offers the possibility of decomposing the time-course of communication between ‘nodes’ in such networks, assessing their func- tionality during task activity, and indeed describing their dysfunction during neurodegenerative disease,17 with the ultimate hope of developing sensitive pharma- codynamic markers of therapeutic response. MEG also offers information complementary to fMRI; the uncertain impact of disease on the time course of the BOLD haemodynamic response function encourages multimodal data acquisition during brain activation (by Figure 5 Sensor space MEG data (A) presented as a two dimensional (2D) topographic map of contrasted α (8–12 Hz) activity in a visual attention task (data concatenated from 38 subjects). α power is lower in the contralateral (attending) hemisphere. MEG data reconstructed into source space (B) with a beamformer approach and presented on a 3D cortical map. Figure 6 Time–frequency plot from posterior sensors following presentation of a visual stimulus (multiple subjects combined). Increased power is noted in θ followed shortly by γ. Desynchronisation instead occurs in α and β bands. Vertical lines denote stimulus onset/offset. HOW TO UNDERSTAND IT 4 Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768
  • 5. necessity non-concurrent, as MEG and fMRI cannot be acquired simultaneously).18 MEG correlates of neurodegeneration Focal slowing in temporoparietal regions was an expected finding in early MEG studies of Alzheimer’s disease, and was furthermore correlated with cogni- tive measures.19 Attempts to model the source of spontaneous α band activity also noted an anterior shift from parieto-occipital regions to predominantly temporal-lobe generators in Alzheimer’s disease versus controls; this was interpreted to reflect somehow a loss of cholinergic transmission.20 Another study pro- vided more convincing evidence that described left temporal MEG activity deficits, which correlated with ipsilateral hippocampal atrophy and behavioural measures.21 Surface EEG had already described abnormalities in preattentive auditory processing of deviant tones in neurodegenerative disease. These excessive evoked response potential (ERP) abnormalities, perhaps reflecting a failure to inhibit or adapt to irrelevant stimuli, were convincingly replicated and localised in MEG studies of Parkinson’s disease,22 Alzheimer’s disease23 and amyotrophic lateral sclerosis.24 Subjects with Parkinson’s disease, even without dementia, also show widespread oscillatory slowing.25 Furthermore, in combination with invasive local recordings, MEG identified a dopamine-responsive long-distance network operating in the β band that showed coherence between prefrontal cortex and sub- thalamic nuclei, in contrast to a spatially and spec- trally distinct network in the α band connecting brainstem with temporoparietal cortex.26 Global resting-state networks in neurodegeneration A growing number of MEG studies have described neurodegenerative alteration to functional connectiv- ity during resting-state recordings, complementing findings from fMRI. Resting-state networks describe Figure 7 Comparison of resting-state networks identified from magnetoencephalography and fMRI data independently. (A) Default mode network, (B) left lateral frontoparietal network, (C) right lateral frontoparietal network, (D) sensorimotor network. (Adapted from Brookes et al14 ). HOW TO UNDERSTAND IT Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768 5
  • 6. the temporally coordinated, but often anatomically disparate, spontaneous fluctuations in brain activity that are present even at rest within distinct functional brain networks.27 Although such networks are obvi- ously engaged during relevant task activity, study of resting-state networks is particularly appealing within patient populations as impaired task performance is no longer a possible confounding factor. Alzheimer’s disease has been most frequently scruti- nised using resting-state measures. A study of 18 patients (mean Mini-Mental State Examination Score 19.2) noted a loss of long-distance interhemispheric connectivity (measured as synchronisation likelihood) within the α and β bands. This correlated with cogni- tive impairment and was not consequent to anticholi- nesterase treatment.28 A repeat study focused on the modular organisation of resting-state networks (decomposed into functional subnetworks), and noted Alzheimer’s disease to cause decrement of intermodu- lar connectivity but also intramodular damage restricted to certain cortical regions.29 Such graph-theory concepts could, in principle, be employed to transfer descriptions of a ‘connectome’ (our unique neural fingerprint that defines us as indivi- duals) across different modalities, including fMRI and diffusion tensor imaging (DTI) studies.30 However, results from these connectivity studies often conflict, perhaps reflecting differing population samples, but also implying a mismatch between functional and structural connection strength,31 which may hint at underlying pathological mechanisms, such as interneuronal dys- function in amyotrophic lateral sclerosis.32 Oscillatory signatures in neurodegeneration The suitability of MEG to capture neuronal activity during relevant motor or cognitive tasks has encour- aged parallel investigation of induced changes in oscil- latory activity—perturbations of spontaneous brain activity patterns are fundamental to all our experi- ences, decisions and actions.1 A block-design study of patients with Alzheimer’s disease or dementia with Lewy bodies contrasted their cortical spectral power during periods of either rest or repeated auditory attention tasks. In both conditions, there were large group differences from anterior sensors in a 3–7 Hz θ band.33 An event-related experimental design was used to study visual working memory tasks attempted by Alzheimer’s disease and vascular dementia patients.34 Those dementia subjects still able to com- plete the task successfully demonstrated (against con- trols) significantly delayed and stronger amplitude α desynchronisation during the task epochs (albeit with limited topographical localisation), in keeping with the comparatively higher burden of cognitive process. Task-based MEG recordings of 12 subjects with fron- totemporal dementia were compared with controls, while making categorical semantic judgements about visually presented objects. There was an early difference in temporoparietal cortex activity followed by a later reduction in frontoparietal activity in each task epoch, interpreted as corresponding to semantic information processing and subsequent action selec- tion.35 This result highlights the high temporal reso- lution achievable in MEG recordings such that component parts of a rapid cognitive task can be distin- guished with confidence in time and anatomical space. Even swallowing has proved to be an informative motor task in the study of neurodegenerative disease with MEG. An investigation of Parkinson’s disease sub- jects with and without dysphagia found evidence for compensatory adaptive cerebral changes to involve wider cortical regions.36 The same researchers have noted right hemispheric lateralisation of swallow-related activity in amyotrophic lateral sclerosis37 and Kennedy’s syndrome,38 perhaps reflecting plasticity in the face of progressive neurodegeneration. Biomarker potential MEG has been used to predict whether subjects were more likely to progress to clinically defined Alzheimer’s disease on the basis of more widespread power changes during a memory task, in a study of a small number of subjects with minimal cognitive impairment.39 A larger (117 Alzheimer’s disease sub- jects) multicentre MEG study was subsequently per- formed; 1 min of resting-state data was sufficient to detect increased functional connectivity.40 Ten-month interval assessment of 31 subjects detailed progressive abnormalities, correlating with worsening neuropsy- chometry. A longitudinal study of Parkinson’s disease showed progressive slowing of oscillatory activity over a 4-year follow-up period in 59 initially non- demented Parkinson’s disease subjects.41 These changes were particularly associated with mild cogni- tive decline and, furthermore, MEG signals, above and beyond neuropsychometry, predicted subsequent conversion to Parkinson’s disease dementia, as borne out at the 7-year follow-up time point.42 CONCLUSION In combination with the increasingly high structural resolution offered by MRI, MEG has unique potential as part of a multimodal approach to brain disorders that is sensitive to time as well as space. It seems clear from presymptomatic studies across a range of neuro- degenerative disorders, that the earliest events occur many years, possibly decades, before the onset of symptoms. Primary prevention of neurodegeneration will require sensitivity to very subtle changes in brain activity that seem likely to operate at the network level.43 As well as studying the patterns of brain activ- ity in the resting state, cognitive or motor MEG-based tasks could reveal key pathological or compensatory patterns of activity that might form the basis for early intervention, including pharmacodynamic biomarkers of therapeutic intervention. HOW TO UNDERSTAND IT 6 Proudfoot M, et al. Pract Neurol 2014;0:1–8. doi:10.1136/practneurol-2013-000768
  • 7. Key points ▸ Magnetoencephalography (MEG) is non-invasive, safe and comfortable. ▸ MEG offers unsurpassed temporal resolution; it can probe neuronal oscillation activity that is fundamen- tal to brain function in health and disease. ▸ Modern MEG systems include several hundred distortion-free sensors surrounding the head to provide high spatial precision over superficial cortical areas. ▸ MEG analysis describes in vivo function of whole brain networks in real time, and has the potential to detect the very earliest changes in neurodegenerative disorders and assess preventative therapies of the future. Acknowledgements We thank George Wallis, OHBA, for providing figures 5 and 6. Contributors MP drafted the manuscript. MWWedited the manuscript. KN edited the manuscript. MRT conceived and edited the manuscript, and is guarantor of the content. Funding This work was support by the Wellcome Trust (092753), the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) based at Oxford University Hospitals and by an MRC UK MEG Partnership Grant, MR/K005464/1. MP receives funding from The Guarantors of Brain and the Oxford BRC. MRT receives funding from the Medical Research Council and Motor Neurone Disease Association UK Lady Edith Wolfson Fellowship (MR/K01014X/1). Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Khalid Hamandi, Cardiff, UK. Open Access This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/3.0/ REFERENCES 1 Buzsaki G. Rhythms of the Brain. 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