101
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Manzouri F, Heller S, Dümpelmann M, Woias P, Schulze-Bonhage A. A Comparison of Machine Learning Classifiers for Energy-Efficient Implementation of Seizure Detection. Front Syst Neurosci 2018; 12:43. [PMID: 30294263 PMCID: PMC6158331 DOI: 10.3389/fnsys.2018.00043] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 08/27/2018] [Indexed: 11/29/2022] Open
Abstract
The closed-loop application of electrical stimulation via chronically implanted electrodes is a novel approach to stop seizures in patients with focal-onset epilepsy. To this end, an energy efficient seizure detector that can be implemented in an implantable device is of crucial importance. In this study, we first evaluated the performance of two machine learning algorithms (Random Forest classifier and support vector machine (SVM)) by using selected time and frequency domain features with a limited need of computational resources. Performance of the algorithms was further compared to a detection strategy implemented in an existing closed loop neurostimulation device for the treatment of epilepsy. The results show a superior performance of the Random Forest classifier compared to the SVM classifier and the reference approach. Next, we implemented the feature extraction and classification process of the Random Forest classifier on a microcontroller to evaluate the energy efficiency of this seizure detector. In conclusion, the feature set in combination with Random Forest classifier is an energy efficient hardware implementation that shows an improvement of detection sensitivity and specificity compared to the presently available closed-loop intervention in epilepsy while preserving a low detection delay.
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Affiliation(s)
- Farrokh Manzouri
- Epilepsy Center, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Simon Heller
- BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.,Department of Microsystems Engineering, Faculty of Engineering, University of Freiburg, Freiburg, Germany
| | - Matthias Dümpelmann
- Epilepsy Center, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Peter Woias
- BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.,Department of Microsystems Engineering, Faculty of Engineering, University of Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
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102
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Hartshorn A, Jobst B. Responsive brain stimulation in epilepsy. Ther Adv Chronic Dis 2018; 9:135-142. [PMID: 29963302 PMCID: PMC6009082 DOI: 10.1177/2040622318774173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/10/2018] [Indexed: 12/29/2022] Open
Abstract
Stimulation devices are considered in patients with drug-resistant epilepsy and who are not surgical candidates. Responsive neurostimulation (RNS) is a cortically based stimulator activated by electrocorticography (ECoG) patterns. Stimulation is applied directly to the seizure focus. The vagal nerve stimulator AspireSR 106 is also a responsive device which, in addition to basal stimulation, is activated by tachycardia. Deep brain stimulation of the anterior nucleus of the thalamus is used in Europe for intractable epilepsy and yields similar response rates to RNS using duty cycle stimulation. Chronic subthreshold cortical stimulation is an experimental form of constant, low-level stimulation applied to a seizure focus. These modalities are discussed and compared in this review.
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Affiliation(s)
- Alendia Hartshorn
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-1000, USA
| | - Barbara Jobst
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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103
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Acharya JN. Responsive neurostimulation for epilepsy: More than stimulation. Clin Neurophysiol Pract 2018; 3:120-121. [PMID: 30215021 PMCID: PMC6133904 DOI: 10.1016/j.cnp.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 11/24/2022] Open
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104
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Sen A, Dugan P, Perucca P, Costello D, Choi H, Bazil C, Radtke R, Andrade D, Depondt C, Heavin S, Adcock J, Pickrell WO, McGinty RN, Nascimento F, Smith P, Rees MI, Kwan P, O'Brien TJ, Goldstein D, Delanty N. The phenotype of bilateral hippocampal sclerosis and its management in "real life" clinical settings. Epilepsia 2018; 59:1410-1420. [PMID: 29901232 DOI: 10.1111/epi.14436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is little detailed phenotypic characterization of bilateral hippocampal sclerosis (HS). We therefore conducted a multicenter review of people with pharmacoresistant epilepsy and bilateral HS to better determine their clinical characteristics. METHODS Databases from 11 EPIGEN centers were searched. For identified cases, clinicians reviewed the medical notes, imaging, and electroencephalographic (EEG), video-EEG, and neuropsychometric data. Data were irretrievably anonymized, and a single database was populated to capture all phenotypic information. These data were compared with phenotyped cases of unilateral HS from the same centers. RESULTS In total, 96 patients with pharmacoresistant epilepsy and bilateral HS were identified (43 female, 53 male; age range = 8-80 years). Twenty-five percent had experienced febrile convulsions, and 27% of patients had experienced status epilepticus. The mean number of previously tried antiepileptic drugs was 5.32, and the average number of currently prescribed medications was 2.99; 44.8% of patients had cognitive difficulties, and 47.9% had psychiatric comorbidity; 35.4% (34/96) of patients continued with long-term medical therapy alone, another 4 being seizure-free on medication. Sixteen patients proceeded to, or were awaiting, neurostimulation, and 11 underwent surgical resection. One patient was rendered seizure-free postresection, with an improvement in seizures for 3 other cases. By comparison, of 201 patients with unilateral HS, a significantly higher number (44.3%) had febrile convulsions and only 11.4% had experienced status epilepticus. Importantly, 41.8% (84/201) of patients with unilateral HS had focal aware seizures, whereas such seizures were less frequently observed in people with bilateral HS, and were never observed exclusively (P = .002; Fisher's exact test). SIGNIFICANCE The current work describes the phenotypic spectrum of people with pharmacoresistant epilepsy and bilateral HS, highlights salient clinical differences from patients with unilateral HS, and provides a large platform from which to develop further studies, both epidemiological and genomic, to better understand etiopathogenesis and optimal treatment regimes in this condition.
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Affiliation(s)
- Arjune Sen
- Oxford Epilepsy Research Group, National Institute for Health Research Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK
| | - Patricia Dugan
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Piero Perucca
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Departments of Neuroscience and Neurology, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Daniel Costello
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland
| | - Hyunmi Choi
- Comprehensive Epilepsy Center, Neurological Institute of New York, New York, NY, USA
| | - Carl Bazil
- Comprehensive Epilepsy Center, Neurological Institute of New York, New York, NY, USA
| | - Rod Radtke
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | | | - Chantal Depondt
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sinead Heavin
- FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jane Adcock
- Oxford Epilepsy Research Group, National Institute for Health Research Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK
| | - W Owen Pickrell
- Neurology Research Group, Institute of Life Science, Swansea University Medical School, Swansea, UK
| | - Ronan N McGinty
- Oxford Epilepsy Research Group, National Institute for Health Research Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK.,Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland
| | | | - Philip Smith
- Department of Neurology, University of Wales, Cardiff, UK
| | - Mark I Rees
- Neurology Research Group, Institute of Life Science, Swansea University Medical School, Swansea, UK
| | - Patrick Kwan
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Departments of Neuroscience and Neurology, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia.,Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Terence J O'Brien
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Departments of Neuroscience and Neurology, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - David Goldstein
- Institute for Genomic Medicine, Columbia University Medical Center, New York, NY, USA
| | - Norman Delanty
- FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland
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105
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Zhou X, Yu T, Zhang G, Ni D, Qiao L, Wang X, Xu C, Liu C, Wang Y, Li Y. The surgical outcome of patients with bilateral temporal lobe epilepsy. Epilepsy Res 2018; 144:7-13. [PMID: 29729534 DOI: 10.1016/j.eplepsyres.2018.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/04/2018] [Accepted: 04/25/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study is to explore the surgical outcome of unilateral anterior temporal lobectomy (ATL) for patients with bilateral temporal lobe epilepsy (BTLE). METHODS We retrospectively reviewed the data of patients who were diagnosed with BTLE by scalp electroencephalogram (EEG) and underwent ATL from 2001 to 2015. In addition, 80 patients were randomly selected as a control group. RESULTS One hundred seventeen patients were included in this study and were divided into four groups by intracranial recordings as follows: 78 patients with unilateral seizure onset (Group 1), 13 patients with lateralizable dominant seizure onset (Group 2), 14 patients with lateralizable neuroimaging abnormalities (Group 3), and 12 patients without lateralizable dominant seizure onset or neuroimaging abnormalities (Group 4). The 12 patients in Group 4 declined surgical resection, whereas the remaining 105 patients received ATL, and 93 of them were followed up for more than 1 year after surgery. At the 1-, 2-, and 3-year follow-ups the percentage of patients who were seizure free was 52.9%, 56.5%, and 58.9%, respectively. For the mean postoperative efficacy, there was a statistical difference in patients who were seizure free either between Group 1 + Group 2 + Group 3 and the control group (44.1% vs. 67.5%, p = 0.002), or between Group 1 and the control group (48.5% vs. 67.5%, p = 0.019), or between Group 2 + Group 3 and the control group (32.0% vs. 67.5%, p = 0.002). However, the difference was significant only at the first year follow-up, and there was no significant difference afterward. SIGNIFICANCE Although the surgical outcome of patients with BTLE is not as good as that of patients with unilateral TLE in short-term follow-up, quite a portion of these patients could benefit from unilateral temporal lobe resection in the long term.
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Affiliation(s)
- Xiaoxia Zhou
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Duanyu Ni
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liang Qiao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Wang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cuiping Xu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuping Wang
- Comprehensive Epilepsy Center of Beijing, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjie Li
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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106
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Tatum W, Rubboli G, Kaplan P, Mirsatari S, Radhakrishnan K, Gloss D, Caboclo L, Drislane F, Koutroumanidis M, Schomer D, Kasteleijn-Nolst Trenite D, Cook M, Beniczky S. Clinical utility of EEG in diagnosing and monitoring epilepsy in adults. Clin Neurophysiol 2018; 129:1056-1082. [DOI: 10.1016/j.clinph.2018.01.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 12/20/2022]
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107
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Chan AY, Knowlton RC, Chang EF, Rao VR. Seizure localization by chronic ambulatory electrocorticography. Clin Neurophysiol Pract 2018; 3:174-176. [PMID: 30560221 PMCID: PMC6288710 DOI: 10.1016/j.cnp.2018.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/16/2018] [Accepted: 03/25/2018] [Indexed: 01/02/2023] Open
Abstract
Two epilepsy patients did not have seizures during three weeks of intracranial EEG. They were implanted with a device that enables chronic electrocorticography. Seizures were localized by ictal recordings at long intervals after implantation.
Aims To present two patients with medically-refractory focal epilepsy who, following non-diagnostic intracranial monitoring studies, had seizures localized by chronic ambulatory electrocorticography with an implanted neurostimulation device. Methods Case reports with clinical details and electrocorticograms showing seizures. Results Using electrodes placed at the suspected seizure onset zones, the neurostimulator recorded seizures in both patients at long intervals following implantation (49 days and 7.5 months). Conclusions Chronic ambulatory electrocorticography can provide valuable diagnostic information when there is a narrow hypothesis about seizure localization, though there are important caveats related to limited spatial sampling.
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Affiliation(s)
- Alvin Y. Chan
- Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Robert C. Knowlton
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, CA 94143, USA
| | - Edward F. Chang
- Department of Neurological Surgery and Weill Institute for Neurosciences, University of California, San Francisco, CA 94143, USA
| | - Vikram R. Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, CA 94143, USA
- Corresponding author.
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108
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Abstract
The goal of any epilepsy surgery is to improve patient's quality of life by achieving seizure freedom or by reducing the frequency of severely debilitating seizures. To achieve this goal, non-invasive and invasive diagnostic methods must precisely delineate the epileptogenic zone (EZ), which is defined as the area that needs to be resected to obtain seizure freedom. At the same time, the correct identification of eloquent brain areas is inevitable to avoid new neurological deficits from surgery. In recent years, the technical advances in diagnostics have enabled us to achieve these goals in an increasing number of cases. As a consequence, and with new surgical treatment options available, the number of patients who might benefit from epilepsy surgery is constantly increasing. Especially in pediatric epilepsy, early surgical intervention is becoming frequently advocated as it has been shown to improve cognitive and behavioral outcome. Specialized epilepsy centers and multidisciplinary teams are required to provide adequate care and treatment. The goal of this review is to describe important diseases that are accessible to epilepsy surgery and to give an overview of current diagnostic methods. The focus lies on established as well as novel techniques in epilepsy surgery. The presurgical work-up and patient selection is outlined.
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Affiliation(s)
- Johannes Herta
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria -
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109
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Ormond DR, Clusmann H, Sassen R, Hoppe C, Helmstaedter C, Schramm J, Grote A. Pediatric Temporal Lobe Epilepsy Surgery in Bonn and Review of the Literature. Neurosurgery 2018; 84:844-856. [DOI: 10.1093/neuros/nyy125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/15/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Ryan Ormond
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Hans Clusmann
- Department of Neurosurgery, University of Aachen, Aachen, Germany
| | - Robert Sassen
- Department of Epileptology, Bonn University Medical Center, Bonn, Germany
| | - Christian Hoppe
- Department of Neuropsychology, Bonn University Medical Center, Bonn, Germany
| | | | | | - Alexander Grote
- Department of Neurosurgery, Bielefeld Medical Center, Bielefeld, Germany
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110
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The roles of surgery and technology in understanding focal epilepsy and its comorbidities. Lancet Neurol 2018; 17:373-382. [DOI: 10.1016/s1474-4422(18)30031-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 01/21/2023]
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111
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Petito GT, Wharen RE, Feyissa AM, Grewal SS, Lucas JA, Tatum WO. The impact of stereotactic laser ablation at a typical epilepsy center. Epilepsy Behav 2018; 78:37-44. [PMID: 29172137 DOI: 10.1016/j.yebeh.2017.10.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/29/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Stereotactic laser ablation (SLA) is a novel form of epilepsy surgery for patients with drug-resistant focal epilepsy. We evaluated one hundred consecutive surgeries performed for patients with epilepsy to address the impact of SLA on our therapeutic approach, as well as patient outcomes. METHODS A retrospective, single center analysis of the last one hundred neurosurgeries for epilepsy was performed from 2013 to 2015. Demographics, surgical procedures, and postoperative measures were assessed up to 5years to compare the effect of SLA on outcome. Confidence intervals (CI) and comparative tests of proportions compared outcomes for SLA and resective surgery. Procedural categorical comparison used Chi-square and Kaplan-Meier curves. Student t-test was utilized for single variables such as age at procedure and seizure onset. RESULTS One hundred surgeries for epilepsy yielded thirty-three SLAs and twenty-one resections with a mean of 21.7-month and 21.3-month follow-up, respectively. The temporal lobe was the most common target for SLA (92.6%) and resection (75%). A discrete lesion was present on brain magnetic resonance imaging (MRI) in 27/32 (84.4%) of SLA patients compared with 7/20 (35%) of resection patients with a normal MRI. Overall, 55-60% of patients became seizure-free (SF). Four of five patients with initial failure to SLA became SF with subsequent resection surgery. Complications were more frequent with resection although SF outcomes did not differ (Chi square; p=0.79). Stereotactic laser ablation patients were older than those with resections (47.0years vs. 35.4years, p=0.001). The mean length of hospitalization prior to discharge was shorter for SLA (1.18days) compared with open resection (3.43days; SD: 3.16 days) (p=0.0002). CONCLUSION We now use SLA as a first line therapy at our center in patients with lesional temporal lobe epilepsy (TLE) before resection. Seizure-free outcome with SLA and resection was similar but with a shorter length of stay. Long-term follow-up is recommended to determine sustained SF status from SLA.
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Affiliation(s)
- Gabrielle T Petito
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Robert E Wharen
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Anteneh M Feyissa
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Sanjeet S Grewal
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - John A Lucas
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - William O Tatum
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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112
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Prospects for a Robust Cortical Recording Interface. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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113
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Alvim MKM, Morita ME, Yasuda CL, Damasceno BP, Lopes TM, Coan AC, Ghizoni E, Tedeschi H, Cendes F. Is inpatient ictal video-electroencephalographic monitoring mandatory in mesial temporal lobe epilepsy with unilateral hippocampal sclerosis? A prospective study. Epilepsia 2017; 59:410-419. [DOI: 10.1111/epi.13977] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Marina K. M. Alvim
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas, Campinas,; São Paulo Brazil
| | - Marcia E. Morita
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas, Campinas,; São Paulo Brazil
| | - Clarissa L. Yasuda
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas, Campinas,; São Paulo Brazil
| | - Benito P. Damasceno
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas, Campinas,; São Paulo Brazil
| | - Tátila M. Lopes
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas, Campinas,; São Paulo Brazil
| | - Ana Carolina Coan
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas, Campinas,; São Paulo Brazil
| | - Enrico Ghizoni
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas, Campinas,; São Paulo Brazil
| | - Helder Tedeschi
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas, Campinas,; São Paulo Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory; Department of Neurology; State University of Campinas, Campinas,; São Paulo Brazil
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114
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Sun FT, Arcot Desai S, Tcheng TK, Morrell MJ. Changes in the electrocorticogram after implantation of intracranial electrodes in humans: The implant effect. Clin Neurophysiol 2017; 129:676-686. [PMID: 29233473 DOI: 10.1016/j.clinph.2017.10.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/29/2017] [Accepted: 10/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Subacute and long-term electrocorticographic (ECoG) changes in ambulatory patients with depth and cortical strip electrodes were evaluated in order to determine the length of the implant effect. METHODS ECoG records were assessed in patients with medically intractable epilepsy who had depth and/or strip leads implanted in order to be treated with brain-responsive stimulation. Changes in total spectral power, band-limited spectral power, and spike rate were assessed. RESULTS 121 patients participating in trials of the RNS® System had a total of 93994 ECoG records analyzed. Significant changes in total spectral power occurred from the first to second months after implantation, involving 55% of all ECoG channels (68% of strip and 47% of depth lead channels). Significant, but less pronounced, changes continued over the 2nd to 5th post-implant months, after which total power became more stable. Similar patterns of changes were observed within frequency bands and spike rate. CONCLUSIONS ECoG spectral power and spike rates are not stable in the first 5 months after implantation, presumably due to neurophysiological and electrode-tissue interface changes. SIGNIFICANCE ECoG data collected in the first 5 months after implantation of intracranial electrodes may not be fully representative of chronic cortical electrophysiology.
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Affiliation(s)
| | | | | | - Martha J Morrell
- NeuroPace, Inc., Mountain View, CA 94043, USA; Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
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115
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Ravindra VM, Sweney MT, Bollo RJ. Recent developments in the surgical management of paediatric epilepsy. Arch Dis Child 2017; 102:760-766. [PMID: 28096104 DOI: 10.1136/archdischild-2016-311183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/12/2016] [Accepted: 12/21/2016] [Indexed: 11/08/2022]
Abstract
Among the 1% of children affected by epilepsy, failure of pharmacological therapy and early age of seizure onset can lead to worse long-term cognitive outcomes, mental health disorders and impaired functional status. Surgical management often improves functional and cognitive outcomes in children with medically refractory epilepsy, especially when seizure remission is achieved. However, surgery remains underused in children with drug-resistant epilepsy, creating a large treatment gap. Several recent innovations have led to considerable improvement in surgical technique, including the recent development of minimally invasive diagnostic and therapeutic techniques such as stereotactic EEG, transcranial magnetic stimulation, MRI-guided laser ablation, as well as novel paradigms of neurostimulation. This article discusses the current landscape of surgical innovation in the management of paediatric epilepsy, leading to a paradigm shift towards minimally invasive therapy and closing the treatment gap in children suffering from drug-resistant seizures.
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Affiliation(s)
- Vijay M Ravindra
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, Slat Lake City, Utah, USA
| | - Matthew T Sweney
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Robert J Bollo
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, Slat Lake City, Utah, USA
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116
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El Tahry R, Wang IZ. Failed epilepsy surgery: is this the end? Acta Neurol Belg 2017; 117:433-440. [PMID: 28303525 DOI: 10.1007/s13760-017-0769-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/07/2017] [Indexed: 12/14/2022]
Abstract
Resective epilepsy surgery can lead to sustained seizure control in 70-80% of patients evaluated for epilepsy surgery, indicating that up to 30% of patients still have recurrent seizures after surgery. Definitions of failed epilepsy surgery vary amongst studies. This review focuses on seizure outcome predictors after reoperation, possible mechanisms of failure and best management for this difficult patient population.
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Affiliation(s)
- Riëm El Tahry
- Department of Neurology, Center for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium.
- Department of Pneumology, Sleep Laboratory, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Av Hippocrate 10, 1200, Brussels, Belgium.
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Gupta K, Raskin JS, Raslan AM. Intraoperative Computed Tomography and Nexframe-Guided Placement of Bilateral Hippocampal-Based Responsive Neurostimulation: Technical Note. World Neurosurg 2017; 101:161-169. [DOI: 10.1016/j.wneu.2017.01.109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/25/2017] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
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Geller EB, Skarpaas TL, Gross RE, Goodman RR, Barkley GL, Bazil CW, Berg MJ, Bergey GK, Cash SS, Cole AJ, Duckrow RB, Edwards JC, Eisenschenk S, Fessler J, Fountain NB, Goldman AM, Gwinn RP, Heck C, Herekar A, Hirsch LJ, Jobst BC, King-Stephens D, Labar DR, Leiphart JW, Marsh WR, Meador KJ, Mizrahi EM, Murro AM, Nair DR, Noe KH, Park YD, Rutecki PA, Salanova V, Sheth RD, Shields DC, Skidmore C, Smith MC, Spencer DC, Srinivasan S, Tatum W, Van Ness PC, Vossler DG, Wharen RE, Worrell GA, Yoshor D, Zimmerman RS, Cicora K, Sun FT, Morrell MJ. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy. Epilepsia 2017; 58:994-1004. [DOI: 10.1111/epi.13740] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Carl W. Bazil
- Columbia University Medical Center; New York City New York U.S.A
| | - Michael J. Berg
- University of Rochester Medical Center; Rochester New York U.S.A
| | | | - Sydney S. Cash
- Massachusetts General Hospital; Boston Massachusetts U.S.A
| | - Andrew J. Cole
- Massachusetts General Hospital; Boston Massachusetts U.S.A
| | | | | | | | - James Fessler
- University of Rochester Medical Center; Rochester New York U.S.A
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Donald C. Shields
- George Washington University School of Medicine & Health Sciences; Washington Washington DC U.S.A
| | | | | | | | | | - William Tatum
- Mayo Clinic College of Medicine; Jacksonville Florida U.S.A
| | | | | | | | | | | | | | | | | | - Martha J. Morrell
- NeuroPace, Inc.; Mountain View California U.S.A
- Stanford University School of Medicine; Stanford California U.S.A
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Rao VR, Leonard MK, Kleen JK, Lucas BA, Mirro EA, Chang EF. Chronic ambulatory electrocorticography from human speech cortex. Neuroimage 2017; 153:273-282. [PMID: 28396294 DOI: 10.1016/j.neuroimage.2017.04.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/15/2017] [Accepted: 04/04/2017] [Indexed: 01/07/2023] Open
Abstract
Direct intracranial recording of human brain activity is an important approach for deciphering neural mechanisms of cognition. Such recordings, usually made in patients with epilepsy undergoing inpatient monitoring for seizure localization, are limited in duration and depend on patients' tolerance for the challenges associated with recovering from brain surgery. Thus, typical intracranial recordings, similar to most non-invasive approaches in humans, provide snapshots of brain activity in acute, highly constrained settings, limiting opportunities to understand long timescale and natural, real-world phenomena. A new device for treating some forms of drug-resistant epilepsy, the NeuroPace RNS® System, includes a cranially-implanted neurostimulator and intracranial electrodes that continuously monitor brain activity and respond to incipient seizures with electrical counterstimulation. The RNS System can record epileptic brain activity over years, but whether it can record meaningful, behavior-related physiological responses has not been demonstrated. Here, in a human subject with electrodes implanted over high-level speech-auditory cortex (Wernicke's area; posterior superior temporal gyrus), we report that cortical evoked responses to spoken sentences are robust, selective to phonetic features, and stable over nearly 1.5 years. In a second subject with RNS System electrodes implanted over frontal cortex (Broca's area, posterior inferior frontal gyrus), we found that word production during a naming task reliably evokes cortical responses preceding speech onset. The spatiotemporal resolution, high signal-to-noise, and wireless nature of this system's intracranial recordings make it a powerful new approach to investigate the neural correlates of human cognition over long timescales in natural ambulatory settings.
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Affiliation(s)
- Vikram R Rao
- University of California, San Francisco, Department of Neurology, San Francisco, CA 94143, United States.
| | - Matthew K Leonard
- University of California, San Francisco, Department of Neurosurgery, San Francisco, CA 94143, United States; Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Jonathan K Kleen
- University of California, San Francisco, Department of Neurology, San Francisco, CA 94143, United States
| | - Ben A Lucas
- University of California, San Francisco, Department of Neurosurgery, San Francisco, CA 94143, United States; Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Emily A Mirro
- NeuroPace, Inc., Mountain View, CA 94043, United States
| | - Edward F Chang
- University of California, San Francisco, Department of Neurosurgery, San Francisco, CA 94143, United States; Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94143, United States
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120
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Crepeau AZ, Sirven JI. Management of Adult Onset Seizures. Mayo Clin Proc 2017; 92:306-318. [PMID: 28160877 DOI: 10.1016/j.mayocp.2016.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 12/12/2022]
Abstract
Epilepsy is a common yet heterogeneous disease. As a result, management often requires complex decision making. The ultimate goal of seizure management is for the patient to have no seizures and no considerable adverse effects from the treatment. Antiepileptic drugs are the mainstay of therapy, with more than 20 medications currently approved in the United States. Antiepileptic drug selection requires an understanding of the patient's epilepsy, along with consideration of comorbidities and potential for adverse events. After a patient has failed at least 2 appropriate antiepileptic drugs, they are determined to be medically refractory. At this time, additional therapy, including dietary, device, or surgical treatments, need to be considered, typically at a certified epilepsy center. All these treatments require consideration of the potential for seizure freedom, balanced against potential adverse effects, and can have a positive effect on seizure control and quality of life. This review article discussed the treatment options available for adults with epilepsy, including medical, surgical, dietary, and device therapies.
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Khambhati AN, Bassett DS, Oommen BS, Chen SH, Lucas TH, Davis KA, Litt B. Recurring Functional Interactions Predict Network Architecture of Interictal and Ictal States in Neocortical Epilepsy. eNeuro 2017; 4:ENEURO.0091-16.2017. [PMID: 28303256 PMCID: PMC5343278 DOI: 10.1523/eneuro.0091-16.2017] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 01/10/2023] Open
Abstract
Human epilepsy patients suffer from spontaneous seizures, which originate in brain regions that also subserve normal function. Prior studies demonstrate focal, neocortical epilepsy is associated with dysfunction, several hours before seizures. How does the epileptic network perpetuate dysfunction during baseline periods? To address this question, we developed an unsupervised machine learning technique to disentangle patterns of functional interactions between brain regions, or subgraphs, from dynamic functional networks constructed from approximately 100 h of intracranial recordings in each of 22 neocortical epilepsy patients. Using this approach, we found: (1) subgraphs from ictal (seizure) and interictal (baseline) epochs are topologically similar, (2) interictal subgraph topology and dynamics can predict brain regions that generate seizures, and (3) subgraphs undergo slower and more coordinated fluctuations during ictal epochs compared to interictal epochs. Our observations suggest that seizures mark a critical shift away from interictal states that is driven by changes in the dynamical expression of strongly interacting components of the epileptic network.
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Affiliation(s)
- Ankit N. Khambhati
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
| | - Danielle S. Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Brian S. Oommen
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Stephanie H. Chen
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Timothy H. Lucas
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Kathryn A. Davis
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Brian Litt
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
- Penn Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
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Epileptic networks in patients with bitemporal epilepsy: the role of SEEG for the selection of good surgical candidates. Epilepsy Res 2016; 128:73-82. [DOI: 10.1016/j.eplepsyres.2016.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/29/2016] [Accepted: 10/24/2016] [Indexed: 11/22/2022]
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Ung H, Davis KA, Wulsin D, Wagenaar J, Fox E, McDonnell JJ, Patterson N, Vite CH, Worrell G, Litt B. Temporal behavior of seizures and interictal bursts in prolonged intracranial recordings from epileptic canines. Epilepsia 2016; 57:1949-1957. [PMID: 27807850 DOI: 10.1111/epi.13591] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Epilepsy is a chronic disorder, but seizure recordings are usually obtained in the acute setting. The chronic behavior of seizures and the interictal bursts that sometimes initiate them is unknown. We investigate the variability of these electrographic patterns over an extended period of time using chronic intracranial recordings in canine epilepsy. METHODS Continuous, yearlong intracranial electroencephalography (iEEG) recordings from four dogs with naturally occurring epilepsy were analyzed for seizures and interictal bursts. Following automated detection and clinician verification of interictal bursts and seizures, temporal trends of seizures, burst count, and burst-burst similarities were determined. One dog developed status epilepticus, the recordings of which were also investigated. RESULTS Multiple seizure types, determined by onset channels, were observed in each dog, with significant temporal variation between types. The first 14 days of invasive recording, analogous to the average duration of clinical invasive recordings in humans, did not capture the entirety of seizure types. Seizures typically occurred in clusters, and isolated seizures were rare. The count and dynamics of interictal bursts form distinct groups and do not stabilize until several weeks after implantation. SIGNIFICANCE There is significant temporal variability in seizures and interictal bursts after electrode implantation that requires several weeks to reach steady state. These findings, comparable to those reported in humans implanted with the NeuroPace Responsive Neurostimulator System (RNS) device, suggest that transient network changes following electrode implantation may need to be taken into account when interpreting or analyzing iEEG during evaluation for epilepsy surgery. Chronic, ambulatory iEEG may be better suited to accurately map epileptic networks in appropriate individuals.
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Affiliation(s)
- Hoameng Ung
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Kathryn A Davis
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.,Penn Epilepsy Center, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Drausin Wulsin
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Joost Wagenaar
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Emily Fox
- Department of Statistics, University of Washington, Seattle, Washington, U.S.A
| | - John J McDonnell
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ned Patterson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, U.S.A
| | - Charles H Vite
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Brian Litt
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.,Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.,Penn Epilepsy Center, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Abstract
Closed-loop, responsive focal brain stimulation provides a new treatment option for patients with refractory partial onset seizures who are not good candidates for potentially curative epilepsy surgery. The first responsive brain neurostimulator (RNS® System, NeuroPace), provides stimulation directly to the seizure focus when abnormal electrocorticographic is detected. Seizure reductions of 44% at one year increase to 60 to 66% at years 3 to 6 of treatment. There is no negative impact on cognition and mood. Risks are similar to other implanted medical devices and therapeutic stimulation is not perceived.
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Affiliation(s)
- Martha J Morrell
- NeuroPace, Inc, 455 North Bernardo Avenue, Mountain View, CA 94043, USA; Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Casey Halpern
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive A301, MC 5325, Stanford, CA 94305, USA
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Liu C, Zhang R, Zhang G, Yu T, Tai J, Du W, Li L, Wang Y. High frequency oscillations for lateralizing suspected bitemporal epilepsy. Epilepsy Res 2016; 127:233-240. [PMID: 27639348 DOI: 10.1016/j.eplepsyres.2016.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 07/28/2016] [Accepted: 09/04/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In some cases of single focus epilepsy, conventional video electroencephalography (EEG) cannot reveal the epileptogenic focus even when intracranial electrodes are used. Here, we tested whether analyzing high frequency oscillations (HFOs) can be used to determine the ictal onset zone in suspected bitemporal epilepsy and improve seizure outcome. METHODS We prospectively studied 13 patients with refractory temporal seizures who were treated over a 4-year period and underwent bilateral placement of intracranial electrodes. Subdural strips were used in all cases, and depth electrodes were implanted into mesial temporal lobes in 10 patients. The mean patient age was 30.92 years, and 30.7% of patients were male. Patients were monitored by conventional and wide-band frequency amplifiers. RESULTS Conventional invasive EEG monitoring of interictal periods showed bilateral epileptiform abnormalities in 12 patients (92.3%) and unilateral epileptiform abnormalities in one (7.7%), and monitoring of ictal periods revealed unilateral seizure origins in nine patients (69.2%) and bilateral origins in four (30.8%). In contrast, high frequency invasive EEG monitoring of interictal periods showed bilateral HFOs in seven patients (53.8%) and unilateral HFOs in six (46.2%), and monitoring of ictal periods revealed unilateral HFOs in all 10 patients who were tested. Three patients were not monitored during ictal periods because of time limitations. All 13 patients subsequently underwent a standard unilateral temporal lobectomy and have been followed-up for a minimum of 12 months. Eleven (84%) had a Class I outcome, one (8%) a Class II outcome, and one a Class III outcome. SIGNIFICANCE Bilateral placement of subdural strip and depth electrodes for seizure monitoring in patients with suspected bitemporal epilepsy is both safe and effective. Monitoring high frequency oscillations can help determine the laterality of the onset zone when localization using conventional EEG or brain MRI fails.
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Affiliation(s)
- Chunyan Liu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Ruihua Zhang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China; Department of Functional Neurology, Lu He Hospital, Capital Medical University, Beijing 101149, China
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Junli Tai
- Department of Functional Neurosurgery, Lu He Hospital, Capital Medical University, Beijing 101149, China
| | - Wei Du
- Beijing Institute of Functional Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Liping Li
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Yuping Wang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China.
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Yu KJ, Kuzum D, Hwang SW, Kim BH, Juul H, Kim NH, Won SM, Chiang K, Trumpis M, Richardson AG, Cheng H, Fang H, Thomson M, Bink H, Talos D, Seo KJ, Lee HN, Kang SK, Kim JH, Lee JY, Huang Y, Jensen FE, Dichter MA, Lucas TH, Viventi J, Litt B, Rogers JA. Bioresorbable silicon electronics for transient spatiotemporal mapping of electrical activity from the cerebral cortex. NATURE MATERIALS 2016; 15:782-791. [PMID: 27088236 PMCID: PMC4919903 DOI: 10.1038/nmat4624] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/14/2016] [Indexed: 05/18/2023]
Abstract
Bioresorbable silicon electronics technology offers unprecedented opportunities to deploy advanced implantable monitoring systems that eliminate risks, cost and discomfort associated with surgical extraction. Applications include postoperative monitoring and transient physiologic recording after percutaneous or minimally invasive placement of vascular, cardiac, orthopaedic, neural or other devices. We present an embodiment of these materials in both passive and actively addressed arrays of bioresorbable silicon electrodes with multiplexing capabilities, which record in vivo electrophysiological signals from the cortical surface and the subgaleal space. The devices detect normal physiologic and epileptiform activity, both in acute and chronic recordings. Comparative studies show sensor performance comparable to standard clinical systems and reduced tissue reactivity relative to conventional clinical electrocorticography (ECoG) electrodes. This technology offers general applicability in neural interfaces, with additional potential utility in treatment of disorders where transient monitoring and modulation of physiologic function, implant integrity and tissue recovery or regeneration are required.
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Affiliation(s)
- Ki Jun Yu
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Duygu Kuzum
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Electrical and Computer Engineering, University of California, San Diego, San Diego, CA 92093
| | - Suk-Won Hwang
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul 136-701, Republic of Korea
| | - Bong Hoon Kim
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Halvor Juul
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nam Heon Kim
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Sang Min Won
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Ken Chiang
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Michael Trumpis
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Andrew G. Richardson
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Huanyu Cheng
- Department of Engineering Science and Mechanics, Penn State University, University Park, PA 16802, USA
| | - Hui Fang
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Marissa Thomson
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Chemical and Biomolecular Engineering University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Hank Bink
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Delia Talos
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kyung Jin Seo
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Hee Nam Lee
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana- Champaign, Urbana, IL 61801, USA
| | - Seung-Kyun Kang
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Jae-Hwan Kim
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Jung Yup Lee
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana- Champaign, Urbana, IL 61801, USA
| | - Younggang Huang
- Department of Mechanical Engineering and Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Frances E. Jensen
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Marc A. Dichter
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Timothy H. Lucas
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jonathan Viventi
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Brian Litt
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- To whom correspondence should be addressed. or
| | - John A. Rogers
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- To whom correspondence should be addressed. or
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Seizure outcomes in nonresective epilepsy surgery: an update. Neurosurg Rev 2016; 40:181-194. [PMID: 27206422 DOI: 10.1007/s10143-016-0725-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/31/2016] [Accepted: 03/06/2016] [Indexed: 12/18/2022]
Abstract
In approximately 30 % of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy. Fortunately, several nonresective surgical options are now available at various epilepsy centers, including novel therapies which have been pioneered in recent years. Ablative procedures such as stereotactic laser ablation and stereotactic radiosurgery offer minimally invasive alternatives to open surgery with relatively favorable seizure outcomes, particularly in patients with mesial temporal lobe epilepsy. For certain individuals who are not candidates for ablation or resection, palliative neuromodulation procedures such as vagus nerve stimulation, deep brain stimulation, or responsive neurostimulation may result in a significant decrease in seizure frequency and improved quality of life. Finally, disconnection procedures such as multiple subpial transections and corpus callosotomy continue to play a role in select patients with an eloquent epileptogenic zone or intractable atonic seizures, respectively. Overall, open surgical resection remains the gold standard treatment for drug-resistant epilepsy, although it is significantly underutilized. While nonresective epilepsy procedures have not replaced the need for resection, there is hope that these additional surgical options will increase the number of patients who receive treatment for this devastating disorder-particularly individuals who are not candidates for or who have failed resection.
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von Ellenrieder N, Frauscher B, Dubeau F, Gotman J. Interaction with slow waves during sleep improves discrimination of physiologic and pathologic high-frequency oscillations (80-500 Hz). Epilepsia 2016; 57:869-78. [PMID: 27184021 DOI: 10.1111/epi.13380] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To characterize the interaction between physiologic and pathologic high-frequency oscillations (HFOs) and slow waves during sleep, and to evaluate the practical significance of these interactions by automatically classifying channels as recording from normal or epileptic brain regions. METHODS We automatically detected HFOs in intracerebral electroencephalography (EEG) recordings of 45 patients. We characterized the interaction between the HFOs and the amplitude and phase of automatically detected slow waves during sleep. We computed features associated with HFOs, and compared classic features such as rate, amplitude, duration, and frequency to novel features related to the interaction between HFOs and slow waves. To quantify the practical significance of the difference in these features we classified the channels as recording from normal/epileptic regions using logistic regression. We assessed the results in different brain regions to study differences in the HFO characteristics at the lobar level. RESULTS We found a clear difference in the coupling between the phase of slow waves during sleep and the occurrence of HFOs. In channels recording physiologic activity, the HFOs tend to occur after the peak of the deactivated state of the slow wave, and in channels with epileptic activity, the HFOs occur more often before this peak. This holds for HFOs in the ripple (80-250 Hz) and fast ripple (250-500 Hz) bands, and different regions of the brain. When using this interaction to automatically classify channels as recording from normal/epileptic brain regions, the performance is better than when using other HFO characteristics. We confirmed differences in the HFO characteristics in mesiotemporal structures and in the occipital lobe. SIGNIFICANCE We found the association between slow waves and HFOs to be different in normal and epileptic brain regions, emphasizing their different origin. This is also of practical significance, since it improves the separation between channels recording from normal and epileptic brain regions.
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Affiliation(s)
- Nicolás von Ellenrieder
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada.,LEICI, CONICET-National University of La Plata, La Plata, Argentina
| | - Birgit Frauscher
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada
| | - François Dubeau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada
| | - Jean Gotman
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada
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Goldman AM, LaFrance WC, Benke T, Asato M, Drane D, Pack A, Syed T, Doss R, Lhatoo S, Fureman B, Dingledine R. 2014 Epilepsy Benchmarks Area IV: Limit or Prevent Adverse Consequence of Seizures and Their Treatment Across The Lifespan. Epilepsy Curr 2016; 16:198-205. [PMID: 27330453 PMCID: PMC4913859 DOI: 10.5698/1535-7511-16.3.198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alica M. Goldman
- Associate Professor, Department of Neurology, Baylor College of Medicine, One Baylor Plaza, NB222, Houston, TX, USA
| | - W. Curt LaFrance
- Associate Professor, Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Providence RI 02903-4923 USA
| | - Tim Benke
- Associate Professor, Departments of Pediatrics, Neurology, Pharmacology and Otolaryngology, University of Colorado School of Medicine, Aurora, CO
| | - Miya Asato
- Associate Professor, Pediatrics and Psychiatry, Divisionof Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Dan Drane
- Assistant Professor, Departments of Neurology and Pediatrics, Emory University School of Medicine and Department of Neurology, University of Washington School of Medicine
| | - Alison Pack
- Associate Professor of Neurology, Department of Neurology, Columbia University Medical Center, New York, NY
| | - Tanvir Syed
- Assistant Professor of Neurology, University Hospitals Case Medical Center, Cleveland, OH
| | - Robert Doss
- Clinical Neuropsychologist, Minnesota Epilepsy Group, P.A., St. Paul, MN and Department of Neurology, University of Minnesota-Twin Cities, MN
| | - Samden Lhatoo
- Professor and Chair, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Brandy Fureman
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Ray Dingledine
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta GA
| | - for the American Epilepsy Society (AES)/National Institute of Neurological Disorders and Stroke (NINDS) Epilepsy Benchmark Stewards.
- Associate Professor, Department of Neurology, Baylor College of Medicine, One Baylor Plaza, NB222, Houston, TX, USA
- Associate Professor, Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Providence RI 02903-4923 USA
- Associate Professor, Departments of Pediatrics, Neurology, Pharmacology and Otolaryngology, University of Colorado School of Medicine, Aurora, CO
- Associate Professor, Pediatrics and Psychiatry, Divisionof Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA
- Assistant Professor, Departments of Neurology and Pediatrics, Emory University School of Medicine and Department of Neurology, University of Washington School of Medicine
- Associate Professor of Neurology, Department of Neurology, Columbia University Medical Center, New York, NY
- Assistant Professor of Neurology, University Hospitals Case Medical Center, Cleveland, OH
- Clinical Neuropsychologist, Minnesota Epilepsy Group, P.A., St. Paul, MN and Department of Neurology, University of Minnesota-Twin Cities, MN
- Professor and Chair, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta GA
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Aghaei-Lasboo A, Fisher RS. Methods for Measuring Seizure Frequency and Severity. Neurol Clin 2016; 34:383-94, viii. [DOI: 10.1016/j.ncl.2015.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dlugos D, Worrell G, Davis K, Stacey W, Szaflarski J, Kanner A, Sunderam S, Rogawski M, Jackson-Ayotunde P, Loddenkemper T, Diehl B, Fureman B, Dingledine R. 2014 Epilepsy Benchmarks Area III: Improve Treatment Options for Controlling Seizures and Epilepsy-Related Conditions Without Side Effects. Epilepsy Curr 2016; 16:192-7. [PMID: 27330452 PMCID: PMC4913858 DOI: 10.5698/1535-7511-16.3.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Dennis Dlugos
- Professor of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Greg Worrell
- Associate Professor of Neurology, Mayo Systems Electrophysiology Laboratory, Departments of Neurology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Kathryn Davis
- Assistant Professor, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - William Stacey
- Assistant Professor of Neurology, Department of Neurology, Department of Biomedical Engineering, University of Michigan
| | - Jerzy Szaflarski
- Professor, Department of Neurology, University of Alabama at Birmingham Department of Neurology and UAB Epilepsy Center, Birmingham, AL
| | - Andres Kanner
- Profressor of Clinical Neurology, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
| | - Sridhar Sunderam
- Assistant Professor, Department of Biomedical Engineering, University of Kentucky, Lexington, KY
| | - Mike Rogawski
- Professor, Center for Neurotherapeutics Discovery and Development and Department of Neurology, UC Davis School of Medicine, Sacramento, CA
| | - Patrice Jackson-Ayotunde
- Associate Professor, Department of Pharmaceutical Sciences, University of Maryland Eastern Shore, Princess Anne, MD
| | - Tobias Loddenkemper
- Associate Professor, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Beate Diehl
- Clinical Neurophysiologist and Neurologist, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - Brandy Fureman
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Ray Dingledine
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta, GA
| | - for the Epilepsy Benchmark Stewards
- Professor of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Associate Professor of Neurology, Mayo Systems Electrophysiology Laboratory, Departments of Neurology and Biomedical Engineering, Mayo Clinic, Rochester, MN
- Assistant Professor, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Assistant Professor of Neurology, Department of Neurology, Department of Biomedical Engineering, University of Michigan
- Professor, Department of Neurology, University of Alabama at Birmingham Department of Neurology and UAB Epilepsy Center, Birmingham, AL
- Profressor of Clinical Neurology, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
- Assistant Professor, Department of Biomedical Engineering, University of Kentucky, Lexington, KY
- Professor, Center for Neurotherapeutics Discovery and Development and Department of Neurology, UC Davis School of Medicine, Sacramento, CA
- Associate Professor, Department of Pharmaceutical Sciences, University of Maryland Eastern Shore, Princess Anne, MD
- Associate Professor, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA
- Clinical Neurophysiologist and Neurologist, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta, GA
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Abstract
In the approximately 1% of children affected by epilepsy, pharmacoresistance and early age of seizure onset are strongly correlated with poor cognitive outcomes, depression, anxiety, developmental delay, and impaired activities of daily living. These children often require multiple surgical procedures, including invasive diagnostic procedures with intracranial electrodes to identify the seizure-onset zone. The recent development of minimally invasive surgical techniques, including stereotactic electroencephalography (SEEG) and MRI-guided laser interstitial thermal therapy (MRgLITT), and new applications of neurostimulation, such as responsive neurostimulation (RNS), are quickly changing the landscape of the surgical management of pediatric epilepsy. In this review, the authors discuss these various technologies, their current applications, and limitations in the treatment of pediatric drug-resistant epilepsy, as well as areas for future research. The development of minimally invasive diagnostic and ablative surgical techniques together with new paradigms in neurostimulation hold vast potential to improve the efficacy and reduce the morbidity of the surgical management of children with drug-resistant epilepsy.
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Affiliation(s)
- Michael Karsy
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Jian Guan
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Katrina Ducis
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Robert J Bollo
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
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135
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Murphy MD, Guggenmos DJ, Bundy DT, Nudo RJ. Current Challenges Facing the Translation of Brain Computer Interfaces from Preclinical Trials to Use in Human Patients. Front Cell Neurosci 2016; 9:497. [PMID: 26778962 PMCID: PMC4702293 DOI: 10.3389/fncel.2015.00497] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 12/10/2015] [Indexed: 12/13/2022] Open
Abstract
Current research in brain computer interface (BCI) technology is advancing beyond preclinical studies, with trials beginning in human patients. To date, these trials have been carried out with several different types of recording interfaces. The success of these devices has varied widely, but different factors such as the level of invasiveness, timescale of recorded information, and ability to maintain stable functionality of the device over a long period of time all must be considered in addition to accuracy in decoding intent when assessing the most practical type of device moving forward. Here, we discuss various approaches to BCIs, distinguishing between devices focusing on control of operations extrinsic to the subject (e.g., prosthetic limbs, computer cursors) and those focusing on control of operations intrinsic to the brain (e.g., using stimulation or external feedback), including closed-loop or adaptive devices. In this discussion, we consider the current challenges facing the translation of various types of BCI technology to eventual human application.
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Affiliation(s)
- Maxwell D Murphy
- Bioengineering Graduate Program, University of KansasLawrence, KS, USA; Department of Rehabilitation Medicine, University of Kansas Medical CenterKansas City, KS, USA
| | - David J Guggenmos
- Department of Rehabilitation Medicine, University of Kansas Medical Center Kansas City, KS, USA
| | - David T Bundy
- Department of Rehabilitation Medicine, University of Kansas Medical Center Kansas City, KS, USA
| | - Randolph J Nudo
- Department of Rehabilitation Medicine, University of Kansas Medical CenterKansas City, KS, USA; Landon Center on Aging, University of Kansas Medical CenterKansas City, KS, USA
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136
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Abstract
Despite the development of new antiepileptic drugs (AEDs), ~20%-30% of people with epilepsy remain refractory to treatment and are said to have drug-resistant epilepsy (DRE). This multifaceted condition comprises intractable seizures, neurobiochemical changes, cognitive decline, and psychosocial dysfunction. An ongoing challenge to both researchers and clinicians alike, DRE management is complicated by the heterogeneity among this patient group. The underlying mechanism of DRE is not completely understood. Many hypotheses exist, and relate to both the intrinsic characteristics of the particular epilepsy (associated syndrome/lesion, initial response to AED, and the number and type of seizures prior to diagnosis) and other pharmacological mechanisms of resistance. The four current hypotheses behind pharmacological resistance are the "transporter", "target", "network", and "intrinsic severity" hypotheses, and these are reviewed in this paper. Of equal challenge is managing patients with DRE, and this requires a multidisciplinary approach, involving physicians, surgeons, psychiatrists, neuropsychologists, pharmacists, dietitians, and specialist nurses. Attention to comorbid psychiatric and other diseases is paramount, given the higher prevalence in this cohort and associated poorer health outcomes. Treatment options need to consider the economic burden to the patient and the likelihood of AED compliance and tolerability. Most importantly, higher mortality rates, due to comorbidities, suicide, and sudden death, emphasize the importance of seizure control in reducing this risk. Overall, resective surgery offers the best rates of seizure control. It is not an option for all patients, and there is often a significant delay in referring to epilepsy surgery centers. Optimization of AEDs, identification and treatment of comorbidities, patient education to promote adherence to treatment, and avoidance of triggers should be periodically performed until further insights regarding causative pathology can guide better therapies.
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Affiliation(s)
| | - Mark J Cook
- St Vincent's Hospital, Centre for Clinical Neurosciences and Neurological Research; Department of Medicine, The University of Melbourne, Melbourne, Australia
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