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Samanta D, Aungaroon G, Albert GW, Karakas C, Joshi CN, Singh RK, Oluigbo C, Perry MS, Naik S, Reeders PC, Jain P, Abel TJ, Pati S, Shaikhouni A, Haneef Z. Advancing thalamic neuromodulation in epilepsy: Bridging adult data to pediatric care. Epilepsy Res 2024; 205:107407. [PMID: 38996686 DOI: 10.1016/j.eplepsyres.2024.107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
Thalamic neuromodulation has emerged as a treatment option for drug-resistant epilepsy (DRE) with widespread and/or undefined epileptogenic networks. While deep brain stimulation (DBS) and responsive neurostimulation (RNS) depth electrodes offer means for electrical stimulation of the thalamus in adult patients with DRE, the application of thalamic neuromodulation in pediatric epilepsy remains limited. To address this gap, the Neuromodulation Expert Collaborative was established within the Pediatric Epilepsy Research Consortium (PERC) Epilepsy Surgery Special Interest Group. In this expert review, existing evidence and recommendations for thalamic neuromodulation modalities using DBS and RNS are summarized, with a focus on the anterior (ANT), centromedian(CMN), and pulvinar nuclei of the thalamus. To-date, only DBS of the ANT is FDA approved for treatment of DRE in adult patients based on the results of the pivotal SANTE (Stimulation of the Anterior Nucleus of Thalamus for Epilepsy) study. Evidence for other thalamic neurmodulation indications and targets is less abundant. Despite the lack of evidence, positive responses to thalamic stimulation in adults with DRE have led to its off-label use in pediatric patients. Although caution is warranted due to differences between pediatric and adult epilepsy, the efficacy and safety of pediatric neuromodulation appear comparable to that in adults. Indeed, CMN stimulation is increasingly accepted for generalized and diffuse onset epilepsies, with recent completion of one randomized trial. There is also growing interest in using pulvinar stimulation for temporal plus and posterior quadrant epilepsies with one ongoing clinical trial in Europe. The future of thalamic neuromodulation holds promise for revolutionizing the treatment landscape of childhood epilepsy. Ongoing research, technological advancements, and collaborative efforts are poised to refine and improve thalamic neuromodulation strategies, ultimately enhancing the quality of life for children with DRE.
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Affiliation(s)
- Debopam Samanta
- Division of Child Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gregory W Albert
- Department of Neurosurgery, University of Arkansas for Medical Sciences, USA
| | - Cemal Karakas
- Division of Pediatric Neurology, Department of Neurology, Norton Children's Hospital, University of Louisville, Louisville, KY 40202, USA
| | - Charuta N Joshi
- Division of Pediatric Neurology, Childrens Medical Center Dallas, UTSW, USA
| | - Rani K Singh
- Department of Pediatrics, Atrium Health-Levine Children's; Wake Forest University School of Medicine, USA
| | - Chima Oluigbo
- Department of Neurosurgery, Children's National Hospital, Washington, DC, USA
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Ft Worth, TX, USA
| | - Sunil Naik
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Puck C Reeders
- Brain Institute, Nicklaus Children's Hospital, Miami, FL, USA
| | - Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh School of Medicine and Department of Bioengineering, University of Pittsburgh
| | - Sandipan Pati
- The University of Texas Health Science Center at Houston, USA
| | - Ammar Shaikhouni
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Zulfi Haneef
- Neurology Care Line, VA Medical Center, Houston, TX 77030, USA; Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
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Pati S, Agashe S, Kheder A, Riley K, Gavvala J, McGovern R, Suresh S, Chaitanya G, Thompson S. Stereoelectroencephalography of the Deep Brain: Basal Ganglia and Thalami. J Clin Neurophysiol 2024; 41:423-429. [PMID: 38935656 DOI: 10.1097/wnp.0000000000001097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
SUMMARY Stereoelectroencephalography (SEEG) has emerged as a transformative tool in epilepsy surgery, shedding light on the complex network dynamics involved in focal epilepsy. This review explores the role of SEEG in elucidating the role of deep brain structures, namely the basal ganglia and thalamus, in epilepsy. SEEG advances understanding of their contribution to seizure generation, propagation, and control by permitting precise and minimally invasive sampling of these brain regions. The basal ganglia, comprising the subthalamic nucleus, globus pallidus, substantia nigra, and striatum, have gained recognition for their involvement in both focal and generalized epilepsy. Electrophysiological recordings reveal hyperexcitability and increased synchrony within these structures, reinforcing their role as critical nodes within the epileptic network. Furthermore, low-frequency and high-frequency stimulation of the basal ganglia have demonstrated potential in modulating epileptogenic networks. Concurrently, the thalamus, a key relay center, has garnered prominence in epilepsy research. Disrupted thalamocortical connectivity in focal epilepsy underscores its significance in seizure maintenance. The thalamic subnuclei, including the anterior nucleus, centromedian, and medial pulvinar, present promising neuromodulatory targets, suggesting pathways for personalized epilepsy therapies. The prospect of multithalamic SEEG and thalamic SEEG stimulation trials has the potential to revolutionize epilepsy management, offering tailored solutions for challenging cases. SEEG's ability to unveil the dynamics of deep brain structures in epilepsy promises enhanced and personalized epilepsy care in our new era of precision medicine. Until deep brain SEEG is accepted as a standard of care, a rigorous informed consent process remains paramount for patients for whom such an exploration is proposed.
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Affiliation(s)
- Sandipan Pati
- Texas Comprehensive Epilepsy Program, Department of Neurology, The University of Texas Health Science Center at Houston, Texas, U.S.A
| | - Shruti Agashe
- Department of Neurology, Duke Comprehensive Epilepsy Center, Duke University, Durham, North Carolina, U.S.A
| | - Ammar Kheder
- Department of Neurology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, U.S.A
| | - Kristen Riley
- Department of Neurosurgery, Heersink School of Medicine, University of Alabama at Birmingham, Alabama, U.S.A
| | - Jay Gavvala
- Texas Comprehensive Epilepsy Program, Department of Neurology, The University of Texas Health Science Center at Houston, Texas, U.S.A
| | - Robert McGovern
- Department of Neurosurgery, University of Minnesota, Minnesota, U.S.A.; and
| | - Surya Suresh
- Texas Comprehensive Epilepsy Program, Department of Neurology, The University of Texas Health Science Center at Houston, Texas, U.S.A
| | - Ganne Chaitanya
- Texas Comprehensive Epilepsy Program, Department of Neurology, The University of Texas Health Science Center at Houston, Texas, U.S.A
| | - Stephen Thompson
- Neurology Division of the Department of Medicine, Hamilton Health Sciences and McMaster University, Canada
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Singh J, Miller JA, Lucas T, Yang J, Sollars C, Eliashiv DS, Bartolomei F. Anterior thalamic nucleus local field potentials during focal temporal lobe epileptic seizures. Front Neurol 2024; 15:1419835. [PMID: 38962474 PMCID: PMC11221306 DOI: 10.3389/fneur.2024.1419835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Objective To analyze the local field potentials (LFPs) in patients with focal drug-resistant epilepsy (DRE) from the anterior nucleus of the thalamus (ANT) during inter-ictal state and seizure state. Method ANT stereotactic EEG (SEEG) recordings were studied in four patients with focal temporal lobe epilepsy. SEEG data was classified as inter-ictal and ictal state and sub-categorized into electrographic (ESz), focal aware seizure (FAS), focal with impaired awareness (FIA), or focal to bilateral tonic-clonic seizure (FBTC). LFP was analyzed at 4 Hz, 8 Hz, 16 Hz, 32 Hz, high gamma (100 Hz), and ripples (200 Hz) using spectrogram analysis and a statistical comparison of normalized power spectral density (PSD) averaged during seizures versus pre-ictal baseline segments. Result The LFP recordings were analyzed for 162 seizures (127 ESz, 23 FAS, 6 FIA, and 6 FBTC). Based on time-frequency data (spectrogram), a broad band of activity, occurring between 2 and 6 Hz and centered at 4 Hz, and thin-band activity occurring specifically at 8 Hz on the frequency spectrogram were observed during the inter-ictal state. Statistically significant changes in LFP-PSD were seen for FAS, FIA, and FBTC. We observed a significant gain in LFP at the lower frequency band during FAS at 4 Hz, FIA, and FBTC at 4, 8, and 16 Hz while also observing increases at higher frequencies during FBTC at 100 and 200 Hz and a decrease during FAS seizures at 32 Hz. In contrast, no significant change in LFP power was seen for electrographic seizures. Interpretation Our observations from a limited dataset indicate that all clinical seizure types, but not electrographic seizures, caused a change in ANT-LFP based on the magnitude of the associated power spectral density (PSD). Future work will be needed to validate the use of ANT-LFP at these frequencies as accurate measurements of seizure occurrence and severity. This work represents a first step toward understanding ANT thalamic LFP patterns during focal seizures and developing adaptive DBS strategies.
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Affiliation(s)
- Jaysingh Singh
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Jacob A. Miller
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Timothy Lucas
- Depart of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Jimmy Yang
- Depart of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Caleb Sollars
- Lead EEG Technician, Neurodiagnostic EEG Lab, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Dawn S. Eliashiv
- Department of Neurology, David Gefen School of Medicine, UCLA, Los Angeles, CA, United States
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology Department, Marseille, France
- Univ Aix Marseille, INSERM, INS, Inst Neurosci Syst, Marseille, France
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Krutoshinskaya Y, Coulehan K, Pushchinska G, Spiegel R. The Reciprocal Relationship between Sleep and Epilepsy. J Pers Med 2024; 14:118. [PMID: 38276240 PMCID: PMC10817641 DOI: 10.3390/jpm14010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
The relationship between sleep and epilepsy is bidirectional. Certain epilepsy syndromes predominantly or exclusively manifest during sleep, with seizures frequently originating from non-rapid eye movement (NREM) sleep. Interictal epileptiform discharges observed on electroencephalograms are most likely to be activated during the deep NREM sleep stage known as N3. Conversely, epileptiform discharges, anti-seizure medications (ASMs), as well as other anti-seizure therapies can exert detrimental effects on sleep architecture. Moreover, the co-occurrence of sleep disorders has the potential to exacerbate seizure control. Understating the relationship between sleep and epilepsy is crucial for healthcare providers. Addressing and managing sleep-related problems in individuals with epilepsy can potentially contribute to improved seizure control and overall well-being. At the same time, improving seizure control can improve sleep quality and quantity, thus further improving the health of individuals with epilepsy.
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Affiliation(s)
- Yana Krutoshinskaya
- Department of Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA; (K.C.); (G.P.); (R.S.)
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Nanda P, Richardson RM. Evolution of Stereo-Electroencephalography at Massachusetts General Hospital. Neurosurg Clin N Am 2024; 35:87-94. [PMID: 38000845 DOI: 10.1016/j.nec.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
The practice of invasive monitoring for presurgical epilepsy workup has evolved at Massachusetts General Hospital (MGH) in parallel to the evolution in the field's understanding of epilepsy as a network disorder. Implantations have shifted from an emphasis on singularly finding single foci for the purpose of resection to a network-hypothesis-driven approach aiming to delineate patients' seizure networks with the goal of developing surgical interventions that disrupt critical nodes of these networks. Here, the authors review all invasive monitoring cases at MGH from April 2016 through June 2023 to describe how this paradigm shift has taken form.
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Affiliation(s)
- Pranav Nanda
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA.
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
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Yang JC, Yang AI, Gross RE. Sensing-Enabled Deep Brain Stimulation in Epilepsy. Neurosurg Clin N Am 2024; 35:119-123. [PMID: 38000835 DOI: 10.1016/j.nec.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Deep brain stimulation has demonstrated efficacy in reducing seizure frequency in patients with drug-resistant epilepsy who may otherwise not be candidates for other surgical procedures. Recently, a clinical device that can monitor neural activity in the form of local field potentials around the deep brain stimulator lead implant site has been introduced. While this technology has been clinically adopted in other disorders treated with deep brain stimulation, such as Parkinson's disease, its application in epilepsy remains unclear. Previous research using investigational devices has suggested that specific frequency bands may correlate with clinical response to deep brain stimulation in epilepsy, but features of the clinical device may prevent its use. The authors present their experience with using this technology in epilepsy patients and describe some of its limitations. Ultimately, novel biomarkers will need to be identified to elucidate how neural activity at deep brain stimulation sites may change with clinical response.
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Affiliation(s)
- Jimmy C Yang
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Neurosurgery, Emory University, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA.
| | - Andrew I Yang
- Department of Neurosurgery, Emory University, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; Department of Neurology, Emory University School of Medicine, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322
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Yan H, Wang X, Yu T, Ni D, Qiao L, Zhang X, Xu C, Shu W, Wang Y, Ren L. The anterior nucleus of the thalamus plays a role in the epileptic network. Ann Clin Transl Neurol 2022; 9:2010-2024. [PMID: 36334281 PMCID: PMC9735375 DOI: 10.1002/acn3.51693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES We investigated both the metabolic differences and interictal/ictal discharges of the anterior nucleus of the thalamus (ANT) in patients with epilepsy to clarify the relationship between the ANT and the epileptic network. METHODS Nineteen patients with drug-resistant epilepsy who underwent stereoelectroencephalography were studied. Metabolic differences in ANT were analyzed using [18F] fluorodeoxyglucose-positron emission tomography with three-dimensional (3D) visual and quantitative analyses. Interictal and ictal discharges in the ANT were analyzed using visual and time-frequency analyses. The relationship between interictal discharge and metabolic differences was analyzed. RESULTS We found that patients with temporal lobe epilepsy (TLE) showed significant metabolic differences in bilateral ANT compared with extratemporal lobe epilepsy in 3D visual and quantitative analyses. Four types of interictal activities were recorded from the ANT: spike, high-frequency oscillation (HFO), slow-wave, and α-rhythmic activity. Spike and HFO waveforms were recorded mainly in patients with TLE. Two spike patterns were recorded: synchronous and independent. In 83.3% of patients, ANT was involved during seizures. Three seizure onset types of ANT were recorded: low-voltage fast activity, rhythmic spikes, and theta band discharge. The time interval of seizure onset between the seizure onset zone and ANT showed two patterns: immediate and delayed. INTERPRETATION ANT can receive either interictal discharges or ictal discharges which propagate from the epileptogenic zones. Independent epileptic discharges can also be recorded from the ANT in some patients. Metabolic anomalies and epileptic discharges in the ANT indicate that the ANT plays a role in the epileptic network in most patients with epilepsy, especially TLE.
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Affiliation(s)
- Hao Yan
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Xueyuan Wang
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Tao Yu
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Duanyu Ni
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Liang Qiao
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Xiaohua Zhang
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Cuiping Xu
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Wei Shu
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yuping Wang
- Department of Neurology, Comprehensive Epilepsy Center of Beijing, Beijing Key Laboratory of NeuromodulationXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Liankun Ren
- Department of Neurology, Comprehensive Epilepsy Center of Beijing, Beijing Key Laboratory of NeuromodulationXuanwu Hospital, Capital Medical UniversityBeijingChina
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Gadot R, Korst G, Shofty B, Gavvala JR, Sheth SA. Thalamic stereoelectroencephalography in epilepsy surgery: a scoping literature review. J Neurosurg 2022; 137:1210-1225. [PMID: 35276641 DOI: 10.3171/2022.1.jns212613] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (sEEG) is a well-established surgical method for defining the epileptogenic network. Traditionally reserved for identifying discrete cortical regions for resection or ablation, sEEG in current practice is also used for identifying more broadly involved subcortical epileptic network components, driven by the availability of brain-based neuromodulation strategies. In particular, sEEG investigations including thalamic nuclei are becoming more frequent in parallel with the increase in therapeutic strategies involving thalamic targets such as deep brain stimulation (DBS) and responsive neurostimulation (RNS). The objective to this study was to evaluate existing evidence and trends regarding the purpose, techniques, and relevant electrographic findings of thalamic sEEG. METHODS MEDLINE and Embase databases were systematically queried for eligible peer-reviewed studies involving sEEG electrode implantation into thalamic nuclei of patients with epilepsy. Available data were abstracted concerning preoperative workup and purpose for implanting the thalamus, thalamic targets and trajectories, and electrophysiological methodology and findings. RESULTS sEEG investigations have included thalamic targets for both basic and clinical research purposes. Medial pulvinar, dorsomedial, anterior, and centromedian nuclei have been the most frequently studied. Few studies have reported any complications with thalamic sEEG implantation, and no studies have reported long-term complications. Various methods have been utilized to characterize thalamic activity in epileptic disorders including evoked potentials, power spectrograms, synchronization indices, and the epileptogenicity index. Thalamic intracranial recordings are beginning to be used to guide neuromodulation strategies including RNS and DBS, as well as to understand complex, network-dependent seizure disorders. CONCLUSIONS Inclusion of thalamic coverage during sEEG evaluation in drug-resistant epilepsy is a growing practice and is amenable to various methods of electrographic data analysis. Further study is required to establish well-defined criteria for thalamic implantation during invasive investigations as well as safety and ethical considerations.
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Affiliation(s)
| | | | | | - Jay R Gavvala
- 2Neurology, Baylor College of Medicine, Houston, Texas
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Warsi NM, Yan H, Suresh H, Wong SM, Arski ON, Gorodetsky C, Zhang K, Gouveia FV, Ibrahim GM. The anterior and centromedian thalamus: anatomy, function, and dysfunction in epilepsy. Epilepsy Res 2022; 182:106913. [DOI: 10.1016/j.eplepsyres.2022.106913] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/07/2022] [Accepted: 03/21/2022] [Indexed: 01/21/2023]
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10
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Richardson RM. Closed-Loop Brain Stimulation and Paradigm Shifts in Epilepsy Surgery. Neurol Clin 2022; 40:355-373. [PMID: 35465880 PMCID: PMC9271409 DOI: 10.1016/j.ncl.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advances in device technology have created greater flexibility in treating seizures as emergent properties of networks that exist on a local to global continuum. All patients with drug-resistant epilepsy are potential surgical candidates, given that intracranial neuromodulation through deep brain stimulation and responsive neurostimulation can reduce seizures and improve quality of life, even in multifocal and generalized epilepsies. To achieve this goal, indications and strategies for diagnostic epilepsy surgery are evolving. This article describes the state-of-the-art in epilepsy surgery and related changes in how we define indications for diagnostic and therapeutic surgical intervention.
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Ganti B, Chaitanya G, Balamurugan RS, Nagaraj N, Balasubramanian K, Pati S. Time-Series Generative Adversarial Network Approach of Deep Learning Improves Seizure Detection From the Human Thalamic SEEG. Front Neurol 2022; 13:755094. [PMID: 35250803 PMCID: PMC8889931 DOI: 10.3389/fneur.2022.755094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Seizure detection algorithms are often optimized to detect seizures from the epileptogenic cortex. However, in non-localizable epilepsies, the thalamus is frequently targeted for neuromodulation. Developing a reliable seizure detection algorithm from thalamic SEEG may facilitate the translation of closed-loop neuromodulation. Deep learning algorithms promise reliable seizure detectors, but the major impediment is the lack of larger samples of curated ictal thalamic SEEG needed for training classifiers. We aimed to investigate if synthetic data generated by temporal Generative Adversarial Networks (TGAN) can inflate the sample size to improve the performance of a deep learning classifier of ictal and interictal states from limited samples of thalamic SEEG. Thalamic SEEG from 13 patients (84 seizures) was obtained during stereo EEG evaluation for epilepsy surgery. Overall, TGAN generated synthetic data augmented the performance of the bidirectional Long-Short Term Memory (BiLSTM) performance in classifying thalamic ictal and baseline states. Adding synthetic data improved the accuracy of the detection model by 18.5%. Importantly, this approach can be applied to classify electrographic seizure onset patterns or develop patient-specific seizure detectors from implanted neuromodulation devices.
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Affiliation(s)
- Bhargava Ganti
- Department of Electronics and Communication Engineering, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Coimbatore, India
| | - Ganne Chaitanya
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, TX, United States
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Nithin Nagaraj
- Consciousness Studies Programme, National Institute of Advanced Studies, Bengaluru, India
| | - Karthi Balasubramanian
- Department of Electronics and Communication Engineering, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Coimbatore, India
| | - Sandipan Pati
- Texas Institute of Restorative Neurotechnologies, University of Texas Health Science Center, Houston, TX, United States
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
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Ictal high-frequency activity in limbic thalamic nuclei varies with electrographic seizure-onset patterns in temporal lobe epilepsy. Clin Neurophysiol 2022; 137:183-192. [DOI: 10.1016/j.clinph.2022.01.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 01/11/2023]
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13
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Gregg NM, Marks VS, Sladky V, Lundstrom BN, Klassen B, Messina SA, Brinkmann BH, Miller KJ, Van Gompel JJ, Kremen V, Worrell GA. Anterior nucleus of the thalamus seizure detection in ambulatory humans. Epilepsia 2021; 62:e158-e164. [PMID: 34418083 PMCID: PMC10122837 DOI: 10.1111/epi.17047] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 01/17/2023]
Abstract
There is a paucity of data to guide anterior nucleus of the thalamus (ANT) deep brain stimulation (DBS) with brain sensing. The clinical Medtronic Percept DBS device provides constrained brain sensing power within a frequency band (power-in-band [PIB]), recorded in 10-min averaged increments. Here, four patients with temporal lobe epilepsy were implanted with an investigational device providing full bandwidth chronic intracranial electroencephalogram (cEEG) from bilateral ANT and hippocampus (Hc). ANT PIB-based seizure detection was assessed. Detection parameters were cEEG PIB center frequency, bandwidth, and epoch duration. Performance was evaluated against epileptologist-confirmed Hc seizures, and assessed by area under the precision-recall curve (PR-AUC). Data included 99 days of cEEG, and 20, 278, 3, and 18 Hc seizures for Subjects 1-4. The best detector had 7-Hz center frequency, 5-Hz band width, and 10-s epoch duration (group PR-AUC = .90), with 75% sensitivity and .38 false alarms per day for Subject 1, and 100% and .0 for Subjects 3 and 4. Hc seizures in Subject 2 did not propagate to ANT. The relative change of ANT PIB was maximal ipsilateral to seizure onset for all detected seizures. Chronic ANT and Hc recordings provide direct guidance for ANT DBS with brain sensing.
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Affiliation(s)
- Nicholas M. Gregg
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Victoria S. Marks
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Vladimir Sladky
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Kladno, Czech Republic
| | - Brian N. Lundstrom
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryan Klassen
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven A. Messina
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin H. Brinkmann
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kai J. Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Vaclav Kremen
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - Gregory A. Worrell
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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14
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Tan G, Li X, Niu R, Wang H, Chen D, Gong Q, Liu L. Functional connectivity of the thalamocortical circuit in patients with seizure relapse after antiseizure medication withdrawal. Epilepsia 2021; 62:2463-2473. [PMID: 34342885 DOI: 10.1111/epi.17014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To characterize the features of thalamocortical functional connectivity during seizure recurrence at the time of antiseizure medication (ASM) withdrawal. METHODS Patients with chronic epilepsy who attempted to discontinue medications were prospectively registered and followed up; 19 patients remained seizure-free (SF-group), 18 patients had seizure relapses (SR-group) after ASM withdrawal, and 28 healthy controls were recruited. Resting-state functional magnetic resonance imaging was performed before ASM withdrawal. Thalamus subdivisions were set as seeds to calculate voxelwise functional connectivity. Partial correlation analysis between functional connectivity and clinical variables was performed. A support vector machine was used to assess the predictive ability of the specific functional connectivity for seizure relapse. RESULTS The within-group comparison indicated that the SR-group had more extensive functional connectivity than the SF-group; the left inferior pulvinar, left medial pulvinar, and right anterior pulvinar showed a significantly stronger functional connection with the precuneus in the SR-group than in the SF-group (Gaussian random field correction, voxel-level p < .001 and cluster-level p < .05). In the SR-group, a positive correlation was found between the left inferior pulvinar-precuneus connectivity and the active period (r = .46, p = .05), seizure-free period (r = .67, p = .002), and disease duration (r = .53, p = .02), and between the left medial pulvinar-precuneus connectivity and the seizure-free period (r = .58, p = .01). The combination of these thalamocortical connections showed a high predictive ability, with an area under the curve of .92 and accuracy of .90 (p = .01). SIGNIFICANCE This study determined distinct features of thalamocortical functional connectivity at the time of ASM withdrawal in patients with and without seizure relapse, showing a potential for predicting seizure outcomes following ASM withdrawal.
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Affiliation(s)
- Ge Tan
- Epilepsy Center, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiuli Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Running Niu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Haijiao Wang
- Epilepsy Center, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Deng Chen
- Epilepsy Center, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ling Liu
- Epilepsy Center, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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15
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Balzekas I, Sladky V, Nejedly P, Brinkmann BH, Crepeau D, Mivalt F, Gregg NM, Pal Attia T, Marks VS, Wheeler L, Riccelli TE, Staab JP, Lundstrom BN, Miller KJ, Van Gompel J, Kremen V, Croarkin PE, Worrell GA. Invasive Electrophysiology for Circuit Discovery and Study of Comorbid Psychiatric Disorders in Patients With Epilepsy: Challenges, Opportunities, and Novel Technologies. Front Hum Neurosci 2021; 15:702605. [PMID: 34381344 PMCID: PMC8349989 DOI: 10.3389/fnhum.2021.702605] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/29/2021] [Indexed: 01/10/2023] Open
Abstract
Intracranial electroencephalographic (iEEG) recordings from patients with epilepsy provide distinct opportunities and novel data for the study of co-occurring psychiatric disorders. Comorbid psychiatric disorders are very common in drug-resistant epilepsy and their added complexity warrants careful consideration. In this review, we first discuss psychiatric comorbidities and symptoms in patients with epilepsy. We describe how epilepsy can potentially impact patient presentation and how these factors can be addressed in the experimental designs of studies focused on the electrophysiologic correlates of mood. Second, we review emerging technologies to integrate long-term iEEG recording with dense behavioral tracking in naturalistic environments. Third, we explore questions on how best to address the intersection between epilepsy and psychiatric comorbidities. Advances in ambulatory iEEG and long-term behavioral monitoring technologies will be instrumental in studying the intersection of seizures, epilepsy, psychiatric comorbidities, and their underlying circuitry.
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Affiliation(s)
- Irena Balzekas
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
- Mayo Clinic Medical Scientist Training Program, Rochester, MN, United States
| | - Vladimir Sladky
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czechia
| | - Petr Nejedly
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Benjamin H. Brinkmann
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Daniel Crepeau
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Filip Mivalt
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Faculty of Electrical Engineering and Communication, Department of Biomedical Engineering, Brno University of Technology, Brno, Czechia
| | - Nicholas M. Gregg
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Tal Pal Attia
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Victoria S. Marks
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States
| | - Lydia Wheeler
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
| | - Tori E. Riccelli
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
| | - Jeffrey P. Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Brian Nils Lundstrom
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Kai J. Miller
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Jamie Van Gompel
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Vaclav Kremen
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czechia
| | - Paul E. Croarkin
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Gregory A. Worrell
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
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16
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Chaitanya G, Romeo AK, Ilyas A, Irannejad A, Toth E, Elsayed G, Bentley JN, Riley KO, Pati S. Robot-assisted stereoelectroencephalography exploration of the limbic thalamus in human focal epilepsy: implantation technique and complications in the first 24 patients. Neurosurg Focus 2021; 48:E2. [PMID: 32234983 DOI: 10.3171/2020.1.focus19887] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite numerous imaging studies highlighting the importance of the thalamus in a patient's surgical prognosis, human electrophysiological studies involving the limbic thalamic nuclei are limited. The objective of this study was to evaluate the safety and accuracy of robot-assisted stereotactic electrode placement in the limbic thalamic nuclei of patients with suspected temporal lobe epilepsy (TLE). METHODS After providing informed consent, 24 adults with drug-resistant, suspected TLE undergoing evaluation with stereoelectroencephalography (SEEG) were enrolled in the prospective study. The trajectory of one electrode planned for clinical sampling of the operculoinsular cortex was modified to extend it to the thalamus, thereby preventing the need for additional electrode placement for research. The anterior nucleus of the thalamus (ANT) (n = 13) and the medial group of thalamic nuclei (MED) (n = 11), including the mediodorsal and centromedian nuclei, were targeted. The postimplantation CT scan was coregistered to the preoperative MR image, and Morel's thalamic atlas was used to confirm the accuracy of implantation. RESULTS Ten (77%) of 13 patients in the ANT group and 10 (91%) of 11 patients in the MED group had electrodes accurately placed in the thalamic nuclei. None of the patients had a thalamic hemorrhage. However, trace asymptomatic hemorrhages at the cortical-level entry site were noted in 20.8% of patients, who did not require additional surgical intervention. SEEG data from all the patients were interpretable and analyzable. The trajectories for the ANT implant differed slightly from those of the MED group at the entry point-i.e., the precentral gyrus in the former and the postcentral gyrus in the latter. CONCLUSIONS Using judiciously planned robot-assisted SEEG, the authors demonstrate the safety of electrophysiological sampling from various thalamic nuclei for research recordings, presenting a technique that avoids implanting additional depth electrodes or compromising clinical care. With these results, we propose that if patients are fully informed of the risks involved, there are potential benefits of gaining mechanistic insights to seizure genesis, which may help to develop neuromodulation therapies.
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Affiliation(s)
- Ganne Chaitanya
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
| | - Andrew K Romeo
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Adeel Ilyas
- 2Epilepsy and Cognitive Neurophysiology Laboratory, and.,3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Auriana Irannejad
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
| | - Emilia Toth
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
| | - Galal Elsayed
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - J Nicole Bentley
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Kristen O Riley
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Sandipan Pati
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
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Hutson TN, Rezaei F, Gautier NM, Indumathy J, Glasscock E, Iasemidis L. Directed Connectivity Analysis of the Neuro-Cardio- and Respiratory Systems Reveals Novel Biomarkers of Susceptibility to SUDEP. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2020; 1:301-311. [PMID: 34223181 PMCID: PMC8249082 DOI: 10.1109/ojemb.2020.3036544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 01/11/2023] Open
Abstract
Goal: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality and its pathophysiological mechanisms remain unknown. We set to record and analyze for the first time concurrent electroencephalographic (EEG), electrocardiographic (ECG), and unrestrained whole-body plethysmographic (Pleth) signals from control (WT - wild type) and SUDEP-prone mice (KO- knockout Kcna1 animal model). Employing multivariate autoregressive models (MVAR) we measured all tri-organ effective directional interactions by the generalized partial directed coherence (GPDC) in the frequency domain over time (hours). When compared to the control (WT) animals, the SUDEP-prone (KO) animals exhibited (p < 0.001) reduced afferent and efferent interactions between the heart and the brain over the full frequency spectrum (0-200Hz), enhanced efferent interactions from the brain to the lungs and from the heart to the lungs at high (>90 Hz) frequencies (especially during periods with seizure activity), and decreased feedback from the lungs to the brain at low (<40 Hz) frequencies. These results show that impairment in the afferent and efferent pathways in the holistic neuro-cardio-respiratory network could lead to SUDEP, and effective connectivity measures and their dynamics could serve as novel biomarkers of susceptibility to SUDEP and seizures respectively.
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Affiliation(s)
- T. Noah Hutson
- Department of Biomedical EngineeringLouisiana Tech UniversityRustonLA71272USA
| | - Farnaz Rezaei
- Department of Mathematics and StatisticsLouisiana Tech UniversityRustonLA71272USA
| | - Nicole M. Gautier
- Department of Cellular Biology and AnatomyLouisiana State University Health Sciences CenterShreveportLA71130USA
| | - Jagadeeswaran Indumathy
- Department of PhysiologyJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - Edward Glasscock
- Department of Biological SciencesSouthern Methodist UniversityDallasTX75275USA
| | - Leonidas Iasemidis
- Department of Biomedical EngineeringLouisiana Tech UniversityRustonLA71272USA
- Center for Biomedical Engineering and Rehabilitation ScienceLouisiana Tech UniversityRustonLA71272USA
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18
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Toth E, Kumar S, Ganne C, Riley KO, Balasubramanian K, Pati S. Machine learning approach to detect focal-onset seizures in the human anterior nucleus of the thalamus. J Neural Eng 2020; 17. [PMID: 33059336 DOI: 10.1088/1741-2552/abc1b7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/15/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE There is an unmet need to develop seizure detection algorithms from brain regions outside the epileptogenic cortex. The study aimed to demonstrate the feasibility of classifying seizures and interictal states from local field potentials (LFPs) recorded from the human thalamus- a subcortical region remote to the epileptogenic cortex. We tested the hypothesis that spectral and entropy-based features extracted from LFPs recorded from the anterior nucleus of the thalamus (ANT) can distinguish its state of ictal recruitment from other interictal states (including awake, sleep). APPROACH Two supervised machine learning tools (random forest and the random kitchen sink) were used to evaluate the performance of spectral (discrete wavelet transform-DWT), and time-domain (multiscale entropy-MSE) features in classifying seizures from interictal states in patients undergoing stereo EEG evaluation for epilepsy surgery. Under the supervision of IRB, field potentials were recorded from the ANT in consenting adults with drug-resistant temporal lobe epilepsy. Seizures were confirmed in the ANT using line-length and visual inspection. Wilcoxon rank-sum (WRS) method was used to test the differences in spectral patterns between seizure and interictal (awake and sleep) states. MAIN RESULTS 79 seizures (10 patients) and 158 segments (approx. 4 hours) of interictal stereo EEG data were analyzed. The mean seizure detection latencies with line length in the ANT varied between seizure types (range 5-34 seconds). However, the DWT and MSE in the ANT showed significant changes for all seizure types within the first 20 seconds after seizure onset. The random forest (accuracy 93.9 % and false-positive 4.6%) and the random kitchen sink (accuracy 97.3% and false-positive 1.8%) classified seizures and interictal states. SIGNIFICANCE These results suggest that features extracted from the thalamic LFPs can be trained to detect seizures that can be used for monitoring seizure counts and for closed-loop seizure abortive interventions.
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Affiliation(s)
- Emilia Toth
- University of Alabama School of Medicine, Birmingham, Alabama, UNITED STATES
| | - Sachin Kumar
- Centre for Computational Engineering and Networking , Amrita Vishwa Vidyapeetham Amrita School of Engineering, Coimbatore, Tamil Nadu, INDIA
| | - Chaitanya Ganne
- Neurology, University of Alabama at Birmingham, 1720 7th Ave S, Suite 405F, SPARKS building, Birmingham, UNITED STATES
| | - Kristen O Riley
- Neurosurgery, University of Alabama School of Medicine, Birmingham, Alabama, UNITED STATES
| | - Karthi Balasubramanian
- Department of Electronics and Communication Engineering, Amrita Vishwa Vidyapeetham Amrita School of Engineering, Coimbatore, Tamil Nadu, INDIA
| | - Sandipan Pati
- University of Alabama School of Medicine, Birmingham, Alabama, 35294-3412, UNITED STATES
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19
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An N, Ye X, Liu Q, Xu J, Zhang P. Localization of the epileptogenic zone based on ictal stereo-electroencephalogram: Brain network and single-channel signal feature analysis. Epilepsy Res 2020; 167:106475. [PMID: 33045665 DOI: 10.1016/j.eplepsyres.2020.106475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/22/2020] [Accepted: 09/17/2020] [Indexed: 01/21/2023]
Abstract
Accurate localization of the epileptogenic zone (EZ) is crucial for refractory focal epilepsy patients to achieve freedom from seizures following epilepsy surgery. In this study, ictal stereo-electroencephalography data from 35 patients with refractory focal epilepsy were analyzed. Effective networks based on partial directed coherence were analyzed, and a gray level co-occurrence matrix was applied to extract the time-varying features of the in-degree. These features, combined with the single-channel signal time-frequency features, including approximate entropy and line length, were used to localize the EZ based on a cluster algorithm. For all seizure-free patients (n = 23), the proposed method was effective in identifying the clinical-EZ-contacts and clinical-EZ-blocks, with an F1-score of 62.47 % and 72.18 %, respectively. The sensitivity was 96.00 % for the clinical-EZ-block identification, which provided the information for the decision-making of clinicians, prompting clinicians to focus on the identified EZ-blocks and their nearby contacts. The agreement between the EZ identified by the proposed method and the clinical-EZ was worse for non-seizure-free patients (n = 12) than for seizure-free patients. Furthermore, our method provided better results than using only brain network or single-channel signal features. This suggests that combining these complementary features can facilitate more accurate localization of the EZ.
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Affiliation(s)
- Nan An
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Xiaolai Ye
- Department of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
| | - Qiangqiang Liu
- Department of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
| | - Jiwen Xu
- Department of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
| | - Puming Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
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20
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21
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Chaitanya G, Toth E, Pizarro D, Iasemidis L, Murray TA, Riley K, Pati S. Acute modulation of the limbic network with low and high-frequency stimulation of the human fornix. Epilepsy Behav Rep 2020; 14:100363. [PMID: 32435756 PMCID: PMC7232081 DOI: 10.1016/j.ebr.2020.100363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/11/2022] Open
Abstract
Targeted stimulation of white matter has opened newer perspectives in the field of neuromodulation, towards an attempt to improve memory or as a therapy for epilepsy. Stimulation of the fornix, being a part of the Papez circuit, is likely to modulate the limbic network excitability. However, the stimulation-frequency dependent variability in network excitability is unknown. In the case study, which involved stereo electroencephalographic (SEEG) recording of field potentials in a 48-year old left-handed woman with suspected temporal lobe epilepsy, we demonstrated the network effects of acute low (1 and 10 Hz) and high (50 Hz) frequency electrical stimulation of fornix. Mapping the short-latency evoked responses to forniceal stimulation confirmed the SEEG target localization within the Papez circuit. Low and high-frequency stimulation of the fornix produced opposite effects in the post-stimuli excitability, with the latter causing increased excitability in the limbic network that culminated in a clinical seizure. A distinct spectral peak around 8 Hz confirmed that sensing field potentials from the forniceal white matter is feasible. This is the first case study that provided an insight into how the temporal patterning of forniceal stimulation altered the downstream limbic network excitability.
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Affiliation(s)
- Ganne Chaitanya
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emilia Toth
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Diana Pizarro
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leonidas Iasemidis
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Tech Institute, Ruston, LA, USA
| | - Teresa A. Murray
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Tech Institute, Ruston, LA, USA
| | - Kristen Riley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandipan Pati
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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22
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Jaisani Z, Miletich RS, Ramanathan M, Weinstock AL. Clinical FDG‐PET Findings in Patients with Temporal Lobe Epilepsy: Concordance with EEG and MRI. J Neuroimaging 2019; 30:119-125. [DOI: 10.1111/jon.12671] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
- Zeenat Jaisani
- Department of NeurologyUniversity of Alabama at Birmingham (UAB) Birmingham AL
| | - Robert S. Miletich
- Department of Nuclear MedicineUniversity at Buffalo, Jacobs School of Medicine and Biomedical Sciences Buffalo NY
| | - Murali Ramanathan
- Department of Pharmacological SciencesUniversity at Buffalo Buffalo NY
| | - Arie L. Weinstock
- Department of NeurologyUniversity at Buffalo, Jacobs School of Medicine and Biomedical Sciences Buffalo NY
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