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Palao-Duarte S, Altenmüller DM, Scheiwe C, Schinkel A, Mast H, Urbach H, Demerath T, Schwabenland M, Schulze-Bonhage A, Wagner K, Heers M. Electrical stimulation mapping guides individualized surgical approach in an epilepsy-associated tumor within language representing cortex. Epileptic Disord 2024; 26:548-551. [PMID: 38787795 DOI: 10.1002/epd2.20245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/18/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Affiliation(s)
- Susana Palao-Duarte
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
| | - Dirk-Matthias Altenmüller
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
| | - Anika Schinkel
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
| | - Hansjörg Mast
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
| | - Marius Schwabenland
- Institute of Neuropathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
| | - Kathrin Wagner
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
| | - Marcel Heers
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
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2
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Wu S, Issa NP, Rose SL, Haider HA, Nordli DR, Towle VL, Warnke PC, Tao JX. Depth versus surface: A critical review of subdural and depth electrodes in intracranial electroencephalographic studies. Epilepsia 2024; 65:1868-1878. [PMID: 38722693 DOI: 10.1111/epi.18002] [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: 01/02/2024] [Revised: 04/05/2024] [Accepted: 04/24/2024] [Indexed: 07/17/2024]
Abstract
Intracranial electroencephalographic (IEEG) recording, using subdural electrodes (SDEs) and stereoelectroencephalography (SEEG), plays a pivotal role in localizing the epileptogenic zone (EZ). SDEs, employed for superficial cortical seizure foci localization, provide information on two-dimensional seizure onset and propagation. In contrast, SEEG, with its three-dimensional sampling, allows exploration of deep brain structures, sulcal folds, and bihemispheric networks. SEEG offers the advantages of fewer complications, better tolerability, and coverage of sulci. Although both modalities allow electrical stimulation, SDE mapping can tessellate cortical gyri, providing the opportunity for a tailored resection. With SEEG, both superficial gyri and deep sulci can be stimulated, and there is a lower risk of afterdischarges and stimulation-induced seizures. Most systematic reviews and meta-analyses have addressed the comparative effectiveness of SDEs and SEEG in localizing the EZ and achieving seizure freedom, although discrepancies persist in the literature. The combination of SDEs and SEEG could potentially overcome the limitations inherent to each technique individually, better delineating seizure foci. This review describes the strengths and limitations of SDE and SEEG recordings, highlighting their unique indications in seizure localization, as evidenced by recent publications. Addressing controversies in the perceived usefulness of the two techniques offers insights that can aid in selecting the most suitable IEEG in clinical practice.
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Affiliation(s)
- Shasha Wu
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Sandra L Rose
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Hiba A Haider
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Douglas R Nordli
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Vernon L Towle
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
| | - James X Tao
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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3
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Yu L, Dugan P, Doyle W, Devinsky O, Friedman D, Flinker A. A left-lateralized dorsolateral prefrontal network for naming. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.15.594403. [PMID: 38798614 PMCID: PMC11118423 DOI: 10.1101/2024.05.15.594403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
The ability to connect the form and meaning of a concept, known as word retrieval, is fundamental to human communication. While various input modalities could lead to identical word retrieval, the exact neural dynamics supporting this convergence relevant to daily auditory discourse remain poorly understood. Here, we leveraged neurosurgical electrocorticographic (ECoG) recordings from 48 patients and dissociated two key language networks that highly overlap in time and space integral to word retrieval. Using unsupervised temporal clustering techniques, we found a semantic processing network located in the middle and inferior frontal gyri. This network was distinct from an articulatory planning network in the inferior frontal and precentral gyri, which was agnostic to input modalities. Functionally, we confirmed that the semantic processing network encodes word surprisal during sentence perception. Our findings characterize how humans integrate ongoing auditory semantic information over time, a critical linguistic function from passive comprehension to daily discourse.
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Affiliation(s)
- Leyao Yu
- Department of Biomedical Engineering, New York University, New York, 10016, New York, the United States
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Patricia Dugan
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Werner Doyle
- Department of Neurosurgery, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Orrin Devinsky
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Daniel Friedman
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Adeen Flinker
- Department of Biomedical Engineering, New York University, New York, 10016, New York, the United States
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
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4
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Kabakoff H, Yu L, Friedman D, Dugan P, Doyle WK, Devinsky O, Flinker A. Timing and location of speech errors induced by direct cortical stimulation. Brain Commun 2024; 6:fcae053. [PMID: 38505231 PMCID: PMC10948744 DOI: 10.1093/braincomms/fcae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/30/2023] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Cortical regions supporting speech production are commonly established using neuroimaging techniques in both research and clinical settings. However, for neurosurgical purposes, structural function is routinely mapped peri-operatively using direct electrocortical stimulation. While this method is the gold standard for identification of eloquent cortical regions to preserve in neurosurgical patients, there is lack of specificity of the actual underlying cognitive processes being interrupted. To address this, we propose mapping the temporal dynamics of speech arrest across peri-sylvian cortices by quantifying the latency between stimulation and speech deficits. In doing so, we are able to substantiate hypotheses about distinct region-specific functional roles (e.g. planning versus motor execution). In this retrospective observational study, we analysed 20 patients (12 female; age range 14-43) with refractory epilepsy who underwent continuous extra-operative intracranial EEG monitoring of an automatic speech task during clinical bedside language mapping. Latency to speech arrest was calculated as time from stimulation onset to speech arrest onset, controlling for individual speech rate. Most instances of motor-based arrest (87.5% of 96 instances) were in sensorimotor cortex with mid-range latencies to speech arrest with a distributional peak at 0.47 s. Speech arrest occurred in numerous regions, with relatively short latencies in supramarginal gyrus (0.46 s), superior temporal gyrus (0.51 s) and middle temporal gyrus (0.54 s), followed by relatively long latencies in sensorimotor cortex (0.72 s) and especially long latencies in inferior frontal gyrus (0.95 s). Non-parametric testing for speech arrest revealed that region predicted latency; latencies in supramarginal gyrus and in superior temporal gyrus were shorter than in sensorimotor cortex and in inferior frontal gyrus. Sensorimotor cortex is primarily responsible for motor-based arrest. Latencies to speech arrest in supramarginal gyrus and superior temporal gyrus (and to a lesser extent middle temporal gyrus) align with latencies to motor-based arrest in sensorimotor cortex. This pattern of relatively quick cessation of speech suggests that stimulating these regions interferes with the outgoing motor execution. In contrast, the latencies to speech arrest in inferior frontal gyrus and in ventral regions of sensorimotor cortex were significantly longer than those in temporoparietal regions. Longer latencies in the more frontal areas (including inferior frontal gyrus and ventral areas of precentral gyrus and postcentral gyrus) suggest that stimulating these areas interrupts a higher-level speech production process involved in planning. These results implicate the ventral specialization of sensorimotor cortex (including both precentral and postcentral gyri) for speech planning above and beyond motor execution.
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Affiliation(s)
- Heather Kabakoff
- Department of Neurology, New York University School of Medicine, New York, NY 10016, USA
| | - Leyao Yu
- Department of Biomedical Engineering, New York University School of Engineering, Brooklyn, NY 11201, USA
| | - Daniel Friedman
- Department of Neurology, New York University School of Medicine, New York, NY 10016, USA
| | - Patricia Dugan
- Department of Neurology, New York University School of Medicine, New York, NY 10016, USA
| | - Werner K Doyle
- Department of Neurosurgery, New York University School of Medicine, New York, NY 10016, USA
| | - Orrin Devinsky
- Department of Neurology, New York University School of Medicine, New York, NY 10016, USA
| | - Adeen Flinker
- Department of Neurology, New York University School of Medicine, New York, NY 10016, USA
- Department of Biomedical Engineering, New York University School of Engineering, Brooklyn, NY 11201, USA
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5
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Liuzzi AG, Meersmans K, Peeters R, De Deyne S, Dupont P, Vandenberghe R. Semantic representations in inferior frontal and lateral temporal cortex during picture naming, reading, and repetition. Hum Brain Mapp 2024; 45:e26603. [PMID: 38339900 PMCID: PMC10836176 DOI: 10.1002/hbm.26603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/12/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024] Open
Abstract
Reading, naming, and repetition are classical neuropsychological tasks widely used in the clinic and psycholinguistic research. While reading and repetition can be accomplished by following a direct or an indirect route, pictures can be named only by means of semantic mediation. By means of fMRI multivariate pattern analysis, we evaluated whether this well-established fundamental difference at the cognitive level is associated at the brain level with a difference in the degree to which semantic representations are activated during these tasks. Semantic similarity between words was estimated based on a word association model. Twenty subjects participated in an event-related fMRI study where the three tasks were presented in pseudo-random order. Linear discriminant analysis of fMRI patterns identified a set of regions that allow to discriminate between words at a high level of word-specificity across tasks. Representational similarity analysis was used to determine whether semantic similarity was represented in these regions and whether this depended on the task performed. The similarity between neural patterns of the left Brodmann area 45 (BA45) and of the superior portion of the left supramarginal gyrus correlated with the similarity in meaning between entities during picture naming. In both regions, no significant effects were seen for repetition or reading. The semantic similarity effect during picture naming was significantly larger than the similarity effect during the two other tasks. In contrast, several regions including left anterior superior temporal gyrus and left ventral BA44/frontal operculum, among others, coded for semantic similarity in a task-independent manner. These findings provide new evidence for the dynamic, task-dependent nature of semantic representations in the left BA45 and a more task-independent nature of the representational activation in the lateral temporal cortex and ventral BA44/frontal operculum.
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Affiliation(s)
- Antonietta Gabriella Liuzzi
- Laboratory for Cognitive Neurology, Department of NeurosciencesLeuven Brain Institute, KU LeuvenLeuvenBelgium
| | - Karen Meersmans
- Laboratory for Cognitive Neurology, Department of NeurosciencesLeuven Brain Institute, KU LeuvenLeuvenBelgium
| | - Ronald Peeters
- Radiology DepartmentUniversity Hospitals LeuvenLeuvenBelgium
| | - Simon De Deyne
- School of Psychological SciencesUniversity of MelbourneMelbourneAustralia
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of NeurosciencesLeuven Brain Institute, KU LeuvenLeuvenBelgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of NeurosciencesLeuven Brain Institute, KU LeuvenLeuvenBelgium
- Neurology DepartmentUniversity Hospitals LeuvenLeuvenBelgium
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Kabakoff H, Yu L, Friedman D, Dugan P, Doyle WK, Devinsky O, Flinker A. Timing and location of speech errors induced by direct cortical stimulation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.09.14.557732. [PMID: 37745363 PMCID: PMC10515921 DOI: 10.1101/2023.09.14.557732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Cortical regions supporting speech production are commonly established using neuroimaging techniques in both research and clinical settings. However, for neurosurgical purposes, structural function is routinely mapped peri-operatively using direct electrocortical stimulation. While this method is the gold standard for identification of eloquent cortical regions to preserve in neurosurgical patients, there is lack of specificity of the actual underlying cognitive processes being interrupted. To address this, we propose mapping the temporal dynamics of speech arrest across peri-sylvian cortices by quantifying the latency between stimulation and speech deficits. In doing so, we are able to substantiate hypotheses about distinct region-specific functional roles (e.g., planning versus motor execution). In this retrospective observational study, we analyzed 20 patients (12 female; age range 14-43) with refractory epilepsy who underwent continuous extra-operative intracranial EEG monitoring of an automatic speech task during clinical bedside language mapping. Latency to speech arrest was calculated as time from stimulation onset to speech arrest onset, controlling for individual speech rate. Most instances of motor-based arrest (87.5% of 96 instances) were in sensorimotor cortex with mid-range latencies to speech arrest with a distributional peak at 0.47 seconds. Speech arrest occurred in numerous regions, with relatively short latencies in supramarginal gyrus (0.46 seconds), superior temporal gyrus (0.51 seconds), and middle temporal gyrus (0.54 seconds), followed by relatively long latencies in sensorimotor cortex (0.72 seconds) and especially long latencies in inferior frontal gyrus (0.95 seconds). Nonparametric testing for speech arrest revealed that region predicted latency; latencies in supramarginal gyrus and in superior temporal gyrus were shorter than in sensorimotor cortex and in inferior frontal gyrus. Sensorimotor cortex is primarily responsible for motor-based arrest. Latencies to speech arrest in supramarginal gyrus and superior temporal gyrus (and to a lesser extent middle temporal gyrus) align with latencies to motor-based arrest in sensorimotor cortex. This pattern of relatively quick cessation of speech suggests that stimulating these regions interferes with the outgoing motor execution. In contrast, the latencies to speech arrest in inferior frontal gyrus and in ventral regions of sensorimotor cortex were significantly longer than those in temporoparietal regions. Longer latencies in the more frontal areas (including inferior frontal gyrus and ventral areas of precentral gyrus and postcentral gyrus) suggest that stimulating these areas interrupts a higher-level speech production process involved in planning. These results implicate the ventral specialization of sensorimotor cortex (including both precentral and postcentral gyri) for speech planning above and beyond motor execution.
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Affiliation(s)
- Heather Kabakoff
- Department of Neurology, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - Leyao Yu
- Department of Biomedical Engineering, New York University School of Engineering, 6 MetroTech Center Ave., Brooklyn, NY, 11201, USA
| | - Daniel Friedman
- Department of Neurology, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - Patricia Dugan
- Department of Neurology, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - Werner K Doyle
- Department of Neurosurgery, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - Orrin Devinsky
- Department of Neurology, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - Adeen Flinker
- Department of Neurology, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
- Department of Biomedical Engineering, New York University School of Engineering, 6 MetroTech Center Ave., Brooklyn, NY, 11201, USA
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Arya R, Frink C, Kargol C, Byars AW, Huddleston D, Diedenhofer DB, Aungaroon G, Ervin B, Horn PS, Ihnen SKZ, Tenney JR, Kremer K, Fong S, Lin N, Liu W, Arthur TM, Skoch J, Leach JL, Mangano FT, Glauser TA, Greiner HM, Holland KD. Neuropsychological outcomes after epilepsy surgery: A comparison of stereo electroencephalography and subdural electrodes. Eur J Neurol 2023; 30:2986-2998. [PMID: 37329329 PMCID: PMC10529267 DOI: 10.1111/ene.15929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND PURPOSE We analyzed the association of neuropsychological outcomes after epilepsy surgery with the intracranial electrode type (stereo electroencephalography [SEEG] and subdural electrodes [SDE]), and electrical stimulation mapping (ESM) of speech/language. METHODS Drug-resistant epilepsy patients who underwent comprehensive neuropsychological evaluation before and 1 year after epilepsy surgery were included. SEEG and SDE subgroups were matched by age, handedness, operated hemisphere, and seizure freedom. Postsurgical neuropsychological outcomes (adjusted for presurgical scores) and reliable change indices were analyzed as functions of electrode type and ESM. RESULTS Ninety-nine patients aged 6-29 years were included with similar surgical resection/ablation volumes in the SEEG and SDE subgroups. Most of the neuropsychological outcomes were comparable between SEEG and SDE subgroups; however, Working Memory and Processing Speed were significantly improved in the SEEG subgroup. Undergoing language ESM was associated with significant improvements in Spelling, Letter-Word Identification, Vocabulary, Verbal Comprehension, Verbal Learning, and Story Memory scores, but a decline in Calculation scores. CONCLUSIONS Intracranial evaluations with SEEG and SDE are comparable in terms of long-term postsurgical neuropsychological outcomes. Our data suggest that SEEG may be associated with improvements in working memory and processing speed, representing cognitive domains served by spatially distributed networks. Our study also supports wider use of language ESM before epilepsy surgery, preferably using other language tasks in addition to visual naming. Rather than the type of electrode, postsurgical neuropsychological outcomes are driven by whether language ESM was performed or not, with beneficial effects of language mapping.
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Affiliation(s)
- Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, USA
| | - Clayton Frink
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christina Kargol
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David Huddleston
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Donna B Diedenhofer
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brian Ervin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - S K Z Ihnen
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jeffrey R Tenney
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kelly Kremer
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susan Fong
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nan Lin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Wei Liu
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Todd M Arthur
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jesse Skoch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James L Leach
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pediatric Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Francesco T Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tracy A Glauser
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Cockle E, Rayner G, Malpas C, Alpitsis R, Rheims S, O'Brien TJ, Neal A. An international survey of SEEG cortical stimulation practices. Epilepsia Open 2023; 8:1084-1095. [PMID: 37437189 PMCID: PMC10472359 DOI: 10.1002/epi4.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE Cortical stimulation is an important component of stereoelectroencephalography (SEEG). Despite this, there is currently no standardized approach and significant heterogeneity in the literature regarding cortical stimulation practices. Via an international survey of SEEG clinicians, we sought to examine the spectrum of cortical stimulation practices to reveal areas of consensus and variability. METHODS A 68-item questionnaire was developed to understand cortical stimulation practices including neurostimulation parameters, interpretation of epileptogenicity, functional and cognitive assessment and subsequent surgical decisions. Multiple recruitment pathways were pursued, with the questionnaire distributed directly to 183 clinicians. RESULTS Responses were received from 56 clinicians across 17 countries with experience ranging from 2 to 60 years (M = 10.73, SD = 9.44). Neurostimulation parameters varied considerably, with maximum current ranging from 3 to 10 mA (M = 5.33, SD = 2.29) for 1 Hz and from 2 to 15 mA (M = 6.54, SD = 3.68) for 50 Hz stimulation. Charge density ranged from 8 to 200 μC/cm2 , with up to 43% of responders utilizing charge densities higher than recommended upper safety limits, i.e. 55 μC/cm2 . North American responders reported statistically significant higher maximum current (P < 0.001) for 1 Hz stimulation and lower pulse width for 1 and 50 Hz stimulation (P = 0.008, P < 0.001, respectively) compared to European responders. All clinicians evaluated language, speech, and motor function during cortical stimulation; in contrast, 42% assessed visuospatial or visual function, 29% memory, and 13% executive function. Striking differences were reported in approaches to assessment, classification of positive sites, and surgical decisions guided by cortical stimulation. Patterns of consistency were observed for interpretation of the localizing capacity of stimulated electroclinical seizures and auras, with habitual electroclinical seizures induced by 1 Hz stimulation considered the most localizing. SIGNIFICANCE SEEG cortical stimulation practices differed vastly across clinicians internationally, highlighting the need for consensus-based clinical guidelines. In particular, an internationally standardized approach to assessment, classification, and functional prognostication will provide a common clinical and research framework for optimizing outcomes for people with drug-resistant epilepsy.
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Affiliation(s)
- Emily Cockle
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Genevieve Rayner
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Melbourne School of Psychological SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Charles Malpas
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Melbourne School of Psychological SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Medicine, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
| | - Rubina Alpitsis
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Sylvain Rheims
- Lyon Neurosciences Research Center (Inserm U1028, CNRS UMR5292, Lyon 1 University)LyonFrance
- Department of Functional Neurology and EpileptologyHospices Civils de Lyon and Lyon 1 UniversityLyonFrance
- Epilepsy Institute and member of the ERN EpiCARELyonFrance
| | - Terence J O'Brien
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Andrew Neal
- Department of NeurologyAlfred HospitalMelbourneVictoriaAustralia
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
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9
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Aungaroon G, Vedala K, Byars AW, Ervin B, Rozhkov L, Horn PS, Ihnen S, Holland KD, Tenney JR, Kremer K, Fong SL, Lin N, Liu W, Arthur TM, Fujiwara H, Skoch J, Leach JL, Mangano FT, Greiner HM, Arya R. Comparing electrical stimulation functional mapping with subdural electrodes and stereoelectroencephalography. Epilepsia 2023; 64:1527-1540. [PMID: 36872854 PMCID: PMC10239361 DOI: 10.1111/epi.17575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Electrical stimulation mapping (ESM) is the clinical standard for functional localization with subdural electrodes (SDE). As stereoelectroencephalography (SEEG) has emerged as an alternative option, we compared functional responses, afterdischarges (ADs), and unwanted ESM-induced seizures (EISs) between the two electrode types. METHODS Incidence and current thresholds for functional responses (sensory, motor, speech/language), ADs, and EISs were compared between SDE and SEEG using mixed models incorporating relevant covariates. RESULTS We identified 67 SEEG ESM and 106 SDE ESM patients (7207 and 4980 stimulated contacts, respectively). We found similar incidence of language and motor responses between electrode types; however, more SEEG patients reported sensory responses. ADs and EISs occurred less commonly with SEEG than SDE. Current thresholds for language, face motor, and upper extremity (UE) motor responses and EIS significantly decreased with age. However, they were not affected by electrode type, premedication, or dominant hemispheric stimulation. AD thresholds were higher with SEEG than with SDE. For SEEG ESM, language thresholds remained below AD thresholds up to 26 years of age, whereas this relationship was inverse for SDE. Also, face and UE motor thresholds fell below AD thresholds at earlier ages for SEEG than SDE. AD and EIS thresholds were not affected by premedication. SIGNIFICANCE SEEG and SDE have clinically relevant differences for functional brain mapping with electrical stimulation. Although evaluation of language and motor regions is comparable between SEEG and SDE, SEEG offers a higher likelihood of identifying sensory areas. A lower incidence of ADs and EISs, and a favorable relationship between functional and AD thresholds suggest superior safety and neurophysiologic validity for SEEG ESM than SDE ESM.
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Affiliation(s)
- Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Kishore Vedala
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Anna W. Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Brian Ervin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Paul S. Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - S.K.Z. Ihnen
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katherine D. Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Jeffrey R. Tenney
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Kelly Kremer
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Susan L. Fong
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Nan Lin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Wei Liu
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Todd M. Arthur
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Hisako Fujiwara
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Jesse Skoch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - James L. Leach
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neuroradiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Francesco T. Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Hansel M. Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, U.S.A
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10
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Cornwell MA, Kohn A, Spat-Lemus J, Bender HA, Koay JM, McLean E, Mandelbaum S, Wing H, Sacks-Zimmerman A. Foundations of Neuropsychology: Collaborative Care in Neurosurgery. World Neurosurg 2023; 170:268-276. [PMID: 36782425 DOI: 10.1016/j.wneu.2022.09.106] [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: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 02/11/2023]
Abstract
The disciplines of neuropsychology and neurosurgery have a history of partnership that has improved prognoses for patients with neurologic diagnoses that once had poor outcomes. This article outlines the evolution of this relationship and describes the current role that clinical neuropsychology has within a department of neurological surgery across the preoperative, intraoperative, and postoperative stages of treatment. Understanding the foundations of collaboration between neuropsychology and neurosurgery contextualizes present challenges and future innovations for advancing excellence along the continuum of care for all neurosurgical patients.
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Affiliation(s)
- Melinda A Cornwell
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aviva Kohn
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Ferkauf Graduate School of Psychology, Bronx, New York, USA
| | - Jessica Spat-Lemus
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - H Allison Bender
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Jun Min Koay
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Erin McLean
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Sarah Mandelbaum
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Ferkauf Graduate School of Psychology, Bronx, New York, USA
| | - Hannah Wing
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Fordham University Graduate School of Education, New York, New York, USA
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11
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Intermediate stimulation frequencies for language mapping using Stereo-EEG. Clin Neurophysiol 2022; 144:91-97. [PMID: 36327599 DOI: 10.1016/j.clinph.2022.10.003] [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: 05/25/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Identification of eloquent cortices is a prerequisite for the surgical plan but may be challenging, in particular for language areas (LAs), considering the complexity of language function and organization. Electrical intracerebral stimulations (ES) during Stereo-electroencephalography are an essential tool in the localization of LAs and high frequency ES (HFS, 50 Hz) are current gold standard. Low frequencies (1 Hz) are not effective. We aim to investigate different ES frequencies for establishing their utility in localizing LAs. METHODS We implemented an observational and prospective study evaluating frequencies lower than 50 and higher than 1 Hz; indicated as "intermediate" frequencies (IFS) performed at 6, 9 and 12 Hz and lasting 15 seconds. We included ten patients and carried out a standardized protocol comparing IFS to HFS. RESULTS Eighty-six ES were carried out in LAs, positive for a language interference in 61.6% without noteworthy difference between IFS and HFS. Among these, 53.3% IFS vs 21.7% HFS yielded no after-discharge. CONCLUSIONS IFS were similarly effective as HFS, with lower incidence of ADs. Their longer duration facilitated more accurate clinical testing. SIGNIFICANCE Our results are promising, suggesting that IFS can be useful in the study of LAs.
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12
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Kakinuma K, Osawa SI, Hosokawa H, Oyafuso M, Ota S, Kobayashi E, Kawakami N, Ukishiro K, Jin K, Ishida M, Sato T, Sakamoto M, Niizuma K, Tominaga T, Nakasato N, Suzuki K. Determination of language areas in patients with epilepsy using the super-selective Wada test. IBRO Neurosci Rep 2022; 13:156-163. [PMID: 36039070 PMCID: PMC9418183 DOI: 10.1016/j.ibneur.2022.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
The Wada test is the gold standard for determining language-dominant hemisphere. However, the precise determination of language areas in each patient requires more invasive methods, such as electrocortical stimulation. Some studies have reported the use of anesthetic injection into selective cerebral arteries to predict postoperative function. To assess the function of the anterior and posterior language areas separately, we developed an advanced test named the "super-selective Wada test" (ssWada). The ssWada procedure is as follows: an endovascular neurosurgeon identifies the arterial branches of the middle cerebral artery (MCA) perfusing the anterior language area of the inferior frontal gyrus and the posterior language area of the posterior part of the superior temporal gyrus using angiography. Behavioral neurologists assess language symptoms before and after propofol administration using a microcatheter tip in the selected arterial branch. From 30 serial patients with epilepsy who underwent ssWada test at Tohoku University Hospital, we retrospectively reviewed patients in whom multiple areas in the bilateral MCA region was examined. Eight cases were identified in this study. All eight cases had been considered for resection of the area overlapping the classical language area. Three of the eight cases were left-dominant, and the within-hemisphere distribution was also considered typical. One case was determined to be left-dominant but atypical in the intra-hemispheric functional distribution. Two cases were right-dominant, and the intra-hemispheric functional distribution was considered a mirror image of the typical pattern. The remaining two cases were considered atypical, not only in terms of bilateral language function, but also in terms of anterior-posterior functional distribution. This case series demonstrates the potential utility of ssWada in revealing separate function of the anterior and posterior language areas. The ssWada allows simulation of local surgical brain resection and detailed investigation of language function, which potentially contributes to planning the resection area. Although indications for ssWada are quite limited, it could play a complementary role to noninvasive testing because it provides information related to resection using a different approach.
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Key Words
- CTA, computed tomography angiography
- ECD, equivalent current dipole
- ECS, electrocortical stimulation
- EEG, electroencephalography
- Epilepsy
- Epilepsy surgery
- Functional mapping
- Lateralization
- M2 inf, M2 inferior division of middle cerebral artery
- M2 sup, M2 superior division of middle cerebral artery
- MCA, middle cerebral artery
- MEG, magnetoencephalography
- Preoperative planning
- Wada test
- fMRI, functional magnetic resonance imaging
- ssWada, super-selective Wada test
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Affiliation(s)
- Kazuo Kakinuma
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Shin-ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Hiroaki Hosokawa
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
- Department of Rehabilitation, National Hospital Organization Sendai-Nishitaga Hospital, 2-11-11 Kagitorihoncho, Taihaku, Sendai, Miyagi 982-8555, Japan
| | - Marie Oyafuso
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Shoko Ota
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Erena Kobayashi
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
- Department of Neurology and Stroke Medicine, Yokohama City University School of Medicine, Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan
| | - Nobuko Kawakami
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Makoto Ishida
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Takafumi Sato
- Clinical Physiological Laboratory, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi 980-8574, Japan
| | - Mika Sakamoto
- Clinical Physiological Laboratory, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi 980-8574, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
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13
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Holloway T, Leach JL, Tenney JR, Byars AW, Horn PS, Greiner HM, Mangano FT, Holland KD, Arya R. Functional MRI and electrical stimulation mapping for language localization: A comparative meta-analysis. Clin Neurol Neurosurg 2022; 222:107417. [DOI: 10.1016/j.clineuro.2022.107417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022]
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14
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Aron O, Krieg J, Brissart H, Abdallah C, Colnat-Coulbois S, Jonas J, Maillard L. Naming impairments evoked by focal cortical electrical stimulation in the ventral temporal cortex correlate with increased functional connectivity. Neurophysiol Clin 2022; 52:312-322. [PMID: 35777988 DOI: 10.1016/j.neucli.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND High-frequency cortical electrical stimulations (HF-CES) are the gold standard for presurgical functional mapping. In the dominant ventral temporal cortex (VTC) HF-CES can elicit transient naming impairment (eloquent sites), defining a basal temporal language area (BTLA). OBJECTIVE Whether naming impairments induced by HF-CES within the VTC are related to a specific pattern of connectivity of the BTLA within the temporal lobe remains unknown. We addressed this issue by comparing the connectivity of eloquent and non-eloquent sites from the VTC using cortico-cortical evoked potentials (CCEP). METHODS Low frequency cortical electrical stimulations (LF-CES) were used to evoke CCEP in nine individual brains explored with Stereo-Electroencephalography. We compared the connectivity of eloquent versus non eloquent sites within the VTC using Pearson's correlation matrix. RESULTS Overall, within the VTC, eloquent sites were associated with increased functional connectivity compared to non-eloquent sites. Among the VTC structures, this pattern holds true for the inferior temporal gyrus and the parahippocampal gyrus while the fusiform gyrus specifically showed a high connectivity in both non eloquent and eloquent sites. CONCLUSIONS Our findings suggest that the cognitive effects of focal HF-CES are related to the functional connectivity properties of the stimulated sites, and therefore to the disturbance of a wide cortical network. They further suggest that functional specialization of a cortical region emerges from its specific pattern of functional connectivity. Cortical electrical stimulation functional mapping protocols including LF coupled to HF-CES could provide valuable data characterizing both local and distant functional architecture.
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Affiliation(s)
- Olivier Aron
- Department of Neurology, University Hospital of Nancy, Lorraine University, F-54000 Nancy, France; Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR, 7039 Vandoeuvre, France.
| | - Julien Krieg
- Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR, 7039 Vandoeuvre, France
| | - Helene Brissart
- Department of Neurology, University Hospital of Nancy, Lorraine University, F-54000 Nancy, France
| | - Chifaou Abdallah
- Neurology and Neurosurgery Department, Montreal Neurological Institute (C.A.) McGill University, Montreal, Quebec, Canada
| | - Sophie Colnat-Coulbois
- Department of Neurosurgery, University Hospital of Nancy, Lorraine University, F-54000 Nancy, France; Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR, 7039 Vandoeuvre, France
| | - Jacques Jonas
- Department of Neurology, University Hospital of Nancy, Lorraine University, F-54000 Nancy, France; Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR, 7039 Vandoeuvre, France
| | - Louis Maillard
- Department of Neurology, University Hospital of Nancy, Lorraine University, F-54000 Nancy, France; Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR, 7039 Vandoeuvre, France
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15
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Arya R, Ervin B, Buroker J, Greiner HM, Byars AW, Rozhkov L, Skoch J, Horn PS, Frink C, Scholle C, Leach JL, Mangano FT, Glauser TA, Holland KD. Neuronal Circuits Supporting Development of Visual Naming Revealed by Intracranial Coherence Modulations. Front Neurosci 2022; 16:867021. [PMID: 35663562 PMCID: PMC9160526 DOI: 10.3389/fnins.2022.867021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Improvement in visual naming abilities throughout the childhood and adolescence supports development of higher-order linguistic skills. We investigated neuronal circuits underlying improvement in the speed of visual naming with age, and age-related dynamics of these circuits. Methods Response times were electronically measured during an overt visual naming task in epilepsy patients undergoing stereo-EEG monitoring. Coherence modulations among pairs of neuroanatomic parcels were computed and analyzed for relationship with response time and age. Results During the overt visual naming task, mean response time (latency) significantly decreased from 4 to 23 years of age. Coherence modulations during visual naming showed that increased connectivity between certain brain regions, particularly that between left fusiform gyrus/left parahippocampal gyrus and left frontal operculum, is associated with improvement in naming speed. Also, decreased connectivity in other brain regions, particularly between left angular and supramarginal gyri, is associated with decreased mean response time. Further, coherence modulations between left frontal operculum and both left fusiform and left posterior cingulate gyri significantly increase, while that between left angular and supramarginal gyri significantly decrease, with age. Conclusion Naming speed continues to improve from pre-school years into young adulthood. This age-related improvement in efficiency of naming environmental objects occurs likely because of strengthened direct connectivity between semantic and phonological nodes, and elimination of intermediate higher-order cognitive steps.
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Affiliation(s)
- Ravindra Arya
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, OH, United States
| | - Brian Ervin
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, OH, United States
| | - Jason Buroker
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Hansel M. Greiner
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Anna W. Byars
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Leonid Rozhkov
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Jesse Skoch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Paul S. Horn
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Clayton Frink
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Craig Scholle
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - James L. Leach
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Pediatric Neuroradiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Francesco T. Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Tracy A. Glauser
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Katherine D. Holland
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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16
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McGrath H, Mandel M, Sandhu MRS, Lamsam L, Adenu-Mensah N, Farooque P, Spencer DD, Damisah EC. Optimizing the surgical management of MRI-negative epilepsy in the neuromodulation era. Epilepsia Open 2022; 7:151-159. [PMID: 35038792 PMCID: PMC8886105 DOI: 10.1002/epi4.12578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/05/2021] [Accepted: 01/03/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To evaluate the role of intracranial electroencephalography monitoring in diagnosing and directing the appropriate therapy for MRI-negative epilepsy and to present the surgical outcomes of patients following treatment. METHODS Retrospective chart review between 2015 - 2021 at a single institution identified forty-eight patients with no lesion on MRI who received surgical intervention for their epilepsy. The outcomes assessed were the surgical treatment performed and the International League Against Epilepsy seizure outcomes at one year of follow up. RESULTS Eleven patients underwent surgery without invasive monitoring, including vagus nerve stimulation (10%), deep brain stimulation (8%), laser interstitial thermal therapy (2%) and callosotomy (2%). The remaining 37 patients received invasive monitoring followed by resection (35%), responsive neurostimulation (21%) and deep brain stimulation (15%) or no treatment (6%). At one year postoperatively, 39% were Class 1-2, 36% were Class 3-4 and 24% were Class 5. More patients with Class 1-2 or 3-4 outcomes underwent invasive monitoring (100% and 83% respectively) compared to those with poor outcomes (25%, p < 0.001). Patients with Class 1-2 outcomes more commonly underwent resection or responsive neurostimulation: 69% and 31%, respectively (p < 0.001). SIGNIFICANCE The optimal management of MRI-negative focal epilepsy may involve invasive monitoring followed by resection or responsive neurostimulation in most cases, as these treatments were associated with the best seizure outcomes in our cohort. Unless multifocal epileptogenesis is clear from the non-invasive evaluation, invasive monitoring is preferred before pursuing deep brain stimulation or vagal nerve stimulation directly.
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Affiliation(s)
- Hari McGrath
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Mauricio Mandel
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Mani R S Sandhu
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Layton Lamsam
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Nana Adenu-Mensah
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Pue Farooque
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, USA
| | - Dennis D Spencer
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
| | - Eyiyemisi C Damisah
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, USA
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17
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Kanaya K, Mitsuhashi T, Kiuchi T, Kobayashi S. The Efficacy of Intraoperative Passive Language Mapping for Glioma Surgery: A Case Report. Front Neurol 2021; 12:652401. [PMID: 34408717 PMCID: PMC8364957 DOI: 10.3389/fneur.2021.652401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Recently, electrocorticographic (ECoG) studies have emphasized the importance of gamma band-based functional mapping in the presurgical localization of the eloquent cortex. Passive functional mapping using ECoG signals provides a reliable method for identifying receptive language areas without many of the risks and limitations associated with electrical cortical stimulation. We report a surgical case of left temporal malignant glioma with intraoperative passive language mapping. Case Description: A 78-year-old woman was diagnosed with left temporal glioma with inspection of her language difficulty. MRI showed a left temporal tumor measuring 74.6 × 50.0 × 51.5 mm in size. Real-time CortiQ-based mapping using high-gamma activity by word-listening and story-listening tasks was performed. Significant listening task-evoked high gamma activities were detected in 5 channels in the superior temporal gyrus and one channel in the middle temporal gyrus. The tumor was grossly removed except for the region corresponding to listening task-evoked high gamma activities. Postoperatively, the patient's symptoms of language comprehension difficulty improved, and no new neurological deficits were observed. Conclusion: Intraoperative passive language mapping was successfully performed, and the patient's language function was well-preserved. Intraoperative passive language mapping, which is applicable in a short time and under general anesthesia, can be an important tool for detecting language areas.
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Affiliation(s)
- Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Neurosurgery, Iida Municipal Hospital, Nagano, Japan
| | | | - Takafumi Kiuchi
- Department of Neurosurgery, Iida Municipal Hospital, Nagano, Japan
| | - Sumio Kobayashi
- Department of Neurosurgery, Iida Municipal Hospital, Nagano, Japan
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18
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Sellers KK, Chung JE, Zhou J, Triplett MG, Dawes HE, Haque R, Chang EF. Thin-film microfabrication and intraoperative testing of µECoG and iEEG depth arrays for sense and stimulation. J Neural Eng 2021; 18:10.1088/1741-2552/ac1984. [PMID: 34330113 PMCID: PMC10495194 DOI: 10.1088/1741-2552/ac1984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/30/2021] [Indexed: 11/11/2022]
Abstract
Objective.Intracranial neural recordings and electrical stimulation are tools used in an increasing range of applications, including intraoperative clinical mapping and monitoring, therapeutic neuromodulation, and brain computer interface control and feedback. However, many of these applications suffer from a lack of spatial specificity and localization, both in terms of sensed neural signal and applied stimulation. This stems from limited manufacturing processes of commercial-off-the-shelf (COTS) arrays unable to accommodate increased channel density, higher channel count, and smaller contact size.Approach.Here, we describe a manufacturing and assembly approach using thin-film microfabrication for 32-channel high density subdural micro-electrocorticography (µECoG) surface arrays (contacts 1.2 mm diameter, 2 mm pitch) and intracranial electroencephalography (iEEG) depth arrays (contacts 0.5 mm × 1.5 mm, pitch 0.8 mm × 2.5 mm). Crucially, we tackle the translational hurdle and test these arrays during intraoperative studies conducted in four humans under regulatory approval.Main results.We demonstrate that the higher-density contacts provide additional unique information across the recording span compared to the density of COTS arrays which typically have electrode pitch of 8 mm or greater; 4 mm in case of specially ordered arrays. Our intracranial stimulation study results reveal that refined spatial targeting of stimulation elicits evoked potentials with differing spatial spread.Significance.Thin-film,μECoG and iEEG depth arrays offer a promising substrate for advancing a number of clinical and research applications reliant on high-resolution neural sensing and intracranial stimulation.
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Affiliation(s)
- Kristin K Sellers
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States of America
- These authors contributed equally
| | - Jason E Chung
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States of America
- These authors contributed equally
| | - Jenny Zhou
- Lawrence Livermore National Laboratories, Livermore, CA, United States of America
| | - Michael G Triplett
- Lawrence Livermore National Laboratories, Livermore, CA, United States of America
| | - Heather E Dawes
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States of America
| | - Razi Haque
- Lawrence Livermore National Laboratories, Livermore, CA, United States of America
| | - Edward F Chang
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States of America
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19
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Wang Y, Hays MA, Coogan C, Kang JY, Flinker A, Arya R, Korzeniewska A, Crone NE. Spatial-Temporal Functional Mapping Combined With Cortico-Cortical Evoked Potentials in Predicting Cortical Stimulation Results. Front Hum Neurosci 2021; 15:661976. [PMID: 33935673 PMCID: PMC8079642 DOI: 10.3389/fnhum.2021.661976] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Functional human brain mapping is commonly performed during invasive monitoring with intracranial electroencephalographic (iEEG) electrodes prior to resective surgery for drug resistant epilepsy. The current gold standard, electrocortical stimulation mapping (ESM), is time consuming, sometimes elicits pain, and often induces after discharges or seizures. Moreover, there is a risk of overestimating eloquent areas due to propagation of the effects of stimulation to a broader network of language cortex. Passive iEEG spatial-temporal functional mapping (STFM) has recently emerged as a potential alternative to ESM. However, investigators have observed less correspondence between STFM and ESM maps of language than between their maps of motor function. We hypothesized that incongruities between ESM and STFM of language function may arise due to propagation of the effects of ESM to cortical areas having strong effective connectivity with the site of stimulation. We evaluated five patients who underwent invasive monitoring for seizure localization, whose language areas were identified using ESM. All patients performed a battery of language tasks during passive iEEG recordings. To estimate the effective connectivity of stimulation sites with a broader network of task-activated cortical sites, we measured cortico-cortical evoked potentials (CCEPs) elicited across all recording sites by single-pulse electrical stimulation at sites where ESM was performed at other times. With the combination of high gamma power as well as CCEPs results, we trained a logistic regression model to predict ESM results at individual electrode pairs. The average accuracy of the classifier using both STFM and CCEPs results combined was 87.7%, significantly higher than the one using STFM alone (71.8%), indicating that the correspondence between STFM and ESM results is greater when effective connectivity between ESM stimulation sites and task-activated sites is taken into consideration. These findings, though based on a small number of subjects to date, provide preliminary support for the hypothesis that incongruities between ESM and STFM may arise in part from propagation of stimulation effects to a broader network of cortical language sites activated by language tasks, and suggest that more studies, with larger numbers of patients, are needed to understand the utility of both mapping techniques in clinical practice.
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Affiliation(s)
- Yujing Wang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mark A Hays
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Christopher Coogan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Adeen Flinker
- Department of Neurology, New York University School of Medicine, New York, NY, United States
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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20
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Drane DL, Pedersen NP, Sabsevitz DS, Block C, Dickey AS, Alwaki A, Kheder A. Cognitive and Emotional Mapping With SEEG. Front Neurol 2021; 12:627981. [PMID: 33912122 PMCID: PMC8072290 DOI: 10.3389/fneur.2021.627981] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/04/2021] [Indexed: 02/05/2023] Open
Abstract
Mapping of cortical functions is critical for the best clinical care of patients undergoing epilepsy and tumor surgery, but also to better understand human brain function and connectivity. The purpose of this review is to explore existing and potential means of mapping higher cortical functions, including stimulation mapping, passive mapping, and connectivity analyses. We examine the history of mapping, differences between subdural and stereoelectroencephalographic approaches, and some risks and safety aspects, before examining different types of functional mapping. Much of this review explores the prospects for new mapping approaches to better understand other components of language, memory, spatial skills, executive, and socio-emotional functions. We also touch on brain-machine interfaces, philosophical aspects of aligning tasks to brain circuits, and the study of consciousness. We end by discussing multi-modal testing and virtual reality approaches to mapping higher cortical functions.
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Affiliation(s)
- Daniel L. Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Emory Epilepsy Center, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
| | - Nigel P. Pedersen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Emory Epilepsy Center, Atlanta, GA, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - David S. Sabsevitz
- Department of Psychology and Psychiatry, Mayo Clinic, Jacksonville, FL, United States
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Cady Block
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Adam S. Dickey
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Abdulrahman Alwaki
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ammar Kheder
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
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21
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Aron O, Jonas J, Colnat-Coulbois S, Maillard L. Language Mapping Using Stereo Electroencephalography: A Review and Expert Opinion. Front Hum Neurosci 2021; 15:619521. [PMID: 33776668 PMCID: PMC7987679 DOI: 10.3389/fnhum.2021.619521] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Stereo-electroencephalography (sEEG) is a method that uses stereotactically implanted depth electrodes for extra-operative mapping of epileptogenic and functional networks. sEEG derived functional mapping is achieved using electrical cortical stimulations (ECS) that are currently the gold standard for delineating eloquent cortex. As this stands true especially for primary cortices (e.g., visual, sensitive, motor, etc.), ECS applied to higher order brain areas determine more subtle behavioral responses. While anterior and posterior language areas in the dorsal language stream seem to share characteristics with primary cortices, basal temporal language area (BTLA) in the ventral temporal cortex (VTC) behaves as a highly associative cortex. After a short introduction and considerations about methodological aspects of ECS using sEEG, we review the sEEG language mapping literature in this perspective. We first establish the validity of this technique to map indispensable language cortices in the dorsal language stream. Second, we highlight the contrast between the growing empirical ECS experience and the lack of understanding regarding the fundamental mechanisms underlying ECS behavioral effects, especially concerning the dispensable language cortex in the VTC. Evidences for considering network architecture as determinant for ECS behavioral response complexities are discussed. Further, we address the importance of designing new research in network organization of language as this could enhance ECS ability to map interindividual variability, pathology driven reorganization, and ultimately identify network resilience markers in order to better predict post-operative language deficit. Finally, based on a whole body of available studies, we believe there is strong evidence to consider sEEG as a valid, safe and reliable method for defining eloquent language cortices although there have been no proper comparisons between surgical resections with or without extra-operative or intra-operative language mapping.
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Affiliation(s)
- Olivier Aron
- Department of Neurology, Nancy University Hospital Center, Nancy, France
- CRAN, Université́ de Lorraine, CNRS, Nancy, France
| | - Jacques Jonas
- Department of Neurology, Nancy University Hospital Center, Nancy, France
- CRAN, Université́ de Lorraine, CNRS, Nancy, France
| | | | - Louis Maillard
- Department of Neurology, Nancy University Hospital Center, Nancy, France
- CRAN, Université́ de Lorraine, CNRS, Nancy, France
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22
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Karami M, Mehvari Habibabadi J, Nilipour R, Barekatain M, Gaillard WD, Soltanian-Zadeh H. Presurgical Language Mapping in Patients With Intractable Epilepsy: A Review Study. Basic Clin Neurosci 2021; 12:163-176. [PMID: 34925713 PMCID: PMC8672671 DOI: 10.32598/bcn.12.2.2053.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/10/2020] [Accepted: 11/08/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION about 20% to 30% of patients with epilepsy are diagnosed with drug-resistant epilepsy and one third of these are candidates for epilepsy surgery. Surgical resection of the epileptogenic tissue is a well-established method for treating patients with intractable focal epilepsy. Determining language laterality and locality is an important part of a comprehensive epilepsy program before surgery. Functional Magnetic Resonance Imaging (fMRI) has been increasingly employed as a non-invasive alternative method for the Wada test and cortical stimulation. Sensitive and accurate language tasks are essential for any reliable fMRI mapping. METHODS The present study reviews the methods of presurgical fMRI language mapping and their dedicated fMRI tasks, specifically for patients with epilepsy. RESULTS Different language tasks including verbal fluency are used in fMRI to determine language laterality and locality in different languages such as Persian. there are some considerations including the language materials and technical protocols for task design that all presurgical teams should take into consideration. CONCLUSION Accurate presurgical language mapping is very important to preserve patients language after surgery. This review was the first part of a project for designing standard tasks in Persian to help precise presurgical evaluation and in Iranian PWFIE.
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Affiliation(s)
- Mahdieh Karami
- Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | | | - Reza Nilipour
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Majid Barekatain
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - William D. Gaillard
- Center for Neuroscience and Behavioral Health, Children’s National Medical Center, George Washington University, Washington, D.C. USA
| | - Hamid Soltanian-Zadeh
- Departments of Communication, School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
- Departments of Radiology and Research Administration, Henry Ford Health System, Detroit, MI, USA
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23
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Archila-Meléndez ME, Valente G, Gommer ED, Correia JM, Ten Oever S, Peters JC, Reithler J, Hendriks MPH, Cornejo Ochoa W, Schijns OEMG, Dings JTA, Hilkman DMW, Rouhl RPW, Jansma BM, van Kranen-Mastenbroek VHJM, Roberts MJ. Combining Gamma With Alpha and Beta Power Modulation for Enhanced Cortical Mapping in Patients With Focal Epilepsy. Front Hum Neurosci 2020; 14:555054. [PMID: 33408621 PMCID: PMC7779799 DOI: 10.3389/fnhum.2020.555054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/17/2020] [Indexed: 12/03/2022] Open
Abstract
About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping (ESM) is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity (55–200 Hz) recorded with extraoperative electrocorticography (ECoG) during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha (8–12 Hz) and beta (15–25 Hz) bands could further improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy (age: 35.9 ± 9.1 years, range: 22–48, 8 females, 9 right handed) participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model (GLM) approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic (ROC) curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy.
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Affiliation(s)
- Mario E Archila-Meléndez
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Neuroscientific MR-Physics Research Group, Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Munich, Germany.,Technical University of Munich Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, School of Medicine, Technische Universität München, Munich, Germany
| | - Giancarlo Valente
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center (M-BIC), Maastricht University, Maastricht, Netherlands
| | - Erik D Gommer
- Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands
| | - João M Correia
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Basque Center on Cognition, Brain and Language (BCBL), Donostia-San Sebastian, Spain.,Centre for Biomedical Research (CBMR)/Department of Psychology, Universidade do Algarve, Faro, Portugal
| | - Sanne Ten Oever
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center (M-BIC), Maastricht University, Maastricht, Netherlands
| | - Judith C Peters
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center (M-BIC), Maastricht University, Maastricht, Netherlands.,Department of Vision & Cognition, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, Netherlands
| | - Joel Reithler
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center (M-BIC), Maastricht University, Maastricht, Netherlands.,Department of Vision & Cognition, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, Netherlands
| | - Marc P H Hendriks
- Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands.,Department of Neurosurgery, Maastricht University Medical Center Maastricht, Maastricht University, Maastricht, Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - William Cornejo Ochoa
- Grupo Pediaciencias, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Olaf E M G Schijns
- Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands.,Department of Neurosurgery, Maastricht University Medical Center Maastricht, Maastricht University, Maastricht, Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Jim T A Dings
- Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands.,Department of Neurosurgery, Maastricht University Medical Center Maastricht, Maastricht University, Maastricht, Netherlands
| | - Danny M W Hilkman
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands.,Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands
| | - Rob P W Rouhl
- Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bernadette M Jansma
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center (M-BIC), Maastricht University, Maastricht, Netherlands
| | - Vivianne H J M van Kranen-Mastenbroek
- Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands.,Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Mark J Roberts
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands
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24
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Factors Modifying the Amount of Neuroanatomical Overlap between Languages in Bilinguals-A Systematic Review of Neurosurgical Language Mapping Studies. Brain Sci 2020; 10:brainsci10120983. [PMID: 33333820 PMCID: PMC7765203 DOI: 10.3390/brainsci10120983] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022] Open
Abstract
Neurosurgery on individuals with lesions around language areas becomes even more complicated when the patient is bilingual. It is thus important to understand the principles that predict the likelihood of convergent versus separate neuroanatomical organization of the first (L1) and the second language (L2) in these individuals. We reviewed all English-language publications on neurosurgical language mapping in bilinguals before January 2020 in three databases (e.g., PubMed). Our search yielded 28 studies with 207 participants. The reviewed data suggest several principles of language organization in bilingual neurosurgical patients: (1) separate cortical areas uniquely dedicated to each language in both anterior and posterior language sites are the rule rather than occasional findings, (2) In cases where there was a convergent neuroanatomical representation for L1 and L2, two factors explained the overlap: an early age of L2 acquisition and a small linguistic distance between L1 and L2 and (3) When L1 and L2 diverged neuroanatomically, more L1-specific sites were identified for early age of L2 acquisition, high L2 proficiency and a larger linguistic distance. This work provides initial evidence-based principles predicting the likelihood of converging versus separate neural representations of L1 and L2 in neurosurgical patients.
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25
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Grande KM, Ihnen SKZ, Arya R. Electrical Stimulation Mapping of Brain Function: A Comparison of Subdural Electrodes and Stereo-EEG. Front Hum Neurosci 2020; 14:611291. [PMID: 33364930 PMCID: PMC7750438 DOI: 10.3389/fnhum.2020.611291] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Despite technological and interpretative advances, the non-invasive modalities used for pre-surgical evaluation of patients with drug-resistant epilepsy (DRE), fail to generate a concordant anatomo-electroclinical hypothesis for the location of the seizure onset zone in many patients. This requires chronic monitoring with intracranial electroencephalography (EEG), which facilitates better localization of the seizure onset zone, and allows evaluation of the functional significance of cortical regions-of-interest by electrical stimulation mapping (ESM). There are two principal modalities for intracranial EEG, namely subdural electrodes and stereotactic depth electrodes (stereo-EEG). Although ESM is considered the gold standard for functional mapping with subdural electrodes, there have been concerns about its utility with stereo-EEG. This is mainly because subdural electrodes allow contiguous sampling of the dorsolateral convexity of cerebral hemispheres, and permit delineation of the extent of eloquent functional areas on the cortical surface. Stereo-EEG, while having relatively sparse sampling on the cortical surface, offers the ability to access the depth of sulci, mesial and basal surfaces of cerebral hemispheres, and deep structures such as the insula, which are largely inaccessible to subdural electrodes. As stereo-EEG is increasingly the preferred modality for intracranial monitoring, we find it opportune to summarize the literature for ESM with stereo-EEG in this narrative review. Emerging evidence shows that ESM for defining functional neuroanatomy is feasible with stereo-EEG, but probably requires a different approach for interpretation and clinical decision making compared to ESM with subdural electrodes. We have also compared ESM with stereo-EEG and subdural electrodes, for current thresholds required to evoke desired functional responses vs. unwanted after-discharges. In this regard, there is preliminary evidence that ESM with stereo-EEG may be safer than ESM with subdural grids. Finally, we have highlighted important unanswered clinical and scientific questions for ESM with stereo-EEG in the hope to encourage future research and collaborative efforts.
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Affiliation(s)
- Krista M. Grande
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Sarah K. Z. Ihnen
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Ravindra Arya
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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26
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Trébuchon A, Liégeois-Chauvel C, Gonzalez-Martinez JA, Alario FX. Contributions of electrophysiology for identifying cortical language systems in patients with epilepsy. Epilepsy Behav 2020; 112:107407. [PMID: 33181892 DOI: 10.1016/j.yebeh.2020.107407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
A crucial element of the surgical treatment of medically refractory epilepsy is to delineate cortical areas that must be spared in order to avoid clinically relevant neurological and neuropsychological deficits postoperatively. For each patient, this typically necessitates determining the language lateralization between hemispheres and language localization within hemisphere. Understanding cortical language systems is complicated by two primary challenges: the extent of the neural tissue involved and the substantial variability across individuals, especially in pathological populations. We review the contributions made through the study of electrophysiological activity to address these challenges. These contributions are based on the techniques of magnetoencephalography (MEG), intracerebral recordings, electrical-cortical stimulation (ECS), and the electrovideo analyses of seizures and their semiology. We highlight why no single modality alone is adequate to identify cortical language systems and suggest avenues for improving current practice.
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Affiliation(s)
- Agnès Trébuchon
- Aix-Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Catherine Liégeois-Chauvel
- Aix-Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; Department of Neurological Surgery, School of Medicine, University of Pittsburgh (PA), USA
| | | | - F-Xavier Alario
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh (PA), USA; Aix-Marseille Univ, CNRS, LPC, Marseille, France.
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Ervin B, Buroker J, Rozhkov L, Holloway T, Horn PS, Scholle C, Byars AW, Mangano FT, Leach JL, Greiner HM, Holland KD, Arya R. High-gamma modulation language mapping with stereo-EEG: A novel analytic approach and diagnostic validation. Clin Neurophysiol 2020; 131:2851-2860. [PMID: 33137575 DOI: 10.1016/j.clinph.2020.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A novel analytic approach for task-related high-gamma modulation (HGM) in stereo-electroencephalography (SEEG) was developed and evaluated for language mapping. METHODS SEEG signals, acquired from drug-resistant epilepsy patients during a visual naming task, were analyzed to find clusters of 50-150 Hz power modulations in time-frequency domain. Classifier models to identify electrode contacts within the reference neuroanatomy and electrical stimulation mapping (ESM) speech/language sites were developed and validated. RESULTS In 21 patients (9 females), aged 4.8-21.2 years, SEEG HGM model predicted electrode locations within Neurosynth language parcels with high diagnostic odds ratio (DOR 10.9, p < 0.0001), high specificity (0.85), and fair sensitivity (0.66). Another SEEG HGM model classified ESM speech/language sites with significant DOR (5.0, p < 0.0001), high specificity (0.74), but insufficient sensitivity. Time to largest power change reliably localized electrodes within Neurosynth language parcels, while, time to center-of-mass power change identified ESM sites. CONCLUSIONS SEEG HGM mapping can accurately localize neuroanatomic and ESM language sites. SIGNIFICANCE Predictive modelling incorporating time, frequency, and magnitude of power change is a useful methodology for task-related HGM, which offers insights into discrepancies between HGM language maps and neuroanatomy or ESM.
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Affiliation(s)
- Brian Ervin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, OH, USA
| | - Jason Buroker
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Timothy Holloway
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul S Horn
- 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
| | - Craig Scholle
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna W Byars
- 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
| | - Francesco T Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Division of Pediatric Neuro-radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- 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
| | - Katherine D Holland
- 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
| | - Ravindra Arya
- 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.
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Hyslop A, Duchowny M. Electrical stimulation mapping in children. Seizure 2020; 77:59-63. [DOI: 10.1016/j.seizure.2019.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 12/01/2022] Open
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Arya R, Ervin B, Dudley J, Buroker J, Rozhkov L, Scholle C, Horn PS, Vannest J, Byars AW, Leach JL, Mangano FT, Greiner HM, Holland KD, Glauser TA. Electrical stimulation mapping of language with stereo-EEG. Epilepsy Behav 2019; 99:106395. [PMID: 31422309 DOI: 10.1016/j.yebeh.2019.06.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We prospectively validated stereo-electroencephalography (EEG) electrical stimulation mapping (ESM) of language against a reference standard of meta-analytic functional magnetic resonance imaging (fMRI) framework (Neurosynth). METHODS Language ESM was performed using 50 Hz, biphasic, bipolar, stimulation at 1-8 mA, with a picture naming task. Electrode contacts (ECs) were scored as ESM+ if ESM interfered with speech/language function. For each patient, presurgical MRI was transformed to a standard space and coregistered with computed tomographic (CT) scan to obtain EC locations. After whole-brain parcellation, this fused image data were intersected with three-dimensional language fMRI (Neurosynth), and each EC was classified as lying within/outside the fMRI language parcel. Diagnostic odds ratio (DOR) and other indices were estimated. Current thresholds for language inhibition and after-discharges (ADs) were analyzed using multivariable linear mixed models. RESULTS In 10 patients (5 females), aged 5.4-21.2 years, speech/language inhibition was noted with ESM on 87/304 (29%) ECs. Stereo-EEG language ESM was a valid classifier of fMRI (Neurosynth) language sites (DOR: 9.02, p < 0.0001), with high specificity (0.87) but poor sensitivity (0.57). Similar diagnostic indices were seen for ECs in frontal or posterior regions, and gray or white matter. Language threshold (3.1 ± 1.5 mA) was lower than AD threshold (4.0 ± 2.0 mA, p = 0.0001). Language and AD thresholds decreased with age and intelligence quotient. Electrical stimulation mapping triggered seizures/auras represented patients' habitual semiology with 1 Hz stimulation. CONCLUSIONS Stereo-EEG ESM can reliably identify cerebral parcels with/without language function but may under detect all language sites. We suggest a 50-Hz stimulation protocol for language ESM with stereo-EEG.
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Affiliation(s)
- Ravindra Arya
- 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.
| | - Brian Ervin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Electrical Engineering and Computing Systems, University of Cincinnati, Cincinnati, OH, USA
| | - Jonathan Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jason Buroker
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Craig Scholle
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Vannest
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna W Byars
- 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
| | - James L Leach
- Division of Pediatric Neuro-radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Francesco T Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- 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
| | - Katherine D Holland
- 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
| | - Tracy A Glauser
- 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
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Kinney MO, Kovac S, Diehl B. Structured testing during seizures: A practical guide for assessing and interpreting ictal and postictal signs during video EEG long term monitoring. Seizure 2019; 72:13-22. [PMID: 31546090 DOI: 10.1016/j.seizure.2019.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/01/2019] [Accepted: 08/17/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ictal and postictal testing carried out in long-term epilepsy monitoring units is often sub-optimal. Recently, a European consensus protocol for testing patients during and after seizures was developed by a joint taskforce of the International League Against Epilepsy - Commission on European Affairs and the European Epilepsy Monitoring Unit Association. AIM Using this recently developed standardised assessment battery as a framework, the goal of this narrative review is to outline the proposed testing procedure in detail and explain the rationale for each individual component, focusing on the underlying neurobiology. This is intended to serve as an educational resource for staff working in epilepsy monitoring units. METHODS A literature review of PubMed was performed; using the search terms "seizure", "ictal", "postictal", "testing", "examination", and "interview". Relevant literature was reviewed and relevant references were chosen. The work is presented as a narrative review. RESULTS The proposed standardised assessment battery provides a comprehensive and user-friendly format for ictal-postictal testing, and examines consciousness, language, motor, sensory, and visual function. CONCLUSION The standardised approach proposed has the potential to make full use of data recorded during video EEG increasing the diagnostic yield with regards to lateralisation and localisation, aiding both presurgical and diagnostic studies.
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Affiliation(s)
- Michael Owen Kinney
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Stjepana Kovac
- Department of Neurology, University of Münster, Münster, Germany
| | - Beate Diehl
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Ni B, Wang X, Yu T, Wu R, Wang B. Pre-surgical Language Mapping in Epilepsy: Using fMRI in Chinese-Speaking Patients. Front Hum Neurosci 2019; 13:183. [PMID: 31231201 PMCID: PMC6560162 DOI: 10.3389/fnhum.2019.00183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 05/20/2019] [Indexed: 11/15/2022] Open
Abstract
Accurate localization of language processing areas is critical in patients undergoing epilepsy surgery. In this study, we aimed to use functional magnetic resonance imaging (fMRI), which is a non-invasive mapping method, to establish a panel of tasks investigating patients’ language function. We developed six tasks, including a series of progressive comprehension tasks from words, sentence to text, a verb generation task that can detect subtle left-brain activation, an auditory comprehension task that explored the temporal language-related areas, and a visual object-naming task provided for poorly educated patients. We successfully located the language cortex in 40 patients, and subsequently determined hemispheric dominance for the Chinese language. Our results showed a concordance between fMRI tasks and electrical cortical stimulation. The consistency across tasks revealed by the laterality index, as well as the concordance between the surgical outcomes and the results of localization, suggested the validity of our fMRI tasks. Our fMRI tasks also corroborate and extend the finding that the left middle frontal area (BA 9) plays an important role in reading Chinese.
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Affiliation(s)
- Bing Ni
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Wang
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ruijie Wu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,Beijing MR Center for Brain Research, Beijing, China
| | - Bo Wang
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,Beijing MR Center for Brain Research, Beijing, China
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Balter S, Lin G, Leyden KM, Paul BM, McDonald CR. Neuroimaging correlates of language network impairment and reorganization in temporal lobe epilepsy. BRAIN AND LANGUAGE 2019; 193:31-44. [PMID: 27393391 PMCID: PMC5215985 DOI: 10.1016/j.bandl.2016.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/27/2016] [Accepted: 06/15/2016] [Indexed: 06/02/2023]
Abstract
Advanced, noninvasive imaging has revolutionized our understanding of language networks in the brain and is reshaping our approach to the presurgical evaluation of patients with epilepsy. Functional magnetic resonance imaging (fMRI) has had the greatest impact, unveiling the complexity of language organization and reorganization in patients with epilepsy both pre- and postoperatively, while volumetric MRI and diffusion tensor imaging have led to a greater appreciation of structural and microstructural correlates of language dysfunction in different epilepsy syndromes. In this article, we review recent literature describing how unimodal and multimodal imaging has advanced our knowledge of language networks and their plasticity in epilepsy, with a focus on the most frequently studied epilepsy syndrome in adults, temporal lobe epilepsy (TLE). We also describe how new analytic techniques (i.e., graph theory) are leading to a refined characterization of abnormal brain connectivity, and how subject-specific imaging profiles combined with clinical data may enhance the prediction of both seizure and language outcomes following surgical interventions.
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Affiliation(s)
- S Balter
- Department of Neurology, University of California, San Francisco, CA, United States; UCSF Comprehensive Epilepsy Center, United States
| | - G Lin
- Palo Alto University, Palo Alto, CA, United States
| | - K M Leyden
- Multimodal Imaging Laboratory, University of California, San Diego, CA, United States
| | - B M Paul
- Department of Neurology, University of California, San Francisco, CA, United States; UCSF Comprehensive Epilepsy Center, United States
| | - C R McDonald
- Multimodal Imaging Laboratory, University of California, San Diego, CA, United States; Department of Psychiatry, University of California, San Diego, CA, United States.
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Rolinski R, Austermuehle A, Wiggs E, Agrawal S, Sepeta L, Gaillard WD, Zaghloul K, Inati SK, Theodore WH. Functional MRI and direct cortical stimulation: Prediction of postoperative language decline. Epilepsia 2019; 60:560-570. [PMID: 30740700 PMCID: PMC6467056 DOI: 10.1111/epi.14666] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the ability of functional MRI (fMRI) to predict postoperative language decline compared to direct cortical stimulation (DCS) in epilepsy surgery patients. METHODS In this prospective case series, 17 patients with drug-resistant epilepsy had intracranial monitoring and resection from 2012 to 2016 with 1-year follow-up. All patients completed preoperative language fMRI, mapping with DCS of subdural electrodes, pre- and postoperative neuropsychological testing for language function, and resection. Changes in language function before and after surgery were assessed. fMRI activation and DCS electrodes in the resection were evaluated as potential predictors of language decline. RESULTS Four of 17 patients (12 female; median [range] age, 43 [23-59] years) experienced postoperative language decline 1 year after surgery. Two of 4 patients had overlap of fMRI activation, language-positive electrodes in basal temporal regions (within 1 cm), and resection. Two had overlap between resection volume and fMRI activation, but not DCS. fMRI demonstrated 100% sensitivity and 46% specificity for outcome compared to DCS (50% and 85%, respectively). When fMRI and DCS language findings were concordant, the combined tests showed 100% sensitivity and 75% specificity for language outcome. Seizure-onset age, resection side, type, volume, or 1 year seizure outcome did not predict language decline. SIGNIFICANCE Language localization overlap of fMRI and direct cortical stimulation in the resection influences postoperative language performance. Our preliminary study suggests that fMRI may be more sensitive and less specific than direct cortical stimulation. Together they may predict outcome better than either test alone.
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Affiliation(s)
- Rachel Rolinski
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Alison Austermuehle
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Edythe Wiggs
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Shubhi Agrawal
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
- Berman Brain & Spine Institute, Baltimore, MD
| | - Leigh Sepeta
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
- Department of Neurology Children’s National Medical
Center, Washington, D.C
| | - William D Gaillard
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
- Department of Neurology Children’s National Medical
Center, Washington, D.C
| | - Kareem Zaghloul
- Surgical Neurology Branch, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Sara K Inati
- Electroencephalography Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - William H Theodore
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
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Milsap G, Collard M, Coogan C, Crone NE. BCI2000Web and WebFM: Browser-Based Tools for Brain Computer Interfaces and Functional Brain Mapping. Front Neurosci 2019; 12:1030. [PMID: 30814923 PMCID: PMC6381053 DOI: 10.3389/fnins.2018.01030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/19/2018] [Indexed: 11/09/2022] Open
Abstract
BCI2000 has been a popular platform for development of real-time brain computer interfaces (BCIs). Since BCI2000's initial release, web browsers have evolved considerably, enabling rapid development of internet-enabled applications and interactive visualizations. Linking the amplifier abstraction and signal processing native to BCI2000 with the host of technologies and ease of development afforded by modern web browsers could enable a new generation of browser-based BCIs and visualizations. We developed a server and filter module called BCI2000Web providing an HTTP connection capable of escalation into an RFC6455 WebSocket, which enables direct communication between a browser and a BCI2000 distribution in real-time, facilitating a number of novel applications. We also present a JavaScript module, bci2k.js, that allows web developers to create paradigms and visualizations using this interface in an easy-to-use and intuitive manner. To illustrate the utility of BCI2000Web, we demonstrate a browser-based implementation of a real-time electrocorticographic (ECoG) functional mapping suite called WebFM. We also explore how the unique characteristics of our browser-based framework make BCI2000Web an attractive tool for future BCI applications. BCI2000Web leverages the advances of BCI2000 to provide real-time browser-based interactions with human neurophysiological recordings, allowing for web-based BCIs and other applications, including real-time functional brain mapping. Both BCI2000 and WebFM are provided under open source licenses. Enabling a powerful BCI suite to communicate with today's most technologically progressive software empowers a new cohort of developers to engage with BCI technology, and could serve as a platform for internet-enabled BCIs.
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Affiliation(s)
- Griffin Milsap
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Max Collard
- Department of Neurology, Johns Hopkins Universit, Baltimore, MD, United States
| | - Christopher Coogan
- Department of Neurology, Johns Hopkins Universit, Baltimore, MD, United States
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins Universit, Baltimore, MD, United States
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Alarcón G, Bird Pedersen M, Juárez-Torrejón N, Martín-López D, Ughratdar I, Selway RP, Valentín A. The Single Word Auditory Comprehension (SWAC) test: A simple method to identify receptive language areas with electrical stimulation. Epilepsy Behav 2019; 90:266-272. [PMID: 30442560 DOI: 10.1016/j.yebeh.2018.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Resective surgery for medically refractory epilepsy in proximity to speech receptive areas requires balancing adequate resection of the epileptogenic zone for optimal seizure control with preservation of function. We develop a simple test (Single Word Auditory Comprehension or SWAC) to localize speech receptive areas by evaluating patients' ability to comprehend a single word. METHODS Patients were studied during presurgical or intraoperative assessment for epilepsy with intracranial electrodes. They were asked to listen to a common word (target word) and to describe what it meant without saying the target word. Electrical stimulation (trains of biphasic 2-ms pulses, 50 Hz for 3 s) was delivered while the patient listened to the target word, not while the patient explained the meaning of the word. In six patients, SWAC test was carried out during extraoperative chronic recordings, and in one patient in the operating theater under local anesthesia. RESULTS Among the 7 patients where the test identified deficits, 6 underwent resection (4 temporal, 1 supramarginal, and 1 occipital). Two patients showed temporary minor speech deficits after resection. No patient showed permanent speech deficits after resection. CONCLUSION/SIGNIFICANCE The SWAC test is reliable, simple and fast to implement, and suitable for intraoperating mapping. It could be used as a simple initial test to identify receptive language areas where more complex additional tests can be performed.
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Affiliation(s)
- Gonzalo Alarcón
- Comprehensive Epilepsy Center, Neuroscience Institute, Academic Health Systems, Hamad Medical Corporation, Doha, Qatar; Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; Weill Cornell Medicine, Doha, Qatar; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Marie Bird Pedersen
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | | | - David Martín-López
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK
| | - Ismail Ughratdar
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Richard P Selway
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Antonio Valentín
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK.
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Kuhn T, Gullett JM, Boutzoukas AE, Bohsali A, Mareci TH, FitzGerald DB, Carney PR, Bauer RM. Temporal lobe epilepsy affects spatial organization of entorhinal cortex connectivity. Epilepsy Behav 2018; 88:87-95. [PMID: 30243111 PMCID: PMC6294293 DOI: 10.1016/j.yebeh.2018.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 12/15/2022]
Abstract
Evidence for structural connectivity patterns within the medial temporal lobe derives primarily from postmortem histological studies. In humans and nonhuman primates, the parahippocampal gyrus (PHg) is subdivided into parahippocampal (PHc) and perirhinal (PRc) cortices, which receive input from distinct cortical networks. Likewise, their efferent projections to the entorhinal cortex (ERc) are distinct. The PHc projects primarily to the medial ERc (M-ERc). The PRc projects primarily to the lateral portion of the ERc (L-ERc). Both M-ERc and L-ERc, via the perforant pathway, project to the dentate gyrus and hippocampal (HC) subfields. Until recently, these neural circuits could not be visualized in vivo. Diffusion tensor imaging algorithms have been developed to segment gray matter structures based on probabilistic connectivity patterns. However, these algorithms have not yet been applied to investigate connectivity in the temporal lobe or changes in connectivity architecture related to disease processes. In this study, this segmentation procedure was used to classify ERc gray matter based on PRc, ERc, and HC connectivity patterns in 7 patients with temporal lobe epilepsy (TLE) without hippocampal sclerosis (mean age, 14.86 ± 3.34 years) and 7 healthy controls (mean age, 23.86 ± 2.97 years). Within samples paired t-tests allowed for comparison of ERc connectivity between epileptogenic and contralateral hemispheres. In healthy controls, there were no significant within-group differences in surface area, volume, or cluster number of ERc connectivity-defined regions (CDR). Likewise, in line with histology results, ERc CDR in the control group were well-organized, uniform, and segregated via PRc/PHc afferent and HC efferent connections. Conversely, in TLE, there were significantly more PRc and HC CDR clusters in the epileptogenic than the contralateral hemisphere. The surface area of the PRc CDR was greater, and that of the HC CDRs was smaller, in the epileptogenic hemisphere as well. Further, there was no clear delineation between M-ERc and L-ERc connectivity with PRc, PHc or HC in TLE. These results suggest a breakdown of the spatial organization of PHg-ERc-HC connectivity in TLE. Whether this breakdown is the cause or result of epileptic activity remains an exciting research question.
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Affiliation(s)
- Taylor Kuhn
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States of America; Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America.
| | - Joseph M Gullett
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States of America; Department of VA Brain Rehabilitation Research Center, Malcolm Randall VA Center Gainesville, FL, United States of America
| | - Angelique E Boutzoukas
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States of America
| | - Anastasia Bohsali
- Department of Neurology, University of Florida, Gainesville, FL, United States of America
| | - Thomas H Mareci
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL, United States of America
| | - David B FitzGerald
- Department of VA Brain Rehabilitation Research Center, Malcolm Randall VA Center Gainesville, FL, United States of America
| | - Paul R Carney
- Department of Pediatrics, University of Florida, Gainesville, FL, United States of America; Department of Neurology, University of Florida, Gainesville, FL, United States of America; Department of Neuroscience, University of Florida, Gainesville, FL, United States of America; J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States of America; B.J. and Eve Wilder Epilepsy Center Excellence, University of Florida, Gainesville, FL, United States of America
| | - Russell M Bauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States of America; Department of VA Brain Rehabilitation Research Center, Malcolm Randall VA Center Gainesville, FL, United States of America
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Swift JR, Coon WG, Guger C, Brunner P, Bunch M, Lynch T, Frawley B, Ritaccio AL, Schalk G. Passive functional mapping of receptive language areas using electrocorticographic signals. Clin Neurophysiol 2018; 129:2517-2524. [PMID: 30342252 DOI: 10.1016/j.clinph.2018.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To validate the use of passive functional mapping using electrocorticographic (ECoG) broadband gamma signals for identifying receptive language cortex. METHODS We mapped language function in 23 patients using ECoG and using electrical cortical stimulation (ECS) in a subset of 15 subjects. RESULTS The qualitative comparison between cortical sites identified by ECoG and ECS show a high concordance. A quantitative comparison indicates a high level of sensitivity (95%) and a lower level of specificity (59%). Detailed analysis reveals that 82% of all cortical sites identified by ECoG were within one contact of a site identified by ECS. CONCLUSIONS These results show that passive functional mapping reliably localizes receptive language areas, and that there is a substantial concordance between the ECoG- and ECS-based methods. They also point to a more refined understanding of the differences between ECoG- and ECS-based mappings. This refined understanding helps to clarify the instances in which the two methods disagree and can explain why neurosurgical practice has established the concept of a "safety margin." SIGNIFICANCE Passive functional mapping using ECoG signals provides a fast, robust, and reliable method for identifying receptive language areas without many of the risks and limitations associated with ECS.
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Affiliation(s)
- J R Swift
- g.tec neurotechnology USA, Rensselaer, NY, USA; Dept. of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA; National Ctr. for Adaptive Neurotechnologies, Wadsworth Center, NY State Dept. of Health, Albany, NY, USA.
| | - W G Coon
- g.tec neurotechnology USA, Rensselaer, NY, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Dept. of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; National Ctr. for Adaptive Neurotechnologies, Wadsworth Center, NY State Dept. of Health, Albany, NY, USA.
| | - C Guger
- g.tec neurotechnology USA, Rensselaer, NY, USA.
| | - P Brunner
- Dept. of Neurology, Albany Medical College, Albany, NY, USA; National Ctr. for Adaptive Neurotechnologies, Wadsworth Center, NY State Dept. of Health, Albany, NY, USA.
| | - M Bunch
- Dept. of Neurology, Albany Medical College, Albany, NY, USA.
| | - T Lynch
- Dept. of Neurology, Albany Medical College, Albany, NY, USA.
| | - B Frawley
- Dept. of Neurology, Albany Medical College, Albany, NY, USA.
| | - A L Ritaccio
- Dept. of Neurology, Mayo Clinic, Jacksonville, FL, USA; National Ctr. for Adaptive Neurotechnologies, Wadsworth Center, NY State Dept. of Health, Albany, NY, USA.
| | - G Schalk
- Dept. of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA; Dept. of Neurology, Albany Medical College, Albany, NY, USA; National Ctr. for Adaptive Neurotechnologies, Wadsworth Center, NY State Dept. of Health, Albany, NY, USA.
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Rofes A, Mandonnet E, de Aguiar V, Rapp B, Tsapkini K, Miceli G. Language processing from the perspective of electrical stimulation mapping. Cogn Neuropsychol 2018; 36:117-139. [PMID: 29996708 DOI: 10.1080/02643294.2018.1485636] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Electrical Stimulation (ES) is a neurostimulation technique that is used to localize language functions in the brain of people with intractable epilepsy and/or brain tumors. We reviewed 25 ES articles published between 1984 and 2018 and interpreted them from a cognitive neuropsychological perspective. Our aim was to highlight ES as a tool to further our understanding of cognitive models of language. We focused on associations and dissociations between cognitive functions within the framework of two non-neuroanatomically specified models of language. Also, we discussed parallels between the ES and the stroke literatures and showed how ES data can help us to generate hypotheses regarding how language is processed. A good understanding of cognitive models of language is essential to motivate task selection and to tailor surgical procedures, for example, by avoiding testing the same cognitive functions and understanding which functions may be more or less relevant to be tested during surgery.
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Affiliation(s)
- Adrià Rofes
- Global Brain Health Institute, Trinity College Dublin , Dublin , Ireland.,Department of Cognitive Science, Johns Hopkins University , Baltimore , MD , USA
| | - Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital , Paris , France.,University Diderot Paris 7 , Paris , France.,Frontlab, INSERM, ICM , Paris , France
| | - Vânia de Aguiar
- Department of Neurology, Johns Hopkins University , Baltimore , MD , USA
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University , Baltimore , MD , USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins University , Baltimore , MD , USA
| | - Gabriele Miceli
- Center for Mind and Brain Sciences, University of Trento , Trento , Italy
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Wilenius J, Lehtinen H, Paetau R, Salmelin R, Kirveskari E. A simple magnetoencephalographic auditory paradigm may aid in confirming left-hemispheric language dominance in epilepsy patients. PLoS One 2018; 13:e0200073. [PMID: 29966017 PMCID: PMC6028140 DOI: 10.1371/journal.pone.0200073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/19/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The intracarotid amobarbital procedure (IAP) is the current "gold standard" in the preoperative assessment of language lateralization in epilepsy surgery candidates. It is, however, invasive and has several limitations. Here we tested a simple noninvasive language lateralization test performed with magnetoencephalography (MEG). METHODS We recorded auditory MEG responses to pairs of vowels and pure tones in 16 epilepsy surgery candidates who had undergone IAP. For each individual, we selected the pair of planar gradiometer sensors with the strongest N100m response to vowels in each hemisphere and-from the vector sum of signals of this gradiometer pair-calculated the vowel/tone amplitude ratio in the left (L) and right (R) hemisphere and, subsequently, the laterality index: LI = (L-R)/(L+R). In addition to the analysis using a single sensor pair, an alternative analysis was performed using averaged responses over 18 temporal sensor pairs in both hemispheres. RESULTS The laterality index did not correlate significantly with the lateralization data obtained from the IAP. However, an MEG pattern of stronger responses to vowels than tones in the left hemisphere and stronger responses to tones than vowels in the right hemisphere was associated with left-hemispheric language dominance in the IAP in all the six patients who showed this pattern. This results in a specificity of 100% and a sensitivity of 67% of this MEG pattern in predicting left-hemispheric language dominance (p = 0.01, Fisher's exact test). In the analysis using averaged responses over temporal channels, one additional patient who was left-dominant in IAP showed this particular MEG pattern, increasing the sensitivity to 78% (p = 0.003). SIGNIFICANCE This simple MEG paradigm shows promise in feasibly and noninvasively confirming left-hemispheric language dominance in epilepsy surgery candidates. It may aid in reducing the need for the IAP, if the results are confirmed in larger patient samples.
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Affiliation(s)
- Juha Wilenius
- Clinical Neurosciences, Department of Clinical Neurophysiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henri Lehtinen
- Epilepsy Unit, Department of Pediatric Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ritva Paetau
- Clinical Neurosciences, Department of Clinical Neurophysiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Epilepsy Unit, Department of Pediatric Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riitta Salmelin
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Erika Kirveskari
- Clinical Neurosciences, Department of Clinical Neurophysiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Chiong W, Leonard MK, Chang EF. Neurosurgical Patients as Human Research Subjects: Ethical Considerations in Intracranial Electrophysiology Research. Neurosurgery 2018; 83:29-37. [PMID: 28973530 PMCID: PMC5777911 DOI: 10.1093/neuros/nyx361] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/05/2017] [Indexed: 11/14/2022] Open
Abstract
Intracranial electrical recordings and stimulation of neurosurgical patients have been central to the advancement of human neuroscience. The use of these methods has rapidly expanded over the last decade due to theoretical and technical advances, as well as the growing number of neurosurgical patients undergoing functional procedures for indications such as epilepsy, tumor resection, and movement disorders. These methods pose the potential for ethical conflict, as they involve basic neuroscientific research utilizing invasive procedures in human patients undergoing treatment for neurological illnesses. This review addresses technical aspects, clinical contexts, and issues of ethical concern, utilizing a framework that is informed by, but also departs from, existing bioethical literature on matters in clinical research. We conclude with proposals for improving informed consent processes to address potential problems specific to intracranial electrophysiology research, a general schema for scrutinizing research-related risk associated with different methods, and a call for the development of consensus to ensure continuing scientific progress alongside crucial patient protections in this promising area of human neuroscience.
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Affiliation(s)
- Winston Chiong
- Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California
| | - Matthew K Leonard
- Weill Institute for Neurosciences, Department of Neurosurgery, University of California San Francisco, San Francisco, California
| | - Edward F Chang
- Weill Institute for Neurosciences, Department of Neurosurgery, University of California San Francisco, San Francisco, California
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Hale MD, Zaman A, Morrall MC, Chumas P, Maguire MJ. A Novel Functional Magnetic Resonance Imaging Paradigm for the Preoperative Assessment of Auditory Perception in a Musician Undergoing Temporal Lobe Surgery. World Neurosurg 2018; 111:63-67. [DOI: 10.1016/j.wneu.2017.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 11/30/2022]
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Arya R, Wilson JA, Fujiwara H, Vannest J, Byars AW, Rozhkov L, Leach JL, Greiner HM, Buroker J, Scholle C, Horn PS, Crone NE, Rose DF, Mangano FT, Holland KD. Electrocorticographic high-gamma modulation with passive listening paradigm for pediatric extraoperative language mapping. Epilepsia 2018; 59:792-801. [PMID: 29460482 DOI: 10.1111/epi.14029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This prospective study compared the topography of high-gamma modulation (HGM) during a story-listening task requiring negligible patient cooperation, with the conventional electrical stimulation mapping (ESM) using a picture-naming task, for presurgical language localization in pediatric drug-resistant epilepsy. METHODS Patients undergoing extraoperative monitoring with subdural electrodes were included. Electrocorticographic signals were recorded during quiet baseline and a story-listening task. The likelihood of 70- to 150-Hz power modulation during the listening task relative to the baseline was estimated for each electrode and plotted on a cortical surface model. Sensitivity, specificity, accuracy, and diagnostic odds ratio (DOR) were estimated compared to ESM, using a meta-analytic framework. RESULTS Nineteen patients (10 with left hemisphere electrodes) aged 4-19 years were analyzed. HGM during story listening was observed in bilateral posterior superior temporal, angular, supramarginal, and inferior frontal gyri, along with anatomically defined language association areas. Compared to either cognitive or both cognitive and orofacial sensorimotor interference with naming during ESM, left hemisphere HGM showed high specificity (0.82-0.84), good accuracy (0.66-0.70), and DOR of 2.23 and 3.24, respectively. HGM was a better classifier of ESM language sites in the left temporoparietal cortex compared to the frontal lobe. Incorporating visual naming with the story-listening task substantially improved the accuracy (0.80) and DOR (13.61) of HGM mapping, while the high specificity (0.85) was retained. In the right hemisphere, no ESM sites for aphasia were seen, and the results of HGM and ESM comparisons were not significant. SIGNIFICANCE HGM associated with story listening is a specific determinant of left hemisphere ESM language sites. It can be used for presurgical language mapping in children who cannot cooperate with conventional language tasks requiring active engagement. Incorporation of additional language tasks, if feasible, can further improve the diagnostic accuracy of language localization with HGM.
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Affiliation(s)
- Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Adam Wilson
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hisako Fujiwara
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Vannest
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Division of Pediatric Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jason Buroker
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Craig Scholle
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Douglas F Rose
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Arya R, Aungaroon G, Zea Vera A, Horn PS, Byars AW, Greiner HM, Mangano FT, Holland KD. Fosphenytoin pre-medication for pediatric extra-operative electrical stimulation brain mapping. Epilepsy Res 2018; 140:171-176. [PMID: 29367180 DOI: 10.1016/j.eplepsyres.2018.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE We studied the effect of fosphenytoin (FOS) pre-medication on the incidence and thresholds of after-discharges (ADs), seizures, and functional responses during electrical stimulation mapping (ESM). METHODS As individualized by the attending epileptologist, FOS was given intravenously at 2 mg-phenytoin-equivalents (PE)/kg/min or 150 mg-PE/min (whichever slower). Patients who received and did not receive FOS were compared for the incidence and thresholds of ADs, seizures, and functional responses. RESULTS Before ESM, 40 and 82 patients respectively were pre-medicated/not pre-medicated with FOS. The incidence of ESM-induced seizures was significantly lower in FOS pre-medicated patients (22.5% vs. 42.7%, p = 0.044), whereas temporal language threshold was higher (9.2 vs. 6.5 mA, p = 0.032). FOS was more efficacious in preventing ESM-induced seizures in patients with symptomatogenic zone ipsilateral to the side of ESM. Although FOS dose had no significant effect on minimum language, minimum motor, or AD thresholds; seizure and temporal language thresholds showed trends approaching significance, intersecting at 12.2 mg-PE/kg. The incidence of ESM-induced seizures was significantly lower in those who received FOS at a dose of ≤12 mg/kg (9.1%) compared to those who did not receive any FOS (42.7%, p = 0.046), while the temporal language thresholds were not significantly different (6.3 vs. 6.5 mA, p = 0.897). CONCLUSIONS This study provides class III evidence that FOS pre-medication before ESM decreases the incidence of ESM-induced seizures, but increases temporal language threshold. FOS pre-medication may thus be considered before ESM. Future studies should prospectively verify these observations and characterize dose-response relationships.
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Affiliation(s)
- Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alonso Zea Vera
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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ECoG high-gamma modulation versus electrical stimulation for presurgical language mapping. Epilepsy Behav 2018; 79:26-33. [PMID: 29247963 PMCID: PMC5815885 DOI: 10.1016/j.yebeh.2017.10.044] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/17/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This meta-analysis compared diagnostic validity of electrocorticographic (ECoG) high-γ modulation (HGM) with electrical stimulation mapping (ESM) for presurgical language localization. METHODS From a structured literature search, studies with electrode level data comparing ECoG HGM and ESM for language localization were included in the meta-analysis. Outcomes included global measures of diagnostic validity: area under the summary receiver operating characteristic (SROC) curve (AUC), and diagnostic odds ratio (DOR); as well as pooled estimates of sensitivity and specificity. Clinical and technical determinants of sensitivity/specificity were explored. RESULTS Fifteen studies were included in qualitative synthesis, and 10 studies included in the meta-analysis (number of patients 1-17, mean age 10.3-53.6years). Overt picture naming was the most commonly used task for language mapping with either method. Electrocorticographic high-γ modulation was analyzed at 50-400Hz with different bandwidths in individual studies. For ESM, pulse duration, train duration, and maximum current varied greatly among studies. Sensitivity (0.23-0.99), specificity (0.48-0.96), and DOR (1.45-376.28) varied widely across studies. The pooled estimates are: sensitivity 0.61 (95% CI 0.44, 0.76), specificity 0.79 (95% CI 0.68, 0.88), and DOR 6.44 (95% CI 3.47, 11.94). Area under the SROC curve was 0.77. Results of bivariate meta-regression were limited by small samples for individual variables. CONCLUSION Electrocorticographic high-γ modulation is a specific but not sensitive method for language localization compared with gold-standard ESM. Given the pooled DOR of 6.44 and AUC of 0.77, ECoG HGM can fairly reliably ascertain electrodes overlying ESM cortical language sites.
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Bédos Ulvin L, Jonas J, Brissart H, Colnat-Coulbois S, Thiriaux A, Vignal JP, Maillard L. Intracerebral stimulation of left and right ventral temporal cortex during object naming. BRAIN AND LANGUAGE 2017; 175:71-76. [PMID: 29024845 DOI: 10.1016/j.bandl.2017.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 09/06/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
While object naming is traditionally considered asa left hemisphere function, neuroimaging studies have reported activations related to naming in the ventral temporal cortex (VTC) bilaterally. Our aim was to use intracerebral electrical stimulation to specifically compare left and right VTC in naming. In twenty-three epileptic patients tested for visual object naming during stimulation, the proportion of naming impairments was significantly higher in the left than in the right VTC (31.3% vs 13.6%). The highest proportions of positive naming sites were found in the left fusiform gyrus and occipito-temporal sulcus (47.5% and 31.8%). For 17 positive left naming sites, an additional semantic picture matching was carried out, always successfully performed. Our results showed the enhanced role of the left compared to the right VTC in naming and suggest that it may be involved in lexical retrieval rather than in semantic processing.
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Affiliation(s)
- Line Bédos Ulvin
- Service de Neurologie, Centre Hospitalier Universitaire de Reims, Reims, France.
| | - Jacques Jonas
- Service de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France; CRAN, UMR 7039, CNRS et Université de Lorraine, Nancy, France.
| | - Hélène Brissart
- Service de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.
| | | | - Anne Thiriaux
- Service de Neurologie, Centre Hospitalier Universitaire de Reims, Reims, France.
| | - Jean-Pierre Vignal
- Service de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France; CRAN, UMR 7039, CNRS et Université de Lorraine, Nancy, France.
| | - Louis Maillard
- Service de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France; CRAN, UMR 7039, CNRS et Université de Lorraine, Nancy, France.
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Nakai Y, Jeong JW, Brown EC, Rothermel R, Kojima K, Kambara T, Shah A, Mittal S, Sood S, Asano E. Three- and four-dimensional mapping of speech and language in patients with epilepsy. Brain 2017; 140:1351-1370. [PMID: 28334963 PMCID: PMC5405238 DOI: 10.1093/brain/awx051] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/14/2017] [Indexed: 11/13/2022] Open
Abstract
We have provided 3-D and 4D mapping of speech and language function based upon the results of direct cortical stimulation and event-related modulation of electrocorticography signals. Patients estimated to have right-hemispheric language dominance were excluded. Thus, 100 patients who underwent two-stage epilepsy surgery with chronic electrocorticography recording were studied. An older group consisted of 84 patients at least 10 years of age (7367 artefact-free non-epileptic electrodes), whereas a younger group included 16 children younger than age 10 (1438 electrodes). The probability of symptoms transiently induced by electrical stimulation was delineated on a 3D average surface image. The electrocorticography amplitude changes of high-gamma (70-110 Hz) and beta (15-30 Hz) activities during an auditory-naming task were animated on the average surface image in a 4D manner. Thereby, high-gamma augmentation and beta attenuation were treated as summary measures of cortical activation. Stimulation data indicated the causal relationship between (i) superior-temporal gyrus of either hemisphere and auditory hallucination; (ii) left superior-/middle-temporal gyri and receptive aphasia; (iii) widespread temporal/frontal lobe regions of the left hemisphere and expressive aphasia; and (iv) bilateral precentral/left posterior superior-frontal regions and speech arrest. On electrocorticography analysis, high-gamma augmentation involved the bilateral superior-temporal and precentral gyri immediately following question onset; at the same time, high-gamma activity was attenuated in the left orbitofrontal gyrus. High-gamma activity was augmented in the left temporal/frontal lobe regions, as well as left inferior-parietal and cingulate regions, maximally around question offset, with high-gamma augmentation in the left pars orbitalis inferior-frontal, middle-frontal, and inferior-parietal regions preceded by high-gamma attenuation in the contralateral homotopic regions. Immediately before verbal response, high-gamma augmentation involved the posterior superior-frontal and pre/postcentral regions, bilaterally. Beta-attenuation was spatially and temporally correlated with high-gamma augmentation in general but with exceptions. The younger and older groups shared similar spatial-temporal profiles of high-gamma and beta modulation; except, the younger group failed to show left-dominant activation in the rostral middle-frontal and pars orbitalis inferior-frontal regions around stimulus offset. The human brain may rapidly and alternately activate and deactivate cortical areas advantageous or obtrusive to function directed toward speech and language at a given moment. Increased left-dominant activation in the anterior frontal structures in the older age group may reflect developmental consolidation of the language system. The results of our functional mapping may be useful in predicting, across not only space but also time and patient age, sites specific to language function for presurgical evaluation of focal epilepsy.
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Affiliation(s)
- Yasuo Nakai
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA.,Department of Neurological Surgery, Wakayama Medical University, Wakayama-shi, Wakayama, 6418510, Japan
| | - Jeong-Won Jeong
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA.,Department of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Erik C Brown
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Robert Rothermel
- Department of Psychiatry, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Katsuaki Kojima
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA.,Department of Pediatrics, University of California San Francisco, CA, 94143, USA
| | - Toshimune Kambara
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA.,Postdoctoral Fellowship for Research Abroad, Japan Society for the Promotion of Science (JSPS), Chiyoda-ku, Tokyo, 1020083, Japan
| | - Aashit Shah
- Department of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Sandeep Sood
- Department of Neurosurgery, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Eishi Asano
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA.,Department of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, 48201, USA
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47
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Zea Vera A, Aungaroon G, Horn PS, Byars AW, Greiner HM, Tenney JR, Arthur TM, Crone NE, Holland KD, Mangano FT, Arya R. Language and motor function thresholds during pediatric extra-operative electrical cortical stimulation brain mapping. Clin Neurophysiol 2017; 128:2087-2093. [PMID: 28774583 DOI: 10.1016/j.clinph.2017.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine current thresholds and their determinants for language and motor mapping with extra-operative electrical cortical stimulation (ECS). METHODS ECS electrocorticograph recordings were reviewed to determine functional thresholds. Predictors of functional thresholds were found with multivariable analyses. RESULTS In 122 patients (age 11.9±5.4years), average minimum, frontal, and temporal language thresholds were 7.4 (± 3.0), 7.8 (± 3.0), and 7.4 (± 3.1) mA respectively. Average minimum, face, upper and lower extremity motor thresholds were 5.4 (± 2.8), 6.1 (± 2.8), 4.9 (± 2.3), and 5.3 (± 3.3) mA respectively. Functional and after-discharge (AD)/seizure thresholds were significantly related. Minimum, frontal, and temporal language thresholds were higher than AD thresholds at all ages. Minimum motor threshold was higher than minimum AD threshold up to 8.0years of age, face motor threshold was higher than frontal AD threshold up to 11.8years age, and lower subsequently. UE motor thresholds remained below frontal AD thresholds throughout the age range. CONCLUSIONS Functional thresholds are frequently above AD thresholds in younger children. SIGNIFICANCE These findings raise concerns about safety and neurophysiologic validity of ECS mapping. Functional and AD/seizure thresholds relationships suggest individual differences in cortical excitability which cannot be explained by clinical variables.
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Affiliation(s)
- Alonso Zea Vera
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey R Tenney
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Todd M Arthur
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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48
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Hendrix P, Senger S, Griessenauer CJ, Simgen A, Linsler S, Oertel J. Preoperative navigated transcranial magnetic stimulation and tractography in transparietal approach to the trigone of the lateral ventricle. J Clin Neurosci 2017; 41:154-161. [DOI: 10.1016/j.jocn.2017.02.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/10/2017] [Indexed: 11/26/2022]
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49
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Zanin E, Riva M, Bambini V, Cappa SF, Magrassi L, Moro A. The contribution of surgical brain mapping to the understanding of the anatomo-functional basis of syntax: A critical review. Neurol Sci 2017. [PMID: 28624915 DOI: 10.1007/s10072-017-3016-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A wide range of studies on language assessment during awake brain surgery is nowadays available. Yet, a consensus on a standardized protocol for intraoperative language mapping is still lacking. More specifically, very limited information is offered about intraoperative assessment of a crucial component of language such as syntax. This review aims at critically analyzing the intraoperative studies investigating the cerebral basis of syntactic processing. A comprehensive query was performed on the literature, returning a total of 18 studies. These papers were analyzed according to two complementary criteria, based on the distinction between morphosyntax and syntax. The first criterion focused on the tasks and stimuli employed intraoperatively. Studies were divided into three different groups: group 1 included those studies that overtly aimed at investigating morphosyntactic processes; group 2 included studies that did not explicitly focus on syntax, yet employed stimuli requiring morphosyntactic processing; and group 3 included studies reporting some generic form of syntactic deficit, although not further investigated. The second criterion focused on the syntactic structures of the sentences assessed intraoperatively, analyzing the canonicity of sentence structure (i.e., canonical versus non-canonical word order). The global picture emerging from our analysis indicates that what was investigated in the intraoperative literature is morphosyntactic processing, rather than pure syntax. The study of the neurobiology of syntax during awake surgery seems thus to be still at an early stage, in need of systematic, linguistically grounded investigations.
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Affiliation(s)
- Elia Zanin
- Neurocognition, Epistemogy and Theoretical Syntax Research Center (NETS), Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria, 15, 27100, Pavia, Italy.
| | - Marco Riva
- Unit of Oncological Neurosurgery, Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Valentina Bambini
- Neurocognition, Epistemogy and Theoretical Syntax Research Center (NETS), Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria, 15, 27100, Pavia, Italy
| | - Stefano F Cappa
- Neurocognition, Epistemogy and Theoretical Syntax Research Center (NETS), Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria, 15, 27100, Pavia, Italy.,IRCCS S. Cuore Fatebenefratelli, 25125, Brescia, Italy
| | - Lorenzo Magrassi
- Neurocognition, Epistemogy and Theoretical Syntax Research Center (NETS), Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria, 15, 27100, Pavia, Italy.,Neurosurgery - Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy.,Istituto di Genetica Molecolare - Consiglio Nazionale delle Ricerche, 27100, Pavia, Italy
| | - Andrea Moro
- Neurocognition, Epistemogy and Theoretical Syntax Research Center (NETS), Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria, 15, 27100, Pavia, Italy
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50
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Katlowitz KA, Oya H, Howard MA, Greenlee JDW, Long MA. Paradoxical vocal changes in a trained singer by focally cooling the right superior temporal gyrus. Cortex 2017; 89:111-119. [PMID: 28282570 PMCID: PMC5421518 DOI: 10.1016/j.cortex.2017.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/26/2016] [Accepted: 01/30/2017] [Indexed: 11/24/2022]
Abstract
The production and perception of music is preferentially mediated by cortical areas within the right hemisphere, but little is known about how these brain regions individually contribute to this process. In an experienced singer undergoing awake craniotomy, we demonstrated that direct electrical stimulation to a portion of the right posterior superior temporal gyrus (pSTG) selectively interrupted singing but not speaking. We then focally cooled this region to modulate its activity during vocalization. In contrast to similar manipulations in left hemisphere speech production regions, pSTG cooling did not elicit any changes in vocal timing or quality. However, this manipulation led to an increase in the pitch of speaking with no such change in singing. Further analysis revealed that all vocalizations exhibited a cooling-induced increase in the frequency of the first formant, raising the possibility that potential pitch offsets may have been actively avoided during singing. Our results suggest that the right pSTG plays a key role in vocal sensorimotor processing whose impact is dependent on the type of vocalization produced.
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Affiliation(s)
- Kalman A Katlowitz
- NYU Neuroscience Institute, New York University Langone Medical Center, New York, NY, USA; Department of Otolaryngology, New York University Langone Medical Center, New York, NY, USA; Center for Neural Science, New York University, New York, NY, USA
| | - Hiroyuki Oya
- Human Brain Research Lab, Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Matthew A Howard
- Human Brain Research Lab, Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Jeremy D W Greenlee
- Human Brain Research Lab, Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Michael A Long
- NYU Neuroscience Institute, New York University Langone Medical Center, New York, NY, USA; Department of Otolaryngology, New York University Langone Medical Center, New York, NY, USA; Center for Neural Science, New York University, New York, NY, USA.
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