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Kashyap V, Ashby M, Stanslaski S, Nguyen K, Hageman K, Chang YC, Khalessi AA. Feasibility of Endovascular Deep Brain Stimulation of Anterior Nucleus of the Thalamus for Refractory Epilepsy. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01187. [PMID: 38869291 DOI: 10.1227/ons.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Deep brain stimulation (DBS) has developed into an effective therapy for several disease states including treatment-resistant Parkinson disease and medically intractable essential tremor, as well as segmental, generalized and cervical dystonia, and obsessive-compulsive disorder (OCD). Dystonia and OCD are approved with Humanitarian Device Exemption. In addition, DBS is also approved for the treatment of epilepsy in the anterior nucleus of the thalamus. Although overall considered an effective treatment for Parkinson disease and epilepsy, a number of specific factors determine the treatment success for DBS including careful patient selection, effective postoperative programming of DBS devices and accurate electrode placement. Furthermore, invasiveness of the procedure is a rate limiter for patient adoption. It is desired to explore a less invasive way to deliver DBS therapy. METHODS Here, we report for the first time the direct comparison of endovascular and parenchymal DBS in a triplicate ovine model using the anterior nucleus of the thalamus as the parenchymal target for refractory epilepsy. RESULTS Triplicate ovine studies show comparable sensing resolution and stimulation performance of endovascular DBS with parenchymal DBS. CONCLUSION The results from this feasibility study opens up a new frontier for minimally invasive DBS therapy.
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Affiliation(s)
- Varun Kashyap
- Department of Research and Technology, Medtronic Neurovascular, Irvine, California, USA
| | - Mark Ashby
- Department of Research and Technology, Medtronic Neurovascular, Irvine, California, USA
| | - Scott Stanslaski
- Department of Research and Technology, Medtronic Neuromodulation, Minneapolis, Minnesota, USA
| | - Kevin Nguyen
- Department of Research and Technology, Medtronic Neurovascular, Irvine, California, USA
| | - Kristin Hageman
- Department of Research and Technology, Medtronic Neuromodulation, Minneapolis, Minnesota, USA
| | - Yao-Chuan Chang
- Department of Research and Technology, Medtronic Neuromodulation, Minneapolis, Minnesota, USA
| | - Alexander A Khalessi
- Department of Radiology and Neurosciences, Don and Karen Cohn Chancellor's Endowed Chair of Neurological Surgery, University of California, San Diego, San Diego, California, USA
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Carè M, Chiappalone M, Cota VR. Personalized strategies of neurostimulation: from static biomarkers to dynamic closed-loop assessment of neural function. Front Neurosci 2024; 18:1363128. [PMID: 38516316 PMCID: PMC10954825 DOI: 10.3389/fnins.2024.1363128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Despite considerable advancement of first choice treatment (pharmacological, physical therapy, etc.) over many decades, neurological disorders still represent a major portion of the worldwide disease burden. Particularly concerning, the trend is that this scenario will worsen given an ever expanding and aging population. The many different methods of brain stimulation (electrical, magnetic, etc.) are, on the other hand, one of the most promising alternatives to mitigate the suffering of patients and families when conventional treatment fall short of delivering efficacious treatment. With applications in virtually all neurological conditions, neurostimulation has seen considerable success in providing relief of symptoms. On the other hand, a large variability of therapeutic outcomes has also been observed, particularly in the usage of non-invasive brain stimulation (NIBS) modalities. Borrowing inspiration and concepts from its pharmacological counterpart and empowered by unprecedented neurotechnological advancement, the neurostimulation field has seen in recent years a widespread of methods aimed at the personalization of its parameters, based on biomarkers of the individuals being treated. The rationale is that, by taking into account important factors influencing the outcome, personalized stimulation can yield a much-improved therapy. Here, we review the literature to delineate the state-of-the-art of personalized stimulation, while also considering the important aspects of the type of informing parameter (anatomy, function, hybrid), invasiveness, and level of development (pre-clinical experimentation versus clinical trials). Moreover, by reviewing relevant literature on closed loop neuroengineering solutions in general and on activity dependent stimulation method in particular, we put forward the idea that improved personalization may be achieved when the method is able to track in real time brain dynamics and adjust its stimulation parameters accordingly. We conclude that such approaches have great potential of promoting the recovery of lost functions and enhance the quality of life for patients.
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Affiliation(s)
- Marta Carè
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Michela Chiappalone
- Department of Informatics, Bioengineering, Robotics System Engineering (DIBRIS), University of Genova, Genova, Italy
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genova, Italy
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Warren AEL, Tobochnik S, Chua MMJ, Singh H, Stamm MA, Rolston JD. Neurostimulation for Generalized Epilepsy: Should Therapy be Syndrome-specific? Neurosurg Clin N Am 2024; 35:27-48. [PMID: 38000840 PMCID: PMC10676463 DOI: 10.1016/j.nec.2023.08.001] [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] [Indexed: 11/26/2023]
Abstract
Current applications of neurostimulation for generalized epilepsy use a one-target-fits-all approach that is agnostic to the specific epilepsy syndrome and seizure type being treated. The authors describe similarities and differences between the 2 "archetypes" of generalized epilepsy-Lennox-Gastaut syndrome and Idiopathic Generalized Epilepsy-and review recent neuroimaging evidence for syndrome-specific brain networks underlying seizures. Implications for stimulation targeting and programming are discussed using 5 clinical questions: What epilepsy syndrome does the patient have? What brain networks are involved? What is the optimal stimulation target? What is the optimal stimulation paradigm? What is the plan for adjusting stimulation over time?
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Affiliation(s)
- Aaron E L Warren
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Steven Tobochnik
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Melissa M J Chua
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hargunbir Singh
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michaela A Stamm
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John D Rolston
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Gilbert Z, Mason X, Sebastian R, Tang AM, Martin Del Campo-Vera R, Chen KH, Leonor A, Shao A, Tabarsi E, Chung R, Sundaram S, Kammen A, Cavaleri J, Gogia AS, Heck C, Nune G, Liu CY, Kellis SS, Lee B. A review of neurophysiological effects and efficiency of waveform parameters in deep brain stimulation. Clin Neurophysiol 2023; 152:93-111. [PMID: 37208270 DOI: 10.1016/j.clinph.2023.04.007] [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: 09/20/2022] [Revised: 02/09/2023] [Accepted: 04/15/2023] [Indexed: 05/21/2023]
Abstract
Neurostimulation has diverse clinical applications and potential as a treatment for medically refractory movement disorders, epilepsy, and other neurological disorders. However, the parameters used to program electrodes-polarity, pulse width, amplitude, and frequency-and how they are adjusted have remained largely untouched since the 1970 s. This review summarizes the state-of-the-art in Deep Brain Stimulation (DBS) and highlights the need for further research to uncover the physiological mechanisms of neurostimulation. We focus on studies that reveal the potential for clinicians to use waveform parameters to selectively stimulate neural tissue for therapeutic benefit, while avoiding activating tissue associated with adverse effects. DBS uses cathodic monophasic rectangular pulses with passive recharging in clinical practice to treat neurological conditions such as Parkinson's Disease. However, research has shown that stimulation efficiency can be improved, and side effects reduced, through modulating parameters and adding novel waveform properties. These developments can prolong implantable pulse generator lifespan, reducing costs and surgery-associated risks. Waveform parameters can stimulate neurons based on axon orientation and intrinsic structural properties, providing clinicians with more precise targeting of neural pathways. These findings could expand the spectrum of diseases treatable with neuromodulation and improve patient outcomes.
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Affiliation(s)
- Zachary Gilbert
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States.
| | - Xenos Mason
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Rinu Sebastian
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Austin M Tang
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Roberto Martin Del Campo-Vera
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Kuang-Hsuan Chen
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Andrea Leonor
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Arthur Shao
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Emiliano Tabarsi
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Ryan Chung
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Shivani Sundaram
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Alexandra Kammen
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Jonathan Cavaleri
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Angad S Gogia
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Christi Heck
- Department of Neurology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - George Nune
- Department of Neurology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Charles Y Liu
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; Department of Neurology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Spencer S Kellis
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Brian Lee
- Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, United States
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Aker L, Vattoth S, Paksoy Y. Injury to the circuit of Papez: An overlooked cause of recurrent seizures. Clin Case Rep 2023; 11:e7743. [PMID: 37554570 PMCID: PMC10404794 DOI: 10.1002/ccr3.7743] [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: 11/28/2022] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023] Open
Abstract
KEY CLINICAL MESSAGE Papez' circuit is a unique neural pathway in the limbic system that is correlated with seizure activity. Injuries affecting Papez' circuit are often small and unusual in location but can be identifiable in MRI and functional imaging modalities, which can be helpful in the workup of refractory epilepsy. ABSTRACT The Papez circuit is a unique neural pathway in the limbic system of the brain. We review a patient presenting with recurrent seizures as the main manifestation of Papez' circuit pathology. The radiologic features of ischemia involving the mammillothalamic tract in Papez' circuit were correlated with the seizure activity.
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Affiliation(s)
| | - Surjith Vattoth
- Neuroradiology SectionUniversity of Arkansas for Medical Sciences (UAMS)Little RockArkansasUSA
| | - Yahya Paksoy
- Neuroscience InstituteHamad Medical CorporationDohaQatar
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Ilyas A, Alamoudi OA, Riley KO, Pati S. Pro-Ictal State in Human Temporal Lobe Epilepsy. NEJM EVIDENCE 2023; 2:EVIDoa2200187. [PMID: 38320014 DOI: 10.1056/evidoa2200187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND: Studies of continuous electroencephalography (EEG) suggest that seizures in individuals with focal-onset epilepsies preferentially occur during periods of heightened risk, typified by pathologic brain activities, termed pro-ictal states; however, the presence of (pathologic) pro-ictal states among a plethora of otherwise physiologic (e.g., sleep–wake cycle) states has not been established. METHODS: We studied a prospective, consecutive series of 15 patients with temporal lobe epilepsy who underwent limbic thalamic recordings in addition to routine (cortical) intracranial EEG for seizure localization. For each participant, pro-ictal (45 minutes before seizure onset) and interictal (4 hours removed from all seizures) EEG segments were divided into 10-minute, nonoverlapping windows, which were randomly distributed into training and validation cohorts in a 1:1 ratio. A deep neural classifier was applied to distinguish pro-ictal from interictal brain activities in a patient-specific fashion. RESULTS: We analyzed 1800 patient-hours of continuous thalamocortical EEG. Distinct pro-ictal states were detected in each participant. The median area under the receiver-operating characteristic curve of the classifier was 0.92 (interquartile range, 0.90–0.96). Pro-ictal states were distinguished at least 45 minutes before seizure onset in 13 of 15 participants; in 2 of 15 participants, they were distinguished up to 35 minutes prior. CONCLUSIONS: On the basis of thalamocortical EEG, pro-ictal states — pathologic brain activities during periods of heightened seizure risk — could be identified in patients with temporal lobe epilepsy and were detected, in our small sample, more than one half hour before seizure onset.
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Affiliation(s)
- Adeel Ilyas
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UTHealth Houston, Houston
- Texas Institute for Restorative Neurotechnologies, UTHealth Houston, Houston
| | - Omar A Alamoudi
- Texas Institute for Restorative Neurotechnologies, UTHealth Houston, Houston
- Department of Neurology, McGovern Medical School at UTHealth Houston, Houston
- Department of Biomedical Engineering, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kristen O Riley
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Sandipan Pati
- Texas Institute for Restorative Neurotechnologies, UTHealth Houston, Houston
- Department of Neurology, McGovern Medical School at UTHealth Houston, Houston
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7
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Yang Y, Zhang F, Gao X, Feng L, Xu K. Progressive alterations in electrophysiological and epileptic network properties during the development of temporal lobe epilepsy in rats. Epilepsy Behav 2023; 141:109120. [PMID: 36868167 DOI: 10.1016/j.yebeh.2023.109120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE Refractory temporal lobe epilepsy (TLE) with recurring seizures causing continuing pathological changes in neural reorganization. There is an incomplete understanding of how spatiotemporal electrophysiological characteristics changes during the development of TLE. Long-term multi-site epilepsy patients' data is hard to obtain. Thus, our study relied on animal models to reveal the changes in electrophysiological and epileptic network characteristics systematically. METHODS Long-term local field potentials (LFPs) were recorded over a period of 1 to 4 months from 6 pilocarpine-treated TLE rats. We compared variations of seizure onset zone (SOZ), seizure onset pattern (SOP), the latency of seizure onsets, and functional connectivity network from 10-channel LFPs between the early and late stages. Moreover, three machine learning classifiers trained by early-stage data were used to test seizure detection performance in the late stage. RESULTS Compared to the early stage, the earliest seizure onset was more frequently detected in hippocampus areas in the late stage. The latency of seizure onsets between electrodes became shorter. Low-voltage fast activity (LVFA) was the most common SOP and the proportion of it increased in the late stage. Different brain states were observed during seizures using Granger causality (GC). Moreover, seizure detection classifiers trained by early-stage data were less accurate when tested in late-stage data. SIGNIFICANCE Neuromodulation especially closed-loop deep brain stimulation (DBS) is effective in the treatment of refractory TLE. Although the frequency or amplitude of the stimulation is generally adjusted in existing closed-loop DBS devices in clinical usage, the adjustment rarely considers the pathological progression of chronic TLE. This suggests that an important factor affecting the therapeutic effect of neuromodulation may have been overlooked. The present study reveals time-varying electrophysiological and epileptic network properties in chronic TLE rats and indicates that classifiers of seizure detection and neuromodulation parameters might be designed to adapt to the current state dynamically with the progression of epilepsy.
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Affiliation(s)
- Yufang Yang
- Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China; Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Key Laboratory of Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China.
| | - Fang Zhang
- Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China; Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Key Laboratory of Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China.
| | - Xiang Gao
- Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Key Laboratory of Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China; Institute of Advanced Digital Technology and Instrument, Zhejiang University, Hangzhou, China.
| | | | - Kedi Xu
- Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China; Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Key Laboratory of Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China; The MOE Frontier Science Center for Brain Science and Brain-machine Integration, Hangzhou, China.
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8
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Lowet E, Kondabolu K, Zhou S, Mount RA, Wang Y, Ravasio CR, Han X. Deep brain stimulation creates informational lesion through membrane depolarization in mouse hippocampus. Nat Commun 2022; 13:7709. [PMID: 36513664 PMCID: PMC9748039 DOI: 10.1038/s41467-022-35314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Deep brain stimulation (DBS) is a promising neuromodulation therapy, but the neurophysiological mechanisms of DBS remain unclear. In awake mice, we performed high-speed membrane voltage fluorescence imaging of individual hippocampal CA1 neurons during DBS delivered at 40 Hz or 140 Hz, free of electrical interference. DBS powerfully depolarized somatic membrane potentials without suppressing spike rate, especially at 140 Hz. Further, DBS paced membrane voltage and spike timing at the stimulation frequency and reduced timed spiking output in response to hippocampal network theta-rhythmic (3-12 Hz) activity patterns. To determine whether DBS directly impacts cellular processing of inputs, we optogenetically evoked theta-rhythmic membrane depolarization at the soma. We found that DBS-evoked membrane depolarization was correlated with DBS-mediated suppression of neuronal responses to optogenetic inputs. These results demonstrate that DBS produces powerful membrane depolarization that interferes with the ability of individual neurons to respond to inputs, creating an informational lesion.
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Affiliation(s)
- Eric Lowet
- Boston University, Department of Biomedical Engineering, Boston, MA, 02215, USA.
| | - Krishnakanth Kondabolu
- grid.189504.10000 0004 1936 7558Boston University, Department of Biomedical Engineering, Boston, MA 02215 USA
| | - Samuel Zhou
- grid.189504.10000 0004 1936 7558Boston University, Department of Biomedical Engineering, Boston, MA 02215 USA
| | - Rebecca A. Mount
- grid.189504.10000 0004 1936 7558Boston University, Department of Biomedical Engineering, Boston, MA 02215 USA
| | - Yangyang Wang
- grid.189504.10000 0004 1936 7558Boston University, Department of Biomedical Engineering, Boston, MA 02215 USA
| | - Cara R. Ravasio
- grid.189504.10000 0004 1936 7558Boston University, Department of Biomedical Engineering, Boston, MA 02215 USA
| | - Xue Han
- Boston University, Department of Biomedical Engineering, Boston, MA, 02215, USA.
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Staley K. Gene therapy for epilepsy. Science 2022; 378:471-472. [DOI: 10.1126/science.ade8836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
On-demand inhibition of neuronal activity reduced spontaneous seizures in mice
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Affiliation(s)
- Kevin Staley
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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10
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Wu J, Sun J, Song J. Health Assessment Method Based on Multi-sign Information Fusion of Body Area Network. Inf Sci (N Y) 2022. [DOI: 10.1016/j.ins.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Maki Y, Natsume J, Ito Y, Okai Y, Bagarinao E, Yamamoto H, Ogaya S, Takeuchi T, Fukasawa T, Sawamura F, Mitsumatsu T, Maesawa S, Saito R, Takahashi Y, Kidokoro H. Involvement of the Thalamus, Hippocampus, and Brainstem in Hypsarrhythmia of West Syndrome: Simultaneous Recordings of Electroencephalography and fMRI Study. AJNR Am J Neuroradiol 2022; 43:1502-1507. [PMID: 36137665 PMCID: PMC9575537 DOI: 10.3174/ajnr.a7646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE West syndrome is a developmental and epileptic encephalopathy characterized by epileptic spasms, neurodevelopmental regression, and a specific EEG pattern called hypsarrhythmia. Our aim was to investigate the brain activities related to hypsarrhythmia at onset and focal epileptiform discharges in the remote period in children with West syndrome using simultaneous electroencephalography and fMRI recordings. MATERIALS AND METHODS Fourteen children with West syndrome underwent simultaneous electroencephalography and fMRI at the onset of West syndrome. Statistically significant blood oxygen level-dependent responses related to hypsarrhythmia were analyzed using an event-related design of 4 hemodynamic response functions with peaks at 3, 5, 7, and 9 seconds after the onset of each event. Six of 14 children had focal epileptiform discharges after treatment and underwent simultaneous electroencephalography and fMRI from 12 to 25 months of age. RESULTS At onset, positive blood oxygen level-dependent responses were seen in the brainstem (14/14 patients), thalami (13/14), basal ganglia (13/14), and hippocampi (13/14), in addition to multiple cerebral cortices. Group analysis using hemodynamic response functions with peaks at 3, 5, and 7 seconds showed positive blood oxygen level-dependent responses in the brainstem, thalamus, and hippocampus, while positive blood oxygen level-dependent responses in multiple cerebral cortices were seen using hemodynamic response functions with peaks at 5 and 7 seconds. In the remote period, 3 of 6 children had focal epileptiform discharge-related positive blood oxygen level-dependent responses in the thalamus, hippocampus, and brainstem. CONCLUSIONS Positive blood oxygen level-dependent responses with hypsarrhythmia appeared in the brainstem, thalamus, and hippocampus on earlier hemodynamic response functions than the cerebral cortices, suggesting the propagation of epileptogenic activities from the deep brain structures to the neocortices. Activation of the hippocampus, thalamus, and brainstem was still seen in half of the patients with focal epileptiform discharges after adrenocorticotropic hormone therapy.
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Affiliation(s)
- Y Maki
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - J Natsume
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Developmental Disability Medicine (J.N.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - Y Ito
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
- Department of Pediatrics (Y.I.), Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center, Okazaki, Japan
| | - Y Okai
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
- Department of Pediatric Neurology (Y.O.), Toyota Municipal Child Development Center, Toyota, Japan
| | - E Bagarinao
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - H Yamamoto
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - S Ogaya
- Department of Pediatric Neurology (S.O.), Aichi Developmental Disability Center Central Hospital, Kasugai, Japan
| | - T Takeuchi
- Department of Pediatrics (T.T.), Japanese Red Cross Nagoya First Hospital
| | - T Fukasawa
- Nagoya, Japan; and Department of Pediatrics (T.F.), Anjo Kosei Hospital, Anjo, Japan
| | - F Sawamura
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - T Mitsumatsu
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - S Maesawa
- Neurosurgery (S.M., R.S.), Nagoya University Graduate School of Medicine, Nagoya, Japan
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - R Saito
- Neurosurgery (S.M., R.S.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Takahashi
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - H Kidokoro
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
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Bonaccini Calia A, Masvidal-Codina E, Smith TM, Schäfer N, Rathore D, Rodríguez-Lucas E, Illa X, De la Cruz JM, Del Corro E, Prats-Alfonso E, Viana D, Bousquet J, Hébert C, Martínez-Aguilar J, Sperling JR, Drummond M, Halder A, Dodd A, Barr K, Savage S, Fornell J, Sort J, Guger C, Villa R, Kostarelos K, Wykes RC, Guimerà-Brunet A, Garrido JA. Full-bandwidth electrophysiology of seizures and epileptiform activity enabled by flexible graphene microtransistor depth neural probes. NATURE NANOTECHNOLOGY 2022; 17:301-309. [PMID: 34937934 DOI: 10.1038/s41565-021-01041-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/02/2021] [Indexed: 06/14/2023]
Abstract
Mapping the entire frequency bandwidth of brain electrophysiological signals is of paramount importance for understanding physiological and pathological states. The ability to record simultaneously DC-shifts, infraslow oscillations (<0.1 Hz), typical local field potentials (0.1-80 Hz) and higher frequencies (80-600 Hz) using the same recording site would particularly benefit preclinical epilepsy research and could provide clinical biomarkers for improved seizure onset zone delineation. However, commonly used metal microelectrode technology suffers from instabilities that hamper the high fidelity of DC-coupled recordings, which are needed to access signals of very low frequency. In this study we used flexible graphene depth neural probes (gDNPs), consisting of a linear array of graphene microtransistors, to concurrently record DC-shifts and high-frequency neuronal activity in awake rodents. We show here that gDNPs can reliably record and map with high spatial resolution seizures, pre-ictal DC-shifts and seizure-associated spreading depolarizations together with higher frequencies through the cortical laminae to the hippocampus in a mouse model of chemically induced seizures. Moreover, we demonstrate the functionality of chronically implanted devices over 10 weeks by recording with high fidelity spontaneous spike-wave discharges and associated infraslow oscillations in a rat model of absence epilepsy. Altogether, our work highlights the suitability of this technology for in vivo electrophysiology research, and in particular epilepsy research, by allowing stable and chronic DC-coupled recordings.
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Affiliation(s)
- Andrea Bonaccini Calia
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Spain
| | - Eduard Masvidal-Codina
- Institut de Microelectrònica de Barcelona, IMB-CNM (CSIC), Bellaterra, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Trevor M Smith
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, UK
| | - Nathan Schäfer
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Spain
| | - Daman Rathore
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, UK
| | - Elisa Rodríguez-Lucas
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Spain
| | - Xavi Illa
- Institut de Microelectrònica de Barcelona, IMB-CNM (CSIC), Bellaterra, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Jose M De la Cruz
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Spain
| | - Elena Del Corro
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Spain
| | - Elisabet Prats-Alfonso
- Institut de Microelectrònica de Barcelona, IMB-CNM (CSIC), Bellaterra, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Damià Viana
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Spain
| | - Jessica Bousquet
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Spain
| | - Clement Hébert
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Spain
| | - Javier Martínez-Aguilar
- Institut de Microelectrònica de Barcelona, IMB-CNM (CSIC), Bellaterra, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Justin R Sperling
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Spain
| | - Matthew Drummond
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Arnab Halder
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Abbie Dodd
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Katharine Barr
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Sinead Savage
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Jordina Fornell
- Departament de Fisica, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jordi Sort
- Departament de Fisica, Universitat Autonoma de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Christoph Guger
- g.tec medical engineering, Guger Technologies, Schiedlberg, Austria
| | - Rosa Villa
- Institut de Microelectrònica de Barcelona, IMB-CNM (CSIC), Bellaterra, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Kostas Kostarelos
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Spain
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Rob C Wykes
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, UK.
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK.
| | - Anton Guimerà-Brunet
- Institut de Microelectrònica de Barcelona, IMB-CNM (CSIC), Bellaterra, Spain.
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain.
| | - Jose A Garrido
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Spain.
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain.
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13
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Tong X, Wang J, Qin L, Zhou J, Guan Y, Zhai F, Teng P, Wang M, Li T, Wang X, Luan G. Analysis of power spectrum and phase lag index changes following deep brain stimulation of the anterior nucleus of the thalamus in patients with drug-resistant epilepsy: A retrospective study. Seizure 2022; 96:6-12. [PMID: 35042005 DOI: 10.1016/j.seizure.2022.01.004] [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: 08/03/2021] [Revised: 12/18/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The mechanisms underlying the anterior nucleus of the thalamus (ANT) deep brain stimulation (DBS) for the treatment of drug-resistant epilepsy (DRE) have not been fully explored. The present study aimed to measure the changes in whole-brain activity generated by ANT DBS using interictal electroencephalography (EEG). MATERIALS AND METHODS Interictal EEG signals were retrospectively collected in 20 DRE patients who underwent ANT DBS surgery. Patients were classified as responders or non-responders depending on their response to ANT DBS treatment. The power spectrum (PS) and Phase Lag Index (PLI) were determined and data analyzed using a paired sample t-test to evaluate activity differences between pre-and-post-treatment on different frequency categories. Student's t-test, Mann-Whitney test (non-parametric test) and Fisher exact test were used to compare groups in terms of clinical variables and EEG metrics. P values < 0.05 were considered statistically significant, and FDR-corrected values were used for multiple testing. RESULTS PS analysis revealed that whole-brain spectral power had a significant decrease in the beta (p = 0.005) and gamma (p = 0.037) bands following ANT DBS treatment in responders. The analysis of scalp topographic images of all patients showed that ANT DBS decreases PS in the beta band at the F3, F7 and Cz electrode sites. The findings indicated a decrease in PS in the gamma band at the Fp2, F3, Cz, T3, T5 and Oz electrode sites. After ANT DBS treatment, PLI analysis showed a significant decrease in PLI between Fp1 and T3 in the gamma band in responders. CONCLUSION The findings showed that ANT DBS induces a decrease in power in the left frontal lobe, left temporal lobe and midline areas in the beta and gamma bands. Lower whole-brain power in the beta and gamma bands can be used as biomarkers for a favorable therapeutic response to ANT DBS, and decreased synchronization between the left frontal pole and temporal lobe in the gamma band can also be used as a biomarker for effective clinical stimulation to guide postoperative programming.
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Affiliation(s)
- Xuezhi Tong
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Jing Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Lang Qin
- McGovern Institute for Brain Research, Peking University, Beijing 100093, China; Center for MRI Research, Peking University, Beijing 100093, China
| | - Jian Zhou
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Yuguang Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Feng Zhai
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Pengfei Teng
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Tianfu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China; Beijing Key Laboratory of Epilepsy, Beijing 100093, China
| | - Xiongfei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China; Beijing Key Laboratory of Epilepsy, Beijing 100093, China; Epilepsy Institute, Beijing Institute for Brain Disorders, Beijing 100093, China
| | - Guoming Luan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China; Beijing Key Laboratory of Epilepsy, Beijing 100093, China; Epilepsy Institute, Beijing Institute for Brain Disorders, Beijing 100093, China
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14
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Vetkas A, Fomenko A, Germann J, Sarica C, Iorio-Morin C, Samuel N, Yamamoto K, Milano V, Cheyuo C, Zemmar A, Elias G, Boutet A, Loh A, Santyr B, Gwun D, Tasserie J, Kalia SK, Lozano AM. Deep brain stimulation targets in epilepsy: Systematic review and meta-analysis of anterior and centromedian thalamic nuclei and hippocampus. Epilepsia 2022; 63:513-524. [PMID: 34981509 DOI: 10.1111/epi.17157] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 12/11/2022]
Abstract
Deep brain stimulation (DBS) is a neuromodulatory treatment used in patients with drug-resistant epilepsy (DRE). The primary goal of this systematic review and meta-analysis is to describe recent advancements in the field of DBS for epilepsy, to compare the results of published trials, and to clarify the clinical utility of DBS in DRE. A systematic literature search was performed by two independent authors. Forty-four articles were included in the meta-analysis (23 for anterior thalamic nucleus [ANT], 8 for centromedian thalamic nucleus [CMT], and 13 for hippocampus) with a total of 527 patients. The mean seizure reduction after stimulation of the ANT, CMT, and hippocampus in our meta-analysis was 60.8%, 73.4%, and 67.8%, respectively. DBS is an effective and safe therapy in patients with DRE. Based on the results of randomized controlled trials and larger clinical series, the best evidence exists for DBS of the anterior thalamic nucleus. Further randomized trials are required to clarify the role of CMT and hippocampal stimulation. Our analysis suggests more efficient deep brain stimulation of ANT for focal seizures, wider use of CMT for generalized seizures, and hippocampal DBS for temporal lobe seizures. Factors associated with clinical outcome after DBS for epilepsy are electrode location, stimulation parameters, type of epilepsy, and longer time of stimulation. Recent advancements in anatomical targeting, functional neuroimaging, responsive neurostimulation, and sensing of local field potentials could potentially lead to improved outcomes after DBS for epilepsy and reduced sudden, unexpected death of patients with epilepsy. Biomarkers are needed for successful patient selection, targeting of electrodes and optimization of stimulation parameters.
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Affiliation(s)
- Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Neurology Clinic, Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Anton Fomenko
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Christian Iorio-Morin
- Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Nardin Samuel
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vanessa Milano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Cletus Cheyuo
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville, School of Medicine, Louisville, KY, USA
| | - Gavin Elias
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Brendan Santyr
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dave Gwun
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jordy Tasserie
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, Toronto, ON, Canada
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15
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The Endocannabinoid System in Glial Cells and Their Profitable Interactions to Treat Epilepsy: Evidence from Animal Models. Int J Mol Sci 2021; 22:ijms222413231. [PMID: 34948035 PMCID: PMC8709154 DOI: 10.3390/ijms222413231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022] Open
Abstract
Epilepsy is one of the most common neurological conditions. Yearly, five million people are diagnosed with epileptic-related disorders. The neuroprotective and therapeutic effect of (endo)cannabinoid compounds has been extensively investigated in several models of epilepsy. Therefore, the study of specific cell-type-dependent mechanisms underlying cannabinoid effects is crucial to understanding epileptic disorders. It is estimated that about 100 billion neurons and a roughly equal number of glial cells co-exist in the human brain. The glial population is in charge of neuronal viability, and therefore, their participation in brain pathophysiology is crucial. Furthermore, glial malfunctioning occurs in a wide range of neurological disorders. However, little is known about the impact of the endocannabinoid system (ECS) regulation over glial cells, even less in pathological conditions such as epilepsy. In this review, we aim to compile the existing knowledge on the role of the ECS in different cell types, with a particular emphasis on glial cells and their impact on epilepsy. Thus, we propose that glial cells could be a novel target for cannabinoid agents for treating the etiology of epilepsy and managing seizure-like disorders.
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16
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Tenney JR, Williamson BJ, Kadis DS. Cross-Frequency Coupling in Childhood Absence Epilepsy. Brain Connect 2021; 12:489-496. [PMID: 34405685 DOI: 10.1089/brain.2021.0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Absence seizures are the prototypic primarily generalized seizures, but there is incomplete understanding regarding their generation and maintenance. A core network for absence seizures has been defined, including focal cortical and thalamic regions that have frequency-dependent interactions. The purpose of this study was to investigate within-frequency coupling and cross-frequency coupling (CFC) during human absence seizures, to identify key regions (hubs) within the absence network that contribute to propagation and maintenance. Methods: Thirteen children with new-onset and untreated childhood absence epilepsy had over 60 typical absence seizures during both electroencephalography-functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG) recordings. The spatial map of the ictal network was defined using fMRI and used as prior information for MEG connectivity. A multilayer network approach was used to investigate within-frequency coupling and CFC for canonical frequency bands. A rigorous null-modeling approach was used to determine connections outside the noise floor. Results: Strong coupling between beta and gamma frequencies, within the left frontal cortex, and between the left frontal and right parietal regions was observed. There was also strong connectivity between left frontal and right parietal nodes within the gamma band. Multilayer versatility analysis identified a cluster of network hubs in the left frontal region. Interpretation: Cortical regions commonly identified as being critical for absence seizure generation (frontal cortex, precuneus) have strong CFC and within-frequency coupling between beta and gamma bands. As nonpharmacologic treatments, such as neuromodulation, become available for generalized epilepsies, detailed mechanistic understanding of how "diffuse" seizures are generated and maintained will be necessary to provide optimal outcomes.
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Affiliation(s)
- Jeffrey R Tenney
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brady J Williamson
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Darren S Kadis
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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17
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Sohanian Haghighi H, Markazi AHD. Control of epileptic seizures by electrical stimulation: a model-based study. Biomed Phys Eng Express 2021; 7. [PMID: 34488206 DOI: 10.1088/2057-1976/ac240d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/06/2021] [Indexed: 11/12/2022]
Abstract
High frequency electrical stimulation of brain is commonly used in research experiments and clinical trials as a modern tool for control of epileptic seizures. However, the mechanistic basis by which periodic external stimuli alter the brain state is not well understood. This study provides a computational insight into the mechanism of seizure suppression by high frequency stimulation (HFS). In particular, a modified version of the Jansen-Rit neural mass model is employed, in which EEG signals can be considered as the input. The proposed model reproduces seizure-like activity in the output during the ictal period of the input signal. By applying a control signal to the model, a wide range of stimulation amplitudes and frequencies are systematically explored. Simulation results reveal that HFS can effectively suppress the seizure-like activity. Our results suggest that HFS has the ability of shifting the operating state of neural populations away from a critical condition. Furthermore, a closed-loop control strategy is proposed in this paper. The main objective has been to considerably reduce the control effort needed for blocking abnormal activity of the brain. Such an energy reduction could be of practical importance, to reduce possible side effects and increase battery life for implanted neurostimulators.
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Affiliation(s)
| | - Amir H D Markazi
- 1School of Mechanical Engineering, Iran University of Science and Technology, Tehran 16844, Iran
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18
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Silva AB, Khambhati AN, Speidel BA, Chang EF, Rao VR. Effects of anterior thalamic nuclei stimulation on hippocampal activity: Chronic recording in a patient with drug-resistant focal epilepsy. Epilepsy Behav Rep 2021; 16:100467. [PMID: 34458713 PMCID: PMC8379668 DOI: 10.1016/j.ebr.2021.100467] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 11/12/2022] Open
Abstract
Devices for RNS and thalamic DBS were implanted in a single person with epilepsy. RNS electrocorticography enabled characterization of acute and chronic DBS effects. DBS caused acute, phasic, frequency-dependent responses in hippocampus and cortex. DBS modulated functional connectivity and suppressed epileptiform activity over time. Chronic electrocorticography elucidates progressive effects of thalamic stimulation.
Implanted neurostimulation devices are gaining traction as palliative treatment options for certain forms of drug-resistant epilepsy, but clinical utility of these devices is hindered by incomplete mechanistic understanding of their therapeutic effects. Approved devices for anterior thalamic nuclei deep brain stimulation (ANT DBS) are thought to work at a network level, but limited sensing capability precludes characterization of neurophysiological effects outside the thalamus. Here, we describe a patient with drug-resistant temporal lobe epilepsy who was implanted with a responsive neurostimulation device (RNS System), involving hippocampal and ipsilateral temporal neocortical leads, and subsequently received ANT DBS. Over 1.5 years, RNS System electrocorticography enabled multiscale characterization of neurophysiological effects of thalamic stimulation. In brain regions sampled by the RNS System, ANT DBS produced acute, phasic, frequency-dependent responses, including suppression of hippocampal low frequency local field potentials. ANT DBS modulated functional connectivity between hippocampus and neocortex. Finally, ANT DBS progressively suppressed hippocampal epileptiform activity in relation to the extent of hippocampal theta suppression, which informs stimulation parameter selection for ANT DBS. Taken together, this unique clinical scenario, involving hippocampal recordings of unprecedented chronicity alongside ANT DBS, sheds light on the therapeutic mechanism of thalamic stimulation and highlights capabilities needed in next-generation devices.
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Affiliation(s)
- Alexander B Silva
- Medical Scientist Training Program, University of California, San Francisco, USA
| | - Ankit N Khambhati
- Department of Neurological Surgery and Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Benjamin A Speidel
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, United States
| | - Edward F Chang
- Department of Neurological Surgery and Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Vikram R Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, United States
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19
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Stirling RE, Maturana MI, Karoly PJ, Nurse ES, McCutcheon K, Grayden DB, Ringo SG, Heasman JM, Hoare RJ, Lai A, D'Souza W, Seneviratne U, Seiderer L, McLean KJ, Bulluss KJ, Murphy M, Brinkmann BH, Richardson MP, Freestone DR, Cook MJ. Seizure Forecasting Using a Novel Sub-Scalp Ultra-Long Term EEG Monitoring System. Front Neurol 2021; 12:713794. [PMID: 34497578 PMCID: PMC8419461 DOI: 10.3389/fneur.2021.713794] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Accurate identification of seizure activity, both clinical and subclinical, has important implications in the management of epilepsy. Accurate recognition of seizure activity is essential for diagnostic, management and forecasting purposes, but patient-reported seizures have been shown to be unreliable. Earlier work has revealed accurate capture of electrographic seizures and forecasting is possible with an implantable intracranial device, but less invasive electroencephalography (EEG) recording systems would be optimal. Here, we present preliminary results of seizure detection and forecasting with a minimally invasive sub-scalp device that continuously records EEG. Five participants with refractory epilepsy who experience at least two clinically identifiable seizures monthly have been implanted with sub-scalp devices (Minder®), providing two channels of data from both hemispheres of the brain. Data is continuously captured via a behind-the-ear system, which also powers the device, and transferred wirelessly to a mobile phone, from where it is accessible remotely via cloud storage. EEG recordings from the sub-scalp device were compared to data recorded from a conventional system during a 1-week ambulatory video-EEG monitoring session. Suspect epileptiform activity (EA) was detected using machine learning algorithms and reviewed by trained neurophysiologists. Seizure forecasting was demonstrated retrospectively by utilizing cycles in EA and previous seizure times. The procedures and devices were well-tolerated and no significant complications have been reported. Seizures were accurately identified on the sub-scalp system, as visually confirmed by periods of concurrent conventional scalp EEG recordings. The data acquired also allowed seizure forecasting to be successfully undertaken. The area under the receiver operating characteristic curve (AUC score) achieved (0.88), which is comparable to the best score in recent, state-of-the-art forecasting work using intracranial EEG.
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Affiliation(s)
- Rachel E. Stirling
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Matias I. Maturana
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Philippa J. Karoly
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Ewan S. Nurse
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | | | - David B. Grayden
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | | | - John M. Heasman
- Epi-Minder Pty. Ltd., Melbourne, VIC, Australia
- Cochlear Limited, Sydney, NSW, Australia
| | | | - Alan Lai
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Wendyl D'Souza
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Udaya Seneviratne
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, Monash Medical Centre, Melbourne, VIC, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Linda Seiderer
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Karen J. McLean
- Epi-Minder Pty. Ltd., Melbourne, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Kristian J. Bulluss
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Michael Murphy
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Neuroscience, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Benjamin H. Brinkmann
- Bioelectronics Neurophysiology and Engineering Lab, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Mark P. Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Mark J. Cook
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine at St. Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Epi-Minder Pty. Ltd., Melbourne, VIC, Australia
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20
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Mihály I, Orbán-Kis K, Gáll Z, Berki ÁJ, Bod RB, Szilágyi T. Amygdala Low-Frequency Stimulation Reduces Pathological Phase-Amplitude Coupling in the Pilocarpine Model of Epilepsy. Brain Sci 2020; 10:brainsci10110856. [PMID: 33202818 PMCID: PMC7696538 DOI: 10.3390/brainsci10110856] [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: 10/15/2020] [Revised: 10/31/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
Temporal-lobe epilepsy (TLE) is the most common type of drug-resistant epilepsy and warrants the development of new therapies, such as deep-brain stimulation (DBS). DBS was applied to different brain regions for patients with epilepsy; however, the mechanisms of action are not fully understood. Therefore, we tried to characterize the effect of amygdala DBS on hippocampal electrical activity in the lithium-pilocarpine model in male Wistar rats. After status epilepticus (SE) induction, seizure patterns were determined based on continuous video recordings. Recording electrodes were inserted in the left and right hippocampus and a stimulating electrode in the left basolateral amygdala of both Pilo and age-matched control rats 10 weeks after SE. Daily stimulation protocol consisted of 4 × 50 s stimulation trains (4-Hz, regular interpulse interval) for 10 days. The hippocampal electroencephalogram was analyzed offline: interictal epileptiform discharge (IED) frequency, spectral analysis, and phase-amplitude coupling (PAC) between delta band and higher frequencies were measured. We found that the seizure rate and duration decreased (by 23% and 26.5%) and the decrease in seizure rate correlated negatively with the IED frequency. PAC was elevated in epileptic animals and DBS reduced the pathologically increased PAC and increased the average theta power (25.9% ± 1.1 vs. 30.3% ± 1.1; p < 0.01). Increasing theta power and reducing the PAC could be two possible mechanisms by which DBS may exhibit its antiepileptic effect in TLE; moreover, they could be used to monitor effectiveness of stimulation.
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Affiliation(s)
- István Mihály
- Department of Physiology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (K.O.-K.); (Á.-J.B.); (R.-B.B.), (T.S.)
- Correspondence: ; Tel.: +40-749-768-257
| | - Károly Orbán-Kis
- Department of Physiology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (K.O.-K.); (Á.-J.B.); (R.-B.B.), (T.S.)
| | - Zsolt Gáll
- Department of Pharmacology and Clinical Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania;
| | - Ádám-József Berki
- Department of Physiology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (K.O.-K.); (Á.-J.B.); (R.-B.B.), (T.S.)
| | - Réka-Barbara Bod
- Department of Physiology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (K.O.-K.); (Á.-J.B.); (R.-B.B.), (T.S.)
| | - Tibor Szilágyi
- Department of Physiology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (K.O.-K.); (Á.-J.B.); (R.-B.B.), (T.S.)
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21
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Jarosiewicz B, Morrell M. The RNS System: brain-responsive neurostimulation for the treatment of epilepsy. Expert Rev Med Devices 2020; 18:129-138. [PMID: 32936673 DOI: 10.1080/17434440.2019.1683445] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Epilepsy affects more than 1% of the US population, and over 30% of adults with epilepsy do not respond to antiseizure medications without life-impacting medication-related side effects. Resection of the seizure focus is not an option for many patients because it would cause unacceptable neurological or cognitive harm. For these patients, neuromodulation has emerged as a nondestructive, effective, and safe alternative. The NeuroPace® RNS® System, the only brain-responsive neurostimulation device, records neural activity from leads placed at one or two seizure foci. When the neurostimulator detects epileptiform activity, as defined for each patient by his or her physician, brief pulses of electrical stimulation are delivered to normalize the activity.Areas covered: This review describes the RNS System, the results of multi-year clinical trials, and the research discoveries enabled by the chronic ambulatory brain data collected by the RNS System.Expert commentary: Brain-responsive neurostimulation could potentially be used to treat any episodic neurological disorder that's accompanied by a neurophysiological biomarker of severity. Combining advanced machine learning approaches with the chronic ambulatory brain data collected by the RNS System could eventually enable automatic fine-tuning of detection and stimulation for each patient, creating a general-purpose neurotechnological platform for precision medicine.
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Affiliation(s)
| | - Martha Morrell
- NeuroPace, Inc, Mountain View, CA, USA.,Neurology & Neurological Sciences, Stanford University, Stanford Neuroscience Health Center, Palo Alto, CA, USA
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