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Kamada C, Enatsu R, Imataka S, Kanno A, Ochi S, Mikuni N. Functional Brain Mapping Using Depth Electrodes. World Neurosurg 2024; 188:e288-e296. [PMID: 38796150 DOI: 10.1016/j.wneu.2024.05.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE This study investigated the neurologic symptoms and stimulus intensities in the stimulation of deep structures and subcortical fibers with the depth electrodes. METHODS Seventeen patients with drug-refractory epilepsy who underwent functional brain mapping with the depth electrodes were enrolled. The 50 Hz electrical stimulation was applied, and the diffusion tensor image was used to identify subcortical fibers. The responsible structures and stimulus intensities for the induced neurologic symptoms were evaluated. RESULTS Neurologic symptoms were induced in 11 of 17 patients. The opercular stimulation elicited the neurologic symptoms in 6 patients at the median threshold of 4.0 mA (visceral/face/hand sensory, hand/throat motor, negative motor and auditory symptoms). The insular stimulation induced the neurologic symptoms in 4 patients at the median threshold of 4.0 mA (auditory, negative motor, and sensory symptoms). The stimulation of subcortical fibers was induced in 5 of 9 patients at the median threshold of 4.5 mA. The thresholds of depth electrodes were significantly lower than those of subdural electrodes in 8 patients who used both subdural and depth electrodes and induced symptoms with both electrodes. CONCLUSIONS The stimulation of depth electrodes can identify the function of deep structures and subcortical fibers with lower intensities than subdural electrodes.
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Affiliation(s)
- Chie Kamada
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
| | - Seiichiro Imataka
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Aya Kanno
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Satoko Ochi
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
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Mahgoub R, Bayram AK, Spencer DD, Alkawadri R. Functional parcellation of the cingulate gyrus by electrical cortical stimulation: a synthetic literature review and future directions. J Neurol Neurosurg Psychiatry 2024; 95:704-721. [PMID: 38242679 DOI: 10.1136/jnnp-2023-332246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/30/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The cingulate gyrus (CG), a brain structure above the corpus callosum, is recognised as part of the limbic system and plays numerous vital roles. However, its full functional capacity is yet to be understood. In recent years, emerging evidence from imaging modalities, supported by electrical cortical stimulation (ECS) findings, has improved our understanding. To our knowledge, there is a limited number of systematic reviews of the cingulate function studied by ECS. We aim to parcellate the CG by reviewing ECS studies. DESIGN/METHODS We searched PubMed and Embase for studies investigating CG using ECS. A total of 30 studies met the inclusion criteria. We evaluated the ECS responses across the cingulate subregions and summarised the reported findings. RESULTS We included 30 studies (totalling 887 patients, with a mean age of 31.8±9.8 years). The total number of electrodes implanted within the cingulate was 3028 electrode contacts; positive responses were obtained in 941 (31.1%, median percentages, 32.3%, IQR 22.2%-64.3%). The responses elicited from the CG were as follows. Simple motor (8 studies, 26.7 %), complex motor (10 studies, 33.3%), gelastic with and without mirth (7 studies, 23.3%), somatosensory (9 studies, 30%), autonomic (11 studies, 36.7 %), psychic (8 studies, 26.7%) and vestibular (3 studies, 10%). Visual and speech responses were also reported. Despite some overlap, the results indicate that the anterior cingulate cortex is responsible for most emotional, laughter and autonomic responses, while the middle cingulate cortex controls most complex motor behaviours, and the posterior cingulate cortex (PCC) regulates visual, among various other responses. Consistent null responses have been observed across different regions, emphasising PCC. CONCLUSIONS Our results provide a segmental mapping of the functional properties of CG, helping to improve precision in the surgical planning of epilepsy.
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Affiliation(s)
- Rawan Mahgoub
- Department of Neurology, The University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Ayse Kacar Bayram
- Department of Pediatrics, Division of Pediatric Neurology, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey
| | - Dennis D Spencer
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rafeed Alkawadri
- Department of Neurology, The University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
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Sarnthein J, Neidert MC. A profile on the WISE cortical strip for intraoperative neurophysiological monitoring. Expert Rev Med Devices 2024; 21:373-379. [PMID: 38629964 DOI: 10.1080/17434440.2024.2343421] [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: 11/20/2023] [Accepted: 04/11/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION During intraoperative neurophysiological monitoring in neurosurgery, brain electrodes are placed to record electrocorticography or to inject current for direct cortical stimulation. A low impedance electrode may improve signal quality. AREAS COVERED We review here a brain electrode (WISE Cortical Strip, WCS®), where a thin polymer strip embeds platinum nanoparticles to create conductive electrode contacts. The low impedance contacts enable a high signal-to-noise ratio, allowing for better detection of small signals such as high-frequency oscillations (HFO). The softness of the WCS may hinder sliding the electrode under the dura or advancing it to deeper structures as the hippocampus but assures conformability with the cortex even in the resection cavity. We provide an extensive review on WCS including a market overview, an introduction to the device (mechanistics, cost aspects, performance standards, safety and contraindications) and an overview of the available pre- and post-approval data. EXPERT OPINION The WCS improves signal detection by lower impedance and better conformability to the cortex. The higher signal-to-noise ratio improves the detection of challenging signals. The softness of the electrode may be a disadvantage in some applications and an advantage in others.
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Affiliation(s)
- Johannes Sarnthein
- Klinik für Neurochirurgie, Universitätsspital Zürich, Universität Zürich, Zurich, Switzerland
- Klinisches Neurozentrum, Universitätsspital Zürich, Zurich, Switzerland
| | - Marian C Neidert
- Klinik für Neurochirurgie, Universitätsspital Zürich, Universität Zürich, Zurich, Switzerland
- Klinik für Neurochirurgie, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Lee DH, Chung CK, Kim JS, Ryun S. Unraveling tactile categorization and decision-making in the subregions of supramarginal gyrus via direct cortical stimulation. Clin Neurophysiol 2024; 158:16-26. [PMID: 38134532 DOI: 10.1016/j.clinph.2023.12.004] [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: 07/06/2023] [Revised: 11/23/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE This study aims to investigate the potential of direct cortical stimulation (DCS) to modulate tactile categorization and decision-making, as well as to identify the specific locations where these cognitive functions occur. METHODS We analyzed behavioral changes in three epilepsy patients with implanted electrodes using electrocorticography (ECoG) and a vibrotactile discrimination task. DCS was applied to investigate its impact on tactile categorization and decision-making processes. We determined the precise location of the electrodes where each cognitive function was modulated. RESULTS This functional discrimination was related with gamma band activity from ECoG. DCS selectively affected either tactile categorization or decision-making processes. Tactile categorization was modulated by stimulating the rostral part of the supramarginal gyrus, while decision-making was modulated by stimulating the caudal part. CONCLUSIONS DCS can enhance cognitive processes and map brain regions responsible for tactile categorization and decision-making within the supramarginal gyrus. This study also demonstrates that DCS and the gamma activity of ECoG can concordantly identify the detailed brain mapping in a tactile process compared to other functional neuroimaging. SIGNIFICANCE The combination of DCS and ECoG gamma activity provides a more nuanced and detailed understanding of brain function than traditional neuroimaging techniques alone.
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Affiliation(s)
- Dong Hyeok Lee
- Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Chun Kee Chung
- Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul 08826, Republic of Korea; Neuroscience Research Institute, Medical Research Center, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Republic of Korea.
| | - June Sic Kim
- The Research Institute of Basic Sciences, College of Natural Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Seokyun Ryun
- Neuroscience Research Institute, Medical Research Center, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea
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Conner CR, Forseth KJ, Lozano AM, Ritter R, Fenoy AJ. Thalamo-cortical evoked potentials during stimulation of the dentato-rubro-thalamic tract demonstrate synaptic filtering. Neurotherapeutics 2024; 21:e00295. [PMID: 38237402 PMCID: PMC10903089 DOI: 10.1016/j.neurot.2023.10.005] [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: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 02/16/2024] Open
Abstract
Essential tremor DBS targeting the ventral intermediate nucleus (Vim) of the thalamus and its input, the dentato-rubro-thalamic tract (DRTt), has proven to be an effective treatment strategy. We examined thalamo-cortical evoked potentials (TCEPs) and cortical dynamics during stimulation of the DRTt. We recorded TCEPs in primary motor cortex during clinical and supra-clinical stimulation of the DRTt in ten essential tremor patients. Stimulation was varied over pulse amplitude (2-10 mA) and pulse width (30-250 μs) to allow for strength-duration testing. Testing at clinical levels (3 mA, 60 μs) for stimulation frequencies of 1-160 Hz was performed and phase amplitude coupling (PAC) of beta phase and gamma power was calculated. Primary motor cortex TCEPs displayed two responses: early and all-or-none (<20 ms) or delayed and charge-dependent (>50 ms). Strength-duration curve approximation indicates that the chronaxie of the neural elements related to the TCEPs is <200 μs. At the range of clinical stimulation (amplitude 2-5 mA, pulse width 30-60 μs), TCEPs were not noted over primary motor cortex. Decreased pathophysiological phase-amplitude coupling was seen above 70 Hz stimulation without changes in power spectra and below the threshold of TCEPs. Our findings demonstrate that DRTt stimulation within normal clinical bounds does not excite fibers directly connected with primary motor cortex but that supra-clinical stimulation can excite a direct axonal tract. Both clinical efficacy and phase-amplitude coupling were frequency-dependent, favoring a synaptic filtering model as a possible mechanism of action.
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Affiliation(s)
- Christopher R Conner
- Division of Neurosurgery, Department of Surgery, University of Connecticut, Hartford, CT, USA.
| | - Kiefer J Forseth
- Division of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert Ritter
- Department of Neurosurgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Albert J Fenoy
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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Frauscher B, Bartolomei F, Baud MO, Smith RJ, Worrell G, Lundstrom BN. Stimulation to probe, excite, and inhibit the epileptic brain. Epilepsia 2023; 64 Suppl 3:S49-S61. [PMID: 37194746 PMCID: PMC10654261 DOI: 10.1111/epi.17640] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
Direct cortical stimulation has been applied in epilepsy for nearly a century and has experienced a renaissance, given unprecedented opportunities to probe, excite, and inhibit the human brain. Evidence suggests stimulation can increase diagnostic and therapeutic utility in patients with drug-resistant epilepsies. However, choosing appropriate stimulation parameters is not a trivial issue, and is further complicated by epilepsy being characterized by complex brain state dynamics. In this article derived from discussions at the ICTALS 2022 Conference (International Conference on Technology and Analysis for Seizures), we succinctly review the literature on cortical stimulation applied acutely and chronically to the epileptic brain for localization, monitoring, and therapeutic purposes. In particular, we discuss how stimulation is used to probe brain excitability, discuss evidence on the usefulness of stimulation to trigger and stop seizures, review therapeutic applications of stimulation, and finally discuss how stimulation parameters are impacted by brain dynamics. Although research has advanced considerably over the past decade, there are still significant hurdles to optimizing use of this technique. For example, it remains unclear to what extent short timescale diagnostic biomarkers can predict long-term outcomes and to what extent these biomarkers add information to already existing biomarkers from passive electroencephalographic recordings. Further questions include the extent to which closed loop stimulation offers advantages over open loop stimulation, what the optimal closed loop timescales may be, and whether biomarker-informed stimulation can lead to seizure freedom. The ultimate goal of bioelectronic medicine remains not just to stop seizures but rather to cure epilepsy and its comorbidities.
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Affiliation(s)
- Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, France. AP-HM, Service de Neurophysiologie Clinique, Hôpital de la Timone, Marseille, France
| | - Maxime O. Baud
- Sleep-Wake-Epilepsy Center, NeuroTec and Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern
| | - Rachel J. Smith
- University of Alabama at Birmingham, Electrical and Computer Engineering Department, Birmingham, Alabama, US. University of Alabama at Birmingham, Neuroengineering Program, Birmingham, Alabama, US
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, US
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Zhao XM, Wan HJ, Shao XQ, Zhang JG, Meng FG, Hu WH, Zhang C, Wang X, Mo JJ, Tao XR, Zhang K, Qiao H. Associated factors with stimulation induced seizures and the relevance with surgical outcomes. Clin Neurol Neurosurg 2023; 232:107865. [PMID: 37480785 DOI: 10.1016/j.clineuro.2023.107865] [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: 03/18/2023] [Revised: 05/11/2023] [Accepted: 06/25/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE To analyze the associated factors with stimulation-induced seizures (SIS) and the relevant factors in predicting surgical outcomes. METHODS We analyzed 80 consecutive epilepsy patients explored by stereo-electroencephalography with routine electrical stimulation mapping (ESM). If seizures induced by ESM, patients were classified as SIS-positive (SIS-P); otherwise, SIS-negative (SIS-N). Patients received radical surgery were further classified as favorable (Engel I) and unfavorable (Engel II-IV) groups. RESULTS Of the 80 patients included, we identified 44 (55.0%) and 36(45.0%) patients in the SIS-P and SIS-N groups, respectively. Multivariate analysis revealed that the seizure onset pattern (SOP) of preceding repetitive epileptiform discharges following LVFA (PRED→LVFA) (OR 3.319, 95% CI 1.200-9.183, P = 0.021) and pathology of focal cortical dysplasia (FCD) type II (OR 3.943, 95% CI 1.093-14.226, P = 0.036) were independent factors influencing whether the electrical stimulation can induce a seizure. Among the patients received radical surgery, there were 55 and 15 patients in the favorable and unfavorable groups separately. Multivariate analysis revealed that the SOP of PRED→LVFA induced seizures by stimulation (OR 11.409, 95% CI 1.182-110.161, P = 0.035) and bilateral implantation (OR 0.048, 95% CI 0.005-0.497, P = 0.011) were independent factors affecting surgical outcomes. The previous epilepsy surgery had a trend to be a negative factor with SIS (OR 0.156, 95% CI 0.028-0.880, P = 0.035) and surgical outcomes (OR 0.253, 95% CI 0.053-1.219, P = 0.087). CONCLUSION ESM is a highly valuable method for localizing the seizure onset zone. The SOP of PRED→LVFA and FCD type II were associated with elicitation of SIS by ESM, whereas a previous epilepsy surgery showed a negative association. Furthermore, the SOP of PRED→LVFA together with SIS in the same patient predicted favorable surgical outcomes, whereas bilateral electrode implantation predicted unfavorable outcomes.
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Affiliation(s)
- Xue-Min Zhao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hui-Juan Wan
- Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fan-Gang Meng
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia-Jie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Rong Tao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Hui Qiao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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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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Lettieri C, Pauletto G, Valiante G, Ius T, Verriello L, Valente M, Skrap M, Gigli GL, Budai R. Fast or Slow? A Comparison Between Two Transcranial Electrical Stimulation Techniques for Eliciting Motor-Evoked Potentials During Supratentorial Surgery. J Clin Neurophysiol 2023; 40:465-470. [PMID: 35452204 DOI: 10.1097/wnp.0000000000000902] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE During intraoperative neurophysiological monitoring of motor pathways, two types of transcranial electrical stimulation are available, i.e., constant-current and constant-voltage stimulation. Few previous studies, performed only during spinal surgery, analyzed and compared them during intraoperative neurophysiological monitoring. The aim of our study was to compare these two stimulation techniques for eliciting motor-evoked potentials during intraoperative neurophysiological monitoring in a group of patients affected by supratentorial lesions. METHODS Supratentorial lesions from 16 patients were retrospectively collected and analyzed. Motor-evoked potentials were performed only from transcranial electrical stimulation because the inability to place the subdural strip electrodes correctly did not permit to perform direct cortical stimulation. At the beginning of surgery, in each patient, motor-evoked potentials were monitored by using both "fast-charge" constant-voltage and "slow-charge" constant-current stimulation. Several neurophysiological parameters were collected and compared between the two stimulation techniques by means of statistical analysis. RESULTS "Fast-charge" constant-voltage stimulation allowed statistically higher efficiency rates for eliciting motor-evoked potentials compared with "slow-charge" constant-current stimulation, both for upper and lower limbs. We also found that threshold and maximal charge as well as charge density were significantly lower during constant-voltage stimulation, thus lowering the potential tissue damage. CONCLUSIONS "Fast-charge" constant-voltage transcranial electrical stimulation is feasible and safe during intraoperative neurophysiological monitoring for supratentorial surgery and may be preferable to "slow-charge" constant-current stimulation.
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Affiliation(s)
- Christian Lettieri
- Neurology and Clinical Neurophysiology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Giada Pauletto
- Neurology and Clinical Neurophysiology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Gabriele Valiante
- Neurology and Clinical Neurophysiology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Tamara Ius
- Neurosurgery Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Lorenzo Verriello
- Neurology and Clinical Neurophysiology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy ; and
- Departments of Medicine (DAME) and
| | - Miran Skrap
- Neurosurgery Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Gian L Gigli
- Clinical Neurology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy ; and
- Mathematics, Informatics and Physics (DMIF), University of Udine, Udine, Italy
| | - Riccardo Budai
- Neurology and Clinical Neurophysiology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
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Geva-Sagiv M, Mankin EA, Eliashiv D, Epstein S, Cherry N, Kalender G, Tchemodanov N, Nir Y, Fried I. Augmenting hippocampal-prefrontal neuronal synchrony during sleep enhances memory consolidation in humans. Nat Neurosci 2023; 26:1100-1110. [PMID: 37264156 PMCID: PMC10244181 DOI: 10.1038/s41593-023-01324-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 04/06/2023] [Indexed: 06/03/2023]
Abstract
Memory consolidation during sleep is thought to depend on the coordinated interplay between cortical slow waves, thalamocortical sleep spindles and hippocampal ripples, but direct evidence is lacking. Here, we implemented real-time closed-loop deep brain stimulation in human prefrontal cortex during sleep and tested its effects on sleep electrophysiology and on overnight consolidation of declarative memory. Synchronizing the stimulation to the active phases of endogenous slow waves in the medial temporal lobe (MTL) enhanced sleep spindles, boosted locking of brain-wide neural spiking activity to MTL slow waves, and improved coupling between MTL ripples and thalamocortical oscillations. Furthermore, synchronized stimulation enhanced the accuracy of recognition memory. By contrast, identical stimulation without this precise time-locking was not associated with, and sometimes even degraded, these electrophysiological and behavioral effects. Notably, individual changes in memory accuracy were highly correlated with electrophysiological effects. Our results indicate that hippocampo-thalamocortical synchronization during sleep causally supports human memory consolidation.
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Affiliation(s)
- Maya Geva-Sagiv
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Center of Neuroscience, University of California, Davis, Davis, CA, USA
| | - Emily A Mankin
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dawn Eliashiv
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Shdema Epstein
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalie Cherry
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Guldamla Kalender
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Natalia Tchemodanov
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yuval Nir
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
| | - Itzhak Fried
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA.
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Andrade-Machado R, Javarayee P, Koop JI, Farias-Moeller R, Kim I, Lew SM. Neural representations of self-perception of voice: An intracortical evoked potential analysis based on an adolescent with right temporal lobe epilepsy. Seizure 2023; 109:1-4. [PMID: 37172443 DOI: 10.1016/j.seizure.2023.04.003] [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: 03/06/2023] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION The neural bases for language perception have been studied elsewhere using Transcranial Magnetic Stimulation, functional Magnetic Resonance Imaging and Direct Cortical Stimulation. However, to our knowledge, there is no previous report about a patient identifying the change in his voice tone, speed, and prosody because of right temporal cortical stimulation. Nor has there been a cortico-cortical evoked potential (CCEP) assessment of the network underlying this process. CASE REPORT We present CCEP from a patient with right focal refractory temporal lobe epilepsy of tumoral etiology who reported changes in the perception of his own speech prosody during stimulation. This report will serve as a complement to the understanding of the neural networks of language and prosody. CONCLUSION The present report shows that right superior temporal gyrus, transverse temporal gyrus, right amygdala, hippocampus, and fusiform gyrus (FG) are part of the neural network subjacent to own human voice perception.
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Affiliation(s)
- Rene Andrade-Machado
- Children's Wisconsin, Neurology Department, Division of Pediatric Neurology. Medical College of Wisconsin, United States.
| | - Pradeep Javarayee
- Children's Wisconsin, Neurology Department, Division of Pediatric Neurology. Medical College of Wisconsin, United States
| | - Jennifer I Koop
- Children's Wisconsin, Neurology Department, Division of Neuropsychology, Medical College of Wisconsin, United States
| | - Raquel Farias-Moeller
- Children's Wisconsin, Neurology Department, Division of Pediatric Neurology. Medical College of Wisconsin, United States
| | - Irene Kim
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Sean M Lew
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
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Hays MA, Kamali G, Koubeissi MZ, Sarma SV, Crone NE, Smith RJ, Kang JY. Towards optimizing single pulse electrical stimulation: High current intensity, short pulse width stimulation most effectively elicits evoked potentials. Brain Stimul 2023; 16:772-782. [PMID: 37141936 PMCID: PMC10330807 DOI: 10.1016/j.brs.2023.04.023] [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: 02/04/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND While single pulse electrical stimulation (SPES) is increasingly used to study effective connectivity, the effects of varying stimulation parameters on the resulting cortico-cortical evoked potentials (CCEPs) have not been systematically explored. OBJECTIVE We sought to understand the interacting effects of stimulation pulse width, current intensity, and charge on CCEPs through an extensive testing of this parameter space and analysis of several response metrics. METHODS We conducted SPES in 11 patients undergoing intracranial EEG monitoring using five combinations of current intensity (1.5, 2.0, 3.0, 5.0, and 7.5 mA) and pulse width at each of three charges (0.750, 1.125, and 1.500 μC/phase) to study how CCEP amplitude, distribution, latency, morphology, and stimulus artifact amplitude vary with each parameter. RESULTS Stimulations with a greater charge or a greater current intensity and shorter pulse width at a given charge generally resulted in greater CCEP amplitudes and spatial distributions, shorter latencies, and increased waveform correlation. These effects interacted such that stimulations with the lowest charge and highest current intensities resulted in greater response amplitudes and spatial distributions than stimulations with the highest charge and lowest current intensities. Stimulus artifact amplitude increased with charge, but this could be mitigated by using shorter pulse widths. CONCLUSIONS Our results indicate that individual combinations of current intensity and pulse width, in addition to charge, are important determinants of CCEP magnitude, morphology, and spatial extent. Together, these findings suggest that high current intensity, short pulse width stimulations are optimal SPES settings for eliciting strong and consistent responses while minimizing charge.
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Affiliation(s)
- Mark A Hays
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
| | - Golnoosh Kamali
- Johns Hopkins Technology Ventures, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sridevi V Sarma
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA; Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel J Smith
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neuroengineering, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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Caston RM, Smith EH, Davis TS, Singh H, Rahimpour S, Rolston JD. Psychophysical pain encoding in the cingulate cortex predicts responsiveness of electrical stimulation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.18.23287266. [PMID: 36993429 PMCID: PMC10055607 DOI: 10.1101/2023.03.18.23287266] [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: 06/19/2023]
Abstract
Background The anterior cingulate cortex (ACC) plays an important role in the cognitive and emotional processing of pain. Prior studies have used deep brain stimulation (DBS) to treat chronic pain, but results have been inconsistent. This may be due to network adaptation over time and variable causes of chronic pain. Identifying patient-specific pain network features may be necessary to determine patient candidacy for DBS. Hypothesis Cingulate stimulation would increase patients' hot pain thresholds if non-stimulation 70-150 Hz activity encoded psychophysical pain responses. Methods In this study, four patients who underwent intracranial monitoring for epilepsy monitoring participated in a pain task. They placed their hand on a device capable of eliciting thermal pain for five seconds and rated their pain. We used these results to determine the individual's thermal pain threshold with and without electrical stimulation. Two different types of generalized linear mixed-effects models (GLME) were employed to assess the neural representations underlying binary and graded pain psychophysics. Results The pain threshold for each patient was determined from the psychometric probability density function. Two patients had a higher pain threshold with stimulation than without, while the other two patients had no difference. We also evaluated the relationship between neural activity and pain responses. We found that patients who responded to stimulation had specific time windows where high-frequency activity was associated with increased pain ratings. Conclusion Stimulation of cingulate regions with increased pain-related neural activity was more effective at modulating pain perception than stimulating non-responsive areas. Personalized evaluation of neural activity biomarkers could help identify the best target for stimulation and predict its effectiveness in future studies evaluating DBS.
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Affiliation(s)
- Rose M Caston
- University of Utah Department of Biomedical Engineering
- University of Utah Department of Neurosurgery
| | - Elliot H Smith
- University of Utah Department of Neurosurgery
- University of Utah Interdepartmental Program in Neuroscience
| | | | - Hargunbir Singh
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School
| | - Shervin Rahimpour
- University of Utah Department of Biomedical Engineering
- University of Utah Department of Neurosurgery
| | - John D Rolston
- University of Utah Department of Biomedical Engineering
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School
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Song Y, Surgenor JV, Leeds ZT, Kanter JH, Martinez-Camblor P, Smith WJ, Boone MD, Abess AT, Evans LT, Kobylarz EJ. Variables associated with cortical motor mapping thresholds: A retrospective data review with a unique case of interlimb motor facilitation. Front Neurol 2023; 14:1150670. [PMID: 37114230 PMCID: PMC10128911 DOI: 10.3389/fneur.2023.1150670] [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: 01/24/2023] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Intraoperative neuromonitoring (IONM) is crucial to preserve eloquent neurological functions during brain tumor resections. We observed a rare interlimb cortical motor facilitation phenomenon in a patient with recurrent high-grade glioma undergoing craniotomy for tumor resection; the patient's upper arm motor evoked potentials (MEPs) increased in amplitude significantly (up to 44.52 times larger, p < 0.001) following stimulation of the ipsilateral posterior tibial nerve at 2.79 Hz. With the facilitation effect, the cortical MEP stimulation threshold was reduced by 6 mA to maintain appropriate continuous motor monitoring. It likely has the benefit of reducing the occurrence of stimulation-induced seizures and other adverse events associated with excessive stimulation. Methods We conducted a retrospective data review including 120 patients who underwent brain tumor resection with IONM at our center from 2018 to 2022. A broad range of variables collected pre-and intraoperatively were reviewed. The review aimed to determine: (1) whether we overlooked this facilitation phenomenon in the past, (2) whether this unique finding is related to any specific demographic information, clinical presentation, stimulation parameter (s) or anesthesia management, and (3) whether it is necessary to develop new techniques (such as facilitation methods) to reduce cortical stimulation intensity during intraoperative functional mapping. Results There is no evidence suggesting that clinical presentation, stimulation configuration, or intraoperative anesthesia management of the patient with the facilitation effect were significantly different from our general patient cohort. Even though we did not identify the same facilitation effect in any of these patients, we were able to determine that stimulation thresholds for motor mapping are significantly associated with the location of stimulation (p = 0.003) and the burst suppression ratio (BSR) (p < 0.001). Stimulation-induced seizures, although infrequent (4.05%), could occur unexpectedly even when the BSR was 70%. Discussion We postulated that functional reorganization and neuronal hyperexcitability induced by glioma progression and repeated surgeries were probable underlying mechanisms of the interlimb facilitation phenomenon. Our retrospective review also provided a practical guide to cortical motor mapping in brain tumor patients under general anesthesia. We also underscored the need for developing new techniques to reduce the stimulation intensity and, hence, seizure occurrence.
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Affiliation(s)
- Yinchen Song
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- *Correspondence: Yinchen Song,
| | - James V. Surgenor
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Haverford College, Haverford, PA, United States
| | - Zachary T. Leeds
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - John H. Kanter
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - William J. Smith
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - M. Dustin Boone
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Alexander T. Abess
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Linton T. Evans
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Erik J. Kobylarz
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
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15
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Qi L, Xu C, Wang X, Du J, He Q, Wu D, Wang X, Jin G, Wang Q, Chen J, Wang D, Zhang H, Zhang X, Wei P, Shan Y, Cui Z, Wang Y, Shu Y, Zhao G, Yu T, Ren L. Intracranial direct electrical mapping reveals the functional architecture of the human basal ganglia. Commun Biol 2022; 5:1123. [PMID: 36274105 PMCID: PMC9588773 DOI: 10.1038/s42003-022-04084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/07/2022] [Indexed: 11/30/2022] Open
Abstract
The basal ganglia play a key role in integrating a variety of human behaviors through the cortico–basal ganglia–thalamo–cortical loops. Accordingly, basal ganglia disturbances are implicated in a broad range of debilitating neuropsychiatric disorders. Despite accumulating knowledge of the basal ganglia functional organization, the neural substrates and circuitry subserving functions have not been directly mapped in humans. By direct electrical stimulation of distinct basal ganglia regions in 35 refractory epilepsy patients undergoing stereoelectroencephalography recordings, we here offer currently the most complete overview of basal ganglia functional characterization, extending not only to the expected sensorimotor responses, but also to vestibular sensations, autonomic responses, cognitive and multimodal effects. Specifically, some locations identified responses weren’t predicted by the model derived from large-scale meta-analyses. Our work may mark an important step toward understanding the functional architecture of the human basal ganglia and provide mechanistic explanations of non-motor symptoms in brain circuit disorders. Direct electrical stimulation of the basal ganglia using implanted SEEG electrodes produced a variety of motor and non-motor effects in human participants, providing insight into the functional architecture of this key brain region.
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Jaroszynski C, Amorim-Leite R, Deman P, Perrone-Bertolotti M, Chabert F, Job-Chapron AS, Minotti L, Hoffmann D, David O, Kahane P. Brain mapping of auditory hallucinations and illusions induced by direct intracortical electrical stimulation. Brain Stimul 2022; 15:1077-1087. [PMID: 35952963 DOI: 10.1016/j.brs.2022.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The exact architecture of the human auditory cortex remains a subject of debate, with discrepancies between functional and microstructural studies. In a hierarchical framework for sensory perception, simple sound perception is expected to take place in the primary auditory cortex, while the processing of complex, or more integrated perceptions is proposed to rely on associative and higher-order cortices. OBJECTIVES We hypothesize that auditory symptoms induced by direct electrical stimulation (DES) offer a window into the architecture of the brain networks involved in auditory hallucinations and illusions. The intracranial recordings of these evoked perceptions of varying levels of integration provide the evidence to discuss the theoretical model. METHODS We analyzed SEEG recordings from 50 epileptic patients presenting auditory symptoms induced by DES. First, using the Juelich cytoarchitectonic parcellation, we quantified which regions induced auditory symptoms when stimulated (ROI approach). Then, for each evoked auditory symptom type (illusion or hallucination), we mapped the cortical networks showing concurrent high-frequency activity modulation (HFA approach). RESULTS Although on average, illusions were found more laterally and hallucinations more posteromedially in the temporal lobe, both perceptions were elicited in all levels of the sensory hierarchy, with mixed responses found in the overlap. The spatial range was larger for illusions, both in the ROI and HFA approaches. The limbic system was specific to the hallucinations network, and the inferior parietal lobule was specific to the illusions network. DISCUSSION Our results confirm a network-based organization underlying conscious sound perception, for both simple and complex components. While symptom localization is interesting from an epilepsy semiology perspective, the hallucination-specific modulation of the limbic system is particularly relevant to tinnitus and schizophrenia.
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Affiliation(s)
- Chloé Jaroszynski
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, GIN, 38000, Grenoble, France.
| | - Ricardo Amorim-Leite
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, GIN, 38000, Grenoble, France
| | - Pierre Deman
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, GIN, 38000, Grenoble, France
| | - Marcela Perrone-Bertolotti
- Univ. Grenoble Alpes, CNRS, UMR5105, Laboratoire Psychologie et NeuroCognition, LPNC, 38000, Grenoble, France
| | - Florian Chabert
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, GIN, 38000, Grenoble, France
| | - Anne-Sophie Job-Chapron
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, GIN, 38000, Grenoble, France
| | - Lorella Minotti
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, GIN, 38000, Grenoble, France
| | - Dominique Hoffmann
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, GIN, 38000, Grenoble, France
| | - Olivier David
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, GIN, 38000, Grenoble, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.
| | - Philippe Kahane
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, GIN, 38000, Grenoble, France.
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Le Lann F, Cristante J, De Schlichting E, Quehan R, Réhault E, Lotterie JA, Roux FE. Variability of Intraoperative Electrostimulation Parameters in Conscious Individuals: Language Fasciculi. World Neurosurg 2022; 164:e194-e202. [PMID: 35472645 DOI: 10.1016/j.wneu.2022.04.066] [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: 02/17/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The authors analyzed the current-intensity thresholds for electrostimulation of language fasciculi and the possible consequences of threshold variability on brain mapping. METHODS A prospective protocol of subcortical electrostimulation was used in 50 patients undergoing brain mapping, directly stimulating presumed language fasciculi identified by diffusion tensor imaging. RESULTS The stimulation-intensity thresholds for identification of language fasciculi varied among patients (mean minimum current intensity of 4.4 mA, range = 1.5-10 mA, standard deviation = 1.1 mA), and 23% of fascicular interferences were detected only above 5 mA. Repeated stimulation of the same site with the same intensity led to different types of interferences in 20% of patients, and a higher current intensity led to changes in the type of response in 27%. The mean minimum stimulation intensities did not differ significantly between different fasciculi, between the different types of interference obtained, or with age, sex, or type of tumor. Positive results on cortical mapping were significantly associated with positive results on subcortical mapping (P < 0.001). Subcortical intensity thresholds were slightly lower than cortical ones (mean = 4.43 vs. 5.25 mA, P = 0.034). In 23 of 50 subcortical mappings, fascicular stimulation produced no language interference. CONCLUSIONS Individual variability of minimum stimulation-intensity thresholds for identification of language fasciculi is frequent. Nevertheless, even when a high current intensity was used, many stimulations on language fasciculi remained negative for various hypothetic reasons. Finding the optimal current intensity for identifying language fasciculi is of paramount importance to refine the clinical results and scientific data derived from brain mapping.
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Affiliation(s)
- Florian Le Lann
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France.
| | | | - Emmanuel De Schlichting
- Université Grenoble Alpes, Faculté de Médecine, Grenoble, France; Neurochirurgie, Centre Hospitalo-Universitaire de Grenoble, Toulouse, France
| | - Romain Quehan
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France
| | - Emilie Réhault
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Jean-Albert Lotterie
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France
| | - Franck-Emmanuel Roux
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France; Centre de Recherche Cerveau et Cognition (CNRS; CerCo), Toulouse, France
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Parvizi J, Veit MJ, Barbosa DA, Kucyi A, Perry C, Parker JJ, Shivacharan RS, Chen F, Yih J, Gross JJ, Fisher R, McNab JA, Falco-Walter J, Halpern CH. Complex negative emotions induced by electrical stimulation of the human hypothalamus. Brain Stimul 2022; 15:615-623. [DOI: 10.1016/j.brs.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/21/2022] [Accepted: 04/05/2022] [Indexed: 11/02/2022] Open
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Rahman Z, Murray NWG, Sala-Padró J, Bartley M, Dexter M, Fung VSC, Mahant N, Bleasel AF, Wong CH. Investigating the Precise Localization of the Grasping Action in the Mid-Cingulate Cortex and Future Directions. Front Hum Neurosci 2022; 16:815749. [PMID: 35280209 PMCID: PMC8909638 DOI: 10.3389/fnhum.2022.815749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To prospectively study the cingulate cortex for the localization and role of the grasping action in humans during electrical stimulation of depth electrodes. Methods All the patients (n = 23) with intractable focal epilepsy and a depth electrode stereotactically placed in the cingulate cortex, as part of their pre-surgical epilepsy evaluation from 2015 to 2017, were included. Cortical stimulation was performed and examined for grasping actions. Post-implantation volumetric T1 MRIs were co-registered to determine the exact electrode position. Results Five patients (male: female 4:1; median age 31) exhibited contralateral grasping actions during electrical stimulation. All patients had electrodes implanted in the ventral bank of the right cingulate sulcus adjacent to the vertical anterior commissure (VAC) line. Stimulation of other electrodes in adjacent regions did not elicit grasping. Conclusion Grasping action elicited from a localized region in the mid-cingulate cortex (MCC) directly supports the concept of the cingulate cortex being crucially involved in the grasping network. This opens an opportunity to explore this region with deep brain stimulation as a motor neuromodulation target for treatment in specific movement disorders or neurorehabilitation.
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Affiliation(s)
- Zebunnessa Rahman
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- *Correspondence: Zebunnessa Rahman,
| | | | | | - Melissa Bartley
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Mark Dexter
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Victor S. C. Fung
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Neil Mahant
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Andrew Fabian Bleasel
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Chong H. Wong
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
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Journée HL, Shils JL. Safety issues during surgical monitoring. HANDBOOK OF CLINICAL NEUROLOGY 2022; 186:83-99. [PMID: 35772901 DOI: 10.1016/b978-0-12-819826-1.00003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
While intra-operative neuro-physiologic assessment and monitoring improve the safety of patients, its use may also introduce new risks of injuries. This chapter looks at the electric safety of equipment and the potential hazards during the set-up of the monitoring. The physical and functional physiologic effects of electric shocks and stimulation currents, standards for safety limits, and conditions for tissue damage are described from basic physical principles. Considered are the electrode-tissue interface in relation to electrode dimensions and stimulation parameters as applied in various modalities of evoked sensory and motor potentials as to-date used in intra-operative monitoring, mapping of neuro-physiologic functions. A background is given on circumstances for electric tissue heating and heat drainage, thermal toxicity, protection against thermal injuries and side effects of unintended activation of neural and cardiac tissues, adverse effects of physiologic amplifiers from transcranial stimulation (TES) and excitotoxicity of direct cortical stimulation. Addressed are safety issues of TES and measures for prevention. Safety issues include bite and movement-induced injuries, seizures, and after discharges, interaction with implanted devices as cardiac pacemaker and deep brain stimulators. Further discussed are safety issues of equipment leakage currents, protection against electric shocks, and maintenance.
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Affiliation(s)
- H Louis Journée
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Jay L Shils
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, United States
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21
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Simon MV, Nuwer MR, Szelényi A. Electroencephalography, electrocorticography, and cortical stimulation techniques. HANDBOOK OF CLINICAL NEUROLOGY 2022; 186:11-38. [PMID: 35772881 DOI: 10.1016/b978-0-12-819826-1.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Electroencephalography (EEG) and electrocorticography (ECoG) are two important neurophysiologic techniques used in the operating room for monitoring and mapping electrical brain activity. In this chapter, we detail their principle, recording methodology, and address specifics of their interpretation in the intraoperative setting (e.g., effect of anesthetics), as well as their clinical applications in epilepsy and non-epilepsy surgeries. In addition, we address differences between scalp, surface, and deep cortical recordings that will help towards a more reliable interpretation of the significance of electrophysiologic parameters such as amplitude and morphology as well as in differentiation between abnormal and normal patterns of electrical brain activity. Electrical stimulation is used for intraoperative mapping of different cortical functions such as language, parietal, and motor. Stimulation paradigms used in clinical practice vary with regard to stimulation frequencies and probes being used. Parameters, such as the number of phases per pulse, pulse/phase duration, pulse frequency, organization, and polarity, define their characteristics, including their safety, propensity to trigger seizures, efficiency and reliability of stimulation, and the mapping thresholds. Specifically, in this chapter, we will address differences between monopolar and bipolar stimulation; anodal and cathodal polarity; monophasic and biphasic pulses; constant voltage, and constant current paradigms.
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Affiliation(s)
- Mirela V Simon
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
| | - Marc R Nuwer
- Departments of Neurology and Clinical Neurophysiology, David Geffen School of Medicine, University of California Los Angeles, and Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States
| | - Andrea Szelényi
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
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22
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Rachidi I, Minotti L, Martin G, Hoffmann D, Bastin J, David O, Kahane P. The Insula: A Stimulating Island of the Brain. Brain Sci 2021; 11:1533. [PMID: 34827532 PMCID: PMC8615692 DOI: 10.3390/brainsci11111533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/07/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Direct cortical stimulation (DCS) in epilepsy surgery patients has a long history of functional brain mapping and seizure triggering. Here, we review its findings when applied to the insula in order to map the insular functions, evaluate its local and distant connections, and trigger seizures. Clinical responses to insular DCS are frequent and diverse, showing a partial segregation with spatial overlap, including a posterior somatosensory, auditory, and vestibular part, a central olfactory-gustatory region, and an anterior visceral and cognitive-emotional portion. The study of cortico-cortical evoked potentials (CCEPs) has shown that the anterior (resp. posterior) insula has a higher connectivity rate with itself than with the posterior (resp. anterior) insula, and that both the anterior and posterior insula are closely connected, notably between the homologous insular subdivisions. All insular gyri show extensive and complex ipsilateral and contralateral extra-insular connections, more anteriorly for the anterior insula and more posteriorly for the posterior insula. As a rule, CCEPs propagate first and with a higher probability around the insular DCS site, then to the homologous region, and later to more distal regions with fast cortico-cortical axonal conduction delays. Seizures elicited by insular DCS have rarely been specifically studied, but their rate does not seem to differ from those of other DCS studies. They are mainly provoked from the insular seizure onset zone but can also be triggered by stimulating intra- and extra-insular early propagation zones. Overall, in line with the neuroimaging studies, insular DCS studies converge on the view that the insula is a multimodal functional hub with a fast propagation of information, whose organization helps understand where insular seizures start and how they propagate.
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Affiliation(s)
- Inès Rachidi
- CHU Grenoble Alpes, 38000 Grenoble, France; (L.M.); (G.M.); (D.H.); (P.K.)
| | - Lorella Minotti
- CHU Grenoble Alpes, 38000 Grenoble, France; (L.M.); (G.M.); (D.H.); (P.K.)
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; (J.B.); (O.D.)
| | - Guillaume Martin
- CHU Grenoble Alpes, 38000 Grenoble, France; (L.M.); (G.M.); (D.H.); (P.K.)
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; (J.B.); (O.D.)
| | - Dominique Hoffmann
- CHU Grenoble Alpes, 38000 Grenoble, France; (L.M.); (G.M.); (D.H.); (P.K.)
| | - Julien Bastin
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; (J.B.); (O.D.)
| | - Olivier David
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; (J.B.); (O.D.)
| | - Philippe Kahane
- CHU Grenoble Alpes, 38000 Grenoble, France; (L.M.); (G.M.); (D.H.); (P.K.)
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; (J.B.); (O.D.)
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23
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Manzouri F, Meisel C, Kunz L, Dümpelmann M, Stieglitz T, Schulze-Bonhage A. Low-frequency electrical stimulation reduces cortical excitability in the human brain. Neuroimage Clin 2021; 31:102778. [PMID: 34375883 PMCID: PMC8358685 DOI: 10.1016/j.nicl.2021.102778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/02/2021] [Accepted: 07/25/2021] [Indexed: 12/03/2022]
Abstract
Effective seizure control remains challenging for about 30% of epilepsy patients who are resistant to present-day pharmacotherapy. Novel approaches that not only reduce the severity and frequency of seizures, but also have limited side effects are therefore desirable. Accordingly, various neuromodulation approaches such as cortical electrical stimulation have been implemented to reduce seizure burden; however, the underlying mechanisms are not completely understood. Given that the initiation and spread of epileptic seizures critically depend on cortical excitability, understanding the neuromodulatory effects of cortical electrical stimulation on cortical excitability levels is paramount. Based on observations that synchronization in the electrocorticogram closely tracks brain excitability level, the effects of low-frequency (1 Hz) intracranial brain stimulation on the levels of cortical phase synchronization before, during, and after 1 Hz electrical stimulation were assessed in twelve patients. Analysis of phase synchronization levels across three broad frequency bands (1-45 Hz, 55-95 Hz, and 105-195 Hz) revealed that in patients with stimulation sites in the neocortex, phase synchronization levels were significantly reduced within the 55-95 Hz and 105-195 Hz bands during post-stimulation intervals compared to baseline; this effect persisted for at least 30 min post-stimulation. Similar effects were observed when phase synchronization levels were examined in the classic frequency bands, whereby a significant reduction was found during the post-stimulation intervals in the alpha, beta, and gamma bands. The anatomical extent of these effects was then assessed. Analysis of the results from six patients with intracranial electrodes in both hemispheres indicated that reductions in phase synchronization in the 1-45 Hz and 55-95 Hz frequency ranges were more prominent in the stimulated hemisphere. Overall, these findings demonstrate that low-frequency electrical stimulation reduces phase synchronization and hence cortical excitability in the human brain. Low-frequency stimulation of the epileptic focus may therefore contribute to the prevention of impending epileptic seizures.
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Affiliation(s)
- Farrokh Manzouri
- Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany.
| | - Christian Meisel
- Department of Neurology, Charité- Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany; Center for Stroke Research Berlin, Berlin, Germany
| | - Lukas Kunz
- Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Matthias Dümpelmann
- Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany
| | - Thomas Stieglitz
- Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany; Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Freiburg, Germany; Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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24
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Hays MA, Coogan C, Crone NE, Kang JY. Graph theoretical analysis of evoked potentials shows network influence of epileptogenic mesial temporal region. Hum Brain Mapp 2021; 42:4173-4186. [PMID: 34165233 PMCID: PMC8356982 DOI: 10.1002/hbm.25418] [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: 12/03/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/08/2023] Open
Abstract
It is now widely accepted that seizures arise from the coordinated activity of epileptic networks, and as a result, traditional methods of analyzing seizures have been augmented by techniques like single-pulse electrical stimulation (SPES) that estimate effective connectivity in brain networks. We used SPES and graph analytics in 18 patients undergoing intracranial EEG monitoring to investigate effective connectivity between recording sites within and outside mesial temporal structures. We compared evoked potential amplitude, network density, and centrality measures inside and outside the mesial temporal region (MTR) across three patient groups: focal epileptogenic MTR, multifocal epileptogenic MTR, and non-epileptogenic MTR. Effective connectivity within the MTR had significantly greater magnitude (evoked potential amplitude) and network density, regardless of epileptogenicity. However, effective connectivity between MTR and surrounding non-epileptogenic regions was of greater magnitude and density in patients with focal epileptogenic MTR compared to patients with multifocal epileptogenic MTR and those with non-epileptogenic MTR. Moreover, electrodes within focal epileptogenic MTR had significantly greater outward network centrality compared to electrodes outside non-epileptogenic regions and to multifocal and non-epileptogenic MTR. Our results indicate that the MTR is a robustly connected subnetwork that can exert an overall elevated propagative influence over other brain regions when it is epileptogenic. Understanding the underlying effective connectivity and roles of epileptogenic regions within the larger network may provide insights that eventually lead to improved surgical outcomes.
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Affiliation(s)
- Mark A Hays
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Coogan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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25
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Does the Prefrontal Cortex Play an Essential Role in Consciousness? Insights from Intracranial Electrical Stimulation of the Human Brain. J Neurosci 2021; 41:2076-2087. [PMID: 33692142 DOI: 10.1523/jneurosci.1141-20.2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022] Open
Abstract
A central debate in philosophy and neuroscience pertains to whether PFC activity plays an essential role in the neural basis of consciousness. Neuroimaging and electrophysiology studies have revealed that the contents of conscious perceptual experience can be successfully decoded from PFC activity, but these findings might be confounded by postperceptual cognitive processes, such as thinking, reasoning, and decision-making, that are not necessary for consciousness. To clarify the involvement of the PFC in consciousness, we present a synthesis of research that has used intracranial electrical stimulation (iES) for the causal modulation of neural activity in the human PFC. This research provides compelling evidence that iES of only certain prefrontal regions (i.e., orbitofrontal cortex and anterior cingulate cortex) reliably perturbs conscious experience. Conversely, stimulation of anterolateral prefrontal sites, often considered crucial in higher-order and global workspace theories of consciousness, seldom elicits any reportable alterations in consciousness. Furthermore, the wide variety of iES-elicited effects in the PFC (e.g., emotions, thoughts, and olfactory and visual hallucinations) exhibits no clear relation to the immediate environment. Therefore, there is no evidence for the kinds of alterations in ongoing perceptual experience that would be predicted by higher-order or global workspace theories. Nevertheless, effects in the orbitofrontal and anterior cingulate cortices suggest a specific role for these PFC subregions in supporting emotional aspects of conscious experience. Overall, this evidence presents a challenge for higher-order and global workspace theories, which commonly point to the PFC as the basis for conscious perception based on correlative and possibly confounded information.
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26
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Bu L, Lu J, Zhang J, Wu J. Intraoperative Cognitive Mapping Tasks for Direct Electrical Stimulation in Clinical and Neuroscientific Contexts. Front Hum Neurosci 2021; 15:612891. [PMID: 33762913 PMCID: PMC7982856 DOI: 10.3389/fnhum.2021.612891] [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: 10/01/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Direct electrical stimulation (DES) has been widely applied in both guidance of lesion resection and scientific research; however, the design and selection of intraoperative cognitive mapping tasks have not been updated in a very long time. We introduce updated mapping tasks for language and non-language functions and provide recommendations for optimal design and selection of intraoperative mapping tasks. In addition, with DES becoming more critical in current neuroscientific research, a task design that has not been widely used in DES yet (subtraction and conjunction paradigms) was introduced for more delicate mapping of brain functions especially for research purposes. We also illustrate the importance of designing a common task series for DES and other non-invasive mapping techniques. This review gives practical updated guidelines for advanced application of DES in clinical and neuroscientific research.
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Affiliation(s)
- Linghao Bu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China.,Zhangjiang Lab, Institute of Brain-Intelligence Technology, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Junfeng Lu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China.,Zhangjiang Lab, Institute of Brain-Intelligence Technology, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Jie Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China.,Zhangjiang Lab, Institute of Brain-Intelligence Technology, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China.,Zhangjiang Lab, Institute of Brain-Intelligence Technology, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
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27
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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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28
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Kämpfer C, Racz A, Quesada CM, Elger CE, Surges R. Predictive value of electrically induced seizures for postsurgical seizure outcome. Clin Neurophysiol 2020; 131:2289-2297. [PMID: 32674959 DOI: 10.1016/j.clinph.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether semiological similarity of electrically induced seizures (EIS) and spontaneously occurring habitual seizures (SHS) is associated with postsurgical seizure outcome in patients undergoing invasive video-EEG monitoring (VEM) before resective epilepsy surgery. METHODS Data of patients undergoing invasive VEM were retrospectively reviewed and included if at least one EIS and SHS during VEM occurred and the brain region in which EIS were elicited was resected. Seizure outcome was evaluated at three follow-up (FU) visits after surgery (1, 2 years and last available FU) according to the classification by Engel and the International League Against Epilepsy (ILAE). The level of semiological similarity of EIS and SHS was rated blinded to the surgical outcome. Statistics were done using Fisher's exact test and a mixed linear-logistic regression model. RESULTS 65 patients were included. Postsurgical seizure freedom was achieved in 51% (ILAE class 1) and 58% (Engel class I) at last FU (median 36 months). Patients with identical EIS and SHS displayed significantly better postsurgical seizure outcomes (ILAE class 1 at last FU: 76% vs. 31%, p < 0.001; Engel class I: 83% vs. 39%, p < 0.001). CONCLUSION EIS are useful to confirm the location of the epileptogenic zone. A high level of similarity between EIS and SHS is associated with a favorable postsurgical seizure outcome. SIGNIFICANCE EIS may be used as an additional predictor of postsurgical outcome when counselling patients to proceed to resective epilepsy surgery.
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Affiliation(s)
- Christopher Kämpfer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany; Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Attila Racz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Carlos M Quesada
- Department of Epileptology, University Hospital Bonn, Bonn, Germany; Department of Neurology, University Hospital Essen, Essen, Germany
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.
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29
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Fox KCR, Shi L, Baek S, Raccah O, Foster BL, Saha S, Margulies DS, Kucyi A, Parvizi J. Intrinsic network architecture predicts the effects elicited by intracranial electrical stimulation of the human brain. Nat Hum Behav 2020; 4:1039-1052. [PMID: 32632334 DOI: 10.1038/s41562-020-0910-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/04/2020] [Indexed: 12/12/2022]
Abstract
Intracranial electrical stimulation (iES) of the human brain has long been known to elicit a remarkable variety of perceptual, motor and cognitive effects, but the functional-anatomical basis of this heterogeneity remains poorly understood. We conducted a whole-brain mapping of iES-elicited effects, collecting first-person reports following iES at 1,537 cortical sites in 67 participants implanted with intracranial electrodes. We found that intrinsic network membership and the principal gradient of functional connectivity strongly predicted the type and frequency of iES-elicited effects in a given brain region. While iES in unimodal brain networks at the base of the cortical hierarchy elicited frequent and simple effects, effects became increasingly rare, heterogeneous and complex in heteromodal and transmodal networks higher in the hierarchy. Our study provides a comprehensive exploration of the relationship between the hierarchical organization of intrinsic functional networks and the causal modulation of human behaviour and experience with iES.
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Affiliation(s)
- Kieran C R Fox
- Stanford Human Intracranial Cognitive Electrophysiology Program, Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA. .,School of Medicine, Stanford University, Stanford, CA, USA.
| | - Lin Shi
- Stanford Human Intracranial Cognitive Electrophysiology Program, Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sori Baek
- Stanford Human Intracranial Cognitive Electrophysiology Program, Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Omri Raccah
- Stanford Human Intracranial Cognitive Electrophysiology Program, Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Brett L Foster
- Departments of Neurosurgery and Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Srijani Saha
- Stanford Human Intracranial Cognitive Electrophysiology Program, Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Daniel S Margulies
- Centre National de la Recherche Scientifique (CNRS), UMR 7225, Frontlab, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Aaron Kucyi
- Stanford Human Intracranial Cognitive Electrophysiology Program, Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Josef Parvizi
- Stanford Human Intracranial Cognitive Electrophysiology Program, Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
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30
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Nakatani M, Matsumoto R, Kobayashi K, Hitomi T, Inouchi M, Matsuhashi M, Kinoshita M, Kikuchi T, Yoshida K, Kunieda T, Miyamoto S, Takahashi R, Hattori N, Ikeda A. Electrical cortical stimulations modulate spike and post-spike slow-related high-frequency activities in human epileptic foci. Clin Neurophysiol 2020; 131:1741-1754. [PMID: 32504935 DOI: 10.1016/j.clinph.2020.03.042] [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: 07/05/2019] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Using interictal epileptiform discharges (IEDs), consisting of spikes and post-spike slow waves (PSSs), and IED-related high-frequency activities (HFAs), we elucidated inhibitory effects of electrical cortical stimulation (ECS) on human epileptic foci. METHODS We recruited 8 patients with intractable focal epilepsy, and 50-Hz ECS was applied to the seizure-onset zone (SOZ) and non-SOZ. Before (5-min) and after (20-min) ECS, we evaluated the number of IED, the amplitudes of spikes and PSSs, spike-related HFA power, and PSS-related low gamma (30-50 Hz) activities. RESULTS SOZ stimulation significantly decreased the number of IEDs and amplitude of spikes. Spike-related HFA power values in fast ripple (200-300 Hz) and ripple (80-150 Hz) bands were significantly suppressed only by SOZ stimulation in 4 and 3 patients, respectively. Among 4 patients with discrete PSSs, the amplitude ratio of spike/PSS decreased and the PSS-related low gamma activity power increased significantly in 2 patients and marginally in 1 patient. CONCLUSIONS ECS potentially modulates cortical excitability by reducing excitation and increasing inhibition, and monitoring IED-related HFAs may help achieve the optimal effects of ECS. SIGNIFICANCE IED and IED-related HFAs are dynamic, potential surrogate markers for epileptic excitability during the interictal period.
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Affiliation(s)
- Mitsuyoshi Nakatani
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takefumi Hitomi
- Department of Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Morito Inouchi
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masako Kinoshita
- Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurosurgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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31
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Electrical Cortical Stimulation: Mapping for Function and Seizures. Neurosurg Clin N Am 2020; 31:435-448. [PMID: 32475491 DOI: 10.1016/j.nec.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Surgical procedures for the treatment of epilepsy and brain tumors can involve resection of regions closed or merged to functionally eloquent cortical areas. Removal of language, primary motor, or sensory areas can be associated with transient or permanent functional deficits, which should be avoided if possible. Functional electrical cortical stimulation is a reliable technique to prevent or minimize motor, sensory and language deficits and has been used in humans since the 1950s to identify functional cortex, and it can also localize epileptogenic regions. This article discusses functional electrical stimulation in adults and children for different functional modalities.
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32
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George DD, Ojemann SG, Drees C, Thompson JA. Stimulation Mapping Using Stereoelectroencephalography: Current and Future Directions. Front Neurol 2020; 11:320. [PMID: 32477236 PMCID: PMC7238877 DOI: 10.3389/fneur.2020.00320] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/02/2020] [Indexed: 01/06/2023] Open
Abstract
Electrical stimulation mapping (ESM) using stereoelectroencephalography (SEEG) is an essential component in the workup of surgical epilepsy. Since the initial application of ESM in the mid-1960s, it remains unparalleled in defining eloquent brain areas and delimiting seizure foci for the purposes of surgical planning. Here, we briefly review the current state of SEEG stimulation, with a focus on the techniques used for identifying the epileptogenic zone and eloquent cortex. We also summarize clinical data on the efficacy of SEEG stimulation in surgical outcomes and functional mapping. Finally, we briefly highlight future applications of SEEG ESM, including novel functional mapping approaches, identifying rare seizure semiologies, neurophysiologic investigations for understanding cognitive function, and its role in SEEG-guided radiofrequency thermal coagulation.
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Affiliation(s)
- Derek D George
- School of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Steven G Ojemann
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Cornelia Drees
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - John A Thompson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States.,Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
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Loizon M, Ryvlin P, Chatard B, Jung J, Bouet R, Guenot M, Mazzola L, Bezin L, Rheims S. Transient hypoxemia induced by cortical electrical stimulation: A mapping study in 75 patients. Neurology 2020; 94:e2323-e2336. [PMID: 32371448 DOI: 10.1212/wnl.0000000000009497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/26/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To identify which cortical regions are associated with direct electrical stimulation (DES)-induced alteration of breathing significant enough to impair pulse oximetry (SpO2). METHODS Evolution of SpO2 after 1,352 DES was analyzed in 75 patients with refractory focal epilepsy who underwent stereo-EEG recordings. For each DES, we assessed the change in SpO2 from 30 seconds prior to DES onset to 120 seconds following the end of the DES. The primary outcome was occurrence of stimulation-induced transient hypoxemia as defined by decrease of SpO2 ≥5% within 60 seconds after stimulation onset as compared to pre-DES SpO2 or SpO2 nadir <90% during at least 5 seconds. Localization of the stimulated contacts was defined according to MarsAtlas brain parcellation and Freesurfer segmentation. RESULTS A stimulation-induced transient hypoxemia was observed after 16 DES (1.2%) in 10 patients (13%), including 6 in whom SpO2 nadir was <90%. Among these 16 DES, 7 (44%) were localized within the perisylvian cortex. After correction for individual effects and the varying number of DES contributed by each person, significant decrease of SpO2 was significantly associated with the localization of DES (p = 0.019). CONCLUSION Though rare, a significant decrease of SpO2 could be elicited by cortical direct electrical stimulation outside the temporo-limbic structures, most commonly after stimulation of the perisylvian cortex.
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Affiliation(s)
- Marine Loizon
- From the Departments of Functional Neurology and Epileptology (M.L., J.J., S.R.) and Functional Neurosurgery (M.G.), Hospices Civils de Lyon and University of Lyon, France; Department of Clinical Neurosciences (P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland; INSERM U1028/CNRS UMR 5292 (B.C., J.J., R.B., M.G., L.M., L.B., S.R.), Lyon's Neuroscience Research Center; Neurology Department (L.M.), University Hospital, Saint-Etienne; and Epilepsy Institute (L.B., S.R.), Lyon, France
| | - Philippe Ryvlin
- From the Departments of Functional Neurology and Epileptology (M.L., J.J., S.R.) and Functional Neurosurgery (M.G.), Hospices Civils de Lyon and University of Lyon, France; Department of Clinical Neurosciences (P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland; INSERM U1028/CNRS UMR 5292 (B.C., J.J., R.B., M.G., L.M., L.B., S.R.), Lyon's Neuroscience Research Center; Neurology Department (L.M.), University Hospital, Saint-Etienne; and Epilepsy Institute (L.B., S.R.), Lyon, France
| | - Benoit Chatard
- From the Departments of Functional Neurology and Epileptology (M.L., J.J., S.R.) and Functional Neurosurgery (M.G.), Hospices Civils de Lyon and University of Lyon, France; Department of Clinical Neurosciences (P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland; INSERM U1028/CNRS UMR 5292 (B.C., J.J., R.B., M.G., L.M., L.B., S.R.), Lyon's Neuroscience Research Center; Neurology Department (L.M.), University Hospital, Saint-Etienne; and Epilepsy Institute (L.B., S.R.), Lyon, France
| | - Julien Jung
- From the Departments of Functional Neurology and Epileptology (M.L., J.J., S.R.) and Functional Neurosurgery (M.G.), Hospices Civils de Lyon and University of Lyon, France; Department of Clinical Neurosciences (P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland; INSERM U1028/CNRS UMR 5292 (B.C., J.J., R.B., M.G., L.M., L.B., S.R.), Lyon's Neuroscience Research Center; Neurology Department (L.M.), University Hospital, Saint-Etienne; and Epilepsy Institute (L.B., S.R.), Lyon, France
| | - Romain Bouet
- From the Departments of Functional Neurology and Epileptology (M.L., J.J., S.R.) and Functional Neurosurgery (M.G.), Hospices Civils de Lyon and University of Lyon, France; Department of Clinical Neurosciences (P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland; INSERM U1028/CNRS UMR 5292 (B.C., J.J., R.B., M.G., L.M., L.B., S.R.), Lyon's Neuroscience Research Center; Neurology Department (L.M.), University Hospital, Saint-Etienne; and Epilepsy Institute (L.B., S.R.), Lyon, France
| | - Marc Guenot
- From the Departments of Functional Neurology and Epileptology (M.L., J.J., S.R.) and Functional Neurosurgery (M.G.), Hospices Civils de Lyon and University of Lyon, France; Department of Clinical Neurosciences (P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland; INSERM U1028/CNRS UMR 5292 (B.C., J.J., R.B., M.G., L.M., L.B., S.R.), Lyon's Neuroscience Research Center; Neurology Department (L.M.), University Hospital, Saint-Etienne; and Epilepsy Institute (L.B., S.R.), Lyon, France
| | - Laure Mazzola
- From the Departments of Functional Neurology and Epileptology (M.L., J.J., S.R.) and Functional Neurosurgery (M.G.), Hospices Civils de Lyon and University of Lyon, France; Department of Clinical Neurosciences (P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland; INSERM U1028/CNRS UMR 5292 (B.C., J.J., R.B., M.G., L.M., L.B., S.R.), Lyon's Neuroscience Research Center; Neurology Department (L.M.), University Hospital, Saint-Etienne; and Epilepsy Institute (L.B., S.R.), Lyon, France
| | - Laurent Bezin
- From the Departments of Functional Neurology and Epileptology (M.L., J.J., S.R.) and Functional Neurosurgery (M.G.), Hospices Civils de Lyon and University of Lyon, France; Department of Clinical Neurosciences (P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland; INSERM U1028/CNRS UMR 5292 (B.C., J.J., R.B., M.G., L.M., L.B., S.R.), Lyon's Neuroscience Research Center; Neurology Department (L.M.), University Hospital, Saint-Etienne; and Epilepsy Institute (L.B., S.R.), Lyon, France
| | - Sylvain Rheims
- From the Departments of Functional Neurology and Epileptology (M.L., J.J., S.R.) and Functional Neurosurgery (M.G.), Hospices Civils de Lyon and University of Lyon, France; Department of Clinical Neurosciences (P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland; INSERM U1028/CNRS UMR 5292 (B.C., J.J., R.B., M.G., L.M., L.B., S.R.), Lyon's Neuroscience Research Center; Neurology Department (L.M.), University Hospital, Saint-Etienne; and Epilepsy Institute (L.B., S.R.), Lyon, France.
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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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Brage L, Pérez-Lorensu PJ, Plata-Bello J, Saponaro-González Á, Pérez-Orribo L, García-Conde M, Febles-García P, Roldán-Delgado H, García-Marín V. Direct cortical stimulation with cylindrical depth electrodes in the interhemispheric fissure for leg motor evoked potential monitoring. Clin Neurophysiol 2019; 131:127-132. [PMID: 31760211 DOI: 10.1016/j.clinph.2019.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/27/2019] [Accepted: 10/02/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate cylindrical depth electrodes in the interhemispheric fissure as an alternative to subdural strip electrodes for direct cortical stimulation (DCS) leg motor evoked potential (MEP) monitoring. METHODS A cylindrical depth electrode was positioned in the interhemispheric fissure of 37 patients who underwent supratentorial brain surgery. Leg sensory and motor cortices were localized by highest tibial nerve somatosensory evoked potential amplitude and lowest DCS leg MEP threshold; the lowest-threshold electrode was then used for DCS leg MEP monitoring. RESULTS Intraoperative leg MEPs were obtained from all the patients in the series. The mean intensity applied for leg MEP monitoring with the cylindrical depth electrode was 15.2 ± 4.0 mA. No complications secondary to neurophysiological monitoring were detected. CONCLUSIONS Lower extremity MEPs were consistently recorded using a multi-contact cylindrical depth electrode in the interhemispheric fissure by DCS. SIGNIFICANCE Cylindrical depth electrodes may be a safe and effective alternative for DCS in the interhemispheric fissure, where subdural strips are difficult to place.
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Affiliation(s)
- Liberto Brage
- Department of Neurosurgery, Hospital Universitario de Canarias, S/C de Tenerife, Spain.
| | - Pedro Javier Pérez-Lorensu
- Intraoperative Neurophysiologic Monitoring Unit, Hospital Universitario de Canarias, S/C de Tenerife, Spain
| | - Julio Plata-Bello
- Department of Neurosurgery, Hospital Universitario de Canarias, S/C de Tenerife, Spain
| | - Ángel Saponaro-González
- Intraoperative Neurophysiologic Monitoring Unit, Hospital Universitario de Canarias, S/C de Tenerife, Spain
| | - Luis Pérez-Orribo
- Department of Neurosurgery, Hospital Universitario de Canarias, S/C de Tenerife, Spain
| | - Mario García-Conde
- Department of Neurosurgery, Hospital Universitario de Canarias, S/C de Tenerife, Spain
| | - Pablo Febles-García
- Department of Neurosurgery, Hospital Universitario de Canarias, S/C de Tenerife, Spain
| | - Héctor Roldán-Delgado
- Department of Neurosurgery, Hospital Universitario de Canarias, S/C de Tenerife, Spain
| | - Víctor García-Marín
- Department of Neurosurgery, Hospital Universitario de Canarias, S/C de Tenerife, Spain
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Jun S, Kim JS, Chung CK. Direct Stimulation of Human Hippocampus During Verbal Associative Encoding Enhances Subsequent Memory Recollection. Front Hum Neurosci 2019; 13:23. [PMID: 30804768 PMCID: PMC6371751 DOI: 10.3389/fnhum.2019.00023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 01/18/2019] [Indexed: 11/16/2022] Open
Abstract
Previous studies have reported conflicting results regarding the effect of direct electrical stimulation of the human hippocampus on memory performance. A major function of the hippocampus is to form associations between individual elements of experience. However, the effect of direct hippocampal stimulation on associative memory remains largely inconclusive, with most evidence coming from studies employing non-invasive stimulation. Here, we therefore tested the hypothesis that direct electrical stimulation of the hippocampus specifically enhances hippocampal-dependent associative memory. To test this hypothesis, we recruited surgical patients with implanted subdural electrodes to perform a word pair memory task during which the hippocampus was stimulated. Our results indicate that stimulation of the hippocampus during encoding helped to build strong associative memories and enhanced recollection in subsequent trials. Moreover, stimulation significantly increased theta power in the lateral middle temporal cortex during successful memory encoding. Overall, our findings indicate that hippocampal stimulation positively impacts performance during a word pair memory task, suggesting that successful memory encoding involves the temporal cortex, which may act together with the hippocampus.
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Affiliation(s)
- Soyeon Jun
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, South Korea
| | - June Sic Kim
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, South Korea.,Research Institute of Basic Sciences, Seoul National University, Seoul, South Korea
| | - Chun Kee Chung
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, South Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
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Mălîia MD, Donos C, Barborica A, Popa I, Ciurea J, Cinatti S, Mîndruţă I. Functional mapping and effective connectivity of the human operculum. Cortex 2018; 109:303-321. [PMID: 30414541 DOI: 10.1016/j.cortex.2018.08.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 05/05/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
The operculum, defined as the cortex adjacent to the insula, is a large structure encompassing three lobes, with a recognized role in a variety of neurologic and psychiatric conditions. Its complex functions include sensory, motor, autonomic and cognitive processing. In humans, these are extended with the addition of language. These functions are implemented by highly specialized neuronal populations and their widespread connections, which our study aims at mapping in detail. We studied a group of 31 patients that were explored with intracranial electrodes during the pre-surgical workup for drug-resistant epilepsy. We have selected the subset of contacts implanted in non-epileptogenic opercular cortex and we analyzed the neurophysiological and behavioral responses to direct electrical stimulation. The functional mapping was performed by applying 1 Hz and 50 Hz electrical stimulation on 252 contact pairs and recording the threshold for evoking clinical effects. The effective connectivity was assessed using cortico-cortical evoked potentials elicited by single-pulse electrical stimulation in a subset of 19 patients. The locations of the effects grouped in twelve distinct semiological classes were analyzed. The most frequent effects evoked by stimulation of the frontal operculum were language related (29%). The Rolandic area produced most often oropharyngeal symptoms (47%), the parietal operculum produced somatosensory effects (67%), while the temporal evoked auditory (58%) semiology. The connectivity pattern was complex, with these structures having widespread ipsilateral and contralateral projections. The local connections between the opercular subregions and with the insula, as well as with more distant areas like the cingulate gyrus, were distinguished by strength and between-subjects consistency. In conclusion, we demonstrate specific opercular functionality, distinct from the one of the insular cortex. The study is complemented by a literature review on the opercular functional connectome in human and non-human primates.
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Affiliation(s)
- Mihai-Dragoş Mălîia
- Neurology Department, University Emergency Hospital, Bucharest, Romania; Physics Department, University of Bucharest, Bucharest, Romania
| | - Cristian Donos
- Physics Department, University of Bucharest, Bucharest, Romania
| | - Andrei Barborica
- Physics Department, University of Bucharest, Bucharest, Romania; FHC Inc., Bowdoin, ME, USA
| | - Irina Popa
- Neurology Department, University Emergency Hospital, Bucharest, Romania; Neurology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Jean Ciurea
- Neurosurgery Department, Bagdasar-Arseni Hospital, Bucharest, Romania
| | - Sandra Cinatti
- Neurology Department, University Emergency Hospital, Bucharest, Romania
| | - Ioana Mîndruţă
- Neurology Department, University Emergency Hospital, Bucharest, Romania; Neurology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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Electrical Stimulation Mapping of the Brain: Basic Principles and Emerging Alternatives. J Clin Neurophysiol 2018; 35:86-97. [PMID: 29499015 DOI: 10.1097/wnp.0000000000000440] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The application of electrical stimulation mapping (ESM) of the brain for clinical use is approximating a century. Despite this long-standing history, the value of ESM for guiding surgical resections and sparing eloquent cortex is documented largely by small retrospective studies, and ESM protocols are largely inherited and lack standardization. Although models are imperfect and mechanisms are complex, the probabilistic causality of ESM has guaranteed its perpetuation into the 21st century. At present, electrical stimulation of cortical tissue is being revisited for network connectivity. In addition, noninvasive and passive mapping techniques are rapidly evolving to complement and potentially replace ESM in specific clinical situations. Lesional and epilepsy neurosurgery cases now offer different opportunities for multimodal functional assessments.
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Jayakar P. Cortical Electrical Stimulation Mapping: Special Considerations in Children. J Clin Neurophysiol 2018; 35:106-109. [PMID: 29499017 DOI: 10.1097/wnp.0000000000000451] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cortical electrical stimulation mapping is often required to accurately delineate eloquent function before resective surgery for tumors or epilepsy. Although the technique is well established in adults, mapping poses special challenges in children that are addressed in this article. The concept of what constitutes a critical cortex is more difficult to assess, given the implications of plasticity and impact of deficits. Developmental factors affect the underlying neurophysiologic bases of responses to electrical stimulation, and evolving maturation requires adaptation of methodology. Furthermore, malformative substrates are the commonest substrate and often lead to aberrant representations of eloquent function.
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Affiliation(s)
- Prasanna Jayakar
- Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A
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Electrical Stimulation Modulates High γ Activity and Human Memory Performance. eNeuro 2018; 5:eN-NWR-0369-17. [PMID: 29404403 PMCID: PMC5797477 DOI: 10.1523/eneuro.0369-17.2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/08/2018] [Accepted: 01/12/2018] [Indexed: 11/30/2022] Open
Abstract
Direct electrical stimulation of the brain has emerged as a powerful treatment for multiple neurological diseases, and as a potential technique to enhance human cognition. Despite its application in a range of brain disorders, it remains unclear how stimulation of discrete brain areas affects memory performance and the underlying electrophysiological activities. Here, we investigated the effect of direct electrical stimulation in four brain regions known to support declarative memory: hippocampus (HP), parahippocampal region (PH) neocortex, prefrontal cortex (PF), and lateral temporal cortex (TC). Intracranial EEG recordings with stimulation were collected from 22 patients during performance of verbal memory tasks. We found that high γ (62–118 Hz) activity induced by word presentation was modulated by electrical stimulation. This modulatory effect was greatest for trials with “poor” memory encoding. The high γ modulation correlated with the behavioral effect of stimulation in a given brain region: it was negative, i.e., the induced high γ activity was decreased, in the regions where stimulation decreased memory performance, and positive in the lateral TC where memory enhancement was observed. Our results suggest that the effect of electrical stimulation on high γ activity induced by word presentation may be a useful biomarker for mapping memory networks and guiding therapeutic brain stimulation.
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Prime D, Rowlands D, O'Keefe S, Dionisio S. Considerations in performing and analyzing the responses of cortico-cortical evoked potentials in stereo-EEG. Epilepsia 2017; 59:16-26. [DOI: 10.1111/epi.13939] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 12/14/2022]
Affiliation(s)
- David Prime
- Griffith University School of Engineering; Brisbane Qld Australia
- Mater Advanced Epilepsy Unit; Mater Hospital; Brisbane Qld Australia
| | - David Rowlands
- Griffith University School of Engineering; Brisbane Qld Australia
| | - Steven O'Keefe
- Griffith University School of Engineering; Brisbane Qld Australia
| | - Sasha Dionisio
- Mater Advanced Epilepsy Unit; Mater Hospital; Brisbane Qld Australia
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Gkogkidis CA, Wang X, Schubert T, Gierthmühlen M, Kohler F, Schulze-Bonhage A, Burgard W, Rickert J, Haberstroh J, Schüttler M, Stieglitz T, Ball T. Closed-loop interaction with the cerebral cortex using a novel micro-ECoG-based implant: the impact of beta vs. gamma stimulation frequencies on cortico-cortical spectral responses. BRAIN-COMPUTER INTERFACES 2017. [DOI: 10.1080/2326263x.2017.1381829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C. Alexis Gkogkidis
- Translational Neurotechnology Lab, Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, Faculty of Engineering, University of Freiburg, Freiburg, Germany
| | - Xi Wang
- Translational Neurotechnology Lab, Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, Faculty of Engineering, University of Freiburg, Freiburg, Germany
| | - Tobias Schubert
- Department of Computer Science, Faculty of Engineering, University of Freiburg, Freiburg, Germany
| | - Mortimer Gierthmühlen
- Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Andreas Schulze-Bonhage
- Epilepsy Center, Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfram Burgard
- Department of Computer Science, Faculty of Engineering, University of Freiburg, Freiburg, Germany
| | | | - Jörg Haberstroh
- CEMT, Experimental Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, Faculty of Engineering, University of Freiburg, Freiburg, Germany
| | - Tonio Ball
- Translational Neurotechnology Lab, Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Abalkhail TM, MacDonald DB, AlThubaiti I, AlOtaibi FA, Stigsby B, Mokeem AA, AlHamoud IA, Hassounah MI, Baz SM, AlSemari A, AlDhalaan HM, Khan S. Intraoperative direct cortical stimulation motor evoked potentials: Stimulus parameter recommendations based on rheobase and chronaxie. Clin Neurophysiol 2017; 128:2300-2308. [PMID: 29035822 DOI: 10.1016/j.clinph.2017.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/04/2017] [Accepted: 09/19/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine optimal interstimulus interval (ISI) and pulse duration (D) for direct cortical stimulation (DCS) motor evoked potentials (MEPs) based on rheobase and chronaxie derived with two techniques. METHODS In 20 patients under propofol/remifentanil anesthesia, 5-pulse DCS thenar MEP rheobase and chronaxie with 2, 3, 4 and 5ms ISI were measured by linear regression of five charge thresholds at 0.05, 0.1, 0.2, 0.5 and 1msD, and estimated from two charge thresholds at 0.1 and 1msD using simple arithmetic. Optimal parameters were defined by minimum threshold energy: the ISI with lowest rheobase2×chronaxie, and D at its chronaxie. Near-optimal was defined as threshold energy <25% above minimum. RESULTS The optimal ISI was 3 or 4 (n=7 each), 2 (n=4), or 5ms (n=2), but only 4ms was always either optimal or near-optimal. The optimal D was ∼0.2 (n=12), ∼0.1 (n=7) or ∼0.3ms (n=1). Two-point estimates closely approximated five-point measurements. CONCLUSIONS Optimal ISI/D varies, with 4ms/0.2ms being most consistently optimal or near-optimal. Two-point estimation is sufficiently accurate. SIGNIFICANCE The results endorse 4ms ISI and 0.2msD for general use. Two-point estimation could enable quick individual optimization.
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Affiliation(s)
- Tariq M Abalkhail
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (KFSH), Saudi Arabia
| | - David B MacDonald
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (KFSH), Saudi Arabia.
| | - Ibrahim AlThubaiti
- Section of Neurosurgery, Department of Neurosciences, KFSH, Saudi Arabia
| | - Faisal A AlOtaibi
- Section of Neurosurgery, Department of Neurosciences, KFSH, Saudi Arabia
| | - Bent Stigsby
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (KFSH), Saudi Arabia
| | - Amal A Mokeem
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (KFSH), Saudi Arabia
| | - Iftetah A AlHamoud
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (KFSH), Saudi Arabia
| | - Maher I Hassounah
- Section of Neurosurgery, Department of Neurosciences, KFSH, Saudi Arabia
| | - Salah M Baz
- Section of Neurology, Department of Neurosciences, KFSH, Saudi Arabia
| | | | - Hesham M AlDhalaan
- Section of Pediatric Neurology, Department of Neurosciences, KFSH, Saudi Arabia
| | - Sameena Khan
- Section of Pediatric Neurology, Department of Neurosciences, KFSH, Saudi Arabia
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Pallud J, Mandonnet E, Corns R, Dezamis E, Parraga E, Zanello M, Spena G. Technical principles of direct bipolar electrostimulation for cortical and subcortical mapping in awake craniotomy. Neurochirurgie 2017; 63:158-163. [DOI: 10.1016/j.neuchi.2016.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 11/24/2016] [Accepted: 12/04/2016] [Indexed: 12/01/2022]
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Phielipp NM, Saha U, Sankar T, Yugeta A, Chen R. Safety of repetitive transcranial magnetic stimulation in patients with implanted cortical electrodes. An ex-vivo study and report of a case. Clin Neurophysiol 2017; 128:1109-1115. [DOI: 10.1016/j.clinph.2017.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 01/11/2017] [Accepted: 01/26/2017] [Indexed: 11/29/2022]
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Hiremath SV, Tyler-Kabara EC, Wheeler JJ, Moran DW, Gaunt RA, Collinger JL, Foldes ST, Weber DJ, Chen W, Boninger ML, Wang W. Human perception of electrical stimulation on the surface of somatosensory cortex. PLoS One 2017; 12:e0176020. [PMID: 28489913 PMCID: PMC5425101 DOI: 10.1371/journal.pone.0176020] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 04/04/2017] [Indexed: 12/01/2022] Open
Abstract
Recent advancement in electrocorticography (ECoG)-based brain-computer interface technology has sparked a new interest in providing somatosensory feedback using ECoG electrodes, i.e., cortical surface electrodes. We conducted a 28-day study of cortical surface stimulation in an individual with arm paralysis due to brachial plexus injury to examine the sensation produced by electrical stimulation of the somatosensory cortex. A high-density ECoG grid was implanted over the somatosensory and motor cortices. Stimulation through cortical surface electrodes over the somatosensory cortex successfully elicited arm and hand sensations in our participant with chronic paralysis. There were three key findings. First, the intensity of perceived sensation increased monotonically with both pulse amplitude and pulse frequency. Second, changing pulse width changed the type of sensation based on qualitative description provided by the human participant. Third, the participant could distinguish between stimulation applied to two neighboring cortical surface electrodes, 4.5 mm center-to-center distance, for three out of seven electrode pairs tested. Taken together, we found that it was possible to modulate sensation intensity, sensation type, and evoke sensations across a range of locations from the fingers to the upper arm using different stimulation electrodes even in an individual with chronic impairment of somatosensory function. These three features are essential to provide effective somatosensory feedback for neuroprosthetic applications.
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Affiliation(s)
- Shivayogi V. Hiremath
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for the Neural Basis of Cognition, Pittsburgh, Pennsylvania, United States of America
- Department of Physical Therapy, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Elizabeth C. Tyler-Kabara
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jesse J. Wheeler
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Daniel W. Moran
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Robert A. Gaunt
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jennifer L. Collinger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for the Neural Basis of Cognition, Pittsburgh, Pennsylvania, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Stephen T. Foldes
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for the Neural Basis of Cognition, Pittsburgh, Pennsylvania, United States of America
- Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania, United States of America
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, United States of America
| | - Douglas J. Weber
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for the Neural Basis of Cognition, Pittsburgh, Pennsylvania, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Weidong Chen
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, Zhejiang, China
| | - Michael L. Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Wei Wang
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for the Neural Basis of Cognition, Pittsburgh, Pennsylvania, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Mallinckrodt Institute of Radiology, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri, United States of America
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Merkow MB, Burke JF, Ramayya AG, Sharan AD, Sperling MR, Kahana MJ. Stimulation of the human medial temporal lobe between learning and recall selectively enhances forgetting. Brain Stimul 2017; 10:645-650. [PMID: 28073638 PMCID: PMC5410394 DOI: 10.1016/j.brs.2016.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Direct electrical stimulation applied to the human medial temporal lobe (MTL) typically disrupts performance on memory tasks, however, the mechanism underlying this effect is not known. OBJECTIVE To study the effects of MTL stimulation on memory performance. METHODS We studied the effects of MTL stimulation on memory in five patients undergoing invasive electrocorticographic monitoring during various phases of a memory task (encoding, distractor, recall). RESULTS We found that MTL stimulation disrupted memory performance in a timing-dependent manner; we observed greater forgetting when applying stimulation during the delay between encoding and recall, compared to when it was applied during encoding or recall. CONCLUSIONS The results suggest that recall is most dependent on the MTL between learning and retrieval.
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Affiliation(s)
- Maxwell B Merkow
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - John F Burke
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Ashwin G Ramayya
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Ashwini D Sharan
- Department of Neurosurgery, Thomas Jefferson University, 19107, United States
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, 19107, United States
| | - Michael J Kahana
- Department of Psychology, University of Pennsylvania, 19104, United States.
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