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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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2
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Woolnough O, Tandon N. Dissociation of reading and naming in ventral occipitotemporal cortex. Brain 2024; 147:2522-2529. [PMID: 38289871 PMCID: PMC11224612 DOI: 10.1093/brain/awae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/22/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024] Open
Abstract
Lesions in the language-dominant ventral occipitotemporal cortex (vOTC) can result in selective impairment of either reading or naming, resulting in alexia or anomia. Yet, functional imaging studies that show differential activation for naming and reading do not reveal activity exclusively tuned to one of these inputs. To resolve this dissonance in the functional architecture of the vOTC, we used focused stimulation to the vOTC in 49 adult patients during reading and naming, and generated a population-level, probabilistic map to evaluate if reading and naming are clearly dissociable within individuals. Language mapping (50 Hz, 2829 stimulations) was performed during passage reading (216 positive sites) and visual naming (304 positive sites). Within the vOTC, we isolated sites that selectively disrupted reading (24 sites in 11 patients) or naming (27 sites in 12 patients), and those that disrupted both processes (75 sites in 21 patients). The anteromedial vOTC had a higher probability of producing naming disruption, while posterolateral regions resulted in greater reading-specific disruption. Between them lay a multi-modal region where stimulation disrupted both reading and naming. This work provides a comprehensive view of vOTC organization-the existence of a heteromodal cortex critical to both reading and naming, along with a causally dissociable unimodal naming cortex, and a reading-specific visual word form area in the vOTC. Their distinct roles as associative regions may thus relate to their connectivity within the broader language network that is disrupted by stimulation, more than to highly selective tuning properties. Our work also implies that pre-surgical mapping of both reading and naming is essential for patients requiring vOTC resections, as these functions are not co-localized, and such mapping may prevent the occurrence of unexpected deficits.
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Affiliation(s)
- Oscar Woolnough
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX 77030, USA
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX 77030, USA
- Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Memorial Hermann Hospital, Texas Medical Center, Houston, TX 77030, USA
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3
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Lesser RP, Webber WRS, Miglioretti DL. Pan-cortical electrophysiologic changes underlying attention. Sci Rep 2024; 14:2680. [PMID: 38302535 PMCID: PMC10834435 DOI: 10.1038/s41598-024-52717-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
We previously reported that pan-cortical effects occur when cognitive tasks end afterdischarges. For this report, we analyzed wavelet cross-coherence changes during cognitive tasks used to terminate afterdischarges studying multiple time segments and multiple groups of inter-electrode-con distances. We studied 12 patients with intractable epilepsy, with 970 implanted electrode contacts, and 39,871 electrode contact combinations. When cognitive tasks ended afterdischarges, coherence varied similarly across the cortex throughout the tasks, but there were gradations with time, distance, and frequency: (1) They tended to progressively decrease relative to baseline with time and then to increase toward baseline when afterdischarges ended. (2) During most time segments, decreases from baseline were largest for the closest inter-contact distances, moderate for intermediate inter-contact distances, and smallest for the greatest inter-contact distances. With respect to our patients' intractable epilepsy, the changes found suggest that future therapies might treat regions beyond those closest to regions of seizure onset and treat later in a seizure's evolution. Similar considerations might apply to other disorders. Our findings also suggest that cognitive tasks can result in pan-cortical coherence changes that participate in underlying attention, perhaps complementing the better-known regional mechanisms.
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Affiliation(s)
- Ronald P Lesser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
- Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - W R S Webber
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, Davis, School of Medicine, University of California, Davis, CA, 95616, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA
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4
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Soloukey S, Collée E, Verhoef L, Satoer DD, Dirven CMF, Bos EM, Schouten JW, Generowicz BS, Mastik F, De Zeeuw CI, Koekkoek SKE, Vincent AJPE, Smits M, Kruizinga P. Human brain mapping using co-registered fUS, fMRI and ESM during awake brain surgeries: A proof-of-concept study. Neuroimage 2023; 283:120435. [PMID: 37914090 DOI: 10.1016/j.neuroimage.2023.120435] [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: 07/27/2023] [Revised: 10/15/2023] [Accepted: 10/29/2023] [Indexed: 11/03/2023] Open
Abstract
Accurate, depth-resolved functional imaging is key in both understanding and treatment of the human brain. A new sonography-based imaging technique named functional Ultrasound (fUS) uniquely combines high sensitivity with submillimeter-subsecond spatiotemporal resolution available in large fields-of-view. In this proof-of-concept study we show that: (A) fUS reveals the same eloquent regions as found by fMRI while concomitantly visualizing in-vivo microvascular morphology underlying these functional hemodynamics and (B) fUS-based functional maps are confirmed by Electrocortical Stimulation Mapping (ESM), the current gold-standard in awake neurosurgical practice. This unique cross-modality experiment was performed using motor, visual and language-related functional tasks in patients undergoing awake brain tumor resection. The current work serves as an important milestone towards further maturity of fUS as well as a novel avenue to increase our understanding of hemodynamics-based functional brain imaging.
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Affiliation(s)
- S Soloukey
- Department of Neuroscience, Erasmus MC, Wytemaweg 80 3015 CN, Rotterdam 3015 CN, the Netherlands; Department of Neurosurgery, Erasmus MC, Rotterdam 3015 CN, the Netherlands
| | - E Collée
- Department of Neurosurgery, Erasmus MC, Rotterdam 3015 CN, the Netherlands
| | - L Verhoef
- Department of Neuroscience, Erasmus MC, Wytemaweg 80 3015 CN, Rotterdam 3015 CN, the Netherlands
| | - D D Satoer
- Department of Neurosurgery, Erasmus MC, Rotterdam 3015 CN, the Netherlands
| | - C M F Dirven
- Department of Neurosurgery, Erasmus MC, Rotterdam 3015 CN, the Netherlands
| | - E M Bos
- Department of Neurosurgery, Erasmus MC, Rotterdam 3015 CN, the Netherlands
| | - J W Schouten
- Department of Neurosurgery, Erasmus MC, Rotterdam 3015 CN, the Netherlands
| | - B S Generowicz
- Department of Neuroscience, Erasmus MC, Wytemaweg 80 3015 CN, Rotterdam 3015 CN, the Netherlands
| | - F Mastik
- Department of Neuroscience, Erasmus MC, Wytemaweg 80 3015 CN, Rotterdam 3015 CN, the Netherlands
| | - C I De Zeeuw
- Department of Neuroscience, Erasmus MC, Wytemaweg 80 3015 CN, Rotterdam 3015 CN, the Netherlands; Netherlands Institute for Neuroscience, Royal Dutch Academy for Arts and Sciences, Amsterdam 1105 BA, the Netherlands
| | - S K E Koekkoek
- Department of Neuroscience, Erasmus MC, Wytemaweg 80 3015 CN, Rotterdam 3015 CN, the Netherlands
| | - A J P E Vincent
- Department of Neurosurgery, Erasmus MC, Rotterdam 3015 CN, the Netherlands
| | - M Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam 3015 CN, the Netherlands
| | - P Kruizinga
- Department of Neuroscience, Erasmus MC, Wytemaweg 80 3015 CN, Rotterdam 3015 CN, the Netherlands.
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5
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Harmata GI, Rhone AE, Kovach CK, Kumar S, Mowla MR, Sainju RK, Nagahama Y, Oya H, Gehlbach BK, Ciliberto MA, Mueller RN, Kawasaki H, Pattinson KT, Simonyan K, Davenport PW, Howard MA, Steinschneider M, Chan AC, Richerson GB, Wemmie JA, Dlouhy BJ. Failure to breathe persists without air hunger or alarm following amygdala seizures. JCI Insight 2023; 8:e172423. [PMID: 37788112 PMCID: PMC10721319 DOI: 10.1172/jci.insight.172423] [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: 05/24/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023] Open
Abstract
Postictal apnea is thought to be a major cause of sudden unexpected death in epilepsy (SUDEP). However, the mechanisms underlying postictal apnea are unknown. To understand causes of postictal apnea, we used a multimodal approach to study brain mechanisms of breathing control in 20 patients (ranging from pediatric to adult) undergoing intracranial electroencephalography for intractable epilepsy. Our results indicate that amygdala seizures can cause postictal apnea. Moreover, we identified a distinct region within the amygdala where electrical stimulation was sufficient to reproduce prolonged breathing loss persisting well beyond the end of stimulation. The persistent apnea was resistant to rising CO2 levels, and air hunger failed to occur, suggesting impaired CO2 chemosensitivity. Using es-fMRI, a potentially novel approach combining electrical stimulation with functional MRI, we found that amygdala stimulation altered blood oxygen level-dependent (BOLD) activity in the pons/medulla and ventral insula. Together, these findings suggest that seizure activity in a focal subregion of the amygdala is sufficient to suppress breathing and air hunger for prolonged periods of time in the postictal period, likely via brainstem and insula sites involved in chemosensation and interoception. They further provide insights into SUDEP, may help identify those at greatest risk, and may lead to treatments to prevent SUDEP.
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Affiliation(s)
- Gail I.S. Harmata
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
- Interdisciplinary Graduate Program in Neuroscience
- Pharmacological Sciences Training Program
- Department of Psychiatry
| | | | | | | | | | | | | | - Hiroyuki Oya
- Department of Neurosurgery
- Iowa Neuroscience Institute
| | | | | | - Rashmi N. Mueller
- Department of Neurosurgery
- Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA
| | | | - Kyle T.S. Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kristina Simonyan
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul W. Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, USA
| | - Matthew A. Howard
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
| | | | | | - George B. Richerson
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
- Interdisciplinary Graduate Program in Neuroscience
- Department of Neurology
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, USA
- Department of Veterans Affairs Medical Center, Iowa City, Iowa, USA
| | - John A. Wemmie
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
- Interdisciplinary Graduate Program in Neuroscience
- Department of Psychiatry
- Department of Internal Medicine
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Veterans Affairs Medical Center, Iowa City, Iowa, USA
| | - Brian J. Dlouhy
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
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6
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Aungaroon G, Vedala K, Byars AW, Ervin B, Rozhkov L, Horn PS, Ihnen S, Holland KD, Tenney JR, Kremer K, Fong SL, Lin N, Liu W, Arthur TM, Fujiwara H, Skoch J, Leach JL, Mangano FT, Greiner HM, Arya R. Comparing electrical stimulation functional mapping with subdural electrodes and stereoelectroencephalography. Epilepsia 2023; 64:1527-1540. [PMID: 36872854 PMCID: PMC10239361 DOI: 10.1111/epi.17575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Electrical stimulation mapping (ESM) is the clinical standard for functional localization with subdural electrodes (SDE). As stereoelectroencephalography (SEEG) has emerged as an alternative option, we compared functional responses, afterdischarges (ADs), and unwanted ESM-induced seizures (EISs) between the two electrode types. METHODS Incidence and current thresholds for functional responses (sensory, motor, speech/language), ADs, and EISs were compared between SDE and SEEG using mixed models incorporating relevant covariates. RESULTS We identified 67 SEEG ESM and 106 SDE ESM patients (7207 and 4980 stimulated contacts, respectively). We found similar incidence of language and motor responses between electrode types; however, more SEEG patients reported sensory responses. ADs and EISs occurred less commonly with SEEG than SDE. Current thresholds for language, face motor, and upper extremity (UE) motor responses and EIS significantly decreased with age. However, they were not affected by electrode type, premedication, or dominant hemispheric stimulation. AD thresholds were higher with SEEG than with SDE. For SEEG ESM, language thresholds remained below AD thresholds up to 26 years of age, whereas this relationship was inverse for SDE. Also, face and UE motor thresholds fell below AD thresholds at earlier ages for SEEG than SDE. AD and EIS thresholds were not affected by premedication. SIGNIFICANCE SEEG and SDE have clinically relevant differences for functional brain mapping with electrical stimulation. Although evaluation of language and motor regions is comparable between SEEG and SDE, SEEG offers a higher likelihood of identifying sensory areas. A lower incidence of ADs and EISs, and a favorable relationship between functional and AD thresholds suggest superior safety and neurophysiologic validity for SEEG ESM than SDE ESM.
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Affiliation(s)
- Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Kishore Vedala
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Anna W. Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Brian Ervin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Paul S. Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - S.K.Z. Ihnen
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katherine D. Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Jeffrey R. Tenney
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Kelly Kremer
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Susan L. Fong
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Nan Lin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Wei Liu
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Todd M. Arthur
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Hisako Fujiwara
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Jesse Skoch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - James L. Leach
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neuroradiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Francesco T. Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Hansel M. Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, U.S.A
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7
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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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8
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Zauli FM, Del Vecchio M, Russo S, Mariani V, Pelliccia V, d'Orio P, Sartori I, Avanzini P, Caruana F. The web of laughter: frontal and limbic projections of the anterior cingulate cortex revealed by cortico-cortical evoked potential from sites eliciting laughter. Philos Trans R Soc Lond B Biol Sci 2022; 377:20210180. [PMID: 36126672 PMCID: PMC9489285 DOI: 10.1098/rstb.2021.0180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/02/2022] [Indexed: 12/20/2022] Open
Abstract
According to an evolutionist approach, laughter is a multifaceted behaviour affecting social, emotional, motor and speech functions. Albeit previous studies have suggested that high-frequency electrical stimulation (HF-ES) of the pregenual anterior cingulate cortex (pACC) may induce bursts of laughter-suggesting a crucial contribution of this region to the cortical control of this behaviour-the complex nature of laughter implies that outward connections from the pACC may reach and affect a complex network of frontal and limbic regions. Here, we studied the effective connectivity of the pACC by analysing the cortico-cortical evoked potentials elicited by single-pulse electrical stimulation of pACC sites whose HF-ES elicited laughter in 12 patients. Once these regions were identified, we studied their clinical response to HF-ES, to reveal the specific functional target of pACC representation of laughter. Results reveal that the neural representation of laughter in the pACC interacts with several frontal and limbic regions, including cingulate, orbitofrontal, medial prefrontal and anterior insular regions-involved in interoception, emotion, social reward and motor behaviour. These results offer neuroscientific support to the evolutionist approach to laughter, providing a possible mechanistic explanation of the interplay between this behaviour and emotion regulation, speech production and social interactions. This article is part of the theme issue 'Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience'.
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Affiliation(s)
- F M Zauli
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milan, Italy
- Department of Philosophy 'Piero Martinetti', University of Milan, Milan, Italy
- 'Claudio Munari' Epilepsy Surgery Center, ASST GOM Niguarda, Milan, Italy
| | - M Del Vecchio
- Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy
| | - S Russo
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milan, Italy
- Department of Philosophy 'Piero Martinetti', University of Milan, Milan, Italy
- Allen Institute, Seattle, WA
| | - V Mariani
- Neurology and Stroke Unit Division, Circolo Hospital ASST Settelaghi University of Insubria, Varese, Italy
| | - V Pelliccia
- 'Claudio Munari' Epilepsy Surgery Center, ASST GOM Niguarda, Milan, Italy
| | - P d'Orio
- 'Claudio Munari' Epilepsy Surgery Center, ASST GOM Niguarda, Milan, Italy
- Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma
| | - I Sartori
- 'Claudio Munari' Epilepsy Surgery Center, ASST GOM Niguarda, Milan, Italy
| | - P Avanzini
- Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy
| | - F Caruana
- Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy
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9
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Holloway T, Leach JL, Tenney JR, Byars AW, Horn PS, Greiner HM, Mangano FT, Holland KD, Arya R. Functional MRI and electrical stimulation mapping for language localization: A comparative meta-analysis. Clin Neurol Neurosurg 2022; 222:107417. [DOI: 10.1016/j.clineuro.2022.107417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022]
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10
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Parmigiani S, Mikulan EP, Russo S, Sarasso S, Zauli FM, Rubino A, Cattani A, Fecchio M, Giampiccolo D, Lanzone J, D'Orio P, Del Vecchio M, Avanzini P, Nobili L, Sartori I, Massimini M, Pigorini A. Simultaneous stereo-EEG and high-density scalp EEG recordings to study the effects of intracerebral stimulation parameters. Brain Stimul 2022; 15:664-675. [PMID: 35421585 DOI: 10.1016/j.brs.2022.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cortico-cortical evoked potentials (CCEPs) recorded by stereo-electroencephalography (SEEG) are a valuable tool to investigate brain reactivity and effective connectivity. However, invasive recordings are spatially sparse since they depend on clinical needs. This sparsity hampers systematic comparisons across-subjects, the detection of the whole-brain effects of intracortical stimulation, as well as their relationships to the EEG responses evoked by non-invasive stimuli. OBJECTIVE To demonstrate that CCEPs recorded by high-density electroencephalography (hd-EEG) provide additional information with respect SEEG alone and to provide an open, curated dataset to allow for further exploration of their potential. METHODS The dataset encompasses SEEG and hd-EEG recordings simultaneously acquired during Single Pulse Electrical Stimulation (SPES) in drug-resistant epileptic patients (N = 36) in whom stimulations were delivered with different physical, geometrical, and topological parameters. Differences in CCEPs were assessed by amplitude, latency, and spectral measures. RESULTS While invasively and non-invasively recorded CCEPs were generally correlated, differences in pulse duration, angle and stimulated cortical area were better captured by hd-EEG. Further, intracranial stimulation evoked site-specific hd-EEG responses that reproduced the spectral features of EEG responses to transcranial magnetic stimulation (TMS). Notably, SPES, albeit unperceived by subjects, elicited scalp responses that were up to one order of magnitude larger than the responses typically evoked by sensory stimulation in awake humans. CONCLUSIONS CCEPs can be simultaneously recorded with SEEG and hd-EEG and the latter provides a reliable descriptor of the effects of SPES as well as a common reference to compare the whole-brain effects of intracortical stimulation to those of non-invasive transcranial or sensory stimulations in humans.
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Affiliation(s)
- S Parmigiani
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - E P Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - S Russo
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Philosophy "Piero Martinetti", Università degli Studi di Milano, Milan, Italy
| | - S Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - F M Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Philosophy "Piero Martinetti", Università degli Studi di Milano, Milan, Italy
| | - A Rubino
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - A Cattani
- Department of Mathematics & Statistics, Boston University, Boston, MA, USA
| | - M Fecchio
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - D Giampiccolo
- Department of Neurosurgery, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Institute of Neurosciences, Cleveland Clinic London, London, UK
| | - J Lanzone
- Department of Systems Medicine, Neuroscience, University of Rome Tor Vergata, Rome, Italy; Istituti Clinici Scientifici Maugeri, IRCCS, Neurorehabilitation Department of Milano Institute, Milan, Italy
| | - P D'Orio
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy; Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - M Del Vecchio
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - P Avanzini
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - L Nobili
- Child Neuropsychiatry, IRCCS Istituto G. Gaslini, Genova, Italy
| | - I Sartori
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - M Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy; Azrieli Program in Brain, Mind and Consciousness, Canadian Institute for Advanced Research, Toronto, Canada
| | - A Pigorini
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Biomedical, V, Università degli Studi di Milano, Milan, Italy.
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11
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Turker S, Hartwigsen G. The use of noninvasive brain stimulation techniques to improve reading difficulties in dyslexia: A systematic review. Hum Brain Mapp 2022; 43:1157-1173. [PMID: 34716977 PMCID: PMC8764483 DOI: 10.1002/hbm.25700] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/29/2021] [Accepted: 10/08/2021] [Indexed: 02/05/2023] Open
Abstract
Noninvasive brain stimulation (NIBS) allows to actively and noninvasively modulate brain function. Aside from inhibiting specific processes, NIBS may also enhance cognitive functions, which might be used for the prevention and intervention of learning disabilities such as dyslexia. However, despite the growing interest in modulating learning abilities, a comprehensive, up-to-date review synthesizing NIBS studies with dyslexics is missing. Here, we fill this gap and elucidate the potential of NIBS as treatment option in dyslexia. The findings of the 15 included studies suggest that repeated sessions of reading training combined with different NIBS protocols may induce long-lasting improvements of reading performance in child and adult dyslexics, opening promising avenues for future research. In particular, the "classical" reading areas seem to be most successfully modulated through NIBS, and facilitatory protocols can improve various reading-related subprocesses. Moreover, we emphasize the need to further explore the potential to modulate auditory cortex function as a preintervention and intervention approach for affected children, for example, to avoid the development of auditory and phonological difficulties at the core of dyslexia. Finally, we outline how future studies may increase our understanding of the neurobiological basis of NIBS-induced improvements in dyslexia.
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Affiliation(s)
- Sabrina Turker
- Lise Meitner Research Group Cognition and PlasticityMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
- Alexander von Humboldt FoundationBerlinGermany
| | - Gesa Hartwigsen
- Lise Meitner Research Group Cognition and PlasticityMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
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12
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Mulinari Pinheiro Machado M, Voda A, Besançon G, Becq G, Kahane P, David O. Brain tissue classification from stereoelectroencephalographic recordings. J Neurosci Methods 2022; 365:109375. [PMID: 34627927 DOI: 10.1016/j.jneumeth.2021.109375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Stereoelectroencephalographic (SEEG) recordings can be performed before final resective surgery in some drug-resistant patients with focal epilepsies. For good SEEG signal interpretation, it is important to correctly identify the brain tissue in which each contact is inserted. Tissue classification is usually done with the coregistration of CT scan (with implanted SEEG electrodes) with preoperative MRI. NEW METHOD Brain tissue classification is done here directly from SEEG signals obtained at rest by a linear discriminant analysis (LDA) classifier using measured SEEG signals. The classification operates on features extracted from Bode plots obtained via non-parametric frequency domain transfer functions of adjacent contacts pairs. Classification results have been compared with classification from T1 MRI following the labelling procedure described in Deman et al. (2018), together with minor corrections by visual inspection by specialists. RESULTS With the data processed from 19 epileptic patients representing 1284 contact pairs, an accuracy of 72 ± 3% was obtained for homogeneous tissue separation. To our knowledge only one previous study conducted brain tissue classification using the power spectra of SEEG signals, and the distance between contacts on a shaft. The features proposed in our article performed better with the LDA classifier. However, the Bayesian classifier proposed in Greene et al. (2020) is more robust and could be used in a future study to enhance the classification performance. CONCLUSIONS AND SIGNIFICANCE Our findings suggest that careful analysis of the transfer function between adjacent contacts measuring resting activity via frequency domain identification, could allow improved interpretation of SEEG data and or their co-registration with subject's anatomy.
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Affiliation(s)
| | - Alina Voda
- Univ. Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, 38000 Grenoble, France.
| | - Gildas Besançon
- Univ. Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, 38000 Grenoble, France.
| | - Guillaume Becq
- Univ. Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, 38000 Grenoble, France.
| | - Philippe Kahane
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, 38000 Grenoble, France.
| | - Olivier David
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, 38000 Grenoble, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systémes, Marseille, France.
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13
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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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14
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TAKAHASHI Y, ENATSU R, KANNO A, IMATAKA S, KOMURA S, TAMADA T, SAKASHITA K, CHIBA R, SAITO T, MIKUNI N. Comparison of Thresholds between Bipolar and Monopolar Electrical Cortical Stimulation. Neurol Med Chir (Tokyo) 2022; 62:294-299. [PMID: 35466117 PMCID: PMC9259081 DOI: 10.2176/jns-nmc.2021-0389] [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] [Indexed: 11/20/2022] Open
Abstract
Electrical cortical stimulation is widely performed and is the gold standard for functional mapping in intractable epilepsy patients; however, a standard protocol has not yet been established. With respect to stimulation methods, two techniques can be applied: monopolar and bipolar stimulation. We compared the threshold to induce clinical symptoms between these two stimulation techniques. Twenty patients with intractable epilepsy who underwent electrical cortical stimulation for functional mapping were retrospectively investigated. We evaluated the stimulation intensity thresholds required to induce motor, sensory, and language symptoms. A total of 114 electrodes in 20 patients were used to investigate motor, sensory, and language symptoms. The thresholds required to induce motor (median value, bipolar: 4 mA, monopolar: 5 mA, p < 0.05) and language symptoms (bipolar: 8 mA, monopolar: 10 mA, p < 0.0005) were significantly higher for monopolar stimulation than those for bipolar stimulation. However, for sensory symptoms, no significant differences were found in the required thresholds between monopolar and bipolar stimulation (bipolar: 4 mA, monopolar: 4 mA, p = 0.474). Bipolar cortical stimulation required lower intensities to produce clinical motor and language symptoms and thus would be safe and suitable for screening of the eloquent area in functional mapping.
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Affiliation(s)
- Yasuhiro TAKAHASHI
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Rei ENATSU
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Aya KANNO
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Seiichiro IMATAKA
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Shoichi KOMURA
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Tomoaki TAMADA
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Kyoya SAKASHITA
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Ryohei CHIBA
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Takuro SAITO
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Nobuhiro MIKUNI
- Department of Neurosurgery, Sapporo Medical University School of Medicine
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15
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Cerebellar Transcranial Direct Current Stimulation in Children with Autism Spectrum Disorder: A Pilot Study on Efficacy, Feasibility, Safety, and Unexpected Outcomes in Tic Disorder and Epilepsy. J Clin Med 2021; 11:jcm11010143. [PMID: 35011884 PMCID: PMC8745597 DOI: 10.3390/jcm11010143] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with autism spectrum disorder (ASD) display distinctive neurophysiological characteristics associated with significant cognitive, emotional, and behavioral symptoms. Transcranial direct current stimulation (tDCS) applied to the frontal or temporoparietal lobes has demonstrated potential to reduce the severity of ASD-related symptoms. Recently, the cerebellum has been identified as a brain area involved in ASD pathophysiology. In this open-label pilot study, seven ASD patients aged between 9 and 13 years underwent 20 daily sessions of 20 min cathodal stimulation of the right cerebellar lobe. At the end of the treatment, the Aberrant Behavior Checklist (ABC) scores showed a 25% mean reduction in global severity of symptoms, with a more pronounced reduction in the “social withdrawal and lethargy” (−35%), “hyperactivity and noncompliance” (−26%), and “irritability, agitation, and crying” (−25%) subscales. Minor and no improvement were observed in the “stereotypic behavior” (−18%) and “inappropriate speech” (−0%) subscales, respectively. Improvements were not detected in the two patients who were taking psychotropic drugs during the study. Clinical response showed a symptom-specific time course. Quality of sleep and mood improved earlier than hyperactivity and social withdrawal. The treatment was generally accepted by patients and well tolerated. No serious adverse events were reported. Stimulation also appeared to markedly reduce the severity of tics in a patient with comorbid tic disorder and led to the disappearance of a frontal epileptogenic focus in another patient with a history of seizures. In conclusion, cerebellar tDCS is safe, feasible, and potentially effective in the treatment of ASD symptoms among children. Strategies to improve recruitment and retention are discussed.
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16
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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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17
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Meikle SJ, Wong YT. Neurophysiological considerations for visual implants. Brain Struct Funct 2021; 227:1523-1543. [PMID: 34773502 DOI: 10.1007/s00429-021-02417-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/17/2021] [Indexed: 11/26/2022]
Abstract
Neural implants have the potential to restore visual capabilities in blind individuals by electrically stimulating the neurons of the visual system. This stimulation can produce visual percepts known as phosphenes. The ideal location of electrical stimulation for achieving vision restoration is widely debated and dependent on the physiological properties of the targeted tissue. Here, the neurophysiology of several potential target structures within the visual system will be explored regarding their benefits and downfalls in producing phosphenes. These regions will include the lateral geniculate nucleus, primary visual cortex, visual area 2, visual area 3, visual area 4 and the middle temporal area. Based on the existing engineering limitations of neural prostheses, we anticipate that electrical stimulation of any singular brain region will be incapable of achieving high-resolution naturalistic perception including color, texture, shape and motion. As improvements in visual acuity facilitate improvements in quality of life, emulating naturalistic vision should be one of the ultimate goals of visual prostheses. To achieve this goal, we propose that multiple brain areas will need to be targeted in unison enabling different aspects of vision to be recreated.
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Affiliation(s)
- Sabrina J Meikle
- Department of Electrical and Computer Systems Engineering, Monash University, 14 Alliance Lane, Clayton, Vic, 3800, Australia
- Department of Physiology and Biomedicine Discovery Institute, Monash University, 14 Alliance Lane, Clayton, Vic, 3800, Australia
- Monash Vision Group, Monash University, 14 Alliance Lane, Clayton, Vic, 3800, Australia
| | - Yan T Wong
- Department of Electrical and Computer Systems Engineering, Monash University, 14 Alliance Lane, Clayton, Vic, 3800, Australia.
- Department of Physiology and Biomedicine Discovery Institute, Monash University, 14 Alliance Lane, Clayton, Vic, 3800, Australia.
- Monash Vision Group, Monash University, 14 Alliance Lane, Clayton, Vic, 3800, Australia.
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18
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Onder H, Comoglu S. Alexia without agraphia: a disconnection syndrome or a primary involvement of a visual language center? Neurol Sci 2021; 43:709-711. [PMID: 34718896 DOI: 10.1007/s10072-021-05678-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Şehit Ömer Halisdemir Street. No: 20 Altındag, Ankara, 06110, Turkey.
| | - Selcuk Comoglu
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Şehit Ömer Halisdemir Street. No: 20 Altındag, Ankara, 06110, Turkey
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19
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Eroğlu HH, Puonti O, Göksu C, Gregersen F, Siebner HR, Hanson LG, Thielscher A. On the reconstruction of magnetic resonance current density images of the human brain: Pitfalls and perspectives. Neuroimage 2021; 243:118517. [PMID: 34481368 DOI: 10.1016/j.neuroimage.2021.118517] [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: 04/29/2021] [Revised: 07/21/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022] Open
Abstract
Magnetic resonance current density imaging (MRCDI) of the human brain aims to reconstruct the current density distribution caused by transcranial electric stimulation from MR-based measurements of the current-induced magnetic fields. So far, the MRCDI data acquisition achieves only a low signal-to-noise ratio, does not provide a full volume coverage and lacks data from the scalp and skull regions. In addition, it is only sensitive to the component of the current-induced magnetic field parallel to the scanner field. The reconstruction problem thus involves coping with noisy and incomplete data, which makes it mathematically challenging. Most existing reconstruction methods have been validated using simulation studies and measurements in phantoms with simplified geometries. Only one reconstruction method, the projected current density algorithm, has been applied to human in-vivo data so far, however resulting in blurred current density estimates even when applied to noise-free simulated data. We analyze the underlying causes for the limited performance of the projected current density algorithm when applied to human brain data. In addition, we compare it with an approach that relies on the optimization of the conductivities of a small number of tissue compartments of anatomically detailed head models reconstructed from structural MR data. Both for simulated ground truth data and human in-vivo MRCDI data, our results indicate that the estimation of current densities benefits more from using a personalized volume conductor model than from applying the projected current density algorithm. In particular, we introduce a hierarchical statistical testing approach as a principled way to test and compare the quality of reconstructed current density images that accounts for the limited signal-to-noise ratio of the human in-vivo MRCDI data and the fact that the ground truth of the current density is unknown for measured data. Our results indicate that the statistical testing approach constitutes a valuable framework for the further development of accurate volume conductor models of the head. Our findings also highlight the importance of tailoring the reconstruction approaches to the quality and specific properties of the available data.
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Affiliation(s)
- Hasan H Eroğlu
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark; Section for Magnetic Resonance, DTU Health Tech, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Oula Puonti
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Cihan Göksu
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark; High-Field Magnetic Resonance Center, Max-Planck-Institute for Biological Cybernetics, Tübingen, Germany
| | - Fróði Gregersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark; Section for Magnetic Resonance, DTU Health Tech, Technical University of Denmark, Kgs Lyngby, Denmark; Sino-Danish Center for Education and Research, Aarhus, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital Frederiksberg and Bispebjerg, Copenhagen, Denmark; Department for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars G Hanson
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark; Section for Magnetic Resonance, DTU Health Tech, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark; Section for Magnetic Resonance, DTU Health Tech, Technical University of Denmark, Kgs Lyngby, Denmark.
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20
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Yamada S, Enatsu R, Kimura Y, Komatsu K, Akiyama Y, Mikami T, Ochi S, Mikuni N. Effects of polarity of bipolar sensorimotor direct cortical stimulation on intraoperative motor evoked potentials. Clin Neurophysiol 2021; 132:2351-2356. [PMID: 34454261 DOI: 10.1016/j.clinph.2021.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/24/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The present study investigated the effects of the stimulus polarity and location of motor evoked potential (MEP) to establish a stimulation protocol. METHODS Nineteen patients who intraoperatively underwent MEP in bipolar direct cortical stimulation were enrolled in the present study. Somatosensory evoked potentials (SEP) of the contralateral median nerve stimulation were recorded to determine stimulation sites. MEP was performed under two settings in all patients: 1. Anodal bipolar stimulation: an anode on the precentral gyrus and a cathode on the postcentral gyrus, 2. Cathodal bipolar stimulation: a cathode on the precentral gyrus and an anode on the postcentral gyrus. MEP amplitudes and the coefficient of variation (CV) at a stimulation intensity of 25 mA and the thresholds of induced MEP were compared between the two settings. RESULTS An electrical stimulation at 25 mA induced a significantly higher amplitude in cathodal bipolar stimulation than in anodal bipolar stimulation. Cathodal bipolar stimulation also showed significantly lower thresholds than anodal stimulation. CV did not significantly differ between the two groups. CONCLUSIONS These results indicate that cathodal bipolar stimulation is superior to anodal bipolar stimulation for intraoperative MEP monitoring. SIGNIFICANCE MEP in cathodal bipolar cortical stimulation may be used in a safe and useful evaluation method of motor fiber damage that combines sensitivity and specificity.
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Affiliation(s)
- Shoto Yamada
- Division of Clinical Engineering, Sapporo Medical University Hospital, Sapporo, Japan
| | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University Hospital, Sapporo, Japan.
| | - Yusuke Kimura
- Department of Neurosurgery, Sapporo Medical University Hospital, Sapporo, Japan
| | - Katsuya Komatsu
- Department of Neurosurgery, Sapporo Medical University Hospital, Sapporo, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University Hospital, Sapporo, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University Hospital, Sapporo, Japan
| | - Satoko Ochi
- Department of Neurosurgery, Sapporo Medical University Hospital, Sapporo, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University Hospital, Sapporo, Japan
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21
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Sun F, Zhang G, Yu T, Zhang X, Wang X, Yan X, Qiao L, Ma K, Zhang X. Functional characteristics of the human primary somatosensory cortex: An electrostimulation study. Epilepsy Behav 2021; 118:107920. [PMID: 33770611 DOI: 10.1016/j.yebeh.2021.107920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
The common knowledge of the functional organization of the human primary somatosensory cortex (S1) had been primarily established by Penfield who electrically stimulated the exposed surface [referred as Brodmann area (BA)1] of S1 under neurosurgical conditions. Nevertheless, the functional information regarding the deep surface (BA 2 and 3) of S1 is poorly understood. We retrospectively analyzed all the clinical manifestations induced by extra-operative cortical electrical stimulation (ES) in 33 patients with medically intractable epilepsy who underwent stereo-electroencephalography (SEEG) monitoring for presurgical assessment. Demographic and clinical data were gathered and evaluated to delineate the determinants of the occurrence of positive responses, types of responses, and size of body regions involved. The stimulation of 244 sites in S1 yielded 198 positive sites (81.1%), most of which were located in the sulcal cortex. In multivariable analyses, no clinical or demographic factors predicted the occurrence of responses or their threshold levels. The size of body region involved in the responses had ordinal association with the stimulated BA sites (p < 0.001). Various types of responses elicited from the S1 were documented and classified, and the predictors of those responses were also assessed. Our analysis revealed the functional characteristics of the entire S1 and proved the multiplicity of functions of S1.
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Affiliation(s)
- Fengqiao Sun
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China.
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Xiaohua Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Xueyuan Wang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Xiaoming Yan
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Liang Qiao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Kai Ma
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Xi Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
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22
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Bährend I, Muench MR, Schneider H, Moshourab R, Dreyer FR, Vajkoczy P, Picht T, Faust K. Incidence and linguistic quality of speech errors: a comparison of preoperative transcranial magnetic stimulation and intraoperative direct cortex stimulation. J Neurosurg 2021; 134:1409-1418. [PMID: 32470943 DOI: 10.3171/2020.3.jns193085] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Given the interindividual variance of functional language anatomy, risk prediction based merely on anatomical data is insufficient in language area-related brain tumor surgery, suggesting the need for direct cortical and subcortical mapping during awake surgery. Reliable, noninvasive preoperative methods of language localization hold the potential for reducing the necessity for awake procedures and may improve patient counseling and surgical planning. Repetitive navigated transcranial magnetic stimulation (rnTMS) is an evolving tool for localizing language-eloquent areas. The aim of this study was to investigate the reliability of rnTMS in locating cortical language sites. METHODS Twenty-five patients with brain tumors in speech-related areas were prospectively evaluated with preoperative rnTMS (5 Hz, train of five, average 105% resting motor threshold) and navigated direct cortical stimulation (DCS; bipolar, 50 Hz, 6-8 mA, 200-μsec pulse width) during awake surgeries employing a picture-naming task. Positive and negative stimulation spots within the craniotomy were documented in the same MRI data set. TMS and DCS language-positive areas were compared with regard to their spatial overlap, their allocation in a cortical parcellation system, and their linguistic qualities. RESULTS There were over twofold more positive language spots within the exposed area on rnTMS than on DCS. The comparison of positive rnTMS and DCS (ground truth) overlaps revealed low sensitivity (35%) and low positive predictive value (16%) but high specificity (90%) and high negative predictive value (96%). Within the overlaps, there was no correlation in error quality. On DCS, 73% of language-positive spots were located in the pars opercularis and pars triangularis of the frontal operculum and 24% within the supramarginal gyrus and dorsal portion of the superior temporal gyrus, while on rnTMS language positivity was distributed more evenly over a large number of gyri. CONCLUSIONS The current protocol for rnTMS for language mapping identified language-negative sites with good dependability but was unable to reliably detect language-positive spots. Further refinements of the technique will be needed to establish rnTMS language mapping as a useful clinical tool.
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Affiliation(s)
| | | | | | | | - Felix R Dreyer
- 3Brain Language Laboratory, Freie Universität Berlin, Germany
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23
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Collavini S, Fernández-Corazza M, Oddo S, Princich JP, Kochen S, Muravchik CH. Improvements on spatial coverage and focality of deep brain stimulation in pre-surgical epilepsy mapping. J Neural Eng 2021; 18. [PMID: 33578398 DOI: 10.1088/1741-2552/abe5b9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/12/2021] [Indexed: 12/20/2022]
Abstract
Objective.Electrical stimulation mapping (ESM) of the brain using stereo-electroencephalography (SEEG) intracranial electrodes, also known as depth-ESM (DESM), is being used as part of the pre-surgical planning for brain surgery in drug-resistant epilepsy patients. Typically, DESM consists in applying the electrical stimulation using adjacent contacts of the SEEG electrodes and in recording the EEG responses to those stimuli, giving valuable information of critical brain regions to better delimit the region to resect. However, the spatial extension or coverage of the stimulated area is not well defined even though the precise electrode locations can be determined from computed tomography images.Approach.We first conduct electrical simulations of DESM for different shapes of commercial SEEG electrodes showing the stimulation extensions for different intensities of injected current. We then evaluate the performance of DESM in terms of spatial coverage and focality on two realistic head models of real patients undergoing pre-surgical evaluation. We propose a novel strategy for DESM that consist in applying the current using contacts of different SEEG electrodes (x-DESM), increasing the versatility of DESM without implanting more electrodes. We also present a clinical case where x-DESM replicated the full semiology of an epilepsy seizure using a very low-intensity current injection, when typical adjacent DESM only reproduced partial symptoms with much larger intensities. Finally, we show one example of DESM optimal stimulation to achieve maximum intensity, maximum focality or intermediate solution at a pre-defined target, and one example of temporal interference in DESM capable of increasing focality in brain regions not immediately touching the electrode contacts.Main results.It is possible to define novel current injection patterns using contacts of different electrodes (x-DESM) that might improve coverage and/or focality, depending on the characteristics of the candidate brain. If individual simulations are not possible, we provide the estimated radius of stimulation as a function of the injected current and SEEG electrode brand as a reference for the community.Significance.Our results show that subject-specific electrical stimulations are a valuable tool to use in the pre-surgical planning to visualize the extension of the stimulated regions. The methods we present here are also applicable to pre-surgical planning of tumor resections and deep brain stimulation treatments.
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Affiliation(s)
- Santiago Collavini
- Research Institute of Electronics, Control and Signal Processing (LEICI), National University of La Plata-CONICET, Calle 116 s/n, La Plata B1900, Argentina.,Neurosciences and Complex Systems Unit (EnyS), CONICET, Hosp. El Cruce 'N. Kirchner', National University A. Jauretche (UNAJ), Calchaqui 5401, Florencio Varela 1888 Buenos Aires, Argentina.,National Council of Scientific and Technical Research (CONICET), calle 8, 1467, La Plata, Buenos Aires B1904, Argentina.,Institute of Engineering and Agronomy, National University Arturo Jauretche, Av. Calchaquí 6200, Florencio Varela, Buenos Aires 1888, Argentina
| | - Mariano Fernández-Corazza
- Research Institute of Electronics, Control and Signal Processing (LEICI), National University of La Plata-CONICET, Calle 116 s/n, La Plata B1900, Argentina.,National Council of Scientific and Technical Research (CONICET), calle 8, 1467, La Plata, Buenos Aires B1904, Argentina
| | - Silvia Oddo
- Neurosciences and Complex Systems Unit (EnyS), CONICET, Hosp. El Cruce 'N. Kirchner', National University A. Jauretche (UNAJ), Calchaqui 5401, Florencio Varela 1888 Buenos Aires, Argentina.,National Council of Scientific and Technical Research (CONICET), calle 8, 1467, La Plata, Buenos Aires B1904, Argentina
| | - Juan Pablo Princich
- Neurosciences and Complex Systems Unit (EnyS), CONICET, Hosp. El Cruce 'N. Kirchner', National University A. Jauretche (UNAJ), Calchaqui 5401, Florencio Varela 1888 Buenos Aires, Argentina.,National Council of Scientific and Technical Research (CONICET), calle 8, 1467, La Plata, Buenos Aires B1904, Argentina
| | - Silvia Kochen
- Neurosciences and Complex Systems Unit (EnyS), CONICET, Hosp. El Cruce 'N. Kirchner', National University A. Jauretche (UNAJ), Calchaqui 5401, Florencio Varela 1888 Buenos Aires, Argentina.,National Council of Scientific and Technical Research (CONICET), calle 8, 1467, La Plata, Buenos Aires B1904, Argentina
| | - Carlos H Muravchik
- Research Institute of Electronics, Control and Signal Processing (LEICI), National University of La Plata-CONICET, Calle 116 s/n, La Plata B1900, Argentina.,Scientific Research Commission of the Province of Buenos Aires (CIC-PBA), Argentina
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24
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Cuisenier P, Testud B, Minotti L, El Bouzaïdi Tiali S, Martineau L, Job AS, Trébuchon A, Deman P, Bhattacharjee M, Hoffmann D, Lachaux JP, Baciu M, Kahane P, Perrone-Bertolotti M. Relationship between direct cortical stimulation and induced high-frequency activity for language mapping during SEEG recording. J Neurosurg 2021; 134:1251-1261. [PMID: 32330883 DOI: 10.3171/2020.2.jns192751] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors assessed the clinical relevance of preoperative task-induced high-frequency activity (HFA) for language mapping in patients with refractory epilepsy during stereoelectroencephalography recording. Although HFA evaluation was described as a putative biomarker of cognition, its clinical relevance for mapping language networks was assessed predominantly by studies using electrocorticography (ECOG). METHODS Forty-two patients with epilepsy who underwent intracranial electrode implantation during both task-induced HFA and direct cortical stimulation (DCS) language mapping were evaluated. The spatial and functional relevance of each method in terms of specificity and sensitivity were evaluated. RESULTS The results showed that the two methods were able to map classic language regions, and a large and bilateral language network was obtained with induced HFA. At a regional level, differences were observed between methods for parietal and temporal lobes: HFA recruited a larger number of cortical parietal sites, while DCS involved more cortical temporal sites. Importantly, the results showed that HFA predicts language interference induced by DCS with high specificity (92.4%; negative predictive value 95.9%) and very low sensitivity (8.9%; positive predictive value 4.8%). CONCLUSIONS DCS language mapping appears to be more appropriate for an extensive temporal mapping than induced HFA mapping. Furthermore, induced HFA should be used as a complement to DCS to preselect the number of stimulated sites during DCS, by omitting those reported as HFA-. This may be a considerable advantage because it allows a reduction in the duration of the stimulation procedure. Several parameters to be used for each method are discussed and the results are interpreted in relation to previous results reported in ECOG studies.
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Affiliation(s)
| | | | - Lorella Minotti
- 1Department of Neurology, CHU Grenoble Alpes, Grenoble
- 3Université Grenoble Alpes, Institut des Neurosciences, GIN, Grenoble
| | | | | | - Anne-Sophie Job
- 1Department of Neurology, CHU Grenoble Alpes, Grenoble
- 3Université Grenoble Alpes, Institut des Neurosciences, GIN, Grenoble
| | - Agnès Trébuchon
- 4Aix Marseille Université, INSERM, INS, Institut de Neurosciences des Systèmes, Marseille
| | - Pierre Deman
- 3Université Grenoble Alpes, Institut des Neurosciences, GIN, Grenoble
| | | | | | - Jean-Philippe Lachaux
- 5INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, DYCOG, Lyon
- 6Université Lyon 1, Lyon, France; and
| | - Monica Baciu
- 2Université Grenoble Alpes, CNRS, LPNC UMR 5105, Grenoble
- 7Institut Universitaire de France
| | - Philippe Kahane
- 1Department of Neurology, CHU Grenoble Alpes, Grenoble
- 4Aix Marseille Université, INSERM, INS, Institut de Neurosciences des Systèmes, Marseille
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25
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Sun F, Zhang G, Ren L, Yu T, Ren Z, Gao R, Zhang X. Functional organization of the human primary somatosensory cortex: A stereo-electroencephalography study. Clin Neurophysiol 2021; 132:487-497. [PMID: 33465535 DOI: 10.1016/j.clinph.2020.11.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/31/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The classical homunculus of the human primary somatosensory cortex (S1) established by Penfield has mainly portrayed the functional organization of convexial cortex, namely Brodmann area (BA) 1. However, little is known about the functions in fissural cortex including BA2 and BA3. We aim at drawing a refined and detailed somatosensory homunculus of the entire S1. METHODS We recruited 20 patients with drug-resistant focal epilepsy who underwent stereo-electroencephalography for preoperative assessments. Direct electrical stimulation was performed for functional mapping. Montreal Neurological Institute coordinates of the stimulation sites lying in S1 were acquired. RESULTS Stimulation of 177 sites in S1 yielded 149 positive sites (84%), most of which were located in the sulcal cortex. The spatial distribution of different body-part representations across the S1 surface revealed that the gross medial-to-lateral sequence of body representations within the entire S1 was consistent with the classical "homunculus". And we identified several unreported body-part representations from the sulcal cortex, such as forehead, deep elbow and wrist joints, and some dorsal body regions. CONCLUSIONS Our results reveal general somatotopical characteristics of the entire S1 cortex and differences with the previous works of Penfield. SIGNIFICANCE The classical S1 homunculus was extended by providing further refinement and additional detail.
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Affiliation(s)
- Fengqiao Sun
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China.
| | - Liankun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Zhiwei Ren
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Runshi Gao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
| | - Xiaohua Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
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26
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Curot J, Roux FE, Sol JC, Valton L, Pariente J, Barbeau EJ. Awake Craniotomy and Memory Induction Through Electrical Stimulation: Why Are Penfield's Findings Not Replicated in the Modern Era? Neurosurgery 2021; 87:E130-E137. [PMID: 31914177 DOI: 10.1093/neuros/nyz553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/13/2019] [Indexed: 01/21/2023] Open
Abstract
From the 1930s through the early 1960s, Wilder Penfield12 collected a large number of memories induced by electrical brain stimulation (EBS) during awake craniotomy. As a result, he was a major contributor to several neuroscientific and neuropsychological concepts of long-term memory. His 1963 paper, which recorded all the cases of memories he induced in his operating room, remains a substantial point of reference in neuroscience in 2019, although some of his interpretations are now debatable. However, it is highly surprising that, since Penfield's12 reports, there has been no other surgical publication on memories induced during awake surgery. In this review, we explore this phenomenon and analyze some of the reasons that might explain it. We hypothesize that the main reasons for lack of subsequent reports are related to changes in operative procedures (ie, use of anesthetics, time constraints, and insufficient debriefings) and changes in EBS parameters, rather than to the sites that are stimulated, the pathology treated, or the tasks used. If reminiscences are still induced, they should be reported in detail to add valuable contributions to the understanding of long-term memory networks, especially memories that are difficult to reproduce in the laboratory, such as autobiographical memories.
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Affiliation(s)
- Jonathan Curot
- Department of Neurophysiological Explorations, Hôpital Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Centre de Recherche Cerveau et Cognition CerCo, CNRS, UMR5549, Toulouse, France.,Centre de Recherche Cerveau et Cognition, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Franck-Emmanuel Roux
- Centre de Recherche Cerveau et Cognition CerCo, CNRS, UMR5549, Toulouse, France.,Centre de Recherche Cerveau et Cognition, Université de Toulouse, Université Paul Sabatier, Toulouse, France.,Department of Neurosurgery, Hôpital Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Christophe Sol
- Department of Neurosurgery, Hôpital Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,INSERM, U1214, TONIC, Toulouse Mind and Brain Institute, Toulouse, France
| | - Luc Valton
- Department of Neurophysiological Explorations, Hôpital Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,INSERM, U1214, TONIC, Toulouse Mind and Brain Institute, Toulouse, France.,Centre de Recherche Cerveau et Cognition, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Jéremie Pariente
- Department of Cognitive Neurology, Hôpital Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,INSERM, U1214, TONIC, Toulouse Mind and Brain Institute, Toulouse, France
| | - Emmanuel J Barbeau
- Centre de Recherche Cerveau et Cognition CerCo, CNRS, UMR5549, Toulouse, France.,Centre de Recherche Cerveau et Cognition, Université de Toulouse, Université Paul Sabatier, Toulouse, France
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27
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Chehade HD, Kobaïter-Maarrawi S, Komboz F, Farhat JP, Magnin M, Garcia-Larrea L, Maarrawi J. Somatosensory Thalamic Activity Modulation by Posterior Insular Stimulation: Cues to Clinical Application Based on Comparison of Frequencies in a Cat Model. Neuromodulation 2020; 24:229-239. [PMID: 33340196 DOI: 10.1111/ner.13343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/14/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The posterior insula (PI) has been proposed as a potential neurostimulation target for neuropathic pain relief as it represents a key-structure in pain processing. However, currently available data remain inconclusive as to efficient stimulation parameters. OBJECTIVE As frequency was shown to be the most correlated parameter to pain relief, this study aims to evaluate the potential modulatory effects of low frequency (LF-IS, 50 Hz) and high-frequency (HF-IS, 150 Hz) posterior insular stimulation on the activity of somatosensory thalamic nuclei. MATERIALS AND METHODS Epidural bipolar electrodes were placed over the PI of healthy adult cats, and extracellular single-unit activities of nociceptive (NS), nonnociceptive (NN), and wide dynamic range (WDR) thalamic cells were recorded within the ventral posterolateral nucleus and the medial division of the thalamic posterior complex. Mean discharge frequency and burst firing mode were analyzed before and after either LF-IS or HF-IS. RESULTS LF-IS showed a significant thalamic modulatory effects increasing the firing rate of NN cells (p ≤ 0.03) and decreasing the burst firing of NS cells (p ≤ 0.03), independently of the thalamic nucleus. Conversely, HF-IS did not induce any change in firing properties of the three recorded cell types. CONCLUSION These data indicate that 50 Hz IS could be a better candidate to control neuropathic pain.
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Affiliation(s)
- Hiba-Douja Chehade
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Sandra Kobaïter-Maarrawi
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fares Komboz
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jean-Paul Farhat
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Michel Magnin
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Luis Garcia-Larrea
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Maarrawi
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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28
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Morshed RA, Young JS, Lee AT, Berger MS, Hervey-Jumper SL. Clinical Pearls and Methods for Intraoperative Awake Language Mapping. Neurosurgery 2020; 89:143-153. [PMID: 33289505 DOI: 10.1093/neuros/nyaa440] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/12/2020] [Indexed: 12/12/2022] Open
Abstract
Intraoperative language mapping of tumor and peritumor tissue is a well-established technique for avoiding permanent neurological deficits and maximizing extent of resection. Although there are several components of language that may be tested intraoperatively (eg, naming, writing, reading, and repetition), there is a lack of consistency in how patients are tested intraoperatively as well as the techniques involved to ensure safety during an awake procedure. Here, we review appropriate patient selection, neuroanesthetic techniques, cortical and subcortical language mapping stimulation paradigms, and selection of intraoperative language tasks used during awake craniotomies. We also expand on existing language mapping reviews by considering how intensity and timing of electrical stimulation may impact interpretation of mapping results.
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29
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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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Tomasino B, Ius T, Skrap M, Luzzatti C. Phonological and surface dyslexia in individuals with brain tumors: Performance pre-, intra-, immediately post-surgery and at follow-up. Hum Brain Mapp 2020; 41:5015-5031. [PMID: 32857483 PMCID: PMC7643394 DOI: 10.1002/hbm.25176] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 11/29/2022] Open
Abstract
We address existing controversies regarding neuroanatomical substrates of reading-aloud processes according to the dual-route processing models, in this particular instance in a series of 49 individuals with brain tumors who performed several reading tasks of real-time neuropsychological testing during surgery (low- to high-grade cerebral neoplasms involving the left hemisphere). We explored how reading abilities in individuals with brain tumors evolve during and after surgery for a brain tumor, and we studied the reading performance in a sample of 33 individuals in a 4-month follow-up after surgery. Impaired reading performance was seen pre-surgery in 7 individuals with brain tumors, intra-surgery in 18 individuals, at immediate post-surgery testing in 26 individuals, and at follow-up in 5 individuals. We classified their reading disorders according to operational criteria for either phonological or surface dyslexia. Neuroimaging results are discussed within the theoretical framework of the dual-route model of reading. Lesion-mask subtraction analyses revealed that areas selectively related with phonological dyslexia were located-along with the left hemisphere dorsal stream-in the Rolandic operculum, the inferior frontal gyrus, the precentral gyrus, the supramarginal gyrus, the insula (and/or the underlying external capsule), and parts of the superior longitudinal fasciculus, whereas lesions related to surface dyslexia involved the ventral stream, that is, the left middle and inferior temporal gyrus and parts of the left inferior longitudinal fasciculus.
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Affiliation(s)
- Barbara Tomasino
- Scientific Institute, IRCCS "E. Medea,"San Vito al TagliamentoPordenoneItaly
| | - Tamara Ius
- Unità Operativa di Neurochirurgia, Azienda Sanitaria Universitaria Integrata S. Maria della MisericordiaUdineItaly
| | - Miran Skrap
- Unità Operativa di Neurochirurgia, Azienda Sanitaria Universitaria Integrata S. Maria della MisericordiaUdineItaly
| | - Claudio Luzzatti
- Dipartimento di PsicologiaUniversità di Milano‐Bicocca and Milan Centre for NeuroscienceMilanItaly
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Roux FE, Djidjeli I, Quéhan R, Réhault E, Giussani C, Durand JB. Intraoperative electrostimulation for awake brain mapping: how many positive interference responses are required for reliability? J Neurosurg 2020; 133:1191-1201. [PMID: 31597115 DOI: 10.3171/2019.6.jns19925] [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: 04/01/2019] [Accepted: 06/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to characterize the reproducibility of language trials within and between brain mapping sessions. METHODS Brain mapping and baseline testing data from 200 adult patients who underwent resection of left-hemisphere tumors were evaluated. Data from 11 additional patients who underwent a second resection for recurrence were analyzed separately to investigate reproducibility over time. In all cases, a specific protocol of electrostimulation brain mapping with a controlled naming task was used to detect language areas, and the results were statistically compared with preoperative and intraoperative baseline naming error rates. All patients had normal preoperative error rates, controlled for educational level and age (mean 8.92%, range 0%-16.25%). Intraoperative baseline error rates within the normal range were highly correlated with preoperative ones (r = 0.74, p < 10-10), although intraoperative rates were usually higher (mean 13.30%, range 0%-26.67%). Initially, 3 electrostimulation trials were performed in each cortical area. If 2 of 3 trials showed language interference, 1 or 2 additional trials were performed (depending on results). RESULTS In the main group of 200 patients, there were 82 single interferences (i.e., positive results in 1 of 3 trials), 227 double interferences (2/3), and 312 full interferences (3/3). Binomial statistics revealed that full interferences were statistically significant (vs intraoperative baseline) in 92.7% of patients, while double interferences were significant only in 38.5% of patients, those with the lowest error rates. On further testing, one-third of the 2/3 trials became 2/4 trials, which was significant in only one-quarter of patients. Double interference could be considered significant for most patients (> 90%) when confirmed by 2 subsequent positive trials (4/5). In the 11 patients who were operated on twice, only 26% of areas that tested positive in the initial operation tested positive in the second and showed the same type of interference and the same current threshold (i.e., met all 3 criteria). CONCLUSIONS Electrostimulation trials in awake brain mapping produced graded patterns of positive reproducibility levels, and their significance varied with the baseline error rates. The results suggest that caution is warranted when 2 of 3 trials are positive, although the need for additional trials depends on the individual patients' baseline error rates. Reproducibility issues should be considered in the interpretation of data from awake brain mapping.
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Affiliation(s)
- Franck-Emmanuel Roux
- 1Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaires de Toulouse
- 2Université de Toulouse, Université Paul Sabatier, Toulouse
- 3Centre de Recherche Cerveau et Cognition (CNRS; CerCo), Toulouse, France; and
| | - Imène Djidjeli
- 1Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaires de Toulouse
- 2Université de Toulouse, Université Paul Sabatier, Toulouse
- 3Centre de Recherche Cerveau et Cognition (CNRS; CerCo), Toulouse, France; and
| | - Romain Quéhan
- 1Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaires de Toulouse
| | - Emilie Réhault
- 1Pôle Neuroscience (Neurochirurgie), Centre Hospitalo-Universitaires de Toulouse
| | - Carlo Giussani
- 4Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
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Solomons CD, Shanmugasundaram V. Transcranial direct current stimulation: A review of electrode characteristics and materials. Med Eng Phys 2020; 85:63-74. [PMID: 33081965 DOI: 10.1016/j.medengphy.2020.09.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 12/15/2022]
Abstract
Electrode characteristics are crucial in transcranial direct current stimulation (tDCS) since electrode design and placement determine the cortical area being modulated, current density and spatial resolution of stimulation. Early research on tDCS sought to determine optimal parameters for stimulation by specifying maximum current, duration and sizes of electrodes. Further research focused on determining efficient ways to deliver stimulation to targeted regions on the cortex with minimal discomfort to the user by altering electrode size, placement, shape and material. This review aims to give an insight on the main characteristics of electrodes used in tDCS and on the variability found in electrode parameters and placements from tDCS to high definition tDCS (HD-tDCS) applications and beyond.
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Affiliation(s)
- Cassandra D Solomons
- School of Electrical Engineering, Vellore Institute of Technology, Vellore 632014, India
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Kundu B, Davis TS, Philip B, Smith EH, Arain A, Peters A, Newman B, Butson CR, Rolston JD. A systematic exploration of parameters affecting evoked intracranial potentials in patients with epilepsy. Brain Stimul 2020; 13:1232-1244. [PMID: 32504827 PMCID: PMC7494632 DOI: 10.1016/j.brs.2020.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Brain activity is constrained by and evolves over a network of structural and functional connections. Corticocortical evoked potentials (CCEPs) have been used to measure this connectivity and to discern brain areas involved in both brain function and disease. However, how varying stimulation parameters influences the measured CCEP across brain areas has not been well characterized. OBJECTIVE To better understand the factors that influence the amplitude of the CCEPs as well as evoked gamma-band power (70-150 Hz) resulting from single-pulse stimulation via cortical surface and depth electrodes. METHODS CCEPs from 4370 stimulation-response channel pairs were recorded across a range of stimulation parameters and brain regions in 11 patients undergoing long-term monitoring for epilepsy. A generalized mixed-effects model was used to model cortical response amplitudes from 5 to 100 ms post-stimulation. RESULTS Stimulation levels <5.5 mA generated variable CCEPs with low amplitude and reduced spatial spread. Stimulation at ≥5.5 mA yielded a reliable and maximal CCEP across stimulation-response pairs over all regions. These findings were similar when examining the evoked gamma-band power. The amplitude of both measures was inversely correlated with distance. CCEPs and evoked gamma power were largest when measured in the hippocampus compared with other areas. Larger CCEP size and evoked gamma power were measured within the seizure onset zone compared with outside this zone. CONCLUSION These results will help guide future stimulation protocols directed at quantifying network connectivity across cognitive and disease states.
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Affiliation(s)
- Bornali Kundu
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Tyler S Davis
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Brian Philip
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Elliot H Smith
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Amir Arain
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Angela Peters
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Blake Newman
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Christopher R Butson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - John D Rolston
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA.
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Cathodal tDCS stimulation of left anterior temporal lobe eliminates cross-category color discrimination response time advantage. Behav Brain Res 2020; 391:112682. [DOI: 10.1016/j.bbr.2020.112682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022]
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Andelman-Gur MM, Gazit T, Andelman F, Kipervasser S, Kramer U, Neufeld MY, Fried I, Fahoum F. Spatial distribution and hemispheric asymmetry of electrically evoked experiential phenomena in the human brain. J Neurosurg 2020; 133:54-62. [PMID: 31200379 DOI: 10.3171/2019.3.jns183429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Experiential phenomena (EP), such as illusions and complex hallucinations, are vivid experiences created in one's mind. They can occur spontaneously as epileptic auras or can be elicited by electrical brain stimulation (EBS) in patients undergoing presurgical evaluation for drug-resistant epilepsy. Previous work suggests that EP arise from activation of different nodes within interconnected neural networks mainly in the temporal lobes. Yet, the anatomical extent of these neural networks has not been described and the question of lateralization of EP has not been fully addressed. To this end, an extended number of brain regions in which electrical stimulation elicited EP were studied to test whether there is a lateralization propensity to EP phenomena. METHODS A total of 19 drug-resistant focal epilepsy patients who underwent EBS as part of invasive presurgical evaluation and who experienced EP during the stimulation were included. Spatial dispersion of visual and auditory illusions and complex hallucinations in each hemisphere was determined by calculation of Euclidean distances between electrodes and their centroid in common space, based on (x, y, z) Cartesian coordinates of electrode locations. RESULTS In total, 5857 stimulation epochs were analyzed; 917 stimulations elicited responses, out of which 130 elicited EP. Complex visual hallucinations were found to be widely dispersed in the right hemisphere, while they were tightly clustered in the occipital lobe of the left hemisphere. Visual illusions were elicited mostly in the occipital lobes bilaterally. Auditory illusions and hallucinations were evoked symmetrically in the temporal lobes. CONCLUSIONS These findings suggest that complex visual hallucinations arise from wider spread in the right compared to the left hemisphere, possibly mirroring the asymmetry in the white matter organization of the two hemispheres. These results offer some insights into lateralized differences in functional organization and connectivity that may be important for functional mapping and planning of surgical resections in patients with epilepsy.
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Affiliation(s)
| | | | | | - Svetlana Kipervasser
- 1Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- 4Epilepsy and EEG Unit, and
| | - Uri Kramer
- 1Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- 5Pediatric Epilepsy Unit, Tel Aviv Medical Center, Tel Aviv, Israel; and
| | - Miri Y Neufeld
- 1Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- 4Epilepsy and EEG Unit, and
| | - Itzhak Fried
- 1Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- 3Functional Neurosurgery Unit
- 6Department of Neurosurgery, University of California, Los Angeles, California
| | - Firas Fahoum
- 1Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- 4Epilepsy and EEG Unit, and
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Intraoperative Electrophysiologic Mapping of Medial Frontal Motor Areas and Functional Outcomes. World Neurosurg 2020; 138:e389-e404. [DOI: 10.1016/j.wneu.2020.02.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
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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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Rhone AE, Kovach CK, Harmata GI, Sullivan AW, Tranel D, Ciliberto MA, Howard MA, Richerson GB, Steinschneider M, Wemmie JA, Dlouhy BJ. A human amygdala site that inhibits respiration and elicits apnea in pediatric epilepsy. JCI Insight 2020; 5:134852. [PMID: 32163374 PMCID: PMC7213805 DOI: 10.1172/jci.insight.134852] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUNDSeizure-induced inhibition of respiration plays a critical role in sudden unexpected death in epilepsy (SUDEP). However, the mechanisms underlying seizure-induced central apnea in pediatric epilepsy are unknown.METHODSWe studied 8 pediatric patients with intractable epilepsy undergoing intracranial electroencephalography. We recorded respiration during seizures and during electrical stimulation mapping of 174 forebrain sites. A machine-learning algorithm was used to delineate brain regions that inhibit respiration.RESULTSIn 2 patients, apnea coincided with seizure spread to the amygdala. Supporting a role for the amygdala in breathing inhibition in children, electrically stimulating the amygdala produced apnea in all 8 subjects (3-17 years old). These effects did not depend on epilepsy type and were relatively specific to the amygdala, as no other site affected breathing. Remarkably, patients were unaware that they had stopped breathing, and none reported dyspnea or arousal, findings critical for SUDEP. Finally, a machine-learning algorithm based on 45 stimulation sites and 210 stimulation trials identified a focal subregion in the human amygdala that consistently produced apnea. This site, which we refer to as the amygdala inhibition of respiration (AIR) site includes the medial subregion of the basal nuclei, cortical and medial nuclei, amygdala transition areas, and intercalated neurons.CONCLUSIONSA focal site in the amygdala inhibits respiration and induces apnea (AIR site) when electrically stimulated and during seizures in children with epilepsy. This site may prove valuable for determining those at greatest risk for SUDEP and as a therapeutic target.FUNDINGNational Institute of Neurological Disorders and Stroke - Congress of Neurological Surgeons, National Institute of General Medical Sciences, Roy J. Carver Charitable Trust.
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Affiliation(s)
| | | | - Gail I.S. Harmata
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
- Interdisciplinary Graduate Program in Neuroscience
- Pharmacological Sciences Training Program
- Department of Psychiatry
| | | | - Daniel Tranel
- Iowa Neuroscience Institute
- Department of Psychological and Brain Sciences
- Department of Neurology
| | | | - Matthew A. Howard
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
| | - George B. Richerson
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
- Interdisciplinary Graduate Program in Neuroscience
- Department of Neurology
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - John A. Wemmie
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
- Interdisciplinary Graduate Program in Neuroscience
- Department of Psychiatry
- Department of Neurology
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Veterans Affairs Medical Center, Iowa City, Iowa, USA
| | - Brian J. Dlouhy
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
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Vanderweyen DC, Theaud G, Sidhu J, Rheault F, Sarubbo S, Descoteaux M, Fortin D. The role of diffusion tractography in refining glial tumor resection. Brain Struct Funct 2020; 225:1413-1436. [PMID: 32180019 DOI: 10.1007/s00429-020-02056-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022]
Abstract
Primary brain tumors are notoriously hard to resect surgically. Due to their infiltrative nature, finding the optimal resection boundary without damaging healthy tissue can be challenging. One potential tool to help make this decision is diffusion-weighted magnetic resonance imaging (dMRI) tractography. dMRI exploits the diffusion of water molecule along axons to generate a 3D modelization of the white matter bundles in the brain. This feature is particularly useful to visualize how a tumor affects its surrounding white matter and plan a surgical path. This paper reviews the different ways in which dMRI can be used to improve brain tumor resection, its benefits and also its limitations. We expose surgical tools that can be paired with dMRI to improve its impact on surgical outcome, such as loading the 3D tractography in the neuronavigation system and direct electrical stimulation to validate the position of the white matter bundles of interest. We also review articles validating dMRI findings using other anatomical investigation techniques, such as postmortem dissections, manganese-enhanced MRI, electrophysiological stimulations, and phantom studies with known ground truth. We will be discussing the areas of the brain where dMRI performs well and where the future challenges are. We will conclude this review with suggestions and take home messages for neurosurgeons, tractographers, and vendors for advancing the field and on how to benefit from tractography's use in clinical practice.
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Affiliation(s)
- Davy Charles Vanderweyen
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, University of Sherbrooke, 3001 12 Ave N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Guillaume Theaud
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - Jasmeen Sidhu
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - François Rheault
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - Silvio Sarubbo
- Division of Neurosurgery, Emergency Area, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - David Fortin
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, University of Sherbrooke, 3001 12 Ave N, Sherbrooke, QC, J1H 5H3, Canada
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Prime D, Woolfe M, O'Keefe S, Rowlands D, Dionisio S. Quantifying volume conducted potential using stimulation artefact in cortico-cortical evoked potentials. J Neurosci Methods 2020; 337:108639. [PMID: 32156547 DOI: 10.1016/j.jneumeth.2020.108639] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cortico-cortical evoked potentials (CCEP) are a technique using low frequency stimulation to infer regions of cortical connectivity in patients undergoing Stereo-electroencephalographic (SEEG) monitoring for refractory epilepsy. Little attention has been given to volume conducted components of CCEP responses, and how they may inflate CCEP connectivity. NEW METHOD Using data from 37 SEEG-CCEPs patients, a novel method was developed to quantify stimulation artefact by measuring the peak-to-peak voltage difference in the first 10 ms after CCEP stimulation. Early responses to CCEP stimulation were also quantified by calculating the root mean square of the 10-100 ms period after each stimulation pulse. Both the early CCEP responses and amplitude of stimulation artefact were regressed by physical distance, stimulation waveform, stimulation intensity and tissue type to identify conduction related properties. RESULTS Both stimulation artefact and early responses were correlated strongly with the inverse square of the distance from the stimulating electrode. Once corrected for the inverse square distance from the electrode, stimulation artefact and CCEP responses showed a linear relationship, indicating a volume conducted component. COMPARISON WITH EXISTING METHODS This is the first study to use stimulation artefact to quantify volume conducted potentials, and is the first to quantify volume conducted potentials in SEEG. A single prior study utilizing electrocorticography has shown that parts of early CCEP responses are due to volume conduction. CONCLUSIONS The linear relationship between stimulation artefact amplitude and CCEP early responses, once corrected for distance, suggests that stimulation artefact can be used as a measure to quantify the volume conducted components.
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Affiliation(s)
- David Prime
- Griffith University School of Engineering, Nathan, QLD, Australia; Mater Advanced Epilepsy Unit, Brisbane, QLD, Australia.
| | - Matthew Woolfe
- Griffith University School of Engineering, Nathan, QLD, Australia; Mater Advanced Epilepsy Unit, Brisbane, QLD, Australia
| | - Steven O'Keefe
- Griffith University School of Engineering, Nathan, QLD, Australia
| | - David Rowlands
- Griffith University School of Engineering, Nathan, QLD, Australia
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Liu A, Friedman D, Barron DS, Wang X, Thesen T, Dugan P. Forced conceptual thought induced by electrical stimulation of the left prefrontal gyrus involves widespread neural networks. Epilepsy Behav 2020; 104:106644. [PMID: 31951969 PMCID: PMC7172015 DOI: 10.1016/j.yebeh.2019.106644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/03/2019] [Accepted: 10/04/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Early accounts of forced thought were reported at the onset of a focal seizure, and characterized as vague, repetitive, and involuntary intellectual auras distinct from perceptual or psychic hallucinations or illusions. Here, we examine the neural underpinnings involved in conceptual thought by presenting a series of 3 patients with epilepsy reporting intrusive thoughts during electrical stimulation of the left lateral prefrontal cortex (PFC) during invasive surgical evaluation. We illustrate the widespread networks involved through two independent brain imaging modalities: resting state functional magnetic resonance imaging (fMRI) (rs-fMRI) and task-based meta-analytic connectivity modeling (MACM). METHODS We report the clinical and stimulation characteristics of three patients with left hemispheric language dominance who demonstrate forced thought with functional mapping. To examine the brain networks underlying this phenomenon, we used the regions of interest (ROI) centered at the active electrode pairs. We modeled functional networks using two approaches: (1) rs-fMRI functional connectivity analysis, representing 81 healthy controls and (2) meta-analytic connectivity modeling (MACM), representing 8260 healthy subjects. We also determined the overlapping regions between these three subjects' rs-fMRI and MACM networks through a conjunction analysis. RESULTS We identified that left PFC was associated with a large-scale functional network including frontal, temporal, and parietal regions, a network that has been associated with multiple cognitive functions including semantics, speech, attention, working memory, and explicit memory. CONCLUSIONS We illustrate the neural networks involved in conceptual thought through a unique patient population and argue that PFC supports this function through activation of a widespread network.
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Affiliation(s)
- Anli Liu
- NYU Langone Medical Center, Department of Neurology, United States of America.
| | - Daniel Friedman
- NYU Langone Medical Center, Department of Neurology, United States of America.
| | | | - Xiuyuan Wang
- NYU Langone Medical Center, Department of Neurology and Radiology, United States of America.
| | - Thomas Thesen
- NYU Langone Medical Center, Department of Neurology, United States of America.
| | - Patricia Dugan
- NYU Langone Medical Center, Department of Neurology, United States of America.
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Gummadavelli A, Quraishi IH, Gerrard JL. Responsive Neurostimulation. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rech F, Herbet G, Gaudeau Y, Mézières S, Moureau JM, Moritz-Gasser S, Duffau H. A probabilistic map of negative motor areas of the upper limb and face: a brain stimulation study. Brain 2019; 142:952-965. [PMID: 30753319 DOI: 10.1093/brain/awz021] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 12/02/2018] [Accepted: 12/14/2018] [Indexed: 11/13/2022] Open
Abstract
Negative motor responses (NMRs) are defined as movement arrests induced by direct electrical stimulation of the brain. The NMRs manifest themselves after the disruption of a corticosubcortical network involved in motor control, referred to as the 'negative motor network'. At present, the spatial topography of the negative motor areas (NMAs) is poorly known. Hence, the objectives of the present study were to establish the first probabilistic map of the NMAs of the upper limbs and face, identify potential subareas, and investigate the NMAs' relationships with the primary motor cortex. A total of 117 patients with low grade glioma underwent awake surgery with direct electrostimulation. The Montreal Neurological Institute coordinates of sites eliciting NMRs (face and upper limbs) were registered. A probabilistic map was created, and subareas were identified in a cluster analysis. Each cluster was then plotted on the Glasser atlas and the 1200 Subjects Group Average Data from the Human Connectome Project, in order to study connectivity and compare the results with recent parcellation data. We elicited 386 NMRs (mean ± standard deviation current intensity: 2.26 ± 0.5 mA) distributed throughout the precentral gyrus in both hemispheres. In each hemisphere, we found two clusters for facial NMRs. For upper limb NMRs, we found two clusters in the right hemisphere; and three in the left. Each cluster overlapped with parcellations from the Glasser atlas. For the face, the NMAs were associated with areas 55b and 6v. For the upper limbs, the NMAs were linked to areas 6v, 6d, and 55b. Each NMA cluster showed a specific pattern of functionally connected areas, such as the inferior frontal gyrus, supplementary motor area, parietal areas, and posterior superior temporal gyrus. The white matter pathways projecting to these subareas involved the frontal aslant tract and the frontostriatal tract-both of which are well known to be associated with NMRs. This study constitutes the largest series to date of NMRs mapped to the lateral surface of both hemispheres. Rather than being randomly distributed, the NMAs appeared to be well structured and corresponded to parcellations identified by functional neuroimaging. Moreover, the white matter pathways known to drive NMRs are also connected to regions encompassing NMAs. Taken as a whole, our results suggest that NMAs belong to a large-scale modulatory motor network. Our new probabilistic map might constitute a valuable tool for use in further clinical and fundamental studies of motor control.
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Affiliation(s)
- Fabien Rech
- Department of Neurosurgery, Central Hospital, CHRU Nancy, 29 avenue du Maréchal de Lattre de Tassigny, F-54000 Nancy, France.,'Plasticity of Central Nervous System, Stem Cells and Glial Tumours' group, INSERM U1051, Institute for Neurosciences of Montpellier, F-34295 Montpellier, France
| | - Guillaume Herbet
- 'Plasticity of Central Nervous System, Stem Cells and Glial Tumours' group, INSERM U1051, Institute for Neurosciences of Montpellier, F-34295 Montpellier, France.,Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 avenue Augustin Fliche, F-34295 Montpellier, France
| | - Yann Gaudeau
- Centre de Recherche en Automatique de Nancy, UMR 7039, Faculté de médecine, Université de Lorraine, F-54000 Nancy, France.,Université de Strasbourg, 30 rue Maire Andre Traband, F-67500 Haguenau, France
| | - Sophie Mézières
- Université de Lorraine, I.E.C.L., INRIA-BIGS, CNRS UMR 7502, F-54506 Vandoeuvre-les-Nancy, France
| | - Jean-Marie Moureau
- Centre de Recherche en Automatique de Nancy, UMR 7039, Faculté de médecine, Université de Lorraine, F-54000 Nancy, France.,Centre de Recherche en Automatique de Nancy, UMR 7039, CNRS, Université de Lorraine, F-54000 Nancy, France
| | - Sylvie Moritz-Gasser
- 'Plasticity of Central Nervous System, Stem Cells and Glial Tumours' group, INSERM U1051, Institute for Neurosciences of Montpellier, F-34295 Montpellier, France.,Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 avenue Augustin Fliche, F-34295 Montpellier, France
| | - Hugues Duffau
- 'Plasticity of Central Nervous System, Stem Cells and Glial Tumours' group, INSERM U1051, Institute for Neurosciences of Montpellier, F-34295 Montpellier, France.,Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 avenue Augustin Fliche, F-34295 Montpellier, France
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Gentilal N, Salvador R, Miranda PC. Temperature control in TTFields therapy of GBM: impact on the duty cycle and tissue temperature. Phys Med Biol 2019; 64:225008. [PMID: 31671414 DOI: 10.1088/1361-6560/ab5323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In TTFields therapy, Optune® is used to deliver the electric field to the tumor via 4 transducer arrays. This device monitors the temperature of the transducers and reduces the current whenever a transducer reaches 41 °C. Our aim is to quantify Optune's duty cycle and to predict the steady-state temperature distribution in the head during GBM treatment. We used a realistic head model and the finite element method to solve Pennes equation and to simulate how Optune operates considering that current reduces to zero when the thermal limit is reached. The thermal impact was evaluated considering the maximum temperature reached by each tissue and using the CEM 43 °C metric. We observed that Optune switches the current on and off intermittently. In our model, one transducer reached the temperature limit quicker than the others and consequently it was the one that controlled current injection. This led to different duty cycles for the anterior-posterior and left-right array pairs. The thermal analysis indicated that the highest temperature in the model, 41.7 °C, was reached on the scalp under a transducer. However, TTFields may lead to significant changes only at the brain level such as BBB permeability increase, cerebral blood flow variation and changes in the concentration of some neurotransmitters. The duty cycle may be increased, e.g. by controlling the current at the transducer level. These predictions should be validated by comparison with experimental data and reconciled with the lack of evidence of thermal impact in clinical trials.
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Affiliation(s)
- Nichal Gentilal
- Institute of Biophysics and Biomedical Engineering, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016, Lisboa, Portugal. Author to whom correspondence should be addressed
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Adverse Events Related to Transcranial Electric Stimulation for Motor-evoked Potential Monitoring in High-risk Spinal Surgery. Spine (Phila Pa 1976) 2019; 44:1435-1440. [PMID: 31589200 DOI: 10.1097/brs.0000000000003115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective multicenter study. OBJECTIVE The aim of this study was to study the incidence of nonneurologic adverse events related to transcranial electric stimulation (TES) for intraoperative spinal cord monitoring (IOM) with motor-evoked potentials (MEPs) (Tc(E)- MEPs) and determine the need for safety precautions. SUMMARY OF BACKGROUND DATA Tc(E)-MEPs monitoring requires high-voltage multipulse TES that causes widespread muscle contraction and movement. Improved awareness of TES-induced movement-related adverse events is needed. METHODS We analyzed data from 2643 patients who underwent high-risk spinal surgery with intraoperative Tc(E)-MEPs at 11 spinal centers from 2010 to 2016. Information about neurologic and non-neurologic postoperative complications was collected, including type of surgical procedure, operative time, estimated blood loss, and treatment for postoperative adverse events. RESULTS A 70% drop in Tc(E)-MEPs amplitude, which was the alarm criterion to interrupt surgery, predicted postoperative motor deficits with 93.5% sensitivity, 91.0% specificity, a false-positive rate of 8.2%, and a false-negative rate of 0.3%. Non-neurologic adverse events developed in 17 (0.64%) patients and were most commonly because of bite injuries (0.57%), including 11 cases of tongue laceration, two cases of lip laceration, and two cases of tooth breakage. Four (0.15%) tongue lacerations required surgical repair with sutures and two tooth breakages required dental treatment. One patient had hair loss corresponding to the TES site. One patient, who underwent additional IOM with transpharyngeal stimulation, had severe nasal hemorrhage following electrode placement by nasal route, which resolved spontaneously. Non-neurologic adverse events did not significantly affect the accuracy of IOM assessment. Neither operative times nor blood loss significantly influenced the occurrence of adverse events. CONCLUSION During TES-IOM, both the surgeon and monitoring team must consider the possibility-although rare-of non-neurologic adverse events, particularly bite injuries. Such complications can be minimized by using a soft bite-block and frequently evaluating the intraoral integrity of the anesthetized patient. LEVEL OF EVIDENCE 4.
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Takeyama H, Matsumoto R, Usami K, Nakae T, Kobayashi K, Shimotake A, Kikuchi T, Yoshida K, Kunieda T, Miyamoto S, Takahashi R, Ikeda A. Human entorhinal cortex electrical stimulation evoked short-latency potentials in the broad neocortical regions: Evidence from cortico-cortical evoked potential recordings. Brain Behav 2019; 9:e01366. [PMID: 31361093 PMCID: PMC6749511 DOI: 10.1002/brb3.1366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/09/2019] [Accepted: 07/01/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE We aimed at clarifying the clinical significance of the responses evoked by human entorhinal cortex (EC) electrical stimulation by means of cortico-cortical evoked potentials (CCEPs). METHODS We enrolled nine patients with medically intractable medial temporal lobe epilepsy who underwent invasive presurgical evaluations with subdural or depth electrodes. Single-pulse electrical stimulation was delivered to the EC and fusiform gyrus (FG), and their evoked potentials were compared. The correlation between the evoked potentials and Wechsler Memory Scale-Revised (WMS-R) score was analyzed to investigate whether memory circuit was involved in the generation of the evoked potentials. RESULTS In most electrodes placed on the neocortex, EC stimulation induced unique evoked potentials with positive polarity, termed as "widespread P1" (P1w). Compared with FG stimulation, P1w induced by EC stimulation were distinguished by their high occurrence rate, short peak latency (mean: 20.1 ms), small peak amplitude, and waveform uniformity among different recording sites. A stimulation of more posterior parts of the EC induced P1w with shorter latency and larger amplitude. P1w peak amplitude had a positive correlation (r = .69) with the visual memory score of the WMS-R. In one patient, with depth electrode implanted into the hippocampus, the giant evoked potentials were recorded in the electrodes of the anterior hippocampus and EC near the stimulus site. CONCLUSIONS The human EC electrical stimulation evoked the short-latency potentials in the broad neocortical regions. The origin of P1w remains unclear, although the limited evidence suggests that P1w is the far-field potential by the volume conduction of giant evoked potential from the EC itself and hippocampus. The significance of the present study is that those evoked potentials may be a potential biomarker of memory impairment in various neurological diseases, and we provided direct evidence for the functional subdivisions along the anterior-posterior axis in the human EC.
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Affiliation(s)
- Hirofumi Takeyama
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University, Kyoto, Japan
| | - Riki Matsumoto
- Department of Neurology, Kyoto University, Kyoto, Japan.,Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kiyohide Usami
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University, Kyoto, Japan
| | - Takuro Nakae
- Department of Neurosurgery, Shiga Medical Center for Adults, Moriyama, Japan
| | | | - Akihiro Shimotake
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University, Kyoto, Japan
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Chouchou F, Mauguière F, Vallayer O, Catenoix H, Isnard J, Montavont A, Jung J, Pichot V, Rheims S, Mazzola L. How the insula speaks to the heart: Cardiac responses to insular stimulation in humans. Hum Brain Mapp 2019; 40:2611-2622. [PMID: 30815964 DOI: 10.1002/hbm.24548] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 12/14/2022] Open
Abstract
Despite numerous studies suggesting the role of insular cortex in the control of autonomic activity, the exact location of cardiac motor regions remains controversial. We provide here a functional mapping of autonomic cardiac responses to intracortical stimulations of the human insula. The cardiac effects of 100 insular electrical stimulations into 47 epileptic patients were divided into tachycardia, bradycardia, and no cardiac response according to the magnitude of RR interval (RRI) reactivity. Sympathetic (low frequency, LF, and low to high frequency powers ratio, LF/HF ratio) and parasympathetic (high frequency power, HF) reactivity were studied using RRI analysis. Bradycardia was induced by 26 stimulations (26%) and tachycardia by 21 stimulations (21%). Right and left insular stimulations induced as often a bradycardia as a tachycardia. Tachycardia was accompanied by an increase in LF/HF ratio, suggesting an increase in sympathetic tone; while bradycardia seemed accompanied by an increase of parasympathetic tone reflected by an increase in HF. There was some left/right asymmetry in insular subregions where increased or decreased heart rates were produced after stimulation. However, spatial distribution of tachycardia responses predominated in the posterior insula, whereas bradycardia sites were more anterior in the median part of the insula. These findings seemed to indicate a posterior predominance of sympathetic control in the insula, whichever the side; whereas the parasympathetic control seemed more anterior. Dysfunction of these regions should be considered when modifications of cardiac activity occur during epileptic seizures and in cardiovascular diseases.
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Affiliation(s)
- Florian Chouchou
- IRISSE Laboratory (EA4075), UFR SHE, University of La Réunion, Le Tampon, France
| | - François Mauguière
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Université de Lyon, Lyon, France.,NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL - INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France
| | - Ophélie Vallayer
- Neurology Department, University Hospital, Saint-Etienne, France
| | - Hélène Catenoix
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Université de Lyon, Lyon, France.,TIGER Lab, Lyon Neuroscience Research Centre, CRNL - INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France
| | - Jean Isnard
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Université de Lyon, Lyon, France.,NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL - INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France
| | - Alexandra Montavont
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Université de Lyon, Lyon, France.,TIGER Lab, Lyon Neuroscience Research Centre, CRNL - INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France
| | - Julien Jung
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Université de Lyon, Lyon, France.,TIGER Lab, Lyon Neuroscience Research Centre, CRNL - INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France
| | - Vincent Pichot
- EA SNA-EPIS 4607, Department of Clinical and Exercise Physiology, University of Lyon, Jean Monnet University, Saint-Etienne, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Université de Lyon, Lyon, France.,TIGER Lab, Lyon Neuroscience Research Centre, CRNL - INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France
| | - Laure Mazzola
- NeuroPain Lab, Lyon Neuroscience Research Centre, CRNL - INSERM U 1028/CNRS UMR 5292, University of Lyon, Lyon, France.,Neurology Department, University Hospital, Saint-Etienne, France
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Alzaidi AI, Yahya A, Rava M, Swee TT, Idris N. A SYSTEMATIC REVIEW ON CURRENT RESEARCH TRENDS IN ELECTROSURGICAL SYSTEMS. BIOMEDICAL ENGINEERING: APPLICATIONS, BASIS AND COMMUNICATIONS 2019. [DOI: 10.4015/s1016237219500042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The use of electrosurgery (also referred to as radiosurgery) is a type of surgery that uses electrical currents in order to perform the surgery. This type of surgery dates back to more than 100 years. For over five decades, different reviews have been conducted in the field of electrosurgery. This has led to a dramatic increase in interest in electrosurgery, resulting to an incredible intervention in microvascular surgery that has provoked the most noteworthy use of radio frequency instruments. The controlled and exact use of these radio frequency electrical current on delicate tissue sites to be cut is accomplished by methods for deliberately composed anodes. This is a persistently advancing field with dynamic research going on in various new applications. There are different sorts of surgery, which can be delivered with high recurrence instruments such as Diathermy, Bipolar, and Monopolar. This paper performs a systematic review by extracting information from a wide variety of research papers in electrosurgery topics. The purpose of a systematic review is to classify and categorize the field of electrosurgery in an unbiased way, listing the current existing trends in electrosurgery, can lead to the classification and understanding of electrosurgery as a whole, and to predict the future direction of the field by analyzing the research interest over the last couple of years.
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Affiliation(s)
- Ali Idham Alzaidi
- Faculty of Biomedical Engineering, Universiti Teknologi Malaysia, 81310 UTM Skudai, Johor, Malaysia
| | - Azli Yahya
- Faculty of Electrical Engineering, Universiti Teknologi Malaysia 81310 UTM Skudai, Johor, Malaysia
| | - Mohammad Rava
- Faculty of Biomedical Engineering, Universiti Teknologi Malaysia, 81310 UTM Skudai, Johor, Malaysia
- Faculty of Computing, Universiti Teknologi Malaysia, 81310 UTM Skudai, Johor, Malaysia
| | - Tan Tian Swee
- Faculty of Biomedical Engineering, Universiti Teknologi Malaysia, 81310 UTM Skudai, Johor, Malaysia
| | - Norhalimah Idris
- Faculty of Management, University Teknologi Malaysia, 81310 Skudai Johor, Malaysia
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Neshige S, Kobayashi K, Matsuhashi M, Hitomi T, Shimotake A, Kikuchi T, Yoshida K, Kunieda T, Matsumoto R, Miyamoto S, Takahashi R, Maruyama H, Ikeda A. A rational, multispectral mapping algorithm for primary motor cortex: A primary step before cortical stimulation. Epilepsia 2019; 60:547-559. [PMID: 30790267 DOI: 10.1111/epi.14669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE For future artificial intelligence-based brain mapping, development of a rational and safe scoring system for a brain motor mapping algorithm using electrocorticography (ECoG score), which contains various spectral, purely intrinsic brain activities, is necessary for either before or in the absence of electrical cortical stimulation (ECS). METHODS We evaluated 1114 electrodes of 10 consecutive focal epilepsy patients who underwent subdural electrode implantation before epilepsy surgery at Kyoto University Hospital during 2011-2017. Data from ECoG-based mapping (bandpass filter of 0.016-300/600 Hz) to define the primary motor area (M1) localization were used to create an ECoG score (range = 0-4) by assigning 1 point each for the occurrence of ECoG components: very slow movement-related cortical potentials (<0.5-1.0 Hz), event-related synchronization (76-100 Hz or 100-200 Hz), and event-related desynchronization (8-12 Hz or 12-24 Hz). The ECoG score was assessed by calculating the sensitivity, specificity, and cutoff values of the score for localization concordance with M1 defined using only ECS as a reference. RESULTS With an area under the receiver operating characteristic curve (AUC) of 0.76, cutoffs of scores of 4 and 1 showed high specificity (94%) and sensitivity (98%) in concordance with ECS-based mapping, respectively. The ECoG score for mapping M1 of the upper limb achieved greater accuracy (AUC = 0.85) compared to that of the face (AUC = 0.64). SIGNIFICANCE The ECoG score proposed in the present study is rational, simple, and useful to define M1, and it is spatially concordant with ECS. Although ECS is still widely employed for presurgical examination, our proposed application of the ECoG score may be suitable for future brain M1 mapping, and possibly beyond M1 mapping, independently of ECS.
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Affiliation(s)
- Shuichiro Neshige
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Katsuya Kobayashi
- Department of Neurology, 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
| | - Takefumi Hitomi
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Shimotake
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, 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, Ehime University Graduate School of Medicine, Noon, Japan
| | - Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, 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
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Nikolin S, Lauf S, Loo CK, Martin D. Effects of High-Definition Transcranial Direct Current Stimulation (HD-tDCS) of the Intraparietal Sulcus and Dorsolateral Prefrontal Cortex on Working Memory and Divided Attention. Front Integr Neurosci 2019; 12:64. [PMID: 30670954 PMCID: PMC6331442 DOI: 10.3389/fnint.2018.00064] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/11/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: There is a need to elucidate the underlying neural mechanisms subserving working memory and divided attention functioning. Recent neuroimaging studies provide evidence for anatomical co-localization of both functions. In the present study we used a functional intervention, whereby we applied a novel type of focalised, non-invasive brain stimulation, High-Definition transcranial Direct Current Stimulation (HD-tDCS), to the regions subserving these processes, the left intraparietal sulcus (IPS) and left dorsolateral prefrontal cortex (LDLPFC). Our aim was therefore to modulate activity in these regions using HD-tDCS and thereby assess their relevance for working memory, divided attention and their shared sub-processes. Method: 78 participants were evenly randomized to one of three conditions in a single blind, parallel group study design. Anodal or sham HD-tDCS was applied to either the left IPS or LDLPFC while participants completed a verbal working memory task, a divided attention task, and two tasks measuring subcomponents of working memory (updating and maintenance). Results: Focalised stimulation of the IPS and LDLPFC did not significantly modulate performance compared to sham stimulation. However, moderate effect sizes were obtained for at least one HD-tDCS condition relative to sham for all tasks, warranting further research into the functional importance of the IPS in subserving these abilities. Conclusions: The current results may be useful for informing future tDCS studies for modulating working memory and divided attention functioning.
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Affiliation(s)
| | | | | | - Donel Martin
- School of Psychiatry, Prince of Wales Hospital, Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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