High frequency stimulation can suppress globally seizures induced by 4-AP in the rat hippocampus: an acute in vivo study

Effects of acute hippocampal stimulation in the nonhuman primate penicillin model of temporal lobe seizures

Asynchronous distributed multielectrode stimulation (ADMES) is a novel approach to deep brain stimulation for medication resistant temporal lobe epilepsy that has shown promise in rodent and in vitro seizure models. To further evaluate its effects on a pre-clinical model, we characterized the effect of unilateral ADMES in an NHP model of temporal lobe seizures induced by intra-hippocampal injection of penicillin (PCN). Four non-human primates were used for this study in two contemporaneous cohorts. One cohort (n = 3 hemispheres) was implanted with the Medtronic RC + S stimulation (GIN cohort) and recording system connected to two 4-contact ring electrodes to evaluate three unilateral stimulation patterns: 7 Hz Ring ADMES, 20 Hz Dual Ring, and 125 Hz Dual Ring (analog of clinical stimulation). In an additional cohort (EPC cohort, n = 2), two 12-contact segmented electrodes were implanted in the right hippocampus and connected to an externalized recording and stimulation system to allow more flexibility in the stimulation pattern. In this second cohort, 4 variations of stimulation were evaluated (7 Hz Full ADMES, 7 Hz Ring ADMES, 31 Hz Wide Ring, and 31 Hz Dual Ring). In the GIN cohort, we found an increase in seizure frequency and time spent in seizure during the 7 Hz Ring ADMES stimulation compared to the respective post-stimulation. A similar post-stimulation effect was found in the EPC cohort. We also found an increase in seizure frequency during the 7Hz full ADMES compared to the respective post-stimulation. However, we did not find a difference between pre-stimulation and stimulation conditions suggesting a possible post stimulation effect of the 7Hz hippocampal stimulation. In conclusion, in the NHP PCN model of temporal lobe seizures, acute asynchronous hippocampal stimulation was not therapeutic, however, our findings related to the post-stimulation effect can support future studies using hippocampal stimulation for the treatment of temporal lobe epilepsy.

Neurostimulation as a Putative Method for the Treatment of Drug-resistant Epilepsy in Patient and Animal Models of Epilepsy

A patient with epilepsy was shown to have neurobiological, psychological, cognitive, and social issues as a result of recurring seizures, which is regarded as a chronic brain disease. However, despite numerous drug treatments, approximately, 30%-40% of all patients are resistant to antiepileptic drugs. Therefore, newer therapeutic modalities are introduced into clinical practice which involve neurostimulation and direct stimulation of the brain. Hence, we review published literature on vagus nerve stimulation, trigeminal nerve stimulation, applying responsive stimulation systems, and deep brain stimulation (DBS) in animals and epileptic patient with an emphasis on drug-resistant epilepsy.

Regulating absence seizures by tri-phase delay stimulation applied to globus pallidus internal

In this paper, a reduced globus pallidus internal (GPI)-corticothalamic (GCT) model is developed, and a tri-phase delay stimulation (TPDS) with sequentially applying three pulses on the GPI representing the inputs from the striatal D ₁ neurons, subthalamic nucleus (STN), and globus pallidus external (GPE), respectively, is proposed. The GPI is evidenced to control absence seizures characterized by 2 Hz-4 Hz spike and wave discharge (SWD). Hence, based on the basal ganglia-thalamocortical (BGCT) model, we firstly explore the triple effects of D _l-GPI, GPE-GPI, and STN-GPI pathways on seizure patterns. Then, using the GCT model, we apply the TPDS on the GPI to potentially investigate the alternative and improved approach if these pathways to the GPI are blocked. The results show that the striatum D ₁, GPE, and STN can indeed jointly and significantly affect seizure patterns. In particular, the TPDS can effectively reproduce the seizure pattern if the D ₁-GPI, GPE-GPI, and STN-GPI pathways are cut off. In addition, the seizure abatement can be obtained by well tuning the TPDS stimulation parameters. This implies that the TPDS can play the surrogate role similar to the modulation of basal ganglia, which hopefully can be helpful for the development of the brain-computer interface in the clinical application of epilepsy.

Suppressing synchronous firing of epileptiform activity by high-frequency stimulation of afferent fibers in rat hippocampus

Aims

Deep brain stimulation (DBS) is a promising technology for treating epilepsy. However, the efficacy and underlying mechanisms of the high‐frequency stimulation (HFS) utilized by DBS to suppress epilepsy remain uncertain. Previous studies have shown that HFS can desynchronize the firing of neurons. In this study, we investigated whether the desynchronization effects of HFS can suppress epileptiform events.

Methods

HFS trains with seconds of duration (short) and a minute of duration (long) were applied at the afferent fibers (ie, Schaffer collaterals) of the hippocampal CA1 region in anesthetized rats in vivo. The amplitude and the rate of population spikes (PS) appeared in the downstream of stimulation were calculated to evaluate the intensity of synchronized firing of neuronal populations between short and long HFS groups. A test of paired‐pulse depression (PPD) was used to assess the alteration of inhibitory neuronal circuits.

Results

The sustained stimulation of a 60‐s long HFS suppressed the afterdischarges that were induced by a 5‐s short HFS to impair the local inhibitions. During the sustained HFS, the mean PS amplitude reduced significantly and the burst firing decreased, while the amount of neuronal firing did not change significantly. The paired‐pulse tests showed that with a similar baseline level of small PS2/PS1 ratio indicating a strong PPD, the 5‐s HFS increased the PS2/PS1 ratio to a value that was significantly greater than the corresponding ratio during sustained HFS, indicating that the PPD impaired by a short HFS may be restored by a sustained HFS.

Conclusions

The sustained HFS can desynchronize the population firing of epileptiform activity and accelerate a recovery of inhibitions to create a balance between the excitation and the inhibition of local neuronal circuits. The study provides new clues for further understanding the mechanism of DBS and for advancing the clinical application of DBS in treating epilepsy.

Neural mass modeling of slow-fast dynamics of seizure initiation and abortion

Epilepsy is a dynamic and complex neurological disease affecting about 1% of the worldwide population, among which 30% of the patients are drug-resistant. Epilepsy is characterized by recurrent episodes of paroxysmal neural discharges (the so-called seizures), which manifest themselves through a large-amplitude rhythmic activity observed in depth-EEG recordings, in particular in local field potentials (LFPs). The signature characterizing the transition to seizures involves complex oscillatory patterns, which could serve as a marker to prevent seizure initiation by triggering appropriate therapeutic neurostimulation methods. To investigate such protocols, neurophysiological lumped-parameter models at the mesoscopic scale, namely neural mass models, are powerful tools that not only mimic the LFP signals but also give insights on the neural mechanisms related to different stages of seizures. Here, we analyze the multiple time-scale dynamics of a neural mass model and explain the underlying structure of the complex oscillations observed before seizure initiation. We investigate population-specific effects of the stimulation and the dependence of stimulation parameters on synaptic timescales. In particular, we show that intermediate stimulation frequencies (>20 Hz) can abort seizures if the timescale difference is pronounced. Those results have the potential in the design of therapeutic brain stimulation protocols based on the neurophysiological properties of tissue.

Study on the mechanisms of seizure-like events suppression effect by electrical stimulation using a microelectrode array

In this paper, we studied the mechanisms underlying the suppression of seizure-like events (SLEs) by electrical stimulation. We conducted an in-vitro experiment using entorhinal cortex combined hippocampal slices and two convulsant drugs, bicuculline and 4-aminopyridine, to induce spontaneous SLEs. We used a microelectrode array to observe network dynamics over the entire hippocampal area simultaneously, including regions far from the stimulation site. We stimulated the entorhinal cortex region, which has been determined to be a focus of SLEs by Granger causality analysis of multichannel time series data, by an external electrode. In bicuculline application, electrical stimulation showed a marked suppression effect, even though the sizes of the effective region differed. In 4-aminopyridine application, however, stimulation under the same conditions did not suppress the activities in ∼80% of SLEs. The suppression effect was more remarkable in the areas surrounding the stimulation site in both cases. Our experimental results could support the neuronal depolarization blockade mechanism by accumulation of extracellular potassium ions, which is one of the most convincing mechanisms to understand seizure suppression phenomena because of electrical stimulation. Computer simulation using a neuronal network model also confirmed the mechanism.

Sinusoidal stimulation trains suppress epileptiform spikes induced by 4-AP in the rat hippocampal CA1 region in-vivo

Deep brain stimulation (DBS) shows promises in the treatment of refractory epilepsy. Due to the complex causes of epilepsy, the mechanisms of DBS are still unclear. Depolarization block caused by the persistent excitation of neurons may be one of the possible mechanisms. To test the hypothesis, 4-aminopyridine (4-AP) was injected in rat hippocampal CA1 region in-vivo to induce epileptiform activity. Sinusoidal stimulation trains were applied to the afferent pathway (Schaffer collaterals) of CA1 region to suppress the epileptiform spikes. Results show that 2-min long trains of sinusoidal stimulation (50 Hz) decreased the firing rate of population spikes (PS) and decreased the PS amplitudes significantly. In addition, small positive sharp waves replaced PS activity during the periods of stimulation. A lower frequency sinusoidal stimulation (10 Hz) failed to decrease the firing rate of PS, but decreased the PS amplitudes significantly. These results suggest that stimulation trains of sinusoidal waves could suppress epileptiform spikes. Presumably, the stimulation with a high enough frequency might excite the downstream neurons persistently and elevate the membrane potentials continuously, thereby cause depolarization blocks in the neurons. The findings of the study provide insights in revealing the mechanisms of DBS, and have important implications to the clinical treatment of epilepsy.

Prediction of the Seizure Suppression Effect by Electrical Stimulation via a Computational Modeling Approach

In this paper, we identified factors that can affect seizure suppression via electrical stimulation by an integrative study based on experimental and computational approach. Preferentially, we analyzed the characteristics of seizure-like events (SLEs) using our previous in vitro experimental data. The results were analyzed in two groups classified according to the size of the effective region, in which the SLE was able to be completely suppressed by local stimulation. However, no significant differences were found between these two groups in terms of signal features or propagation characteristics (i.e., propagation delays, frequency spectrum, and phase synchrony). Thus, we further investigated important factors using a computational model that was capable of evaluating specific influences on effective region size. In the proposed model, signal transmission between neurons was based on two different mechanisms: synaptic transmission and the electrical field effect. We were able to induce SLEs having similar characteristics with differentially weighted adjustments for the two transmission methods in various noise environments. Although the SLEs had similar characteristics, their suppression effects differed. First of all, the suppression effect occurred only locally where directly received the stimulation effect in the high noise environment, but it occurred in the entire network in the low noise environment. Interestingly, in the same noise environment, the suppression effect was different depending on SLE propagation mechanism; only a local suppression effect was observed when the influence of the electrical field transmission was very weak, whereas a global effect was observed with a stronger electrical field effect. These results indicate that neuronal activities synchronized by a strong electrical field effect respond more sensitively to partial changes in the entire network. In addition, the proposed model was able to predict that stimulation of a seizure focus region is more effective for suppression. In conclusion, we confirmed the possibility of a computational model as a simulation tool to analyze the efficacy of deep brain stimulation (DBS) and investigated the key factors that determine the size of an effective region in seizure suppression via electrical stimulation.

Stimulus-induced Epileptic Spike-Wave Discharges in Thalamocortical Model with Disinhibition

Epileptic absence seizure characterized by the typical 2–4 Hz spike-wave discharges (SWD) are known to arise due to the physiologically abnormal interactions within the thalamocortical network. By introducing a second inhibitory neuronal population in the cortical system, here we propose a modified thalamocortical field model to mathematically describe the occurrences and transitions of SWD under the mutual functions between cortex and thalamus, as well as the disinhibitory modulations of SWD mediated by the two different inhibitory interneuronal populations. We first show that stimulation can induce the recurrent seizures of SWD in the modified model. Also, we demonstrate the existence of various types of firing states including the SWD. Moreover, we can identify the bistable parametric regions where the SWD can be both induced and terminated by stimulation perturbations applied in the background resting state. Interestingly, in the absence of stimulation disinhibitory functions between the two different interneuronal populations can also both initiate and abate the SWD, which suggests that the mechanism of disinhibition is comparable to the effect of stimulation in initiating and terminating the epileptic SWD. Hopefully, the obtained results can provide theoretical evidences in exploring dynamical mechanism of epileptic seizures.

Computational modeling of epileptiform activities in medial temporal lobe epilepsy combined with in vitro experiments

In this paper, we propose a comprehensive computational model that is able to reproduce three epileptiform activities. The model targets a hippocampal formation that is known to be an important lesion in medial temporal lobe epilepsy. It consists of four sub-networks consisting of excitatory and inhibitory neurons and well-known signal pathways, with consideration of propagation delay. The three epileptiform activities involve fast and slow interictal discharge and ictal discharge, and those activities can be induced in vitro by application of 4-Aminopyridine in entorhinal cortex combined hippocampal slices. We model the three epileptiform activities upon previously reported biological mechanisms and verify the simulation results by comparing them with in vitro experimental data obtained using a microelectrode array. We use the results of Granger causality analysis of recorded data to set input gains of signal pathways in the model, so that the compatibility between the computational and experimental models can be improved. The proposed model can be expanded to evaluate the suppression effect of epileptiform activities due to new treatment methods.

Seizure reduction through interneuron-mediated entrainment using low frequency optical stimulation

Low frequency electrical stimulation (LFS) can reduce neural excitability and suppress seizures in animals and patients with epilepsy. However the therapeutic outcome could benefit from the determination of the cell types involved in seizure suppression. We used optogenetic techniques to investigate the role of interneurons in LFS (1Hz) in the epileptogenic hippocampus. Optical low frequency stimulation (oLFS) was first used to activate the cation channel channelrhodopsin-2 (ChR2) in the Thy1-ChR2 transgenic mouse that expresses ChR2 in both excitatory and inhibitory neurons. We found that oLFS could effectively reduce epileptiform activity in the hippocampus through the activation of GAD-expressing hippocampal interneurons. This was confirmed using the VGAT-ChR2 transgenic mouse, allowing for selective optical activation of only GABA interneurons. Activating hippocampal interneurons through oLFS was found to cause entrainment of neural activity similar to electrical stimulation, but through a GABAA-mediated mechanism. These results confirm the robustness of the LFS paradigm and indicate that GABA interneurons play an unexpected role of shaping inter-ictal activity to decrease neural excitability in the hippocampus.

Suppression of acute seizures by theta burst electrical stimulation of the hippocampal commissure using a closed-loop system

This study investigated the effects of electrical stimulation with theta burst stimulation (eTBS) on seizure suppression. Optimal parameters of eTBS were determined through open-loop stimulation experiments and then implemented in a close-loop seizure control system. For the experiments, 4-aminopyridine (4-AP) was injected into the right hippocampus of Sprague-Dawley rats to induce an acute seizure. eTBS was applied on the ventral hippocampal commissure and the effects of eTBS with different combinations of burst frequency and number of pulses per burst were analyzed in terms of seizure suppression. A closed-loop seizure control system was then implemented based on optimal eTBS parameters. The efficiency of the closed-loop eTBS was evaluated and compared to that of high frequency stimulation. The results show that eTBS induced global suppression in the hippocampus and this was sustained even after the application of eTBS. The optimal parameter of eTBS in the open-loop stimulation experiments was a burst frequency at 100Hz with nine pulses in a burst. The eTBS integrated with the on-off control law yielded less actions and cumulative delivered charge, but induced longer after-effects of seizure suppression compared to continuous high frequency stimulation (cHFS). To conclude, eTBS has suppressive effects on 4-AP induced seizure. A closed-loop eTBS system provides a more effective way of suppressing seizure and requires less effort compared to cHFS. eTBS may be a novel stimulation protocol for effective seizure control.

Seizure suppression by high frequency optogenetic stimulation using in vitro and in vivo animal models of epilepsy

BACKGROUND

Electrical high frequency stimulation (HFS) has been shown to suppress seizures. However, the mechanisms of seizure suppression remain unclear and techniques for blocking specific neuronal populations are required.

OBJECTIVE

The goal is to study the optical HFS protocol on seizures as well as the underlying mechanisms relevant to the HFS-mediated seizure suppression by using optogenetic methodology.

METHODS

Thy1-ChR2 transgenic mice were used in both vivo and in vitro experiments. Optical stimulation with pulse trains at 20 and 50 Hz was applied on the focus to determine its effects on in vivo seizure activity induced by 4-AP and recorded in the bilateral and ipsilateral-temporal hippocampal CA3 regions. In vitro methodology was then used to study the mechanisms of the in vivo suppression.

RESULTS

Optical HFS was able to generate 82.4% seizure suppression at 50 Hz with light power of 6.1 mW and 80.2% seizure suppression at 20 Hz with light power of 2.0 mW. The suppression percentage increased by increasing the light power and saturated when the power reached above-mentioned values. In vitro experimental results indicate that seizure suppression was mediated by activation of GABA receptors. Seizure suppression effect decreased with continued application but the suppression effect could be restored by intermittent stimulation.

CONCLUSIONS

This study shows that optical stimulation at high frequency targeting an excitatory opsin has potential therapeutic application for fast control of an epileptic focus. Furthermore, electrophysiological observations of extracellular and intracellular signals revealed that GABAergic neurotransmission activated by optical stimulation was responsible for the suppression.

Fiber tract stimulation can reduce epileptiform activity in an in-vitro bilateral hippocampal slice preparation

Mesial temporal lobe epilepsy (MTLE) is a common medically refractory neurological disease that has been treated with electrical stimulation of gray matter with limited success. However, stimulation of a white matter tract connecting the hippocampi could maximize treatment efficacy and extent. We tested low-frequency stimulation (LFS) of a novel target that enables simultaneous targeting of bilateral hippocampi: the ventral hippocampal commissure (VHC) with a novel in-vitro slice preparation containing bilateral hippocampi connected by the VHC. The goal of this study is to understand the role of hippocampal interplay in seizure propagation and reduction by commissural fiber tract stimulation. LFS is applied to the VHC as extracellular and intracellular recording techniques are combined with signal processing to estimate several metrics of epilepsy including: (1) total time occupied by seizure activity (%); (2) seizure duration (s); (3) seizures per minute (#); and (4) power in the ictal (V(2)Hz(-1)); as well as (5) interictal spectra (V(2)Hz(-1)). Bilateral epileptiform activity in this preparation is highly correlated between hippocampi. Application of LFS to the VHC reduces all metrics of epilepsy during treatment in an amplitude and frequency dependent manner. This study lends several insights into the mechanisms of bilateral seizure reduction by LFS of the VHC, including that depolarization blocking, LTD/LTP and GABA(A) are not involved. Importantly, enhanced post-stimulation 1-Hz spiking correlates with long-lasting seizure reduction and both are heightened by targeting bilateral hippocampi via the VHC. Therefore, stimulating bilateral hippocampi via a single electrode in the VHC may provide an effective MTLE treatment.