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Yang B, Zhao B, Li C, Mo J, Guo Z, Li Z, Yao Y, Fan X, Cai D, Sang L, Zheng Z, Gao D, Zhao X, Wang X, Zhang C, Hu W, Shao X, Zhang J, Zhang K. Localizing seizure onset zone by a cortico-cortical evoked potentials-based machine learning approach in focal epilepsy. Clin Neurophysiol 2024; 158:103-113. [PMID: 38218076 DOI: 10.1016/j.clinph.2023.12.135] [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: 08/08/2023] [Revised: 12/03/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE We aimed to develop a new approach for identifying the localization of the seizure onset zone (SOZ) based on corticocortical evoked potentials (CCEPs) and to compare the connectivity patterns in patients with different clinical phenotypes. METHODS Fifty patients who underwent stereoelectroencephalography and CCEP procedures were included. Logistic regression was used in the model, and six CCEP metrics were input as features: root mean square of the first peak (N1RMS) and second peak (N2RMS), peak latency, onset latency, width duration, and area. RESULTS The area under the curve (AUC) for localizing the SOZ ranged from 0.88 to 0.93. The N1RMS values in the hippocampus sclerosis (HS) group were greater than that of the focal cortical dysplasia (FCD) IIa group (p < 0.001), independent of the distance between the recorded and stimulated sites. The sensitivity of localization was higher in the seizure-free group than in the non-seizure-free group (p = 0.036). CONCLUSIONS This new method can be used to predict the SOZ localization in various focal epilepsy phenotypes. SIGNIFICANCE This study proposed a machine-learning approach for localizing the SOZ. Moreover, we examined how clinical phenotypes impact large-scale abnormality of the epileptogenic networks.
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Affiliation(s)
- Bowen Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Li
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhihao Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zilin Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuan Yao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiuliang Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Du Cai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Sang
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Zhong Zheng
- Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, China
| | - Dongmei Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuemin Zhao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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Ramantani G, Westover MB, Gliske S, Sarnthein J, Sarma S, Wang Y, Baud MO, Stacey WC, Conrad EC. Passive and active markers of cortical excitability in epilepsy. Epilepsia 2023; 64 Suppl 3:S25-S36. [PMID: 36897228 PMCID: PMC10512778 DOI: 10.1111/epi.17578] [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: 02/01/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023]
Abstract
Electroencephalography (EEG) has been the primary diagnostic tool in clinical epilepsy for nearly a century. Its review is performed using qualitative clinical methods that have changed little over time. However, the intersection of higher resolution digital EEG and analytical tools developed in the past decade invites a re-exploration of relevant methodology. In addition to the established spatial and temporal markers of spikes and high-frequency oscillations, novel markers involving advanced postprocessing and active probing of the interictal EEG are gaining ground. This review provides an overview of the EEG-based passive and active markers of cortical excitability in epilepsy and of the techniques developed to facilitate their identification. Several different emerging tools are discussed in the context of specific EEG applications and the barriers we must overcome to translate these tools into clinical practice.
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Affiliation(s)
- Georgia Ramantani
- Department of Neuropediatrics and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - M Brandon Westover
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Data Science, Massachusetts General Hospital McCance Center for Brain Health, Boston, Massachusetts, USA
- Research Affiliate Faculty, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Research Affiliate Faculty, Broad Institute, Cambridge, Massachusetts, USA
| | - Stephen Gliske
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Johannes Sarnthein
- Department of Neurosurgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Sridevi Sarma
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yujiang Wang
- Interdisciplinary Computing and Complex BioSystems, School of Computing Science, Newcastle University, Newcastle Upon Tyne, UK
| | - Maxime O Baud
- Sleep-Wake-Epilepsy Center, NeuroTec, Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | - William C Stacey
- Department of Neurology, BioInterfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biomedical Engineering, BioInterfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
- Division of Neurology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Erin C Conrad
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, Penn Epilepsy Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sun K, Wang H, Bai Y, Zhou W, Wang L. MRIES: A Matlab Toolbox for Mapping the Responses to Intracranial Electrical Stimulation. Front Neurosci 2021; 15:652841. [PMID: 34194294 PMCID: PMC8236813 DOI: 10.3389/fnins.2021.652841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
Propose Directed cortical responses to intracranial electrical stimulation are a good standard for mapping inter-regional direct connectivity. Cortico-cortical evoked potential (CCEP), elicited by single pulse electrical stimulation (SPES), has been widely used to map the normal and abnormal brain effective network. However, automated processing of CCEP datasets and visualization of connectivity results remain challenging for researchers and clinicians. In this study, we develop a Matlab toolbox named MRIES (Mapping the Responses to Intracranial Electrical Stimulation) to automatically process CCEP data and visualize the connectivity results. Method The MRIES integrates the processing pipeline of the CCEP datasets and various methods for connectivity calculation based on low- and high-frequency signals with stimulation artifacts removed. The connectivity matrices are saved in different folders for visualization. Different visualization patterns (connectivity matrix, circle map, surface map, and volume map) are also integrated to the graphical user interface (GUI), which makes it easy to intuitively display and compare different connectivity measurements. Furthermore, one sample CCEP data set collected from eight epilepsy patients is used to validate the MRIES toolbox. Result We show the GUI and visualization functions of MRIES using one example CCEP data that has been described in a complete tutorial. We applied this toolbox to the sample CCEP data set to investigate the direct connectivity between the medial temporal lobe and the insular cortex. We find bidirectional connectivity between MTL and insular that are consistent with the findings of previous studies. Conclusion MRIES has a friendly GUI and integrates the full processing pipeline of CCEP data and various visualization methods. The MRIES toolbox, tutorial, and example data can be freely downloaded. As an open-source package, MRIES is expected to improve the reproducibility of CCEP findings and facilitate clinical translation.
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Affiliation(s)
- Kaijia Sun
- School of Systems Science, Beijing Normal University, Beijing, China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Haixiang Wang
- Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing, China
| | - Yunxian Bai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Wenjing Zhou
- Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing, China
| | - Liang Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Kamali G, Smith RJ, Hays M, Coogan C, Crone NE, Kang JY, Sarma SV. Transfer Function Models for the Localization of Seizure Onset Zone From Cortico-Cortical Evoked Potentials. Front Neurol 2020; 11:579961. [PMID: 33362689 PMCID: PMC7758451 DOI: 10.3389/fneur.2020.579961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022] Open
Abstract
Surgical resection of the seizure onset zone (SOZ) could potentially lead to seizure-freedom in medically refractory epilepsy patients. However, localizing the SOZ can be a time consuming and tedious process involving visual inspection of intracranial electroencephalographic (iEEG) recordings captured during passive patient monitoring. Cortical stimulation is currently performed on patients undergoing invasive EEG monitoring for the main purpose of mapping functional brain networks such as language and motor networks. We hypothesized that evoked responses from single pulse electrical stimulation (SPES) can also be used to localize the SOZ as they may express the natural frequencies and connectivity of the iEEG network. To test our hypothesis, we constructed patient specific transfer function models from the evoked responses recorded from 22 epilepsy patients that underwent SPES evaluation and iEEG monitoring. We then computed the frequency and connectivity dependent “peak gain” of the system as measured by the H∞ norm from systems theory. We found that in cases for which clinicians had high confidence in localizing the SOZ, the highest peak gain transfer functions with the smallest “floor gain” (gain at which the dipped H∞ 3dB below DC gain) corresponded to when the clinically annotated SOZ and early spread regions were stimulated. In more complex cases, there was a large spread of the peak-to-floor (PF) ratios when the clinically annotated SOZ was stimulated. Interestingly for patients who had successful surgeries, our ratio of gains, agreed with clinical localization, no matter the complexity of the case. For patients with failed surgeries, the PF ratio did not match clinical annotations. Our findings suggest that transfer function gains and their corresponding frequency responses computed from SPES evoked responses may improve SOZ localization and thus surgical outcomes.
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Affiliation(s)
- Golnoosh Kamali
- Neuromedical Control Systems Laboratory, Department of Electrical and Computer Engineering, Institute of Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Rachel June Smith
- Neuromedical Control Systems Laboratory, Department of Biomedical Engineering, Institute of Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Mark Hays
- Cognitive Research, Online Neuroengineering and Electrophysiology Laboratory, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Christopher Coogan
- Cognitive Research, Online Neuroengineering and Electrophysiology Laboratory, Department of Neurology-Epilepsy, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Nathan E Crone
- Cognitive Research, Online Neuroengineering and Electrophysiology Laboratory, Department of Neurology-Epilepsy, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Joon Y Kang
- Department of Neurology-Epilepsy, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sridevi V Sarma
- Neuromedical Control Systems Laboratory, Department of Electrical and Computer Engineering, Institute of Computational Medicine, Johns Hopkins University, Baltimore, MD, United States.,Neuromedical Control Systems Laboratory, Department of Biomedical Engineering, Institute of Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
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Mitsuhashi T, Sonoda M, Jeong JW, Silverstein BH, Iwaki H, Luat AF, Sood S, Asano E. Four-dimensional tractography animates propagations of neural activation via distinct interhemispheric pathways. Clin Neurophysiol 2020; 132:520-529. [PMID: 33450573 DOI: 10.1016/j.clinph.2020.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To visualize and validate the dynamics of interhemispheric neural propagations induced by single-pulse electrical stimulation (SPES). METHODS This methodological study included three patients with drug-resistant focal epilepsy who underwent measurement of cortico-cortical spectral responses (CCSRs) during bilateral stereo-electroencephalography recording. We delivered SPES to 83 electrode pairs and analyzed CCSRs recorded at 268 nonepileptic electrode sites. Diffusion-weighted imaging (DWI) tractography localized the interhemispheric white matter pathways as streamlines directly connecting two electrode sites. We localized and visualized the putative SPES-related fiber activation, at each 1-ms time window, based on the propagation velocity defined as the DWI-based streamline length divided by the early CCSR peak latency. RESULTS The resulting movie, herein referred to as four-dimensional tractography, delineated the spatiotemporal dynamics of fiber activation via the corpus callosum and anterior commissure. Longer streamline length was associated with delayed peak latency and smaller amplitude of CCSRs. The cortical regions adjacent to each fiber activation site indeed exhibited CCSRs at the same time window. CONCLUSIONS Our four-dimensional tractography successfully animated neural propagations via distinct interhemispheric pathways. SIGNIFICANCE Our novel animation method has the potential to help investigators in addressing the mechanistic significance of the interhemispheric network dynamics supporting physiological function.
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Affiliation(s)
- Takumi Mitsuhashi
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Neurosurgery, Juntendo University, Tokyo, 1138421, Japan
| | - Masaki Sonoda
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Neurosurgery, Yokohama City University, Yokohama, 2360004, Japan
| | - Jeong-Won Jeong
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA
| | - Brian H Silverstein
- Translational Neuroscience Program, Wayne State University, Detroit, MI 48202, USA
| | - Hirotaka Iwaki
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, 9808575, Japan
| | - Aimee F Luat
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA
| | - Sandeep Sood
- Department of Neurosurgery, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA
| | - Eishi Asano
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
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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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Huiskamp G, van Blooijs D, van der Stoel M. Harvesting responses to single pulse electrical stimulation for presurgical evaluation in epilepsy. Clin Neurophysiol 2018; 129:2444-2445. [DOI: 10.1016/j.clinph.2018.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
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