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Abdallah C, Mansilla D, Minato E, Grova C, Beniczky S, Frauscher B. Systematic review of seizure-onset patterns in stereo-electroencephalography: Current state and future directions. Clin Neurophysiol 2024; 163:112-123. [PMID: 38733701 DOI: 10.1016/j.clinph.2024.04.016] [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: 09/29/2023] [Revised: 02/01/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Increasing evidence suggests that the seizure-onset pattern (SOP) in stereo-electroencephalography (SEEG) is important for localizing the "true" seizure onset. Specifically, SOPs with low-voltage fast activity (LVFA) are associated with seizure-free outcome (Engel I). However, several classifications and various terms corresponding to the same pattern have been reported, challenging its use in clinical practice. METHOD Following the Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) guideline, we performed a systematic review of studies describing SOPs along with accompanying figures depicting the reported SOP in SEEG. RESULTS Of 1799 studies, 22 met the selection criteria. Among the various SOPs, we observed that the terminology for low frequency periodic spikes exhibited the most variability, whereas LVFA is the most frequently used term of this pattern. Some SOP terms were inconsistent with standard EEG terminology. Finally, there was a significant but weak association between presence of LVFA and seizure-free outcome. CONCLUSION Divergent terms were used to describe the same SOPs and some of these terms showed inconsistencies with the standard EEG terminology. Additionally, our results confirmed the link between patterns with LVFA and seizure-free outcomes. However, this association was not strong. SIGNIFICANCE These results underline the need for standardization of SEEG terminology.
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Affiliation(s)
- Chifaou Abdallah
- Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec H3A 2B4, Canada.
| | - Daniel Mansilla
- Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec H3A 2B4, Canada
| | - Erica Minato
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Christophe Grova
- Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec H3A 2B4, Canada; Multimodal Functional Imaging Lab, Department of Physics, Concordia University, Montréal, Québec, Canada; PERFORM Centre, Concordia University, Montréal, Québec, Canada
| | - Sandor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark
| | - Birgit Frauscher
- Department of Neurology, Duke University Medical Center, Durham, NC, USA; Department of Biomedical Engineering, Pratt School of Engineering, Durham, NC, USA.
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Panchavati S, Daida A, Edmonds B, Miyakoshi M, Oana S, Ahn SS, Arnold C, Salamon N, Sankar R, Fallah A, Speier W, Nariai H. Uncovering spatiotemporal dynamics of the corticothalamic network at ictal onset. Epilepsia 2024. [PMID: 38662128 DOI: 10.1111/epi.17990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Although the clinical efficacy of deep brain stimulation targeting the anterior nucleus (AN) and centromedian nucleus (CM) of the thalamus has been actively investigated for the treatment of medication-resistant epilepsy, few studies have investigated dynamic ictal changes in corticothalamic connectivity in human electroencephalographic (EEG) recording. This study aims to establish the complex spatiotemporal dynamics of the ictal corticothalamic network associated with various seizure foci. METHODS We analyzed 10 patients (aged 2.7-28.1 years) with medication-resistant focal epilepsy who underwent stereotactic EEG evaluation with thalamic sampling. We examined both undirected and directed connectivity, incorporating coherence and spectral Granger causality analysis (GCA) between the diverse seizure foci and thalamic nuclei (AN and CM) at ictal onset. RESULTS In our analysis of 36 seizures, coherence between seizure onset and thalamic nuclei increased across all frequencies, especially in slower bands (delta, theta, alpha). GCA showed increased information flow from seizure onset to the thalamus across all frequency bands, but outflows from the thalamus were mainly in slower frequencies, particularly delta. In the subgroup analysis based on various seizure foci, the delta coherence showed a more pronounced increase at CM than at AN during frontal lobe seizures. Conversely, in limbic seizures, the delta coherence increase was greater at AN compared to CM. SIGNIFICANCE It appears that the delta frequency plays a pivotal role in modulating the corticothalamic network during seizures. Our results underscore the significance of comprehending the spatiotemporal dynamics of the corticothalamic network at ictal onset, and this knowledge could guide personalized responsive neuromodulation treatment strategies.
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Affiliation(s)
- Saarang Panchavati
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Atsuro Daida
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, California, USA
| | - Benjamin Edmonds
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, California, USA
| | - Makoto Miyakoshi
- Department of Psychiatry and Behavioral Neuroscience, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Shingo Oana
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, California, USA
| | - Samuel S Ahn
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, California, USA
| | - Corey Arnold
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Noriko Salamon
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, California, USA
| | - Raman Sankar
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, California, USA
- UCLA Children's Discovery and Innovation Institute, Los Angeles, California, USA
| | - Aria Fallah
- Department of Neurosurgery, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, California, USA
| | - William Speier
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Hiroki Nariai
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, California, USA
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, California, USA
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Yang JC, Yang AI, Gross RE. Sensing-Enabled Deep Brain Stimulation in Epilepsy. Neurosurg Clin N Am 2024; 35:119-123. [PMID: 38000835 DOI: 10.1016/j.nec.2023.08.005] [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] [Indexed: 11/26/2023]
Abstract
Deep brain stimulation has demonstrated efficacy in reducing seizure frequency in patients with drug-resistant epilepsy who may otherwise not be candidates for other surgical procedures. Recently, a clinical device that can monitor neural activity in the form of local field potentials around the deep brain stimulator lead implant site has been introduced. While this technology has been clinically adopted in other disorders treated with deep brain stimulation, such as Parkinson's disease, its application in epilepsy remains unclear. Previous research using investigational devices has suggested that specific frequency bands may correlate with clinical response to deep brain stimulation in epilepsy, but features of the clinical device may prevent its use. The authors present their experience with using this technology in epilepsy patients and describe some of its limitations. Ultimately, novel biomarkers will need to be identified to elucidate how neural activity at deep brain stimulation sites may change with clinical response.
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Affiliation(s)
- Jimmy C Yang
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Neurosurgery, Emory University, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA.
| | - Andrew I Yang
- Department of Neurosurgery, Emory University, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; Department of Neurology, Emory University School of Medicine, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322
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Hines K, Wu C. Epilepsy Networks and Their Surgical Relevance. Brain Sci 2023; 14:31. [PMID: 38248246 PMCID: PMC10813558 DOI: 10.3390/brainsci14010031] [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: 11/09/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
Surgical epilepsy is a rapidly evolved field. As the understanding and concepts of epilepsy shift towards a network disorder, surgical outcomes may shed light on numerous components of these systems. This review documents the evolution of the understanding of epilepsy networks and examines the data generated by resective, ablative, neuromodulation, and invasive monitoring surgeries in epilepsy patients. As these network tools are better integrated into epilepsy practice, they may eventually inform surgical decisions and improve clinical outcomes.
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Affiliation(s)
- Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA;
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Panchavati S, Daida A, Edmonds B, Miyakoshi M, Oana S, Ahn SS, Arnold C, Salamon N, Sankar R, Fallah A, Speier W, Nariai H. Uncovering Spatiotemporal Dynamics of the Corticothalamic Network during Seizures. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.21.23294382. [PMID: 37662245 PMCID: PMC10473800 DOI: 10.1101/2023.08.21.23294382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Objective Although the clinical efficacy of deep brain stimulation targeting the anterior nucleus (AN) and centromedian nucleus (CM) of the thalamus has been actively investigated for the treatment of medication-resistant epilepsy, few studies have investigated dynamic ictal changes in corticothalamic connectivity in human EEG recording. This study aims to establish the complex spatiotemporal dynamics of the ictal corticothalamic network associated with various seizure foci. Methods We analyzed ten patients (aged 2.7-28.1) with medication-resistant focal epilepsy who underwent stereotactic EEG evaluation with thalamic coverage. We examined both undirected and directed connectivity, incorporating coherence and spectral Granger causality analysis (GCA) between the diverse seizure foci and thalamic nuclei (AN and CM). Results In our analysis of 36 seizures, coherence between seizure onset and thalamic nuclei increased across all frequencies, especially in slower bands (delta, theta, alpha). GCA showed increased information flow from seizure onset to the thalamus across all frequency bands, but outflows from the thalamus were mainly in slower frequencies, particularly delta. In the subgroup analysis based on various seizure foci, the delta coherence showed a more pronounced increase at CM than at AN during frontal lobe seizures. Conversely, in limbic seizures, the delta coherence increase was greater at AN compared to CM. Interpretation It appears that the delta frequency plays a pivotal role in modulating the corticothalamic network during seizures. Our results underscore the significance of comprehending the spatiotemporal dynamics of the corticothalamic network during seizures, and this knowledge could guide personalized neuromodulation treatment strategies.
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Affiliation(s)
- Saarang Panchavati
- Department of Bioengineering, University of California, Los Angeles, CA, USA
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Atsuro Daida
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Benjamin Edmonds
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Makoto Miyakoshi
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shingo Oana
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Samuel S Ahn
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Corey Arnold
- Department of Bioengineering, University of California, Los Angeles, CA, USA
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Raman Sankar
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
- The UCLA Children's Discovery and Innovation Institute, Los Angeles, CA, USA
| | - Aria Fallah
- Department of Neurosurgery, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, CA, USA
| | - William Speier
- Department of Bioengineering, University of California, Los Angeles, CA, USA
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Hiroki Nariai
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
- The UCLA Children's Discovery and Innovation Institute, Los Angeles, CA, USA
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Soulier H, Pizzo F, Jegou A, Lagarde S, Garnier E, Makhalova J, Medina Villalon S, Carron R, Bénar C, Bartolomei F. The anterior and pulvinar thalamic nuclei interactions in mesial temporal lobe seizure networks. Clin Neurophysiol 2023; 150:176-183. [PMID: 37075682 DOI: 10.1016/j.clinph.2023.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/16/2023] [Accepted: 03/17/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To evaluate the respective roles of the anterior thalamic nucleus (ANT) and the medial pulvinar (PuM) during mesial temporal lobe seizures recorded by stereoelectroencephalography (SEEG). METHODS We assessed functional connectivity (FC) in 15 SEEG recorded seizures from 6 patients using a non-linear correlation method. Functional interactions were explored between the mesial temporal region, the temporal neocortex, ANT and PuM. The node total-strength (the summed connectivity of the node with all other nodes) as well as the directionality of the links (IN and OUT strengths) were calculated to estimate drivers and receivers during the cortico-thalamic interactions. RESULTS Significant increased thalamo-cortical FC during seizures was observed, with the node total-strength reaching a maximum at seizure end. There was no significant difference in global connectivity values between ANT and PuM. Regarding directionality, significantly higher thalamic IN strength values were observed. However, compared to ANT, PuM appeared to be the driver at the end of seizures with synchronous termination. CONCLUSIONS This work demonstrates that during temporal seizures, both thalamic nuclei are highly connected with the mesial temporal region and that PuM could play a role in seizure termination. SIGNIFICANCE Understanding functional connectivity between the mesial temporal and thalamic nuclei could contribute to the development of target-specific deep brain stimulation strategies for drug-resistant epilepsy.
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Affiliation(s)
- Hugo Soulier
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille 13005, France
| | - Francesca Pizzo
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille 13005, France; APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille 13005, France
| | - Aude Jegou
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille 13005, France
| | - Stanislas Lagarde
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille 13005, France; APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille 13005, France
| | - Elodie Garnier
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille 13005, France
| | - Julia Makhalova
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille 13005, France; APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille 13005, France
| | - Samuel Medina Villalon
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille 13005, France; APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille 13005, France
| | - Romain Carron
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille 13005, France; APHM, Timone Hospital, Stereotactic and Functional Neurosurgery, Marseille, France
| | - Christian Bénar
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille 13005, France
| | - Fabrice Bartolomei
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille 13005, France; APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille 13005, France.
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Fisher RS. Deep brain stimulation of thalamus for epilepsy. Neurobiol Dis 2023; 179:106045. [PMID: 36809846 DOI: 10.1016/j.nbd.2023.106045] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
Neuromodulation (neurostimulation) is a relatively new and rapidly growing treatment for refractory epilepsy. Three varieties are approved in the US: vagus nerve stimulation (VNS), deep brain stimulation (DBS) and responsive neurostimulation (RNS). This article reviews thalamic DBS for epilepsy. Among many thalamic sub-nuclei, DBS for epilepsy has been targeted to the anterior nucleus (ANT), centromedian nucleus (CM), dorsomedial nucleus (DM) and pulvinar (PULV). Only ANT is FDA-approved, based upon a controlled clinical trial. Bilateral stimulation of ANT reduced seizures by 40.5% at three months in the controlled phase (p = .038) and 75% by 5 years in the uncontrolled phase. Side effects related to paresthesias, acute hemorrhage, infection, occasional increased seizures, and usually transient effects on mood and memory. Efficacy was best documented for focal onset seizures in temporal or frontal lobe. CM stimulation may be useful for generalized or multifocal seizures and PULV for posterior limbic seizures. Mechanisms of DBS for epilepsy are largely unknown, but animal work points to changes in receptors, channels, neurotransmitters, synapses, network connectivity and neurogenesis. Personalization of therapies, in terms of connectivity of the seizure onset zone to the thalamic sub- nucleus and individual characteristics of the seizures, might lead to improved efficacy. Many questions remain about DBS, including the best candidates for different types of neuromodulation, the best targets, the best stimulation parameters, how to minimize side effects and how to deliver current noninvasively. Despite the questions, neuromodulation provides useful new opportunities to treat people with refractory seizures not responding to medicines and not amenable to resective surgery.
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Affiliation(s)
- Robert S Fisher
- Department of Neurology and Neurological Sciences and Neurosurgery by Courtesy, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, Room 4865, Palo Alto, CA 94304, USA.
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Karakis I. Using stereo-electroencephalography to unlock the ictal secrets of the thalamus. Clin Neurophysiol 2022; 137:177-178. [DOI: 10.1016/j.clinph.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/03/2022]
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