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Downey JE, Schone HR, Foldes ST, Greenspon C, Liu F, Verbaarschot C, Biro D, Satzer D, Moon CH, Coffman BA, Youssofzadeh V, Fields D, Hobbs TG, Okorokova E, Tyler-Kabara EC, Warnke PC, Gonzalez-Martinez J, Hatsopoulos NG, Bensmaia SJ, Boninger ML, Gaunt RA, Collinger JL. A roadmap for implanting microelectrode arrays to evoke tactile sensations through intracortical microstimulation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.26.24306239. [PMID: 38712177 PMCID: PMC11071570 DOI: 10.1101/2024.04.26.24306239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Intracortical microstimulation (ICMS) is a method for restoring sensation to people with paralysis as part of a bidirectional brain-computer interface to restore upper limb function. Evoking tactile sensations of the hand through ICMS requires precise targeting of implanted electrodes. Here we describe the presurgical imaging procedures used to generate functional maps of the hand area of the somatosensory cortex and subsequent planning that guided the implantation of intracortical microelectrode arrays. In five participants with cervical spinal cord injury, across two study locations, this procedure successfully enabled ICMS-evoked sensations localized to at least the first four digits of the hand. The imaging and planning procedures developed through this clinical trial provide a roadmap for other brain-computer interface studies to ensure successful placement of stimulation electrodes.
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Affiliation(s)
- John E Downey
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Hunter R Schone
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Stephen T Foldes
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Charles Greenspon
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Fang Liu
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Ceci Verbaarschot
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Daniel Biro
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | - David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | - Chan Hong Moon
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA
| | - Brian A Coffman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Daryl Fields
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Taylor G Hobbs
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Elizaveta Okorokova
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | | | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | | | - Nicholas G Hatsopoulos
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computation Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computation Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
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Alsallom F, Simon MV. Pediatric Intraoperative Neurophysiologic Mapping and Monitoring in Brain Surgery. J Clin Neurophysiol 2024; 41:96-107. [PMID: 38306217 DOI: 10.1097/wnp.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Abstract
SUMMARY Similar to adults, children undergoing brain surgery can significantly benefit from intraoperative neurophysiologic mapping and monitoring. Although young brains present the advantage of increased plasticity, during procedures in close proximity to eloquent regions, the risk of irreversible neurological compromise remains and can be lowered further by these techniques. More so, pathologies specific to the pediatric population, such as neurodevelopmental lesions, often result in medically refractory epilepsy. Thus, their successful surgical treatment also relies on accurate demarcation and resection of the epileptogenic zone, processes in which intraoperative electrocorticography is often employed. However, stemming from the development and maturation of the central and peripheral nervous systems as the child grows, intraoperative neurophysiologic testing in this population poses methodologic and interpretative challenges even to experienced clinical neurophysiologists. For example, it is difficult to perform awake craniotomies and language testing in the majority of pediatric patients. In addition, children may be more prone to intraoperative seizures and exhibit afterdischarges more frequently during functional mapping using electrical cortical stimulation because of high stimulation thresholds needed to depolarize immature cortex. Moreover, choice of anesthetic regimen and doses may be different in pediatric patients, as is the effect of these drugs on immature brain; these factors add additional complexity in terms of interpretation and analysis of neurophysiologic recordings. Below, we are describing the modalities commonly used during intraoperative neurophysiologic testing in pediatric brain surgery, with emphasis on age-specific clinical indications, methodology, and challenges.
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Affiliation(s)
- Faisal Alsallom
- King Fahad Medical City, KFMC Neurosciences Center, Riyadh, Saudi Arabia; and
| | - Mirela V Simon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, U.S.A
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Automatic Localization of Seizure Onset Zone Based on Multi-Epileptogenic Biomarkers Analysis of Single-Contact from Interictal SEEG. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9120769. [PMID: 36550975 PMCID: PMC9774098 DOI: 10.3390/bioengineering9120769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Successful surgery on drug-resistant epilepsy patients (DRE) needs precise localization of the seizure onset zone (SOZ). Previous studies analyzing this issue still face limitations, such as inadequate analysis of features, low sensitivity and limited generality. Our study proposed an innovative and effective SOZ localization method based on multiple epileptogenic biomarkers (spike and HFOs), and analysis of single-contact (MEBM-SC) to address the above problems. We extracted contacts epileptic features from signal distributions and signal energy based on machine learning and end-to-end deep learning. Among them, a normalized pathological ripple rate was designed to reduce the disturbance of physiological ripple and enhance the performance of SOZ localization. Then, a feature selection algorithm based on Shapley value and hypothetical testing (ShapHT+) was used to limit interference from irrelevant features. Moreover, an attention mechanism and a focal loss algorithm were used on the classifier to learn significant features and overcome the unbalance of SOZ/nSOZ contacts. Finally, we provided an SOZ prediction and visualization on magnetic resonance imaging (MRI). Ten patients with DRE were selected to verify our method. The experiment performed cross-validation and revealed that MEBM-SC obtains higher sensitivity. Additionally, the spike has better sensitivity while HFOs have better specificity, and the combination of these biomarkers can achieve the best performance. The study confirmed that MEBM-SC can increase the sensitivity and accuracy of SOZ localization and help clinicians to perform a precise and reliable preoperative evaluation based on interictal SEEG.
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Patient-specific solution of the electrocorticography forward problem in deforming brain. Neuroimage 2022; 263:119649. [PMID: 36167268 DOI: 10.1016/j.neuroimage.2022.119649] [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: 09/30/2021] [Revised: 08/25/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Invasive intracranial electroencephalography (iEEG), or electrocorticography (ECoG), measures electric potential directly on the surface of the brain and can be used to inform treatment planning for epilepsy surgery. Combined with numerical modeling it can further improve accuracy of epilepsy surgery planning. Accurate solution of the iEEG forward problem, which is a crucial prerequisite for solving the iEEG inverse problemin epilepsy seizure onset zone localization, requires accurate representation of the patient's brain geometry and tissue electrical conductivity after implantation of electrodes. However, implantation of subdural grid electrodes causes the brain to deform, which invalidates preoperatively acquired image data. Moreover, postoperative magnetic resonance imaging (MRI) is incompatible with implanted electrodes and computed tomography (CT) has insufficient range of soft tissue contrast, which precludes both MRI and CT from being used to obtain the deformed postoperative geometry. In this paper, we present a biomechanics-based image warping procedure using preoperative MRI for tissue classification and postoperative CT for locating implanted electrodes to perform non-rigid registration of the preoperative image data to the postoperative configuration. We solve the iEEG forward problem on the predicted postoperative geometry using the finite element method (FEM) which accounts for patient-specific inhomogeneity and anisotropy of tissue conductivity. Results for the simulation of a current source in the brain show large differences in electric potential predicted by the models based on the original images and the deformed images corresponding to the brain geometry deformed by placement of invasive electrodes. Computation of the lead field matrix (useful for solution of the iEEG inverse problem) also showed significant differences between the different models. The results suggest that rapid and accurate solution of the forward problem in a deformed brain for a given patient is achievable.
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Shahzadi A, Abrams M, Khatri D, D'Amico R, Langer D, Boockvar JA. Commentary: Intraoperative Seizure Detection During Active Resection of Glioblastoma Through a Novel Hollow Circular Electrocorticography Array. Oper Neurosurg (Hagerstown) 2021; 21:E571-E572. [PMID: 34624891 DOI: 10.1093/ons/opab360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andia Shahzadi
- Department of Neurosurgery, Wyckoff Heights Medical Center, Brooklyn, New York, USA
| | - Madeline Abrams
- Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Deepak Khatri
- Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Randy D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - David Langer
- Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
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