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Barany L, Meszaros C, Alpar A, Ganslandt O, Hore N, Delev D, Schnell O, Kurucz P. Topographical anatomy of the septum verum and its white matter connections. Sci Rep 2024; 14:18064. [PMID: 39103521 PMCID: PMC11300447 DOI: 10.1038/s41598-024-68464-x] [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: 02/28/2024] [Accepted: 07/24/2024] [Indexed: 08/07/2024] Open
Abstract
The human septum verum represents a small but clinically important region of the brain. Based on the results of animal experiments, the stimulation of its medial part was recently proposed with various indications like epilepsy or cognitive impairment after traumatic brain injury. The aim of our study was to present the anatomical relationships of the human septum verum using fiber dissection and histological analysis to support its research and provide essential information for future deep brain stimulation therapies. 16 human cadaveric brains were dissected according to Klingler's method. To validate our macroscopical findings, 12 samples obtained from the dissected brains and 2 additional specimens from unfrozen brains were prepared for histological examinations. We identified the following white matter connections of the septum verum: (1) the precommissural fibers of the fornix; (2) the inferior fascicle of the septum pellucidum; (3) the cingulum; (4) the medial olfactory stria; (5) the ventral amygdalofugal pathway; (6) the stria medullaris of the thalamus and (7) the stria terminalis. Moreover, we could distinguish a less-known fiber bundle connecting the postcommissural column of the fornix to the stria medullaris of the thalamus and the anterior thalamic nuclei. In this study we present valuable anatomical information about this region to promote safe and effective deep brain stimulation therapies in the future.
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Affiliation(s)
- Laszlo Barany
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Cintia Meszaros
- Department of Anatomy, Semmelweis University, Budapest, Hungary
| | - Alan Alpar
- Department of Anatomy, Semmelweis University, Budapest, Hungary
- SE NAP Research Group of Experimental Neuroanatomy and Developmental Biology, Semmelweis University, Budapest, Hungary
| | - Oliver Ganslandt
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Nirjhar Hore
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Daniel Delev
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Peter Kurucz
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
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2
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Piper RJ, Richardson RM, Worrell G, Carmichael DW, Baldeweg T, Litt B, Denison T, Tisdall MM. Towards network-guided neuromodulation for epilepsy. Brain 2022; 145:3347-3362. [PMID: 35771657 PMCID: PMC9586548 DOI: 10.1093/brain/awac234] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/30/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022] Open
Abstract
Epilepsy is well-recognized as a disorder of brain networks. There is a growing body of research to identify critical nodes within dynamic epileptic networks with the aim to target therapies that halt the onset and propagation of seizures. In parallel, intracranial neuromodulation, including deep brain stimulation and responsive neurostimulation, are well-established and expanding as therapies to reduce seizures in adults with focal-onset epilepsy; and there is emerging evidence for their efficacy in children and generalized-onset seizure disorders. The convergence of these advancing fields is driving an era of 'network-guided neuromodulation' for epilepsy. In this review, we distil the current literature on network mechanisms underlying neurostimulation for epilepsy. We discuss the modulation of key 'propagation points' in the epileptogenic network, focusing primarily on thalamic nuclei targeted in current clinical practice. These include (i) the anterior nucleus of thalamus, now a clinically approved and targeted site for open loop stimulation, and increasingly targeted for responsive neurostimulation; and (ii) the centromedian nucleus of the thalamus, a target for both deep brain stimulation and responsive neurostimulation in generalized-onset epilepsies. We discuss briefly the networks associated with other emerging neuromodulation targets, such as the pulvinar of the thalamus, piriform cortex, septal area, subthalamic nucleus, cerebellum and others. We report synergistic findings garnered from multiple modalities of investigation that have revealed structural and functional networks associated with these propagation points - including scalp and invasive EEG, and diffusion and functional MRI. We also report on intracranial recordings from implanted devices which provide us data on the dynamic networks we are aiming to modulate. Finally, we review the continuing evolution of network-guided neuromodulation for epilepsy to accelerate progress towards two translational goals: (i) to use pre-surgical network analyses to determine patient candidacy for neurostimulation for epilepsy by providing network biomarkers that predict efficacy; and (ii) to deliver precise, personalized and effective antiepileptic stimulation to prevent and arrest seizure propagation through mapping and modulation of each patients' individual epileptogenic networks.
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Affiliation(s)
- Rory J Piper
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | | | - Torsten Baldeweg
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Brian Litt
- Department of Neurology and Bioengineering, University of Pennsylvania, Philadelphia, USA
| | | | - Martin M Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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3
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Cole ER, Grogan DP, Laxpati NG, Fernandez AM, Skelton HM, Isbaine F, Gutekunst CA, Gross RE. Evidence supporting deep brain stimulation of the medial septum in the treatment of temporal lobe epilepsy. Epilepsia 2022; 63:2192-2213. [PMID: 35698897 DOI: 10.1111/epi.17326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/28/2022]
Abstract
Electrical brain stimulation has become an essential treatment option for more than one third of epilepsy patients who are resistant to pharmacological therapy and are not candidates for surgical resection. However, currently approved stimulation paradigms achieve only moderate success, on average providing approximately 75% reduction in seizure frequency and extended periods of seizure freedom in nearly 20% of patients. Outcomes from electrical stimulation may be improved through the identification of novel anatomical targets, particularly those with significant anatomical and functional connectivity to the epileptogenic zone. Multiple studies have investigated the medial septal nucleus (i.e., medial septum) as such a target for the treatment of mesial temporal lobe epilepsy. The medial septum is a small midline nucleus that provides a critical functional role in modulating the hippocampal theta rhythm, a 4-7-Hz electrophysiological oscillation mechanistically associated with memory and higher order cognition in both rodents and humans. Elevated theta oscillations are thought to represent a seizure-resistant network activity state, suggesting that electrical neuromodulation of the medial septum and restoration of theta-rhythmic physiology may not only reduce seizure frequency, but also restore cognitive comorbidities associated with mesial temporal lobe epilepsy. Here, we review the anatomical and physiological function of the septohippocampal network, evidence for seizure-resistant effects of the theta rhythm, and the results of stimulation experiments across both rodent and human studies, to argue that deep brain stimulation of the medial septum holds potential to provide an effective neuromodulation treatment for mesial temporal lobe epilepsy. We conclude by discussing the considerations necessary for further evaluating this treatment paradigm with a clinical trial.
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Affiliation(s)
- Eric R Cole
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | | | - Nealen G Laxpati
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alejandra M Fernandez
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Henry M Skelton
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Faical Isbaine
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Claire-Anne Gutekunst
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert E Gross
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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4
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Aykan S, Puglia MH, Kalaycıoğlu C, Pelphrey KA, Tuncalı T, Nalçacı E. Right Anterior Theta Hypersynchrony as a Quantitative Measure Associated with Autistic Traits and K-Cl Cotransporter KCC2 Polymorphism. J Autism Dev Disord 2022; 52:61-72. [PMID: 33635423 DOI: 10.1007/s10803-021-04924-x] [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] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
Our aim was to use theta coherence as a quantitative trait to investigate the relation of the polymorphisms in NKCC1 (rs3087889) and KCC2 (rs9074) channel protein genes to autistic traits (AQ) in neurotypicals. Coherence values for candidate connection regions were calculated from eyes-closed resting EEGs in two independent groups. Hypersynchrony within the right anterior region was related to AQ in both groups (p < 0.05), and variability in this hypersynchrony was related to the rs9074 polymorphism in the total group (p < 0.05). In conclusion, theta hypersynchrony within the right anterior region during eyes-closed rest can be considered a quantitative measure for autistic traits. Replicating our findings in two independent populations with different backgrounds strengthens the validity of the current study.
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Affiliation(s)
- Simge Aykan
- Department of Physiology, Ankara University School of Medicine, Ankara, Turkey.
| | - Meghan H Puglia
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Canan Kalaycıoğlu
- Department of Physiology, Ankara University School of Medicine, Ankara, Turkey
| | - Kevin A Pelphrey
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Timur Tuncalı
- Department of Medical Genetics, Ankara University School of Medicine, Ankara, Turkey
| | - Erhan Nalçacı
- Department of Physiology, Ankara University School of Medicine, Ankara, Turkey
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5
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Abstract
SUMMARY Electrical brain stimulation is an established therapy for movement disorders, epilepsy, obsessive compulsive disorder, and a potential therapy for many other neurologic and psychiatric disorders. Despite significant progress and FDA approvals, there remain significant clinical gaps that can be addressed with next generation systems. Integrating wearable sensors and implantable brain devices with off-the-body computing resources (smart phones and cloud resources) opens a new vista for dense behavioral and physiological signal tracking coupled with adaptive stimulation therapy that should have applications for a range of brain and mind disorders. Here, we briefly review some history and current electrical brain stimulation applications for epilepsy, deep brain stimulation and responsive neurostimulation, and emerging applications for next generation devices and systems.
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Affiliation(s)
- Gregory A Worrell
- Department of Neurology, Mayo Bioelectronics and Neurophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
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6
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Fasano A, Eliashiv D, Herman ST, Lundstrom BN, Polnerow D, Henderson JM, Fisher RS. Experience and consensus on stimulation of the anterior nucleus of thalamus for epilepsy. Epilepsia 2021; 62:2883-2898. [PMID: 34697794 DOI: 10.1111/epi.17094] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/27/2021] [Indexed: 12/11/2022]
Abstract
Deep brain stimulation of the anterior nuclei of thalamus (ANT-DBS) is effective for reduction of seizures, but little evidence is available to guide practitioners in the practical use of this therapy. In an attempt to fill this gap, a questionnaire with 37 questions was circulated to 578 clinicians who were either engaged in clinical trials of or known users of DBS for epilepsy, with responses from 141, of whom 58.2% were epileptologists and 28.4% neurosurgeons. Multiple regions of the world were represented. The survey found that the best candidates for DBS were considered those with temporal or frontal seizures, refractory to at least two medicines. Motivations for renewing therapy upon battery depletion were reduced convulsive, impaired awareness, and severe seizures and improved quality of life. Targeting of leads mainly was by magnetic resonance imaging, sometimes with intraoperative imaging or microelectrode recording. The majority used transventricular approaches. Stimulation parameters mostly imitated the SANTE study parameters, except for initial stimulation amplitudes in the 2-3-V or -mA range, versus 5 V in the SANTE study. Stimulation intensity was most often increased or reduced, respectively, for lack of efficacy or side effects, but changes in active contacts, cycle time, and pulse duration were also employed. Mood or memory problems or paresthesias were the side effects most responsible for adjustments. Off-label sites stimulated included centromedian thalamus, hippocampus, neocortex, and a few others. Several physicians used DBS in conjunction with vagus nerve stimulation or responsive neurostimulation, although our study did not track efficacy for combined use. Experienced users varied more from published parameters than did inexperienced users. In conclusion, surveys of experts can provide Class IV evidence for the most prevalent practical use of ANT-DBS. We present a flowchart for one protocol combining common practices. Controlled comparisons will be needed to choose the best approach.
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Affiliation(s)
- Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Dawn Eliashiv
- Department of Neurology, UCLA Seizure Disorders Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Susan T Herman
- Epilepsy Program, Department of Neurology at Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | | | - Jaimie M Henderson
- Department of Neurosurgery and, by courtesy, Neurology and Neurological Sciences, Wu Tsai Neurosciences Institute and Bio-X Institute, Stanford University, Stanford, California, USA
| | - Robert S Fisher
- Department of Neurology & Neurological Sciences and, by courtesy, Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
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7
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Izadi A, Schedlbauer A, Ondek K, Disse G, Ekstrom AD, Cowen SL, Shahlaie K, Gurkoff GG. Early Intervention via Stimulation of the Medial Septal Nucleus Improves Cognition and Alters Markers of Epileptogenesis in Pilocarpine-Induced Epilepsy. Front Neurol 2021; 12:708957. [PMID: 34557145 PMCID: PMC8452867 DOI: 10.3389/fneur.2021.708957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Over one-third of patients with temporal lobe epilepsy are refractory to medication. In addition, anti-epileptic drugs often exacerbate cognitive comorbidities. Neuromodulation is an FDA treatment for refractory epilepsy, but patients often wait >20 years for a surgical referral for resection or neuromodulation. Using a rodent model, we test the hypothesis that 2 weeks of theta stimulation of the medial septum acutely following exposure to pilocarpine will alter the course of epileptogenesis resulting in persistent behavioral improvements. Electrodes were implanted in the medial septum, dorsal and ventral hippocampus, and the pre-frontal cortex of pilocarpine-treated rats. Rats received 30 min/day of 7.7 Hz or theta burst frequency on days 4-16 post-pilocarpine, prior to the development of spontaneous seizures. Seizure threshold, spikes, and oscillatory activity, as well as spatial and object-based learning, were assessed in the weeks following stimulation. Non-stimulated pilocarpine animals exhibited significantly decreased seizure threshold, increased spikes, and cognitive impairments as compared to vehicle controls. Furthermore, decreased ventral hippocampal power (6-10 Hz) correlated with both the development of spikes and impaired cognition. Measures of spikes, seizure threshold, and cognitive performance in both acute 7.7 Hz and theta burst stimulated animals were statistically similar to vehicle controls when tested during the chronic phase of epilepsy, weeks after stimulation was terminated. These data indicate that modulation of the septohippocampal circuit early after pilocarpine treatment alters the progression of epileptic activity, resulting in elevated seizure thresholds, fewer spikes, and improved cognitive outcome. Results from this study support that septal theta stimulation has the potential to serve in combination or as an alternative to high frequency thalamic stimulation in refractory cases and that further research into early intervention is critical.
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Affiliation(s)
- Ali Izadi
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Amber Schedlbauer
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States
| | - Katelynn Ondek
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Gregory Disse
- Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Arne D Ekstrom
- Department of Psychology, University of Arizona, Tucson, AZ, United States.,McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Stephen L Cowen
- Department of Psychology, University of Arizona, Tucson, AZ, United States.,McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Gene G Gurkoff
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
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Takeuchi Y, Harangozó M, Pedraza L, Földi T, Kozák G, Li Q, Berényi A. Closed-loop stimulation of the medial septum terminates epileptic seizures. Brain 2021; 144:885-908. [PMID: 33501929 DOI: 10.1093/brain/awaa450] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Temporal lobe epilepsy with distributed hippocampal seizure foci is often intractable and its secondary generalization might lead to sudden death. Early termination through spatially extensive hippocampal intervention is not feasible directly, because of the large size and irregular shape of the hippocampus. In contrast, the medial septum is a promising target to govern hippocampal oscillations through its divergent connections to both hippocampi. Combining this 'proxy intervention' concept and precisely timed stimulation, we report here that closed-loop medial septum electrical stimulation can quickly terminate intrahippocampal seizures and suppress secondary generalization in a rat kindling model. Precise stimulus timing governed by internal seizure rhythms was essential. Cell type-specific stimulation revealed that the precisely timed activation of medial septum GABAergic neurons underlaid the effects. Our concept of time-targeted proxy stimulation for intervening pathological oscillations can be extrapolated to other neurological and psychiatric disorders, and has potential for clinical translation.
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Affiliation(s)
- Yuichi Takeuchi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, 467-8603, Japan.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Márk Harangozó
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary
| | - Lizeth Pedraza
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Tamás Földi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Gábor Kozák
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary
| | - Qun Li
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Antal Berényi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged 6720, Hungary.,Neurocybernetics Excellence Center, University of Szeged, Szeged 6720, Hungary.,HCEMM-USZ Magnetotherapeutics Research Group, University of Szeged, Szeged 6720, Hungary.,Neuroscience Institute, New York University, New York, NY 10016, USA
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9
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Magloire V, Lignani G. DBS for refractory epilepsy: is closed-loop stimulation of the medial septum the way forward? Brain 2021; 144:702-705. [PMID: 33844833 DOI: 10.1093/brain/awab051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This scientific commentary refers to ‘Closed-loop stimulation of the medial septum terminates epileptic seizures’, by Takeuchi et al. (doi:10.1093/brain/awaa450), and ‘Medial septal GABAergic neurons reduce seizure duration upon optogenetic closed-loop stimulation’, by Hristova et al. (doi:10.1093/brain/awab042).
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10
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Takeuchi Y, Nagy AJ, Barcsai L, Li Q, Ohsawa M, Mizuseki K, Berényi A. The Medial Septum as a Potential Target for Treating Brain Disorders Associated With Oscillopathies. Front Neural Circuits 2021; 15:701080. [PMID: 34305537 PMCID: PMC8297467 DOI: 10.3389/fncir.2021.701080] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
The medial septum (MS), as part of the basal forebrain, supports many physiological functions, from sensorimotor integration to cognition. With often reciprocal connections with a broad set of peers at all major divisions of the brain, the MS orchestrates oscillatory neuronal activities throughout the brain. These oscillations are critical in generating sensory and emotional salience, locomotion, maintaining mood, supporting innate anxiety, and governing learning and memory. Accumulating evidence points out that the physiological oscillations under septal influence are frequently disrupted or altered in pathological conditions. Therefore, the MS may be a potential target for treating neurological and psychiatric disorders with abnormal oscillations (oscillopathies) to restore healthy patterns or erase undesired ones. Recent studies have revealed that the patterned stimulation of the MS alleviates symptoms of epilepsy. We discuss here that stimulus timing is a critical determinant of treatment efficacy on multiple time scales. On-demand stimulation may dramatically reduce side effects by not interfering with normal physiological functions. A precise pattern-matched stimulation through adaptive timing governed by the ongoing oscillations is essential to effectively terminate pathological oscillations. The time-targeted strategy for the MS stimulation may provide an effective way of treating multiple disorders including Alzheimer's disease, anxiety/fear, schizophrenia, and depression, as well as pain.
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Affiliation(s)
- Yuichi Takeuchi
- Department of Physiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Anett J. Nagy
- MTA-SZTE ‘Momentum’ Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary
| | - Lívia Barcsai
- MTA-SZTE ‘Momentum’ Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary
| | - Qun Li
- MTA-SZTE ‘Momentum’ Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary
| | - Masahiro Ohsawa
- Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Kenji Mizuseki
- Department of Physiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Antal Berényi
- MTA-SZTE ‘Momentum’ Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, Hungary
- Neurocybernetics Excellence Center, University of Szeged, Szeged, Hungary
- HCEMM-USZ Magnetotherapeutics Research Group, University of Szeged, Szeged, Hungary
- Neuroscience Institute, New York University, New York, NY, United States
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11
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Wang Y, Shen Y, Cai X, Yu J, Chen C, Tan B, Tan N, Cheng H, Fan X, Wu X, Liu J, Wang S, Wang Y, Chen Z. Deep brain stimulation in the medial septum attenuates temporal lobe epilepsy via entrainment of hippocampal theta rhythm. CNS Neurosci Ther 2021; 27:577-586. [PMID: 33502829 PMCID: PMC8025637 DOI: 10.1111/cns.13617] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 12/13/2022] Open
Abstract
Aims Temporal lobe epilepsy (TLE), often associated with cognitive impairment, is one of the most common types of medically refractory epilepsy. Deep brain stimulation (DBS) shows considerable promise for the treatment of TLE. However, the optimal stimulation targets and parameters of DBS to control seizures and related cognitive impairment are still not fully illustrated. Methods In the present study, we evaluated the therapeutic potential of DBS in the medial septum (MS) on seizures and cognitive function in mouse acute and chronic epilepsy models. Results We found that DBS in the MS alleviated the severity of seizure activities in both kainic acid‐induced acute seizure model and hippocampal‐kindled epilepsy model. DBS showed antiseizure effects with a wide window of effective stimulation frequencies. The antiseizure effects of DBS were mediated by the hippocampal theta rhythm, as atropine, which reversed the DBS‐induced augmentation of the hippocampal theta oscillation, abolished the antiseizure effects of DBS. Further, in the kainic acid‐induced chronic TLE model, DBS in the MS not only reduced spontaneous seizures, but also improved behavioral performance in novel object recognition. Conclusion DBS in the MS is a promising approach to attenuate TLE probably through entrainment of the hippocampal theta rhythm, which may be therapeutically significant for refractory TLE treatment.
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Affiliation(s)
- Ying Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China.,Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yating Shen
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Xianhui Cai
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Jie Yu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Cong Chen
- Epilepsy Center, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Bei Tan
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Na Tan
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Heming Cheng
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Xiang Fan
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaohua Wu
- Epilepsy Center, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jinggen Liu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuang Wang
- Epilepsy Center, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yi Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China.,Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Zhong Chen
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China.,Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Epilepsy Center, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
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12
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Wang Y, Wang Y, Xu C, Wang S, Tan N, Chen C, Chen L, Wu X, Fei F, Cheng H, Lin W, Qi Y, Chen B, Liang J, Zhao J, Xu Z, Guo Y, Zhang S, Li X, Zhou Y, Duan S, Chen Z. Direct Septum-Hippocampus Cholinergic Circuit Attenuates Seizure Through Driving Somatostatin Inhibition. Biol Psychiatry 2020; 87:843-856. [PMID: 31987494 DOI: 10.1016/j.biopsych.2019.11.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/24/2019] [Accepted: 11/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous studies indicated the involvement of cholinergic neurons in seizure; however, the specific role of the medial septum (MS)-hippocampus cholinergic circuit in temporal lobe epilepsy (TLE) has not yet been completely elucidated. METHODS In the current study, we used magnetic resonance imaging and diffusion tensor imaging to characterize the pathological change of the MS-hippocampus circuit in 42 patients with TLE compared with 22 healthy volunteers. Using optogenetics and chemogenetics, combined with in vivo or in vitro electrophysiology and retrograde rabies virus tracing, we revealed a direct MS-hippocampus cholinergic circuit that potently attenuates seizure through driving somatostatin inhibition in animal TLE models. RESULTS We found that patients with TLE with hippocampal sclerosis showed a decrease of neuronal fiber connectivity of the MS-hippocampus compared with healthy people. In the mouse TLE model, MS cholinergic neurons ceased firing during hippocampal seizures. Optogenetic and chemogenetic activation of MS cholinergic neurons (but not glutamatergic or GABAergic [gamma-aminobutyric acidergic] neurons) significantly attenuated hippocampal seizures, while specific inhibition promoted hippocampal seizures. Electrophysiology combined with modified rabies virus tracing studies showed that direct (but not indirect) MS-hippocampal cholinergic projections mediated the antiseizure effect by preferentially targeting hippocampal GABAergic neurons. Furthermore, chemogenetic inhibition of hippocampal somatostatin-positive (rather than parvalbumin-positive) subtype of GABAergic neurons reversed the antiseizure effect of the MS-hippocampus cholinergic circuit, which was mimicked by activating somatostatin-positive neurons. CONCLUSIONS These findings underscore the notable antiseizure role of the direct cholinergic MS-hippocampus circuit in TLE through driving the downstream somatostatin effector. This may provide a better understanding of the changes of the seizure circuit and the precise spatiotemporal control of epilepsy.
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Affiliation(s)
- Ying Wang
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yi Wang
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China; Institute of Neuroscience, Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Cenglin Xu
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China; Institute of Neuroscience, Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Na Tan
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Cong Chen
- Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liying Chen
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Xiaohua Wu
- Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fan Fei
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Heming Cheng
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Wenkai Lin
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yingbei Qi
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Bin Chen
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Jiao Liang
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China; Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Junli Zhao
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Zhenghao Xu
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yi Guo
- Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shihong Zhang
- Institute of Neuroscience, Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoming Li
- Institute of Neuroscience, Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou, China; Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yudong Zhou
- Institute of Neuroscience, Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou, China; Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shumin Duan
- Institute of Neuroscience, Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou, China; Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhong Chen
- Institute of Pharmacology and Toxicology, NHC and CAMS Key Laboratory of Medical Neurobiology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China; Institute of Neuroscience, Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou, China; Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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13
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The Septum-Hippocampal Cholinergic Circuit: A Novel Pathway for Seizure Control. Biol Psychiatry 2020; 87:785-786. [PMID: 32299581 DOI: 10.1016/j.biopsych.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/23/2022]
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14
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Takeuchi Y, Berényi A. Oscillotherapeutics - Time-targeted interventions in epilepsy and beyond. Neurosci Res 2020; 152:87-107. [PMID: 31954733 DOI: 10.1016/j.neures.2020.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 02/09/2023]
Abstract
Oscillatory brain activities support many physiological functions from motor control to cognition. Disruptions of the normal oscillatory brain activities are commonly observed in neurological and psychiatric disorders including epilepsy, Parkinson's disease, Alzheimer's disease, schizophrenia, anxiety/trauma-related disorders, major depressive disorders, and drug addiction. Therefore, these disorders can be considered as common oscillation defects despite having distinct behavioral manifestations and genetic causes. Recent technical advances of neuronal activity recording and analysis have allowed us to study the pathological oscillations of each disorder as a possible biomarker of symptoms. Furthermore, recent advances in brain stimulation technologies enable time- and space-targeted interventions of the pathological oscillations of both neurological disorders and psychiatric disorders as possible targets for regulating their symptoms.
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Affiliation(s)
- Yuichi Takeuchi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, 6720, Hungary; Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, 467-8603, Japan.
| | - Antal Berényi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, 6720, Hungary; HCEMM-SZTE Magnetotherapeutics Research Group, University of Szeged, Szeged, 6720, Hungary; Neuroscience Institute, New York University, New York, NY 10016, USA.
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15
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Izadi A, Pevzner A, Lee DJ, Ekstrom AD, Shahlaie K, Gurkoff GG. Medial septal stimulation increases seizure threshold and improves cognition in epileptic rats. Brain Stimul 2019; 12:735-742. [PMID: 30733144 DOI: 10.1016/j.brs.2019.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Temporal lobe epilepsy is most prevalent among focal epilepsies, and nearly one-third of patients are refractory to pharmacological intervention. Persistent cognitive and neurobehavioral comorbidities also occur due to the recurrent nature of seizures and medication-related side effects. HYPOTHESIS Electrical neuromodulation is an effective strategy to reduce seizures both in animal models and clinically, but its efficacy to modulate cognition remains unclear. We hypothesized that theta frequency stimulation of the medial septum would increase septohippocampal oscillations, increase seizure threshold, and improve spatial learning in a rat model of pilocarpine-induced epilepsy. METHODS Sham and pilocarpine rats were implanted with electrodes in the medial septum, hippocampus and prefrontal cortex. EEG was assessed days prior to and following stimulation. Sham and pilocarpine-treated rats received either no stimulation, continuous (throughout each behavior), or pre-task (one minute prior to each behavior) 7.7 Hz septal stimulation during the Barnes maze spatial navigation test and also during assessment of flurothyl-induced seizures. RESULTS Both continuous and pre-task stimulation prevented epilepsy-associated reductions in theta oscillations over time. Additionally, both stimulation paradigms significantly improved spatial navigation in the Barnes maze, reducing latency and improving search strategy. Moreover, stimulation led to significant increases in seizure threshold in pilocarpine-treated rats. There was no evidence of cognitive enhancement or increased seizure threshold in stimulated sham rats. CONCLUSION These findings have profound implications as theta stimulation of the septum represents a single frequency and target that has the potential to both improve cognition and reduce seizures for patients with refractory epilepsy.
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Affiliation(s)
- Ali Izadi
- Department of Neurological Surgery, University of California, Davis, USA; Center for Neuroscience, University of California, Davis, USA
| | - Aleksandr Pevzner
- Department of Neurological Surgery, University of California, Davis, USA
| | - Darrin J Lee
- Department of Neurological Surgery, University of California, Davis, USA
| | - Arne D Ekstrom
- Center for Neuroscience, University of California, Davis, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, USA; Center for Neuroscience, University of California, Davis, USA
| | - Gene G Gurkoff
- Department of Neurological Surgery, University of California, Davis, USA; Center for Neuroscience, University of California, Davis, USA.
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16
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Izadi A, Ondek K, Schedlbauer A, Keselman I, Shahlaie K, Gurkoff G. Clinically indicated electrical stimulation strategies to treat patients with medically refractory epilepsy. Epilepsia Open 2018; 3:198-209. [PMID: 30564779 PMCID: PMC6293066 DOI: 10.1002/epi4.12276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 12/25/2022] Open
Abstract
Focal epilepsies represent approximately half of all diagnoses, and more than one-third of these patients are refractory to pharmacologic treatment. Although resection can result in seizure freedom, many patients do not meet surgical criteria, as seizures may be multifocal in origin or have a focus in an eloquent region of the brain. For these individuals, several U.S. Food and Drug Administration (FDA)-approved electrical stimulation paradigms serve as alternative options, including vagus nerve stimulation, responsive neurostimulation, and stimulation of the anterior nucleus of the thalamus. All of these are safe, flexible, and lead to progressive seizure control over time when used as an adjunctive therapy to antiepileptic drugs. Focal epilepsies frequently involve significant comorbidities such as cognitive decline. Similar to antiepilepsy medications and surgical resection, current stimulation targets and parameters have yet to address cognitive impairments directly, with patients reporting persistent comorbidities associated with focal epilepsy despite a significant reduction in the number of their seizures. Although low-frequency theta oscillations of the septohippocampal network are critical for modulating cellular activity and, in turn, cognitive processing, the coordination of neural excitability is also imperative for preventing seizures. In this review, we summarize current FDA-approved electrical stimulation paradigms and propose that theta oscillations of the medial septal nucleus represent a novel neuromodulation target for concurrent seizure reduction and cognitive improvement in epilepsy. Ultimately, further advancements in clinical neurostimulation strategies will allow for the efficient treatment of both seizures and comorbidities, thereby improving overall quality of life for patients with epilepsy.
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Affiliation(s)
- Ali Izadi
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.
| | - Katelynn Ondek
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.,Center for NeuroscienceUniversity of CaliforniaDavisCalifornia,U.S.A.
| | - Amber Schedlbauer
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.
| | - Inna Keselman
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.,Department of NeurologyUniversity of CaliforniaDavisCaliforniaU.S.A.
| | - Kiarash Shahlaie
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.,Center for NeuroscienceUniversity of CaliforniaDavisCalifornia,U.S.A.
| | - Gene Gurkoff
- Department of Neurological SurgeryUniversity of CaliforniaDavisCalifornia,U.S.A.,Center for NeuroscienceUniversity of CaliforniaDavisCalifornia,U.S.A.
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17
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Deep brain stimulation for refractory temporal lobe epilepsy: a systematic review and meta-analysis with an emphasis on alleviation of seizure frequency outcome. Childs Nerv Syst 2018; 34:321-327. [PMID: 28921161 DOI: 10.1007/s00381-017-3596-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 09/04/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Conflicting conclusions have been reported regarding predictors of deep brain stimulation (DBS) outcome in patients with refractory temporal lobe epilepsy (TLE). The main goal of this meta-analysis study was to identify possible predictors of remarkable seizure reduction (RSR). METHODS We conducted a comprehensive search of English-language literature published since 1990 and indexed in PubMed, Embase, and the Cochrane Library that addressed seizure outcomes in patients who underwent DBS for refractory TLE. A pooled RSR rate was determined for eight included studies. RSR rates were analyzed relative to potential prognostic variables. Random- or fixed-effects models were used depending on the presence or absence of heterogeneity. RESULTS The pooled RSR rate among 61 DBS-treated patients with TLE from 8 studies was 59%. Higher likelihood of RSR was found to be associated with lateralization of stimulation, lateralized ictal EEG findings, and a longer follow-up period. Seizure semiology, MRI abnormalities, and patient sex were not predictive of RSR rate. The best electrode type for RSR was the Medtronic 3389. Hippocampal and anterior thalamic nuclei (ATN) sites of stimulation had similar odds of producing RSR. CONCLUSIONS DBS is an effective therapeutic modality for intractable TLE, particularly in patients with lateralized EEG abnormalities and in patients treated on the ictal side. This meta-analysis provides evidence-based information for determining DBS suitability in presurgical counseling and for explaining seizure outcomes.
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18
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Hashimoto A, Sawada T, Natsume K. The change of picrotoxin-induced epileptiform discharges to the beta oscillation by carbachol in rat hippocampal slices. Biophys Physicobiol 2017; 14:137-146. [PMID: 28989834 PMCID: PMC5627988 DOI: 10.2142/biophysico.14.0_137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/08/2017] [Indexed: 12/01/2022] Open
Abstract
The study aimed to determine whether and how the activation of the acetylcholine receptor affects epileptiform discharges in the CA3 region in a rat hippocampus. Picrotoxin (100 μM), a GABAA receptor antagonist, was applied to a hippocampal slice to induce epileptiform discharges. The effects of the cholinergic agonist, carbachol, on the discharges were examined at the several concentrations (1–30 μM). Carbachol had different impacts on epileptiform discharges at the different concentrations. Relatively low concentrations of carbachol (<10 μM) increased the frequency but decreased the amplitude of the discharges. At 10 μM, carbachol induced the discharges, including bursts of theta frequency oscillations. At 30 μM, carbachol could induce bursts of beta frequency oscillations instead of epileptiform discharges. The amplitudes of the oscillations were smaller than those of the discharges. Carbachol suppressed the evoked population EPSPs (pEPSPs) in a dose-dependent manner. These effects were blocked by the muscarinic cholinergic receptor antagonist atropine sulfate. The high level of muscarinic receptor activation can replace epileptiform discharges with theta or beta oscillation. These results suggest that the dose-dependent alternation of the acetylcholine receptor activation may provide the three different stages the epileptiform discharges, the bursts of theta oscillation, and the bursts of the beta oscillation.
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Affiliation(s)
- Ayumi Hashimoto
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Kitakyushu, Fukuoka 808-0196, Japan
| | - Toyohiro Sawada
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Kitakyushu, Fukuoka 808-0196, Japan
| | - Kiyohisa Natsume
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Kitakyushu, Fukuoka 808-0196, Japan
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19
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Lee DJ, Izadi A, Melnik M, Seidl S, Echeverri A, Shahlaie K, Gurkoff GG. Stimulation of the medial septum improves performance in spatial learning following pilocarpine-induced status epilepticus. Epilepsy Res 2017; 130:53-63. [PMID: 28152425 DOI: 10.1016/j.eplepsyres.2017.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/22/2016] [Accepted: 01/09/2017] [Indexed: 01/20/2023]
Abstract
Temporal lobe epilepsy often leads to hippocampal sclerosis and persistent cognitive deficits, including difficulty with learning and memory. Hippocampal theta oscillations are critical in optimizing hippocampal function and facilitating plasticity. We hypothesized that pilocarpine-induced status epilepticus would disrupt oscillations and behavioral performance and that electrical neuromodulation to entrain theta would improve cognition specifically in injured rats. Rats received a pilocarpine (n=30) or saline injection (n=27) and unilateral bi-polar electrodes were implanted into the medial septum and hippocampus the following day. Hippocampal and septal theta were recorded in a Plexiglas box over the first week following implantation. Control and pilocarpine-treated rats were split into stimulation (continuous 7.7Hz, 80μA, 1ms pulse width) and non-stimulation groups for behavioral analysis. Continuous stimulation was initiated one-minute prior to and throughout an object exploration task (post-injury day seven) and again for each of six trials on the Barnes maze (post-injury days 12-14). There was a significant reduction in hippocampal theta power (p<0.05) and percentage of time oscillating in theta (p<0.05). In addition there was a significant decrease in object exploration in rats post-pilocarpine (p<0.05) and an impairment in spatial learning. Specifically, pilocarpine-treated rats were more likely to use random search strategies (p<0.001) and had an increase in latency to find the hidden platform (p<0.05) on the Barnes maze. Stimulation of the medial septum at 7.7Hz in pilocarpine-treated rats resulted in performance similar to shams in both the object recognition and Barnes maze tasks. Stimulation of sham rats resulted in impaired object exploration (p<0.05) with no difference in Barnes maze latency or strategy. In conclusion, pilocarpine-induced seizures diminished hippocampal oscillations and impaired performance in both an object exploration and a spatial memory task in pilocarpine-treated rats. Theta stimulation at 7.7Hz improved behavioral outcome on the Barnes maze task; this improvement in function was not related to a general cognitive enhancement, as shams did not benefit from stimulation. Therefore, stimulation of the medial septum represents an exciting target to improve behavioral outcome in patients with epilepsy.
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Affiliation(s)
- Darrin J Lee
- Department of Neurological Surgery, UC Davis School of Medicine, 4860 Y Street, Suite 3740, Sacramento, CA 95817, United States
| | - Ali Izadi
- Department of Neurological Surgery, UC Davis School of Medicine, 4860 Y Street, Suite 3740, Sacramento, CA 95817, United States; Center for Neuroscience, University of California, 1544 Newton Court, Davis, CA 95618, United States.
| | - Mikhail Melnik
- Department of Neurological Surgery, UC Davis School of Medicine, 4860 Y Street, Suite 3740, Sacramento, CA 95817, United States.
| | - Stacey Seidl
- Department of Neurological Surgery, UC Davis School of Medicine, 4860 Y Street, Suite 3740, Sacramento, CA 95817, United States; Center for Neuroscience, University of California, 1544 Newton Court, Davis, CA 95618, United States.
| | - Angela Echeverri
- Department of Neurological Surgery, UC Davis School of Medicine, 4860 Y Street, Suite 3740, Sacramento, CA 95817, United States.
| | - Kiarash Shahlaie
- Department of Neurological Surgery, UC Davis School of Medicine, 4860 Y Street, Suite 3740, Sacramento, CA 95817, United States; Center for Neuroscience, University of California, 1544 Newton Court, Davis, CA 95618, United States.
| | - Gene G Gurkoff
- Department of Neurological Surgery, UC Davis School of Medicine, 4860 Y Street, Suite 3740, Sacramento, CA 95817, United States; Center for Neuroscience, University of California, 1544 Newton Court, Davis, CA 95618, United States.
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20
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The effect of transcranial direct current stimulation on seizure frequency of patients with mesial temporal lobe epilepsy with hippocampal sclerosis. Clin Neurol Neurosurg 2016; 149:27-32. [DOI: 10.1016/j.clineuro.2016.07.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/23/2016] [Accepted: 07/09/2016] [Indexed: 11/19/2022]
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21
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Pevzner A, Izadi A, Lee DJ, Shahlaie K, Gurkoff GG. Making Waves in the Brain: What Are Oscillations, and Why Modulating Them Makes Sense for Brain Injury. Front Syst Neurosci 2016; 10:30. [PMID: 27092062 PMCID: PMC4823270 DOI: 10.3389/fnsys.2016.00030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/22/2016] [Indexed: 01/19/2023] Open
Abstract
Traumatic brain injury (TBI) can result in persistent cognitive, behavioral and emotional deficits. However, the vast majority of patients are not chronically hospitalized; rather they have to manage their disabilities once they are discharged to home. Promoting recovery to pre-injury level is important from a patient care as well as a societal perspective. Electrical neuromodulation is one approach that has shown promise in alleviating symptoms associated with neurological disorders such as in Parkinson’s disease (PD) and epilepsy. Consistent with this perspective, both animal and clinical studies have revealed that TBI alters physiological oscillatory rhythms. More recently several studies demonstrated that low frequency stimulation improves cognitive outcome in models of TBI. Specifically, stimulation of the septohippocampal circuit in the theta frequency entrained oscillations and improved spatial learning following TBI. In order to evaluate the potential of electrical deep brain stimulation for clinical translation we review the basic neurophysiology of oscillations, their role in cognition and how they are changed post-TBI. Furthermore, we highlight several factors for future pre-clinical and clinical studies to consider, with the hope that it will promote a hypothesis driven approach to subsequent experimental designs and ultimately successful translation to improve outcome in patients with TBI.
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Affiliation(s)
- Aleksandr Pevzner
- Department of Neurological Surgery, University of California-DavisSacramento, CA, USA; Center for Neuroscience, University of California-DavisSacramento, CA, USA
| | - Ali Izadi
- Department of Neurological Surgery, University of California-DavisSacramento, CA, USA; Center for Neuroscience, University of California-DavisSacramento, CA, USA
| | - Darrin J Lee
- Department of Neurological Surgery, University of California-DavisSacramento, CA, USA; Center for Neuroscience, University of California-DavisSacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California-DavisSacramento, CA, USA; Center for Neuroscience, University of California-DavisSacramento, CA, USA
| | - Gene G Gurkoff
- Department of Neurological Surgery, University of California-DavisSacramento, CA, USA; Center for Neuroscience, University of California-DavisSacramento, CA, USA
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22
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Brisch R, Bernstein HG, Dobrowolny H, Krzyżanowska M, Jankowski Z, Bogerts B, Gos T. Volumetric analysis of the diagonal band of Broca in patients with schizophrenia and affective disorders: A post-mortem study. Clin Anat 2015; 29:466-72. [PMID: 26457806 DOI: 10.1002/ca.22656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 10/05/2015] [Accepted: 10/09/2015] [Indexed: 11/09/2022]
Abstract
The human diagonal band of Broca is connected to other parts of the limbic system, such as the hippocampus, that are involved in the pathology of schizophrenia. This study aimed to characterize the volume and anterior-to-posterior distance of the human diagonal band of Broca (vertical limb) from post-mortem brains obtained from three groups: healthy control subjects (N = 17), patients with schizophrenia (N = 26), and patients with affective disorders (N = 12). There were no significant differences in the volume or anterior-to-posterior distance in the patients with schizophrenia or affective disorders compared with the healthy control subjects. To date, this is the first post-mortem investigation measuring the volume and the anterior-to-posterior distance of the diagonal band of Broca (vertical limb) in patients with schizophrenia or affective disorders compared with healthy control subjects.
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Affiliation(s)
- Ralf Brisch
- Department of Forensic Medicine, Ul. Dębowa 23, Medical University of Gdańsk, Gdańsk, Poland
| | - Hans-Gert Bernstein
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany
| | - Henrik Dobrowolny
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany
| | - Marta Krzyżanowska
- Department of Forensic Medicine, Ul. Dębowa 23, Medical University of Gdańsk, Gdańsk, Poland
| | - Zbigniew Jankowski
- Department of Forensic Medicine, Ul. Dębowa 23, Medical University of Gdańsk, Gdańsk, Poland
| | - Bernhard Bogerts
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Tomasz Gos
- Department of Forensic Medicine, Ul. Dębowa 23, Medical University of Gdańsk, Gdańsk, Poland
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