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Baumgartner ME, Qiu L, Philipp LR, Galligan K, Halpern C, Kennedy BC. Technological advances in pediatric epilepsy surgery. Curr Probl Pediatr Adolesc Health Care 2024; 54:101588. [PMID: 38494391 DOI: 10.1016/j.cppeds.2024.101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
| | - Liming Qiu
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Lucas R Philipp
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, USA
| | - Kathleen Galligan
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Casey Halpern
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Benjamin C Kennedy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA; Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, USA.
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Couppey T, Regnacq L, Giraud R, Romain O, Bornat Y, Kolbl F. NRV: An open framework for in silico evaluation of peripheral nerve electrical stimulation strategies. PLoS Comput Biol 2024; 20:e1011826. [PMID: 38995970 PMCID: PMC11268605 DOI: 10.1371/journal.pcbi.1011826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/24/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Electrical stimulation of peripheral nerves has been used in various pathological contexts for rehabilitation purposes or to alleviate the symptoms of neuropathologies, thus improving the overall quality of life of patients. However, the development of novel therapeutic strategies is still a challenging issue requiring extensive in vivo experimental campaigns and technical development. To facilitate the design of new stimulation strategies, we provide a fully open source and self-contained software framework for the in silico evaluation of peripheral nerve electrical stimulation. Our modeling approach, developed in the popular and well-established Python language, uses an object-oriented paradigm to map the physiological and electrical context. The framework is designed to facilitate multi-scale analysis, from single fiber stimulation to whole multifascicular nerves. It also allows the simulation of complex strategies such as multiple electrode combinations and waveforms ranging from conventional biphasic pulses to more complex modulated kHz stimuli. In addition, we provide automated support for stimulation strategy optimization and handle the computational backend transparently to the user. Our framework has been extensively tested and validated with several existing results in the literature.
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Affiliation(s)
- Thomas Couppey
- Laboratoire ETIS, Cergy Paris Université, ENSEA, CNRS UMR 8051, Cergy, France
| | - Louis Regnacq
- Laboratoire ETIS, Cergy Paris Université, ENSEA, CNRS UMR 8051, Cergy, France
- Univ. Bordeaux, CNRS, Bordeaux INP, IMS, UMR 5218, Talence, France
| | - Roland Giraud
- Laboratoire ETIS, Cergy Paris Université, ENSEA, CNRS UMR 8051, Cergy, France
- Univ. Bordeaux, CNRS, Bordeaux INP, IMS, UMR 5218, Talence, France
| | - Olivier Romain
- Laboratoire ETIS, Cergy Paris Université, ENSEA, CNRS UMR 8051, Cergy, France
| | - Yannick Bornat
- Univ. Bordeaux, CNRS, Bordeaux INP, IMS, UMR 5218, Talence, France
| | - Florian Kolbl
- Laboratoire ETIS, Cergy Paris Université, ENSEA, CNRS UMR 8051, Cergy, France
- Univ. Bordeaux, CNRS, Bordeaux INP, IMS, UMR 5218, Talence, France
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3
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Sanger ZT, Henry TR, Park MC, Darrow D, McGovern RA, Netoff TI. Neural signal data collection and analysis of Percept™ PC BrainSense recordings for thalamic stimulation in epilepsy. J Neural Eng 2024; 21:10.1088/1741-2552/ad1dc3. [PMID: 38211344 PMCID: PMC11299490 DOI: 10.1088/1741-2552/ad1dc3] [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: 05/18/2023] [Accepted: 01/11/2024] [Indexed: 01/13/2024]
Abstract
Deep brain stimulation (DBS) using Medtronic's Percept™ PC implantable pulse generator is FDA-approved for treating Parkinson's disease (PD), essential tremor, dystonia, obsessive compulsive disorder, and epilepsy. Percept™ PC enables simultaneous recording of neural signals from the same lead used for stimulation. Many Percept™ PC sensing features were built with PD patients in mind, but these features are potentially useful to refine therapies for many different disease processes. When starting our ongoing epilepsy research study, we found it difficult to find detailed descriptions about these features and have compiled information from multiple sources to understand it as a tool, particularly for use in patients other than those with PD. Here we provide a tutorial for scientists and physicians interested in using Percept™ PC's features and provide examples of how neural time series data is often represented and saved. We address characteristics of the recorded signals and discuss Percept™ PC hardware and software capabilities in data pre-processing, signal filtering, and DBS lead performance. We explain the power spectrum of the data and how it is shaped by the filter response of Percept™ PC as well as the aliasing of the stimulation due to digitally sampling the data. We present Percept™ PC's ability to extract biomarkers that may be used to optimize stimulation therapy. We show how differences in lead type affects noise characteristics of the implanted leads from seven epilepsy patients enrolled in our clinical trial. Percept™ PC has sufficient signal-to-noise ratio, sampling capabilities, and stimulus artifact rejection for neural activity recording. Limitations in sampling rate, potential artifacts during stimulation, and shortening of battery life when monitoring neural activity at home were observed. Despite these limitations, Percept™ PC demonstrates potential as a useful tool for recording neural activity in order to optimize stimulation therapies to personalize treatment.
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Affiliation(s)
- Zachary T Sanger
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, United States of America
| | - Thomas R Henry
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Michael C Park
- Department of Neurosurgery, University of Minnesota, Minneapolis, United States of America
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - David Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, United States of America
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota, Minneapolis, United States of America
| | - Theoden I Netoff
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, United States of America
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Couppey T, Regnacq L, Giraud R, Romain O, Bornat Y, Kölbl F. NRV: An open framework for in silico evaluation of peripheral nerve electrical stimulation strategies. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.15.575628. [PMID: 38293181 PMCID: PMC10827078 DOI: 10.1101/2024.01.15.575628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Electrical stimulation of peripheral nerves has been used in various pathological contexts for rehabilitation purposes or to alleviate the symptoms of neuropathologies, thus improving the overall quality of life of patients. However, the development of novel therapeutic strategies is still a challenging issue requiring extensive in vivo experimental campaigns and technical development. To facilitate the design of new stimulation strategies, we provide a fully open source and self-contained software framework for the in silico evaluation of peripheral nerve electrical stimulation. Our modeling approach, developed in the popular and well-established Python language, uses an object-oriented paradigm to map the physiological and electrical context. The framework is designed to facilitate multi-scale analysis, from single fiber stimulation to whole multifascicular nerves. It also allows the simulation of complex strategies such as multiple electrode combinations and waveforms ranging from conventional biphasic pulses to more complex modulated kHz stimuli. In addition, we provide automated support for stimulation strategy optimization and handle the computational backend transparently to the user. Our framework has been extensively tested and validated with several existing results in the literature.
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Affiliation(s)
| | - Louis Regnacq
- ETIS CNRS UMR 8051, CY Cergy Paris University, ENSEA
- Univ. Bordeaux, Bordeaux INP, IMS CNRS UMR 5218, Aquitaine, Talence, France
| | - Roland Giraud
- ETIS CNRS UMR 8051, CY Cergy Paris University, ENSEA
- Univ. Bordeaux, Bordeaux INP, IMS CNRS UMR 5218, Aquitaine, Talence, France
| | | | - Yannick Bornat
- Univ. Bordeaux, Bordeaux INP, IMS CNRS UMR 5218, Aquitaine, Talence, France
| | - Florian Kölbl
- ETIS CNRS UMR 8051, CY Cergy Paris University, ENSEA
- Univ. Bordeaux, Bordeaux INP, IMS CNRS UMR 5218, Aquitaine, Talence, France
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5
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Boleti APDA, Cardoso PHDO, Frihling BEF, de Moraes LFRN, Nunes EAC, Mukoyama LTH, Nunes EAC, Carvalho CME, Macedo MLR, Migliolo L. Pathophysiology to Risk Factor and Therapeutics to Treatment Strategies on Epilepsy. Brain Sci 2024; 14:71. [PMID: 38248286 PMCID: PMC10813806 DOI: 10.3390/brainsci14010071] [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: 12/18/2023] [Revised: 12/30/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
Abstract
Epilepsy represents a condition in which abnormal neuronal discharges or the hyperexcitability of neurons occur with synchronicity, presenting a significant public health challenge. Prognostic factors, such as etiology, electroencephalogram (EEG) abnormalities, the type and number of seizures before treatment, as well as the initial unsatisfactory effects of medications, are important considerations. Although there are several third-generation antiepileptic drugs currently available, their multiple side effects can negatively affect patient quality of life. The inheritance and etiology of epilepsy are complex, involving multiple underlying genetic and epigenetic mechanisms. Different neurotransmitters play crucial roles in maintaining the normal physiology of different neurons. Dysregulations in neurotransmission, due to abnormal transmitter levels or changes in their receptors, can result in seizures. In this review, we address the roles played by various neurotransmitters and their receptors in the pathophysiology of epilepsy. Furthermore, we extensively explore the neurological mechanisms involved in the development and progression of epilepsy, along with its risk factors. Furthermore, we highlight the new therapeutic targets, along with pharmacological and non-pharmacological strategies currently employed in the treatment of epileptic syndromes, including drug interventions employed in clinical trials related to epilepsy.
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Affiliation(s)
- Ana Paula de Araújo Boleti
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
- Laboratório de Purificação de Proteínas e Suas Funções Biológicas, Unidade de Tecnologia de Alimentos e da Saúde Pública, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil;
| | - Pedro Henrique de Oliveira Cardoso
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
| | - Breno Emanuel Farias Frihling
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
| | - Luiz Filipe Ramalho Nunes de Moraes
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
| | - Ellynes Amancio Correia Nunes
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Norte, Natal 59078-970, Brazil
| | - Lincoln Takashi Hota Mukoyama
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
| | - Ellydberto Amancio Correia Nunes
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Norte, Natal 59078-970, Brazil
| | - Cristiano Marcelo Espinola Carvalho
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
| | - Maria Lígia Rodrigues Macedo
- Laboratório de Purificação de Proteínas e Suas Funções Biológicas, Unidade de Tecnologia de Alimentos e da Saúde Pública, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil;
| | - Ludovico Migliolo
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Norte, Natal 59078-970, Brazil
- Programa de Pós-graduação em Biologia Celular e Molecular, Universidade Federal da Paraíba, João Pessoa 58051-900, Brazil
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Venkatesh P, Wolfe C, Lega B. Neuromodulation of the anterior thalamus: Current approaches and opportunities for the future. CURRENT RESEARCH IN NEUROBIOLOGY 2023; 5:100109. [PMID: 38020810 PMCID: PMC10663132 DOI: 10.1016/j.crneur.2023.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023] Open
Abstract
The role of thalamocortical circuits in memory has driven a recent burst of scholarship, especially in animal models. Investigating this circuitry in humans is more challenging. And yet, the development of new recording and stimulation technologies deployed for clinical indications has created novel opportunities for data collection to elucidate the cognitive roles of thalamic structures. These technologies include stereoelectroencephalography (SEEG), deep brain stimulation (DBS), and responsive neurostimulation (RNS), all of which have been applied to memory-related thalamic regions, specifically for seizure localization and treatment. This review seeks to summarize the existing applications of neuromodulation of the anterior thalamic nuclei (ANT) and highlight several devices and their capabilities that can allow cognitive researchers to design experiments to assay its functionality. Our goal is to introduce to investigators, who may not be familiar with these clinical devices, the capabilities, and limitations of these tools for understanding the neurophysiology of the ANT as it pertains to memory and other behaviors. We also briefly cover the targeting of other thalamic regions including the centromedian (CM) nucleus, dorsomedial (DM) nucleus, and pulvinar, with associated potential avenues of experimentation.
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Affiliation(s)
- Pooja Venkatesh
- Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Cody Wolfe
- Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Bradley Lega
- Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, 75390, USA
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Mathon B. Perspectives de la chirurgie de l’épilepsie à l’heure des nouvelles technologies. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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8
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Xu K, Xie P, Deng J, Tang C, Wang X, Guan Y, Zhou J, Li T, Liang X, Jing B, Gao JH, Luan G. Long-term ANT-DBS effects in pilocarpine-induced epileptic rats: A combined 9.4T MRI and histological study. J Neurosci Res 2023; 101:916-929. [PMID: 36696411 DOI: 10.1002/jnr.25169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) appears to be effective against seizures in animals and humans however, its therapeutic mechanisms remain elusive. This study aimed to combine 9.4T multimodal magnetic resonance imaging (MRI) with histology to investigate the longitudinal effects of long-term ANT-DBS in pilocarpine-induced epileptic rats. Status epilepsy (SE) was induced by LiCl-pilocarpine injection in 11 adult male Sprague-Dawley rats. Four weeks after SE, chronic epileptic rats underwent either ANT-DBS (n = 6) or sham-DBS (n = 5) surgery. Electroencephalography (EEG) and spontaneous recurrent seizures (SRS) were recorded for 1 week. The T2-weighted image and images from resting-state functional MRI (rs-fMRI) were acquired at three states: before SE, at 4 weeks post-SE, and at 5 weeks post-DBS. Volumes of the hippocampal subregions and hippocampal-related functional connectivity (FC) were compared longitudinally. Finally, antibodies against neuronal nuclei (NeuN) and glial fibrillary acidic proteins were used to evaluate neuronal loss and astrogliosis in the hippocampus. Long-term ANT-DBS significantly reduced seizure generalization in pilocarpine-induced epileptic rats. By analyzing the gray matter volume using T2-weighted images, long-term ANT-DBS displayed morphometric restoration of the hippocampal subregions. Neuronal protection of the hippocampal subregions and inhibition of astrogliosis in the hippocampal subregions were observed in the ANT-DBS group. ANT-DBS caused reversible regulation of FC in the insula-hippocampus and subthalamic nucleus-hippocampus. Long-term ANT-DBS provides comprehensive protection of hippocampal histology, hippocampal morphometrics, and hippocampal-related functional networks.
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Affiliation(s)
- Ke Xu
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Pandeng Xie
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Jiahui Deng
- Beijing Key Laboratory of Epilepsy Research, Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Chongyang Tang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiongfei Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Tianfu Li
- Beijing Key Laboratory of Epilepsy Research, Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Epilepsy, Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiaohang Liang
- Beijing City Key Laboratory for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
- Center for MRI Research, Peking University, Beijing, China
| | - Bin Jing
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Jia-Hong Gao
- Beijing City Key Laboratory for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
- Center for MRI Research, Peking University, Beijing, China
| | - Guoming Luan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Epilepsy Research, Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
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Davila CE, Wang DX, Ritzer M, Moran R, Lega BC. A Control-Theoretical System for Modulating Hippocampal Gamma Oscillations using Stimulation of the Posterior Cingulate Cortex. IEEE Trans Neural Syst Rehabil Eng 2022; 30:2242-2253. [PMID: 35849675 PMCID: PMC9469793 DOI: 10.1109/tnsre.2022.3192170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Closed-loop stimulation for targeted modulation of brain signals has emerged as a promising strategy for episodic memory restoration. In parallel, closed-loop neuromodulation strategies have been applied to treat brain conditions including drug-resistant depression, Parkinson’s Disease, and epilepsy. In this study, we seek to apply control theoretical principles to achieve closed loop modulation of hippocampal oscillatory activity. We focus on hippocampal gamma power, a signal with an established association for episodic memory processing, which may be a promising ‘biomarker’ for the modulation of memory performance. To develop a closed-loop stimulation paradigm that effectively modulates hippocampal gamma power, we use a novel data-set in which open-loop stimulation was applied to the posterior cingulate cortex and hippocampal gamma power was recorded during the encoding of episodic memories. The dataset was used to design and evaluate a linear quadratic integral (LQI) servo-controller in order to determine its viability for in-vivo use. In our simulation framework, we demonstrate that applying an LQI servo controller based on an autoregressive with exogenous input (ARX) plant model achieves effective control of hippocampal gamma power in 15 out of 17 experimental subjects. We demonstrate that we are able to modulate gamma power using stimulation thresholds that are physiologically safe and on time scales that are reasonable for application in a clinical system. We outline further experimentation to test our proposed system and compare our findings to emerging closed-loop neuromodulation strategies.
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Moreira-Holguín JC, Barahona-Morán DA, Hidalgo-Esmeraldas J, Guzmán-Rochina C. Neuromodulation of the anterior thalamic nucleus as a therapeutic option for difficult-to-control epilepsy. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:182-189. [PMID: 35725219 DOI: 10.1016/j.neucie.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/16/2020] [Indexed: 06/15/2023]
Abstract
Deep brain stimulation (DBS) consists of the electrical stimulation of the subcortical structures by implanting electrodes connected to a pulse generator. The thalamus, being a structure that has multiple connections with various parts of the central nervous system, is a suitable target for DBS. The anterior thalamic nucleus (ANT) serves as an important relay site for the limbic system by receiving input from the hippocampus and mammillary bodies, and sending input to the cingulate gyrus; thus forming the Papez circuit. Due to these connections, the ANT constitutes an ideal route for the propagation of epileptogenic activity. ANT-DBS has excellent results in the control of complex partial seizures. The vast majority of patients with ANT-DBS have shown a significant reduction in the frequency of their seizures of more than 50%.
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Affiliation(s)
- Juan Carlos Moreira-Holguín
- Servicio de Neurocirugía, Hospital de Especialidades Guayaquil "Dr. Abel Gilbert Pontón", Guayaquil, Ecuador; Escuela de Medicina, Universidad de Guayaquil, Guayaquil, Ecuador.
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Vetkas A, Germann J, Elias G, Loh A, Boutet A, Yamamoto K, Sarica C, Samuel N, Milano V, Fomenko A, Santyr B, Tasserie J, Gwun D, Jung HH, Valiante T, Ibrahim GM, Wennberg R, Kalia SK, Lozano AM. Identifying the neural network for neuromodulation in epilepsy through connectomics and graphs. Brain Commun 2022; 4:fcac092. [PMID: 35611305 PMCID: PMC9123846 DOI: 10.1093/braincomms/fcac092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/13/2021] [Accepted: 03/31/2022] [Indexed: 02/01/2023] Open
Abstract
Deep brain stimulation is a treatment option for patients with drug-resistant epilepsy. The precise mechanism of neuromodulation in epilepsy is unknown, and biomarkers are needed for optimizing treatment. The aim of this study was to describe the neural network associated with deep brain stimulation targets for epilepsy and to explore its potential application as a novel biomarker for neuromodulation. Using seed-to-voxel functional connectivity maps, weighted by seizure outcomes, brain areas associated with stimulation were identified in normative resting state functional scans of 1000 individuals. To pinpoint specific regions in the normative epilepsy deep brain stimulation network, we examined overlapping areas of functional connectivity between the anterior thalamic nucleus, centromedian thalamic nucleus, hippocampus and less studied epilepsy deep brain stimulation targets. Graph network analysis was used to describe the relationship between regions in the identified network. Furthermore, we examined the associations of the epilepsy deep brain stimulation network with disease pathophysiology, canonical resting state networks and findings from a systematic review of resting state functional MRI studies in epilepsy deep brain stimulation patients. Cortical nodes identified in the normative epilepsy deep brain stimulation network were in the anterior and posterior cingulate, medial frontal and sensorimotor cortices, frontal operculum and bilateral insulae. Subcortical nodes of the network were in the basal ganglia, mesencephalon, basal forebrain and cerebellum. Anterior thalamic nucleus was identified as a central hub in the network with the highest betweenness and closeness values, while centromedian thalamic nucleus and hippocampus showed average centrality values. The caudate nucleus and mammillothalamic tract also displayed high centrality values. The anterior cingulate cortex was identified as an important cortical hub associated with the effect of deep brain stimulation in epilepsy. The neural network of deep brain stimulation targets shared hubs with known epileptic networks and brain regions involved in seizure propagation and generalization. Two cortical clusters identified in the epilepsy deep brain stimulation network included regions corresponding to resting state networks, mainly the default mode and salience networks. Our results were concordant with findings from a systematic review of resting state functional MRI studies in patients with deep brain stimulation for epilepsy. Our findings suggest that the various epilepsy deep brain stimulation targets share a common cortico-subcortical network, which might in part underpin the antiseizure effects of stimulation. Interindividual differences in this network functional connectivity could potentially be used as biomarkers in selection of patients, stimulation parameters and neuromodulation targets.
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Affiliation(s)
- Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Neurology clinic, Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gavin Elias
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nardin Samuel
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Milano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anton Fomenko
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brendan Santyr
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jordy Tasserie
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dave Gwun
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hyun Ho Jung
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taufik Valiante
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- CRANIA, University Health Network and University of Toronto, Toronto, ON, M5G 2A2, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
| | - George M Ibrahim
- Division of Pediatric Neurosurgery, Sick Kids Toronto, University of Toronto, Toronto, ON, Canada
| | - Richard Wennberg
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- CRANIA, University Health Network and University of Toronto, Toronto, ON, M5G 2A2, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- CRANIA, University Health Network and University of Toronto, Toronto, ON, M5G 2A2, Canada
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12
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Phillips RK, Aghagoli G, Blum AS, Asaad WF. Bilateral thalamic responsive neurostimulation for multifocal, bilateral frontotemporal epilepsy: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21672. [PMID: 36273865 PMCID: PMC9379679 DOI: 10.3171/case21672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Patients with refractory, bilateral, multifocal epilepsy have few treatment options that typically include a combination of antiseizure medications (ASMs) and vagus nerve stimulation (VNS). A man in his 40s presented with epilepsy refractory to a combination of five ASMs plus VNS; he was still experiencing 7–10 seizures per week. His seizure network involved multiple foci in both frontal and temporal lobes. Bilateral depth electrodes were implanted into the centromedian/parafascicular (CM/PF) complex of the thalamus and connected to the responsive neurostimulation (RNS) system for closed-loop stimulation and neurophysiological monitoring.
OBSERVATIONS
The patient reported clear improvement in his seizures since the procedure, with a markedly reduced number of seizures and decreased seizure intensity. He also reported stretches of seizure freedom not typical of his preoperative baseline, and his remaining seizures were milder, more often with preserved awareness. Generalized seizures with loss of consciousness have decreased to about one per month. RNS data confirmed a right-sided predominance of the bilateral seizure onsets.
LESSONS
In this patient with multifocal, bilateral frontotemporal epilepsy, RNS of the CM/PF thalamic complex combined with VNS was found to be beneficial. The RNS device was able to detect seizures propagating through the thalamus, and stimulation produced a decrease in seizure burden and intensity.
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Affiliation(s)
| | | | - Andrew S. Blum
- Neurology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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13
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Perez-Malagon CD, Lopez-Gonzalez MA. Epilepsy and Deep Brain Stimulation of Anterior Thalamic Nucleus. Cureus 2021; 13:e18199. [PMID: 34584817 PMCID: PMC8458162 DOI: 10.7759/cureus.18199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
Presently, at least 60 million people are suffering from epilepsy worldwide. Although multiple pharmacological options for treatment exist, about 30% to 40% of these patients are estimated to have drug-resistant epilepsy (DRE), which is associated with severe disability and morbidity. The surgical treatment options are restricted to either open surgical procedures or laser ablations. When a resective option is not favorable, then neuromodulation options such as vagal nerve stimulation and deep brain stimulation are considered. A relatively recent and more commonly used clinical application is the deep brain stimulation (DBS) of the anterior thalamic nucleus, FDA approval for which was obtained in 2018. Furthermore, new technological advances in DBS technology are expected to positively impact the treatment options of these patients.
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Affiliation(s)
- Carlos D Perez-Malagon
- Anatomy, Centro de Ciencias Biomedicas, Universidad Autonoma de Aguascalientes, Aguascalientes, MEX
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14
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Elias GJB, Germann J, Neudorfer C, Namasivayam AA, Loh A, Gramer RM, Ibrahim GM, Valiante T, Tomaszczyk JC, McAndrews MP, Kucharczyk W, Boutet A, Lozano AM. Impact of Mesial Temporal Lobe Resection on Brain Structure in Medically Refractory Epilepsy. World Neurosurg 2021; 152:e652-e665. [PMID: 34144173 DOI: 10.1016/j.wneu.2021.06.039] [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: 03/23/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Surgical resection can decrease seizure frequency in medically intractable temporal lobe epilepsy. However, the functional and structural consequences of this intervention on brain circuitry are poorly understood. We investigated structural changes that occur in brain circuits after mesial temporal lobe resection for refractory epilepsy. Specifically, we used neuroimaging techniques to evaluate changes in 1) contralesional hippocampal and bilateral mammillary body volume and 2) brain-wide cortical thickness. METHODS Serial T1-weighted brain magnetic resonance images were acquired before and after surgery (1.6 ± 0.5 year interval) in 21 patients with temporal lobe epilepsy (9 women, 12 men; mean age, 39.4 ± 11.5 years) who had undergone unilateral temporal lobe resection (14 anterior temporal lobectomy; 7 selective amygdalohippocampectomy). Blinded manual segmentation of the unresected hippocampal formation and bilateral mammillary bodies was performed using the Pruessner and Copenhaver protocols, respectively. Brain-wide cortical thickness estimates were computed using the CIVET pipeline. RESULTS Surgical resection was associated with a 5% reduction in contralesional hippocampal volume (P < 0.01) and a 9.5% reduction in mammillary body volume (P = 0.03). In addition, significant changes in cortical thickness were observed in contralesional anterior and middle cingulate gyrus and insula (Pfalse discovery rate < 0.01) as well as in other temporal, frontal, and occipital regions (Pfalse discovery rate < 0.05). Postoperative verbal memory function was significantly associated with cortical thickness change in contralesional inferior temporal gyrus (R2 = 0.39; P = 0.03). CONCLUSIONS These results indicate that mesial temporal lobe resection is associated with both volume loss in spared Papez circuitry and changes in cortical thickness across the brain.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Clemens Neudorfer
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrew A Namasivayam
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Robert M Gramer
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Taufik Valiante
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer C Tomaszczyk
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mary Pat McAndrews
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - Walter Kucharczyk
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
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15
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Sweeney-Reed CM, Buentjen L, Voges J, Schmitt FC, Zaehle T, Kam JWY, Kaufmann J, Heinze HJ, Hinrichs H, Knight RT, Rugg MD. The role of the anterior nuclei of the thalamus in human memory processing. Neurosci Biobehav Rev 2021; 126:146-158. [PMID: 33737103 DOI: 10.1016/j.neubiorev.2021.02.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022]
Abstract
Extensive neuroanatomical connectivity between the anterior thalamic nuclei (ATN) and hippocampus and neocortex renders them well-placed for a role in memory processing, and animal, lesion, and neuroimaging studies support such a notion. The deep location and small size of the ATN have precluded their real-time electrophysiological investigation during human memory processing. However, ATN electrophysiological recordings from patients receiving electrodes implanted for deep brain stimulation for pharmacoresistant focal epilepsy have enabled high temporal resolution study of ATN activity. Theta frequency synchronization of ATN and neocortical oscillations during successful memory encoding, enhanced phase alignment, and coupling between ATN local gamma frequency activity and frontal neocortical and ATN theta oscillations provide evidence of an active role for the ATN in memory encoding, potentially integrating information from widespread neocortical sources. Greater coupling of a broader gamma frequency range with theta oscillations at rest than during memory encoding provides additional support for the hypothesis that the ATN play a role in selecting local, task-relevant high frequency activity associated with particular features of a memory trace.
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Affiliation(s)
- Catherine M Sweeney-Reed
- Neurocybernetics and Rehabilitation, Dept. of Neurology, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany; Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany.
| | - Lars Buentjen
- Dept. of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Jürgen Voges
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Tino Zaehle
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Julia W Y Kam
- Department of Psychology, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Helen Wills Neuroscience Institute, University of California - Berkeley, Berkeley, CA, USA
| | - Jörn Kaufmann
- Dept. of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Neurology, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Hermann Hinrichs
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Neurology, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Robert T Knight
- Helen Wills Neuroscience Institute, University of California - Berkeley, Berkeley, CA, USA; Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Michael D Rugg
- Center for Vital Longevity and School of Behavioral and Brain Sciences, University of Texas, Dallas, TX, USA
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16
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Moreira-Holguín JC, Barahona-Morán DA, Hidalgo-Esmeraldas J, Guzmán-Rochina C. Neuromodulation of the anterior thalamic nucleus as a therapeutic option for difficult-to-control epilepsy. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00002-6. [PMID: 33551281 DOI: 10.1016/j.neucir.2020.12.001] [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: 04/15/2020] [Revised: 11/17/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Deep brain stimulation (DBS) consists of the electrical stimulation of the subcortical structures by implanting electrodes connected to a pulse generator. The thalamus, being a structure that has multiple connections with various parts of the central nervous system, is a suitable target for DBS. The anterior thalamic nucleus (ANT) serves as an important relay site for the limbic system by receiving input from the hippocampus and mammillary bodies, and sending input to the cingulate gyrus; thus forming the Papez circuit. Due to these connections, the ANT constitutes an ideal route for the propagation of epileptogenic activity. ANT-DBS has excellent results in the control of complex partial seizures. The vast majority of patients with ANT-DBS have shown a significant reduction in the frequency of their seizures of more than 50%.
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Affiliation(s)
- Juan Carlos Moreira-Holguín
- Servicio de Neurocirugía, Hospital de Especialidades Guayaquil «Dr. Abel Gilbert Pontón», Guayaquil, Ecuador; Escuela de Medicina, Universidad de Guayaquil, Guayaquil, Ecuador.
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17
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Abstract
More than one million people in the United States suffer from seizures that are not controlled with antiseizure medications. Targeted interventions such as surgery and deep brain stimulation can confer seizure reduction or even freedom in many of these patients with drug-resistant epilepsy, but success critically depends on identification of epileptogenic zones through MR imaging. Ultrahigh field imaging facilitates improved sensitivity and resolution across many imaging modalities and may facilitate better detection of epileptic markers than is achieved at lower field strengths. The increasing availability and clinical adoption of ultrahigh field scanners play an important role in characterizing drug-resistant epilepsy and planning for its treatment.
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Affiliation(s)
- Gaurav Verma
- Biomedical Engineering and Imaging Institute, The Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA.
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
| | - Priti Balchandani
- Biomedical Engineering and Imaging Institute, The Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA; Department of Diagnostic, Molecular and Interventional Radiology, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
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18
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Tang W, He X, Feng L, Liu D, Yang Z, Zhang J, Xiao B, Yang Z. The Role of Hippocampal Neurogenesis in ANT-DBS for LiCl-Pilocarpine-Induced Epileptic Rats. Stereotact Funct Neurosurg 2020; 99:55-64. [PMID: 33302280 DOI: 10.1159/000509314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 06/10/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Abnormal neurogenesis in the hippocampus after status epilepticus (SE) has been suggested as a key pathogeny of temporal lobe epilepsy. This study aimed to investigate the effect of deep brain stimulation of the anterior thalamic nucleus (ANT-DBS) on hippocampal neurogenesis in LiCl-pilocarpine-induced epileptic rats and to analyze its relationship with postoperative spontaneous recurrent seizures (SRS) and anxiety. METHOD SE was induced by a systemic LiCl-pilocarpine injection in adult male rats. Rats in the DBS group underwent ANT-DBS immediately after successful SE induction. SRS was only recorded during the chronic stage. An elevated plus maze was used to evaluate the level of anxiety in rats 7, 28, and 60 days after SE onset. After the elevated plus-maze experiment, rats were sacrificed under anesthesia in order to evaluate hippocampal neurogenesis. Doublecortin (DCX) was used as a marker for neurogenesis. RESULTS During the chronic stage, SRS in rats in the DBS group were significantly decreased. The level of anxiety was increased significantly in rats in the DBS group 28 days after SE, while no significant differences in anxiety levels were found 7 and 60 days after SE. The number of DCX-positive cells in the hippocampus was significantly increased 7 days after SE and was significantly decreased 60 days after SE in all rats in which SE was induced. However, the number of DCX-positive cells in the DBS group was significantly lower than that in the other groups 28 days after SE. CONCLUSIONS ANT-DBS may suppress SRS and increase the postoperative anxiety of epileptic rats by influencing hippocampal neurogenesis.
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Affiliation(s)
- Weiting Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xinghui He
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China,
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuanyi Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Junmei Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
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19
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Apollo NV, Murphy B, Prezelski K, Driscoll N, Richardson AG, Lucas TH, Vitale F. Gels, jets, mosquitoes, and magnets: a review of implantation strategies for soft neural probes. J Neural Eng 2020; 17:041002. [PMID: 32759476 PMCID: PMC8152109 DOI: 10.1088/1741-2552/abacd7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Implantable neuroelectronic interfaces have enabled breakthrough advances in the clinical diagnosis and treatment of neurological disorders, as well as in fundamental studies of brain function, behavior, and disease. Intracranial electroencephalography (EEG) mapping with stereo-EEG (sEEG) depth electrodes is routinely adopted for precise epilepsy diagnostics and surgical treatment, while deep brain stimulation has become the standard of care for managing movement disorders. Intracortical microelectrode arrays for high-fidelity recordings of neural spiking activity have led to impressive demonstrations of the power of brain-machine interfaces for motor and sensory functional recovery. Yet, despite the rapid pace of technology development, the issue of establishing a safe, long-term, stable, and functional interface between neuroelectronic devices and the host brain tissue still remains largely unresolved. A body of work spanning at least the last 15 years suggests that safe, chronic integration between invasive electrodes and the brain requires a close match between the mechanical properties of man-made components and the neural tissue. In other words, the next generation of invasive electrodes should be soft and compliant, without sacrificing biological and chemical stability. Soft neuroelectronic interfaces, however, pose a new and significant surgical challenge: bending and buckling during implantation that can preclude accurate and safe device placement. In this topical review, we describe the next generation of soft electrodes and the surgical implantation methods for safe and precise insertion into brain structures. We provide an overview of the most recent innovations in the field of insertion strategies for flexible neural electrodes such as dissolvable or biodegradable carriers, microactuators, biologically-inspired support structures, and electromagnetic drives. In our analysis, we also highlight approaches developed in different fields, such as robotic surgery, which could be potentially adapted and translated to the insertion of flexible neural probes.
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Affiliation(s)
- Nicholas V Apollo
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, 19104, United States of America
| | - Brendan Murphy
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, 19104, United States of America
- These authors contributed equally
| | - Kayla Prezelski
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, 19104, United States of America
- These authors contributed equally
| | - Nicolette Driscoll
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, 19104, United States of America
| | - Andrew G Richardson
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
| | - Timothy H Lucas
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
| | - Flavia Vitale
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, 19104, United States of America
- These authors contributed equally
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Department of Physical Medicine & Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, United States of America
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20
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He X, Chaitanya G, Asma B, Caciagli L, Bassett DS, Tracy JI, Sperling MR. Disrupted basal ganglia-thalamocortical loops in focal to bilateral tonic-clonic seizures. Brain 2020; 143:175-190. [PMID: 31860076 DOI: 10.1093/brain/awz361] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/16/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
Focal to bilateral tonic-clonic seizures are associated with lower quality of life, higher risk of seizure-related injuries, increased chance of sudden unexpected death, and unfavourable treatment outcomes. Achieving greater understanding of their underlying circuitry offers better opportunity to control these seizures. Towards this goal, we provide a network science perspective of the interactive pathways among basal ganglia, thalamus and cortex, to explore the imprinting of secondary seizure generalization on the mesoscale brain network in temporal lobe epilepsy. Specifically, we parameterized the functional organization of both the thalamocortical network and the basal ganglia-thalamus network with resting state functional MRI in three groups of patients with different focal to bilateral tonic-clonic seizure histories. Using the participation coefficient to describe the pattern of thalamocortical connections among different cortical networks, we showed that, compared to patients with no previous history, those with positive histories of focal to bilateral tonic-clonic seizures, including both remote (none for >1 year) and current (within the past year) histories, presented more uniform distribution patterns of thalamocortical connections in the ipsilateral medial-dorsal thalamic nuclei. As a sign of greater thalamus-mediated cortico-cortical communication, this result comports with greater susceptibility to secondary seizure generalization from the epileptogenic temporal lobe to broader brain networks in these patients. Using interregional integration to characterize the functional interaction between basal ganglia and thalamus, we demonstrated that patients with current history presented increased interaction between putamen and globus pallidus internus, and decreased interaction between the latter and the thalamus, compared to the other two patient groups. Importantly, through a series of 'disconnection' simulations, we showed that these changes in interactive profiles of the basal ganglia-thalamus network in the current history group mainly depended upon the direct but not the indirect basal ganglia pathway. It is intuitively plausible that such disruption in the striatum-modulated tonic inhibition of the thalamus from the globus pallidus internus could lead to an under-suppressed thalamus, which in turn may account for their greater vulnerability to secondary seizure generalization. Collectively, these findings suggest that the broken balance between basal ganglia inhibition and thalamus synchronization can inform the presence and effective control of focal to bilateral tonic-clonic seizures. The mechanistic underpinnings we uncover may shed light on the development of new treatment strategies for patients with temporal lobe epilepsy.
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Affiliation(s)
- Xiaosong He
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ganne Chaitanya
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Burcu Asma
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lorenzo Caciagli
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Joseph I Tracy
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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21
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Different modalities of invasive neurostimulation for epilepsy. Neurol Sci 2020; 41:3527-3536. [PMID: 32740896 DOI: 10.1007/s10072-020-04614-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/19/2020] [Indexed: 01/12/2023]
Abstract
Epilepsy affects 1% of the general population, about one-third of which is pharmacologically resistant. Uncontrolled seizures are associated with an increased risk of traumatic injury and sudden unexpected death of epilepsy. There is a considerable psychological and financial burden on caregivers of patients with epilepsy, particularly among pediatric patients. Epilepsy surgery, when indicated, is the most promising cure for epilepsy. However, when surgery is contraindicated or refused by the patient, neurostimulation is an alternative palliative approach, albeit with a lower chance of entirely curing patients of seizures. There are many options for neurostimulation. The three most commonly used invasive neurostimulation procedures that consistently show evidence of being safe and efficacious are vagal nerve stimulation, responsive neuro stimulation, or anterior thalamic nucleus deep brain stimulation. The goal of this review is to summarize the current evidence supporting the use of these three techniques, which are approved by most regulatory bodies, and discuss different factors that may enable epilepsy surgeons to choose the most appropriate modality for each patient.
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22
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Alomari SO, El Houshiemy MN, Bsat S, Moussalem CK, Allouh M, Omeis IA. Hypothalamic Hamartomas: A comprehensive review of literature – Part 2: Medical and surgical management update. Clin Neurol Neurosurg 2020; 195:106074. [DOI: 10.1016/j.clineuro.2020.106074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/25/2020] [Accepted: 07/06/2020] [Indexed: 11/25/2022]
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23
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Grewal SS, Middlebrooks EH, Okromelidze L, Gosden GP, Tatum WO, Lundstrom BN, Worrell GA, Wharen RE, Van Gompel JJ. Variability Between Direct and Indirect Targeting of the Anterior Nucleus of the Thalamus. World Neurosurg 2020; 139:e70-e77. [PMID: 32302732 DOI: 10.1016/j.wneu.2020.03.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Preoperative thalamic targeting methods have historically relied on indirect targeting techniques that do not fully account for variances in anatomy or for thalamic atrophy in epilepsy. We aimed to address variability noted between traditional indirect targeting and direct targeting methods for the anterior nucleus of the thalamus (ANT). METHODS Fifteen consecutive patients undergoing ANT deep brain stimulator placement were evaluated (30 thalamic nuclei). Direct ANT targeting was performed using a fast gray matter acquisition T1 inversion recovery sequence and compared with standard stereotactic coordinates. Thalamic volumes were calculated for each patient, and degree of thalamic volume loss was assessed compared with matched control subjects. Vertex analysis was performed to assess shape changes in the thalamus compared with age- and sex-matched subjects. RESULTS There was significant variation between direct and indirect targets in the y-axis and z-axis on both sides. On the left, the direct target was located at y = 2 ± 1.3 mm and z = 9.3 ± 1.8 mm (both P = 0.02). On the right, the direct target was located at y = 2.9 ± 1.8 mm and z = 9.2 ± 2 mm (both P ≤ 0.0003). There was no significant difference in the x-coordinate on either side (P > 0.5). Additionally, there was a correlation between thalamic volume and difference between direct and indirect targets in the y-axis and the z-axis. CONCLUSIONS We showed a significant difference in direct and indirect targeting in the y-axis and z-axis when targeting the ANT for deep brain stimulation for epilepsy. This difference is correlated to thalamic volume, with a larger difference noted in patients with thalamic atrophy.
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Affiliation(s)
- Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Lela Okromelidze
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Grant P Gosden
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Robert E Wharen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
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24
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Park H, Choi S, Joo E, Seo DW, Hong S, Lee JI, Hong SC, Lee S, Shon YM. The Role of Anterior Thalamic Deep Brain Stimulation as an Alternative Therapy in Patients with Previously Failed Vagus Nerve Stimulation for Refractory Epilepsy. Stereotact Funct Neurosurg 2019; 97:176-182. [DOI: 10.1159/000502344] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/25/2019] [Indexed: 11/19/2022]
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25
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Caldwell DJ, Ojemann JG, Rao RPN. Direct Electrical Stimulation in Electrocorticographic Brain-Computer Interfaces: Enabling Technologies for Input to Cortex. Front Neurosci 2019; 13:804. [PMID: 31440127 PMCID: PMC6692891 DOI: 10.3389/fnins.2019.00804] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022] Open
Abstract
Electrocorticographic brain computer interfaces (ECoG-BCIs) offer tremendous opportunities for restoring function in individuals suffering from neurological damage and for advancing basic neuroscience knowledge. ECoG electrodes are already commonly used clinically for monitoring epilepsy and have greater spatial specificity in recording neuronal activity than techniques such as electroencephalography (EEG). Much work to date in the field has focused on using ECoG signals recorded from cortex as control outputs for driving end effectors. An equally important but less explored application of an ECoG-BCI is directing input into cortex using ECoG electrodes for direct electrical stimulation (DES). Combining DES with ECoG recording enables a truly bidirectional BCI, where information is both read from and written to the brain. We discuss the advantages and opportunities, as well as the barriers and challenges presented by using DES in an ECoG-BCI. In this article, we review ECoG electrodes, the physics and physiology of DES, and the use of electrical stimulation of the brain for the clinical treatment of disorders such as epilepsy and Parkinson’s disease. We briefly discuss some of the translational, regulatory, financial, and ethical concerns regarding ECoG-BCIs. Next, we describe the use of ECoG-based DES for providing sensory feedback and for probing and modifying cortical connectivity. We explore future directions, which may draw on invasive animal studies with penetrating and surface electrodes as well as non-invasive stimulation methods such as transcranial magnetic stimulation (TMS). We conclude by describing enabling technologies, such as smaller ECoG electrodes for more precise targeting of cortical areas, signal processing strategies for simultaneous stimulation and recording, and computational modeling and algorithms for tailoring stimulation to each individual brain.
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Affiliation(s)
- David J Caldwell
- Department of Bioengineering, University of Washington, Seattle, WA, United States.,Medical Scientist Training Program, University of Washington, Seattle, WA, United States.,Center for Neurotechnology, University of Washington, Seattle, WA, United States
| | - Jeffrey G Ojemann
- Center for Neurotechnology, University of Washington, Seattle, WA, United States.,Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Rajesh P N Rao
- Department of Bioengineering, University of Washington, Seattle, WA, United States.,Center for Neurotechnology, University of Washington, Seattle, WA, United States.,Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
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26
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Zangiabadi N, Ladino LD, Sina F, Orozco-Hernández JP, Carter A, Téllez-Zenteno JF. Deep Brain Stimulation and Drug-Resistant Epilepsy: A Review of the Literature. Front Neurol 2019; 10:601. [PMID: 31244761 PMCID: PMC6563690 DOI: 10.3389/fneur.2019.00601] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/21/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction: Deep brain stimulation is a safe and effective neurointerventional technique for the treatment of movement disorders. Electrical stimulation of subcortical structures may exert a control on seizure generators initiating epileptic activities. The aim of this review is to present the targets of the deep brain stimulation for the treatment of drug-resistant epilepsy. Methods: We performed a structured review of the literature from 1980 to 2018 using Medline and PubMed. Articles assessing the impact of deep brain stimulation on seizure frequency in patients with DRE were selected. Meta-analyses, randomized controlled trials, and observational studies were included. Results: To date, deep brain stimulation of various neural targets has been investigated in animal experiments and humans. This article presents the use of stimulation of the anterior and centromedian nucleus of the thalamus, hippocampus, basal ganglia, cerebellum and hypothalamus. Anterior thalamic stimulation has demonstrated efficacy and there is evidence to recommend it as the target of choice. Conclusion: Deep brain stimulation for seizures may be an option in patients with drug-resistant epilepsy. Anterior thalamic nucleus stimulation could be recommended over other targets.
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Affiliation(s)
- Nasser Zangiabadi
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Lady Diana Ladino
- Epilepsy Program, Hospital Pablo Tobón Uribe, Neuroclinica, University of Antioquia, Medellín, Colombia
| | - Farzad Sina
- Department of Neurology, Rasool Akram Hospital, IUMS, Tehran, Iran
| | - Juan Pablo Orozco-Hernández
- Departamento de Investigación Clínica, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira-Clínica Comfamiliar, Pereira, Colombia
| | - Alexandra Carter
- Saskatchewan Epilepsy Program, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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27
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Wang YC, Grewal SS, Middlebrooks EH, Worrell GA, Stead M, Lundstrom BN, Britton JW, Wu MH, Van Gompel JJ. Targeting analysis of a novel parietal approach for deep brain stimulation of the anterior nucleus of the thalamus for epilepsy. Epilepsy Res 2019; 153:1-6. [PMID: 30913474 DOI: 10.1016/j.eplepsyres.2019.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/02/2019] [Accepted: 03/18/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a promising treatment for refractory epilepsy; however, it remains challenging to successfully target the ANT. The results of Medtronic Registry for Epilepsy (MORE) supported a frontal transventricular(TV) compared to frontal extraventricular (EV) lead trajectory for ANT DBS may have better coverage of the ANT. Here we report the safety and targeting efficacy of a novel, posterior parietal extraventricular (PEV) approach to the ANT. METHODS We conducted a retrospective analysis of ten patients who underwent bilateral ANT DBS (20 total trajectories) for medically-refractory epilepsy. Similar targeting methodology as the MORE trial was used, and the DBS Intrinsic Template Atlas (DISTAL) was utilized for ANT localization and contact position relative to ANT. Clinical data were assessed for DBS targeting efficacy and surgical complications. RESULTS The demonstrated PEV trajectory showed a successful ANT targeting rate of 90% bilaterally. Two or more contacts within ANT were presented in 75% of all leads. Mean contact number in ANT was 2.2+ 1.2. There were no intracranial hemorrhages, cerebrospinal fluid leakage, or permanent neurologic deficits. CONCLUSION In this small series, the novel PEV for ANT DBS is feasible with good targeting accuracy and potential safety advantages. The high accuracy of the PEV trajectory suggests that it is a reasonable alternative trajectory for ANT DBS. Larger studies will be needed to assess this trajectory on clinical outcome of DBS treatment to epilepsy.
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Affiliation(s)
- Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital in Linkou, Chang Gung University, Taiwan; Program of Biomedical Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taiwan
| | | | - Erik H Middlebrooks
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA; Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Min-Hsien Wu
- Program of Biomedical Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taiwan
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Weininger J, Roman E, Tierney P, Barry D, Gallagher H, Murphy P, Levins KJ, O’Keane V, O’Hanlon E, Roddy DW. Papez's Forgotten Tract: 80 Years of Unreconciled Findings Concerning the Thalamocingulate Tract. Front Neuroanat 2019; 13:14. [PMID: 30833890 PMCID: PMC6388660 DOI: 10.3389/fnana.2019.00014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/29/2019] [Indexed: 12/22/2022] Open
Abstract
The thalamocingulate tract is a key component of the Papez circuit that connects the anterior thalamic nucleus (ATN) to the cingulum bundle. While the other white matter connections, consisting of the fornix, cingulum bundle and mammillothalamic tract, were well defined in Papez's original 1937 paper, the anatomy of the thalamocingulate pathway was mentioned only in passing. Subsequent research has been unable to clarify the precise anatomical trajectory of this tract. In particular, the site of thalamocingulate tract interactions with the cingulum bundle have been inconsistently reported. This review aims to synthesize research on this least studied component of the Papez circuit. A systemic approach to reviewing historical anatomical dissection and neuronal tracing studies as well as contemporary diffusion magnetic resonance imaging studies of the thalamocingulate tract was undertaken across species. We found that although inconsistent, prior research broadly encompasses two differing descriptions of how the ATN interfaces with the cingulum after passing laterally through the anterior limb of the internal capsule. The first group of studies show that the pathway turns medially and rostrally and passes to the anterior cingulate region (Brodmann areas 24, 33, and 32) only. A second group suggests that the thalamocingulate tract interfaces with both the anterior and posterior cingulate (Brodmann areas 23 and 31) and retrosplenial region (Brodmann area 29). We discuss potential reasons for these discrepancies such as altering methodologies and species differences. We also discuss how these inconsistencies may be resolved in further research with refinements of terminology for the cingulate cortex and the thalamocingulate tract. Understanding the precise anatomical course of the last remaining unresolved final white matter tract in the Papez circuit may facilitate accurate investigation of the role of the complete Papez circuit in emotion and memory.
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Affiliation(s)
- Joshua Weininger
- REDEEM Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Elena Roman
- REDEEM Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Paul Tierney
- Department of Anatomy, Trinity College Dublin, Dublin, Ireland
| | - Denis Barry
- Department of Anatomy, Trinity College Dublin, Dublin, Ireland
| | - Hugh Gallagher
- Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent’s University Hospital, Dublin, Ireland
| | - Paul Murphy
- Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent’s University Hospital, Dublin, Ireland
| | - Kirk J. Levins
- Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent’s University Hospital, Dublin, Ireland
| | - Veronica O’Keane
- REDEEM Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Erik O’Hanlon
- REDEEM Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Darren W. Roddy
- REDEEM Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
- Department of Physiology, School of Medicine, University College Dublin, Dublin, Ireland
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Järvenpää S, Peltola J, Rainesalo S, Leinonen E, Lehtimäki K, Järventausta K. Reversible psychiatric adverse effects related to deep brain stimulation of the anterior thalamus in patients with refractory epilepsy. Epilepsy Behav 2018; 88:373-379. [PMID: 30290977 DOI: 10.1016/j.yebeh.2018.09.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/07/2018] [Accepted: 09/09/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Anterior nucleus of thalamus (ANT) deep brain stimulation (DBS) is becoming a more common treatment for drug-resistant epilepsy. Epilepsy and depression display a bidirectional association. Anterior nucleus of thalamus has connections to anterior cingulate cortex and orbitomedial prefrontal cortex, hence, a possible role in emotional and executive functions, and thus, ANT DBS might exert psychiatric adverse effects. Our aim was to evaluate previous and current psychiatric symptoms in patients with epilepsy undergoing ANT DBS surgery and assess the predictability of psychiatric adverse effects. Programming-related psychiatric adverse effects are also reported. METHOD Twenty-two patients with ANT DBS for retractable epilepsy were examined, and a psychiatric evaluation of depressive and other psychiatric symptoms was performed with Montgomery and Åsberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI), and Symptom Checklist prior to surgery, concentrating on former and current psychiatric symptoms and medications. The follow-up visit was one year after surgery. RESULTS At the group level, no changes on mood were observed during ANT DBS treatment. Two patients with former histories of depression experienced sudden depressive symptoms related to DBS programming settings; these were quickly alleviated after changing the stimulation parameters. In addition, two patients with no previous histories of psychosis gradually developed clear paranoid and anxiety symptoms that also relieved slowly after changing the programming settings. CONCLUSION The majority of our ANT DBS patients did not experience psychiatric adverse effects. Certain DBS parameters might predispose to sudden depressive or slowly manifesting paranoid symptoms that are reversible via programming changes.
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Affiliation(s)
- Soila Järvenpää
- University of Tampere, Faculty of Medicine and Biosciences, Tampere, Finland; Tampere University Hospital, Department of Neurosciences, Neurology and Rehabilitation, Tampere, Finland.
| | - Jukka Peltola
- University of Tampere, Faculty of Medicine and Biosciences, Tampere, Finland; Tampere University Hospital, Department of Neurosciences, Neurology and Rehabilitation, Tampere, Finland.
| | - Sirpa Rainesalo
- Tampere University Hospital, Department of Neurosciences, Neurology and Rehabilitation, Tampere, Finland.
| | - Esa Leinonen
- University of Tampere, Faculty of Medicine and Biosciences, Tampere, Finland; Tampere University Hospital, Department of Psychiatry, Tampere, Finland.
| | - Kai Lehtimäki
- University of Tampere, Faculty of Medicine and Biosciences, Tampere, Finland; Tampere University Hospital, Department of Neurosciences, Neurology and Rehabilitation, Tampere, Finland.
| | - Kaija Järventausta
- University of Tampere, Faculty of Medicine and Biosciences, Tampere, Finland; Tampere University Hospital, Department of Psychiatry, Tampere, Finland.
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30
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Yang Y, Connolly AT, Shanechi MM. A control-theoretic system identification framework and a real-time closed-loop clinical simulation testbed for electrical brain stimulation. J Neural Eng 2018; 15:066007. [DOI: 10.1088/1741-2552/aad1a8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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31
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Erhardt JB, Fuhrer E, Gruschke OG, Leupold J, Wapler MC, Hennig J, Stieglitz T, Korvink JG. Should patients with brain implants undergo MRI? J Neural Eng 2018. [DOI: 10.1088/1741-2552/aab4e4] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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32
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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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33
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Prinz P, Stengel A. Deep Brain Stimulation-Possible Treatment Strategy for Pathologically Altered Body Weight? Brain Sci 2018; 8:brainsci8010019. [PMID: 29361753 PMCID: PMC5789350 DOI: 10.3390/brainsci8010019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 12/11/2022] Open
Abstract
The treatment of obesity and eating disorders such as binge-eating disorder or anorexia nervosa is challenging. Besides lifestyle changes and pharmacological options, bariatric surgery represents a well-established and effective-albeit invasive-treatment of obesity, whereas for binge-eating disorder and anorexia nervosa mostly psychotherapy options exist. Deep brain stimulation (DBS), a method that influences the neuronal network, is by now known for its safe and effective applicability in patients with Parkinson’s disease. However, the use does not seem to be restricted to these patients. Recent preclinical and first clinical evidence points towards the use of DBS in patients with obesity and eating disorders as well. Depending on the targeted area in the brain, DBS can either inhibit food intake and body weight or stimulate energy intake and subsequently body weight. The current review focuses on preclinical and clinical evidence of DBS to modulate food intake and body weight and highlight the different brain areas targeted, stimulation protocols applied and downstream signaling modulated. Lastly, this review will also critically discuss potential safety issues and gaps in knowledge to promote further studies.
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Affiliation(s)
- Philip Prinz
- Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12200 Berlin, Germany.
| | - Andreas Stengel
- Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12200 Berlin, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany.
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34
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Apollo NV, Jiang J, Cheung W, Baquier S, Lai A, Mirebedini A, Foroughi J, Wallace GG, Shivdasani MN, Prawer S, Chen S, Williams R, Cook MJ, Nayagam DAX, Garrett DJ. Development and Characterization of a Sucrose Microneedle Neural Electrode Delivery System. ACTA ACUST UNITED AC 2017. [DOI: 10.1002/adbi.201700187] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Nicholas V. Apollo
- School of Physics; University of Melbourne; Parkville Victoria 3010 Australia
- The Bionics Institute; 384-388 Albert St. East Melbourne Victoria 3002 Australia
| | - Jonathan Jiang
- Department of Medicine; University of Melbourne; Parkville Victoria 3010 Australia
| | - Warwick Cheung
- Department of Medicine; University of Melbourne; Parkville Victoria 3010 Australia
| | - Sebastien Baquier
- Department of Medicine; University of Melbourne; Parkville Victoria 3010 Australia
- Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Parkville Victoria 3010 Australia
| | - Alan Lai
- Department of Medicine; University of Melbourne; Parkville Victoria 3010 Australia
| | - Azadeh Mirebedini
- Intelligent Polymer Research Institute (IPRI); AIIM Facility; Innovation Campus; University of Wollongong; Wollongong New South Wales 2522 Australia
| | - Javad Foroughi
- Intelligent Polymer Research Institute (IPRI); AIIM Facility; Innovation Campus; University of Wollongong; Wollongong New South Wales 2522 Australia
| | - Gordon G. Wallace
- Intelligent Polymer Research Institute (IPRI); AIIM Facility; Innovation Campus; University of Wollongong; Wollongong New South Wales 2522 Australia
| | - Mohit N. Shivdasani
- The Bionics Institute; 384-388 Albert St. East Melbourne Victoria 3002 Australia
- Department of Medical Bionics; University of Melbourne; Parkville Victoria 3010 Australia
| | - Steven Prawer
- School of Physics; University of Melbourne; Parkville Victoria 3010 Australia
| | - Shou Chen
- Department of Anatomical Pathology; St Vincent's Hospital Melbourne; Fitzroy Victoria 3065 Australia
| | - Richard Williams
- Department of Anatomical Pathology; St Vincent's Hospital Melbourne; Fitzroy Victoria 3065 Australia
- Department of Pathology; University of Melbourne; Parkville Victoria 3010 Australia
| | - Mark J. Cook
- Department of Medicine; University of Melbourne; Parkville Victoria 3010 Australia
| | - David A. X. Nayagam
- The Bionics Institute; 384-388 Albert St. East Melbourne Victoria 3002 Australia
- Department of Pathology; University of Melbourne; Parkville Victoria 3010 Australia
| | - David J. Garrett
- School of Physics; University of Melbourne; Parkville Victoria 3010 Australia
- The Bionics Institute; 384-388 Albert St. East Melbourne Victoria 3002 Australia
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35
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Shanechi MM. Generalized binary noise stimulation enables time-efficient identification of input-output brain network dynamics. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:1766-1769. [PMID: 28268669 DOI: 10.1109/embc.2016.7591059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Identification of input-output (IO) dynamics of brain networks in response to electrical stimulation is essential for devising closed-loop therapies for neurological disorders such as major depression. A critical component for accurate IO identification is the stimulation input design. The time available for open-loop stimulation to perform system identification is typically limited. While our prior design of a binary noise (BN) modulated input pattern satisfies the requirements for optimal identification and clinical safety, it does not incorporate any prior information about the underlying network. When the identification time is constrained, BN identification performance may be improved by incorporating such information. Here we design a generalized binary noise (GBN) modulated stimulation pattern that achieves time-efficient identification of IO dynamics by utilizing the time-constant information of the network. To test GBN's performance, we implemented a closed-loop controller within a clinical stimulation system. We used our closed-loop system to control mood symptoms in depression using simulated neural activity under linear network dynamics. With a short identification time (20 mins), the controller derived from GBN identification performed as well as an ideal controller that had full knowledge of the network model, and better than a controller derived from BN identification. Our results have important implications for optimal system identification and closed-loop control of brain network dynamics.
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36
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Chen M, Guo D, Xia Y, Yao D. Control of Absence Seizures by the Thalamic Feed-Forward Inhibition. Front Comput Neurosci 2017; 11:31. [PMID: 28491031 PMCID: PMC5405150 DOI: 10.3389/fncom.2017.00031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/10/2017] [Indexed: 11/17/2022] Open
Abstract
As a subtype of idiopathic generalized epilepsies, absence epilepsy is believed to be caused by pathological interactions within the corticothalamic (CT) system. Using a biophysical mean-field model of the CT system, we demonstrate here that the feed-forward inhibition (FFI) in thalamus, i.e., the pathway from the cerebral cortex (Ctx) to the thalamic reticular nucleus (TRN) and then to the specific relay nuclei (SRN) of thalamus that are also directly driven by the Ctx, may participate in controlling absence seizures. In particular, we show that increasing the excitatory Ctx-TRN coupling strength can significantly suppress typical electrical activities during absence seizures. Further, investigation demonstrates that the GABAA- and GABAB-mediated inhibitions in the TRN-SRN pathway perform combination roles in the regulation of absence seizures. Overall, these results may provide an insightful mechanistic understanding of how the thalamic FFI serves as an intrinsic regulator contributing to the control of absence seizures.
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Affiliation(s)
- Mingming Chen
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengdu, China
| | - Daqing Guo
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengdu, China.,Center for Information in BioMedicine, University of Electronic Science and Technology of ChinaChengdu, China
| | - Yang Xia
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengdu, China.,Center for Information in BioMedicine, University of Electronic Science and Technology of ChinaChengdu, China
| | - Dezhong Yao
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengdu, China.,Center for Information in BioMedicine, University of Electronic Science and Technology of ChinaChengdu, China
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37
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Walz JM, Pedersen M, Omidvarnia A, Semmelroch M, Jackson GD. Spatiotemporal mapping of epileptic spikes using simultaneous EEG-functional MRI. Brain 2017; 140:998-1010. [PMID: 28334998 DOI: 10.1093/brain/awx007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 12/06/2016] [Indexed: 11/14/2022] Open
Abstract
Epileptic spikes occur on the sub-second timescale and are known to involve not only epileptic foci but also large-scale distributed brain networks. There is likely to be a sequence of neural activity in multiple brain regions that occurs within the duration of a single spike, but standard electroencephalography-functional magnetic resonance imaging analyses, which use only the timing of the spikes to model the functional magnetic resonance imaging data, cannot determine the sequence of these activations. Our aim in this study is to temporally resolve these spatial activations to observe the spatiotemporal dynamics of the spike-related neural activity at a sub-second timescale. We studied eight focal epilepsy patients (age 11-42 years, six female) and used amplitude features of the electroencephalogram specific to different spike components (early and late peaks and troughs) to encode temporal information into our functional magnetic resonance imaging models. This enables us to associate each activation with a specific model of each of the spike components to infer the temporal order of these spike-related spatial activations. In seven of eight patients the distributed networks were associated with the late spike component. The focal activations were more variably coupled with time epochs, but tended to precede the distributed network effects. We also found that incorporating electroencephalogram features into the models increased sensitivity and in six patients revealed additional regions unseen in the standard analysis result. This included strong bilateral thalamus activation in two patients. We demonstrate the clinical utility of this approach in a patient who recently underwent a successful surgical resection of the region where we saw enhanced activation using electroencephalogram amplitude information specific to the early spike component. This focal cluster of activation was larger and more precisely tracked the anatomy compared to what was seen using the standard timing-based analysis. Our novel electroencephalography-functional magnetic resonance imaging data fusion approach, which utilizes information based on the single spike variability across all electroencephalogram channels, has the potential to help us better understand epileptic networks and aid in the interpretation of functional magnetic resonance imaging activation maps during treatment planning.
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Affiliation(s)
- Jennifer M Walz
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, VIC, Australia
| | - Mangor Pedersen
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, VIC, Australia.,The Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Amir Omidvarnia
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, VIC, Australia
| | - Mira Semmelroch
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, VIC, Australia
| | - Graeme D Jackson
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, VIC, Australia.,The Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Department of Neurology, Austin Health, Melbourne, VIC, Australia
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38
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Wang Z, Wang Q. Eliminating Absence Seizures through the Deep Brain Stimulation to Thalamus Reticular Nucleus. Front Comput Neurosci 2017; 11:22. [PMID: 28469569 PMCID: PMC5395627 DOI: 10.3389/fncom.2017.00022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 03/27/2017] [Indexed: 01/19/2023] Open
Abstract
Deep brain stimulation (DBS) can play a crucial role in the modulation of absence seizures, yet relevant biophysical mechanisms are not completely established. In this paper, on the basis of a biophysical mean-field model, we investigate a typical absence epilepsy activity by introducing slow kinetics of GABAB receptors on thalamus reticular nucleus (TRN). We find that the region of spike and slow-wave discharges (SWDs) can be reduced greatly when we add the DBS to TRN. Furthermore, we systematically explore how the corresponding stimulation parameters including frequency, amplitude and positive input duration suppress the SWDs under certain conditions. It is shown that the SWDs can be controlled as key stimulation parameters are suitably chosen. The results in this paper can be helpful for researchers to understand the thalamus stimulation in treating epilepsy patients, and provide theoretical basis for future experimental and clinical studies.
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Affiliation(s)
- Zhihui Wang
- Department of Dynamics and Control, Beihang UniversityBeijing, China
| | - Qingyun Wang
- Department of Dynamics and Control, Beihang UniversityBeijing, China
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39
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Li DH, Yang XF. Remote modulation of network excitability during deep brain stimulation for epilepsy. Seizure 2017; 47:42-50. [DOI: 10.1016/j.seizure.2017.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/20/2017] [Accepted: 02/28/2017] [Indexed: 12/18/2022] Open
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40
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Muzumdar D, Patil M, Goel A, Ravat S, Sawant N, Shah U. Mesial temporal lobe epilepsy – An overview of surgical techniques. Int J Surg 2016; 36:411-419. [DOI: 10.1016/j.ijsu.2016.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/16/2016] [Accepted: 10/18/2016] [Indexed: 12/29/2022]
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41
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Thalamic interictal epileptiform discharges in deep brain stimulated epilepsy patients. J Neurol 2016; 263:2120-6. [DOI: 10.1007/s00415-016-8246-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/24/2016] [Accepted: 07/25/2016] [Indexed: 12/26/2022]
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42
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Son BC, Shon YM, Choi JG, Kim J, Ha SW, Kim SH, Lee SH. Clinical Outcome of Patients with Deep Brain Stimulation of the Centromedian Thalamic Nucleus for Refractory Epilepsy and Location of the Active Contacts. Stereotact Funct Neurosurg 2016; 94:187-97. [PMID: 27434073 DOI: 10.1159/000446611] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 05/04/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the clinical outcome of patients treated with chronic deep brain stimulation (DBS) of the centromedian nucleus (CM) for refractory epilepsy and to determine the location of active contacts. METHODS The outcome of CM stimulation was evaluated as percent seizure reduction compared to the baseline 3 months. To establish the location of active contacts, 27 leads were studied in 14 patients with refractory epilepsy. An analysis was conducted to reveal whether any coordinates of the center of the active contacts predicted percent seizure reduction. RESULTS With an average follow-up of 18.2 ± 5.6 months, the mean percent seizure reduction (n = 14) was 68 ± 22.4% (25-100%). Eleven of the 14 patients (78.6%) achieved >50% improvement in seizure frequency. Specifically, all 4 patients (100%) with generalized epilepsy (Lennox-Gastaut syndrome) and 7 of 10 patients (70%) with multilobar epilepsy showed >50% reduction in seizure frequency. The mean coordinates of the center of the active contact were located in the superior part of the anterior ventrolateral CM. The calculated coordinates of laterality from midline (x), anterior-posterior (y) and height (z) from the posterior commissure did not correlate with seizure outcome measured by percent seizure reduction. However, the locations of active contacts used during chronic CM stimulation in multilobar epilepsy were identified more dorsal to those used in generalized epilepsy. CONCLUSIONS Chronic CM stimulation is a safe and effective means in the treatment of refractory epilepsy.
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Affiliation(s)
- Byung-Chul Son
- Department of Neurosurgery, Seoul St. Mary's Hospital, Seoul, Korea
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43
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Enke AM, St Louis E, Jackson CF, Makin SM. Non-pharmacological treatments for improving memory in people with epilepsy. Hippokratia 2015. [DOI: 10.1002/14651858.cd011945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ashley M Enke
- Mayo Clinic and Foundation; Department of Sleep Medicine; 200 First Street Southwest Rochester Minnesota USA 55905
| | - Erik St Louis
- Mayo Clinic and Foundation; Neurology and Medicine; 200 First Street Southwest Rochester Minnesota USA 55905
| | - Cerian F Jackson
- Institute of Translational Medicine, University of Liverpool; Department of Molecular and Clinical Pharmacology; Clinical Sciences Centre for Research and Education, Lower Lane Fazakerley Liverpool UK L9 7LJ
| | - Selina M Makin
- The Walton Centre NHS Foundation Trust; Lower Lane Fazakerley Liverpool UK L9 7LJ
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Outcome based definition of the anterior thalamic deep brain stimulation target in refractory epilepsy. Brain Stimul 2015; 9:268-75. [PMID: 26680105 DOI: 10.1016/j.brs.2015.09.014] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/19/2015] [Accepted: 09/30/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Deep brain stimulation of the anterior nucleus of the thalamus (ANT) is an emerging therapy for refractory focal epilepsy. However, the most optimal target for stimulation has not been unambiguously described. OBJECTIVE In the present study, we investigated the correlation between the stimulation site and outcome in order to define the optimal target for deep brain stimulation in refractory epilepsy. METHODS The locations of 62 contacts used in 30 treatment attempts in 15 prospectively followed patients during a 5 year period were assessed. Treatment attempts were classified into responding and non-responding trials using seizure reduction and side effect profile as criteria. The locations of active contacts were calculated with respect to mid-commissural point and visible borders of ANT in 3T MRI (ANT-normalized coordinate system) aiming to minimize the confounding effect of individual variation in the location and size of the ANT. RESULTS Contacts in successful treatment trials were located significantly more anterior and superior both in AC-PC and ANT-normalized coordinate systems. Favourable outcome was observed at 3T MRI based location of ANT but not at location predicted by Schaltenbrandt atlas sagittal data. Contacts used in successful trials were at anterior aspect of the ANT complex evidenced by the ANT-normalized coordinate system. CONCLUSION The anti-epileptic effect of anterior thalamic DBS may be dependent on stimulation site especially in the anterior to posterior axis. Extensive anatomical variation confounds severely the targeting of ANT. Therefore, direct visualization of the desired target for stimulation is essential for favourable outcome in refractory epilepsy.
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45
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Low-frequency stimulation of the external globus palladium produces anti-epileptogenic and anti-ictogenic actions in rats. Acta Pharmacol Sin 2015; 36:957-65. [PMID: 26095038 DOI: 10.1038/aps.2015.45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/07/2015] [Indexed: 01/03/2023] Open
Abstract
AIM To investigate the anti-epileptic effects of deep brain stimulation targeting the external globus palladium (GPe) in rats. METHODS For inducing amygdala kindling and deep brain stimulation, bipolar stainless-steel electrodes were implanted in SD rats into right basolateral amygdala and right GPe, respectively. The effects of deep brain stimulation were evaluated in the amygdala kindling model, maximal electroshock model (MES) and pentylenetetrazole (PTZ) model. Moreover, the background EEGs in the amygdala and GPe were recorded. RESULTS Low-frequency stimulation (0.1 ms, 1 Hz, 15 min) at the GPe slowed the progression of seizure stages and shortened the after-discharge duration (ADD) during kindling acquisition. Furthermore, low-frequency stimulation significantly decreased the incidence of generalized seizures, suppressed the average stage, and shortened the cumulative ADD and generalized seizure duration in fully kindled rats. In addition, low-frequency stimulation significantly suppressed the average stage of MES-induced seizures and increased the latency to generalized seizures in the PTZ model. High-frequency stimulation (0.1 ms, 130 Hz, 5 min) at the GPe had no anti-epileptic effect and even aggravated epileptogenesis induced by amygdala kindling. EEG analysis showed that low-frequency stimulation at the GPe reversed the increase in delta power, whereas high-frequency stimulation at the GPe had no such effect. CONCLUSION Low-frequency stimulation, but not high-frequency stimulation, at the GPe exerts therapeutic effect on temporal lobe epilepsy and tonic-colonic generalized seizures, which may be due to interference with delta rhythms. The results suggest that modulation of GPe activity using low-frequency stimulation or drugs may be a promising epilepsy treatment.
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46
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Thompson DM, Koppes AN, Hardy JG, Schmidt CE. Electrical stimuli in the central nervous system microenvironment. Annu Rev Biomed Eng 2015; 16:397-430. [PMID: 25014787 DOI: 10.1146/annurev-bioeng-121813-120655] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electrical stimulation to manipulate the central nervous system (CNS) has been applied as early as the 1750s to produce visual sensations of light. Deep brain stimulation (DBS), cochlear implants, visual prosthetics, and functional electrical stimulation (FES) are being applied in the clinic to treat a wide array of neurological diseases, disorders, and injuries. This review describes the history of electrical stimulation of the CNS microenvironment; recent advances in electrical stimulation of the CNS, including DBS to treat essential tremor, Parkinson's disease, and depression; FES for the treatment of spinal cord injuries; and alternative electrical devices to restore vision and hearing via neuroprosthetics (retinal and cochlear implants). It also discusses the role of electrical cues during development and following injury and, importantly, manipulation of these endogenous cues to support regeneration of neural tissue.
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Affiliation(s)
- Deanna M Thompson
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York 12180;
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47
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Surgical treatment for mesial temporal lobe epilepsy associated with hippocampal sclerosis. Rev Neurol (Paris) 2015; 171:315-25. [DOI: 10.1016/j.neurol.2015.01.561] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/01/2015] [Accepted: 01/30/2015] [Indexed: 02/07/2023]
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48
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Mathon B, Bédos-Ulvin L, Baulac M, Dupont S, Navarro V, Carpentier A, Cornu P, Clemenceau S. Évolution des idées et des techniques, et perspectives d’avenir en chirurgie de l’épilepsie. Rev Neurol (Paris) 2015; 171:141-56. [DOI: 10.1016/j.neurol.2014.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/10/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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49
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Sweeney-Reed CM, Zaehle T, Voges J, Schmitt FC, Buentjen L, Kopitzki K, Esslinger C, Hinrichs H, Heinze HJ, Knight RT, Richardson-Klavehn A. Corticothalamic phase synchrony and cross-frequency coupling predict human memory formation. eLife 2014; 3:e05352. [PMID: 25535839 PMCID: PMC4302268 DOI: 10.7554/elife.05352] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/22/2014] [Indexed: 01/06/2023] Open
Abstract
The anterior thalamic nucleus (ATN) is thought to play an important role in a brain network involving the hippocampus and neocortex, which enables human memories to be formed. However, its small size and location deep within the brain have impeded direct investigation in humans with non-invasive techniques. Here we provide direct evidence for a functional role for the ATN in memory formation from rare simultaneous human intrathalamic and scalp electroencephalogram (EEG) recordings from eight volunteering patients receiving intrathalamic electrodes implanted for the treatment of epilepsy, demonstrating real-time communication between neocortex and ATN during successful memory encoding. Neocortical-ATN theta oscillatory phase synchrony of local field potentials and neocortical-theta-to-ATN-gamma cross-frequency coupling during presentation of complex photographic scenes predicted later memory for the scenes, demonstrating a key role for the ATN in human memory encoding.
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Affiliation(s)
- Catherine M Sweeney-Reed
- Departments of Neurology and Stereotactic Neurosurgery, Otto von Guericke University, Magdeburg, Germany
| | - Tino Zaehle
- Departments of Neurology and Stereotactic Neurosurgery, Otto von Guericke University, Magdeburg, Germany
| | - Juergen Voges
- Departments of Neurology and Stereotactic Neurosurgery, Otto von Guericke University, Magdeburg, Germany
| | - Friedhelm C Schmitt
- Departments of Neurology and Stereotactic Neurosurgery, Otto von Guericke University, Magdeburg, Germany
| | - Lars Buentjen
- Departments of Neurology and Stereotactic Neurosurgery, Otto von Guericke University, Magdeburg, Germany
| | - Klaus Kopitzki
- Departments of Neurology and Stereotactic Neurosurgery, Otto von Guericke University, Magdeburg, Germany
| | - Christine Esslinger
- Departments of Neurology and Stereotactic Neurosurgery, Otto von Guericke University, Magdeburg, Germany
| | - Hermann Hinrichs
- Departments of Neurology and Stereotactic Neurosurgery, Otto von Guericke University, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Departments of Neurology and Stereotactic Neurosurgery, Otto von Guericke University, Magdeburg, Germany
| | - Robert T Knight
- Helen Wills Neuroscience Institute and Department of Psychology, University of California, Berkeley, Berkeley, United States
| | - Alan Richardson-Klavehn
- Departments of Neurology and Stereotactic Neurosurgery, Otto von Guericke University, Magdeburg, Germany
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50
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Cerebellar Directed Optogenetic Intervention Inhibits Spontaneous Hippocampal Seizures in a Mouse Model of Temporal Lobe Epilepsy. eNeuro 2014; 1. [PMID: 25599088 PMCID: PMC4293636 DOI: 10.1523/eneuro.0005-14.2014] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Epilepsy is a condition of spontaneous recurrent seizures. Current treatment options for epilepsy can have major negative side effects and for many patients fail to control seizures. We detected seizures on-line and tested a new selective intervention using a mouse model of temporal lobe epilepsy. Krook-Magnuson et al. report a bidirectional functional connectivity between the hippocampus and the cerebellum in a mouse model of temporal lobe epilepsy, and demonstrate that cerebellar directed on-demand optogenetic intervention can stop seizures recorded from the hippocampus. ![]()
Temporal lobe epilepsy is often medically refractory and new targets for intervention are needed. We used a mouse model of temporal lobe epilepsy, on-line seizure detection, and responsive optogenetic intervention to investigate the potential for cerebellar control of spontaneous temporal lobe seizures. Cerebellar targeted intervention inhibited spontaneous temporal lobe seizures during the chronic phase of the disorder. We further report that the direction of modulation as well as the location of intervention within the cerebellum can affect the outcome of intervention. Specifically, on-demand optogenetic excitation or inhibition of parvalbumin-expressing neurons, including Purkinje cells, in the lateral or midline cerebellum results in a decrease in seizure duration. In contrast, a consistent reduction in spontaneous seizure frequency occurs uniquely with on-demand optogenetic excitation of the midline cerebellum, and was not seen with intervention directly targeting the hippocampal formation. These findings demonstrate that the cerebellum is a powerful modulator of temporal lobe epilepsy, and that intervention targeting the cerebellum as a potential therapy for epilepsy should be revisited.
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