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Sandoval-Bonilla BA, Vargas MFDLC, Nuñez MA, Parpaley Y, Codeiro JG, Cosio JF, de la Torre RAP, Garcia-Muñoz L. Adequate control of seizures in a case of lead migration and neuromodulation of the posterior Sylvian junction: A case report. Surg Neurol Int 2024; 15:124. [PMID: 38742005 PMCID: PMC11090593 DOI: 10.25259/sni_911_2023] [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: 11/13/2023] [Accepted: 02/27/2024] [Indexed: 05/16/2024] Open
Abstract
Background This report aims to describe the neuromodulation effect on seizure control in a patient with a left hippocampal migrated electrode to the Posterior Sylvian Junction (PSJ) during a follow-up of 17 years. Case Description We report a case of a female patient with drug-resistant epilepsy who initiated at seven years old and underwent a stereotactic frame-based insertion of a left hippocampal electrode for deep brain stimulation (DBS). Posterior migration of the electrode was identified at PSJ by postoperative magnetic resonance imaging one month after surgery. A consistent seizure reduction (Engel IC) was obtained with 2v-120 uS-145 Hz, contacts 0-3 negative, casing positive DBS parameters and maintained to this day. Patient data were collected from electronic medical records preceded by obtaining an informed consent for research and publication purposes. Stimulation parameter adjustments were confirmed with the digital records of the local device provider (Medtronic). Results PSJ is a connectivity confluence point of white matter pathways in the posterior quadrant of the hemispheres. White mater DBS could be considered for research as a potential complementary target for neuromodulation of refractory epilepsy.
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Affiliation(s)
- Bayron Alexander Sandoval-Bonilla
- Associate Professor of Neurosurgery, Department of Neurosurgery, Functional NeuroOncology and Epilepsy Surgery Multidisciplinary Board, CMN Siglo XXI, IMSS, Mexico City, Mexico
| | | | | | - Yaroslav Parpaley
- Department of Neurosurgery, University Hospital Bochum, Bochum, Nordrhein-Westfalen, Germany
| | | | - Jesus Fonseca Cosio
- Department of Neurosurgery, Functional Neurosurgery Clinic, CMN Siglo XXI, IMSS, Mexico City, Mexico
| | | | - Luis Garcia-Muñoz
- Department of Radiosurgery, Functional and Stereotactic Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
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Hines K, Wu C. Epilepsy Networks and Their Surgical Relevance. Brain Sci 2023; 14:31. [PMID: 38248246 PMCID: PMC10813558 DOI: 10.3390/brainsci14010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
Surgical epilepsy is a rapidly evolved field. As the understanding and concepts of epilepsy shift towards a network disorder, surgical outcomes may shed light on numerous components of these systems. This review documents the evolution of the understanding of epilepsy networks and examines the data generated by resective, ablative, neuromodulation, and invasive monitoring surgeries in epilepsy patients. As these network tools are better integrated into epilepsy practice, they may eventually inform surgical decisions and improve clinical outcomes.
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Affiliation(s)
- Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA;
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Bou Assi E, Schindler K, de Bézenac C, Denison T, Desai S, Keller SS, Lemoine É, Rahimi A, Shoaran M, Rummel C. From basic sciences and engineering to epileptology: A translational approach. Epilepsia 2023; 64 Suppl 3:S72-S84. [PMID: 36861368 DOI: 10.1111/epi.17566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/03/2023]
Abstract
Collaborative efforts between basic scientists, engineers, and clinicians are enabling translational epileptology. In this article, we summarize the recent advances presented at the International Conference for Technology and Analysis of Seizures (ICTALS 2022): (1) novel developments of structural magnetic resonance imaging; (2) latest electroencephalography signal-processing applications; (3) big data for the development of clinical tools; (4) the emerging field of hyperdimensional computing; (5) the new generation of artificial intelligence (AI)-enabled neuroprostheses; and (6) the use of collaborative platforms to facilitate epilepsy research translation. We highlight the promise of AI reported in recent investigations and the need for multicenter data-sharing initiatives.
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Affiliation(s)
- Elie Bou Assi
- Department of Neuroscience, Université de Montréal, Montréal, Canada
- Centre de Recherche du CHUM (CRCHUM), Montréal, Canada
| | - Kaspar Schindler
- Department of Neurology, Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, Bern University, Bern, Switzerland
| | - Christophe de Bézenac
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Timothy Denison
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
- Department of Engineering Science, University of Oxford, Oxford, UK
| | | | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Émile Lemoine
- Centre de Recherche du CHUM (CRCHUM), Montréal, Canada
- Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, Canada
| | | | - Mahsa Shoaran
- Institute of Electrical and Micro Engineering, Neuro-X Institute, EPFL, Lausanne, Switzerland
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Kalamatianos T, Mavrovounis G, Skouras P, Pandis D, Fountas K, Stranjalis G. Medial Pulvinar Stimulation in Temporal Lobe Epilepsy: A Literature Review and a Hypothesis Based on Neuroanatomical Findings. Cureus 2023; 15:e35772. [PMID: 37025746 PMCID: PMC10071339 DOI: 10.7759/cureus.35772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/07/2023] Open
Abstract
While bilateral stimulation of the anterior thalamic nuclei remains the only approved deep brain stimulation (DBS) option for focal epilepsy, two additional thalamic targets have been proposed. Earlier work indicated the potential of centromedian thalamic nucleus stimulation with recent findings highlighting the medial pulvinar nucleus. The latter has been shown to exhibit electrophysiological and imaging alterations in patients with partial status epilepticus and temporal lobe epilepsy. On this basis, recent studies have begun assessing the feasibility and efficacy of pulvinar stimulation, with encouraging results on the reduction of seizure frequency and severity. Building on existing neuroanatomical knowledge, indicating that the medial pulvinar is connected to the temporal lobe via the temporopulvinar bundle of Arnold, we hypothesize that this is one of the routes through which medial pulvinar stimulation affects temporal lobe structures. We suggest that further anatomic, imaging, and electrophysiologic studies are warranted to deepen our understanding of the subject and guide future clinical applications.
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Hu Y, Feng Z, Zheng L, Xu Y, Wang Z. Adding a single pulse into high-frequency pulse stimulations can substantially alter the following episode of neuronal firing in rat hippocampus. J Neural Eng 2023; 20. [PMID: 36599161 DOI: 10.1088/1741-2552/acb013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/04/2023] [Indexed: 01/05/2023]
Abstract
Background. High-frequency stimulation (HFS) sequences of electrical pulses are commonly utilized in many types of neuromodulation therapies. The temporal pattern of pulse sequences characterized by varying inter-pulse intervals (IPI) has emerged as an adjustable dimension to generate diverse effects of stimulations to meet the needs for developing the therapies.Objective:To explore the hypothesis that a simple manipulation of IPI by inserting a pulse in HFS with a constant IPI can substantially change the neuronal responses.Approach. Antidromic HFS (A-HFS) and orthodromic HFS (O-HFS) sequences were respectively applied at the alveus (the efferent axons) and the Schaffer collaterals (the afferent axons) of hippocampal CA1 region in anesthetized ratsin-vivo. The HFS sequences lasted 120 s with a pulse frequency of 100 Hz and an IPI of 10 ms. In the late steady period (60-120 s) of the HFS, additional pulses were inserted into the original pulse sequences to investigate the alterations of neuronal responses to the changes in IPI. The amplitudes and latencies of antidromic/orthodromic population spikes (APS/OPS) evoked by pulses were measured to evaluate the alterations of the evoked firing of CA1 pyramidal neurons caused by the pulse insertions.Main Results. During the steady period of A-HFS at efferent axons, the evoked APSs were suppressed due to intermittent axonal block. Under this situation, inserting a pulse to shorten an IPI was able to redistribute the following neuronal firing thereby generating an episode of oscillation in the evoked APS sequence including APSs with significantly increased and decreased amplitudes. Also, during the steady period of O-HFS without obvious OPS, a pulse insertion was able to generate a large OPS, indicating a synchronized firing of a large population of post-synaptic neurons induced by a putative redistribution of activations at the afferent axons under O-HFS.Significance. This study firstly showed that under the situation of HFS-induced axonal block, changing an IPI by a single-pulse insertion can substantially redistribute the evoked neuronal responses to increase synchronized firing of neuronal populations during both antidromic and O-HFS with a constant IPI originally. The finding provides a potential way to enhance the HFS action on neuronal networks without losing some other functions of HFS such as generating axonal block.
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Affiliation(s)
- Yifan Hu
- Key Lab of Biomedical Engineering for Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Zhouyan Feng
- Key Lab of Biomedical Engineering for Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Lvpiao Zheng
- Key Lab of Biomedical Engineering for Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yipeng Xu
- Key Lab of Biomedical Engineering for Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Zhaoxiang Wang
- Zhejiang Lab Nanhu Headquarters, Kechuang Avenue, Hangzhou, Zhejiang Province, People's Republic of China
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Schaper FLWVJ, Plantinga BR, Colon AJ, Wagner GL, Boon P, Blom N, Gommer ED, Hoogland G, Ackermans L, Rouhl RPW, Temel Y. Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control? Neurosurgery 2021; 87:602-610. [PMID: 32421806 PMCID: PMC8210468 DOI: 10.1093/neuros/nyaa141] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/16/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site. OBJECTIVE To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control. METHODS The relationship between seizure control and the location of the active contacts to the ANT-MTT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps. RESULTS After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r2 = 0.24, P = .01) and is ∼30% smaller (P = .015) in responders than in non-responders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot. CONCLUSION Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.
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Affiliation(s)
- Frédéric L W V J Schaper
- Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Birgit R Plantinga
- Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Albert J Colon
- Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Heeze, The Netherlands.,Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Louis Wagner
- Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Heeze, The Netherlands.,Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul Boon
- Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Heeze, The Netherlands.,Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - Nadia Blom
- Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Erik D Gommer
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Govert Hoogland
- Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Maastricht, The Netherlands
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Rob P W Rouhl
- Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
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Foit NA, Bernasconi A, Ladbon-Bernasconi N. Contributions of Imaging to Neuromodulatory Treatment of Drug-Refractory Epilepsy. Brain Sci 2020; 10:E700. [PMID: 33023078 PMCID: PMC7601437 DOI: 10.3390/brainsci10100700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022] Open
Abstract
Epilepsy affects about 1% of the world's population, and up to 30% of all patients will ultimately not achieve freedom from seizures with anticonvulsive medication alone. While surgical resection of a magnetic resonance imaging (MRI) -identifiable lesion remains the first-line treatment option for drug-refractory epilepsy, surgery cannot be offered to all. Neuromodulatory therapy targeting "seizures" instead of "epilepsy" has emerged as a valuable treatment option for these patients, including invasive procedures such as deep brain stimulation (DBS), responsive neurostimulation (RNS) and peripheral approaches such as vagus nerve stimulation (VNS). The purpose of this review is to provide in-depth information on current concepts and evidence on network-level aspects of drug-refractory epilepsy. We reviewed the current evidence gained from studies utilizing advanced imaging methodology, with a specific focus on their contributions to neuromodulatory therapy.
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Affiliation(s)
- Niels Alexander Foit
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada; (A.B.); (N.L.-B.)
- Department of Neurosurgery, Medical Center–University of Freiburg, Faculty of Medicine, D-79106 Freiburg, Germany
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada; (A.B.); (N.L.-B.)
| | - Neda Ladbon-Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada; (A.B.); (N.L.-B.)
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Chaitanya G, Toth E, Pizarro D, Iasemidis L, Murray TA, Riley K, Pati S. Acute modulation of the limbic network with low and high-frequency stimulation of the human fornix. Epilepsy Behav Rep 2020; 14:100363. [PMID: 32435756 PMCID: PMC7232081 DOI: 10.1016/j.ebr.2020.100363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/11/2022] Open
Abstract
Targeted stimulation of white matter has opened newer perspectives in the field of neuromodulation, towards an attempt to improve memory or as a therapy for epilepsy. Stimulation of the fornix, being a part of the Papez circuit, is likely to modulate the limbic network excitability. However, the stimulation-frequency dependent variability in network excitability is unknown. In the case study, which involved stereo electroencephalographic (SEEG) recording of field potentials in a 48-year old left-handed woman with suspected temporal lobe epilepsy, we demonstrated the network effects of acute low (1 and 10 Hz) and high (50 Hz) frequency electrical stimulation of fornix. Mapping the short-latency evoked responses to forniceal stimulation confirmed the SEEG target localization within the Papez circuit. Low and high-frequency stimulation of the fornix produced opposite effects in the post-stimuli excitability, with the latter causing increased excitability in the limbic network that culminated in a clinical seizure. A distinct spectral peak around 8 Hz confirmed that sensing field potentials from the forniceal white matter is feasible. This is the first case study that provided an insight into how the temporal patterning of forniceal stimulation altered the downstream limbic network excitability.
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Affiliation(s)
- Ganne Chaitanya
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emilia Toth
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Diana Pizarro
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leonidas Iasemidis
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Tech Institute, Ruston, LA, USA
| | - Teresa A. Murray
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Tech Institute, Ruston, LA, USA
| | - Kristen Riley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandipan Pati
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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Qiu C, Feng Z, Zheng L, Ma W. Selective modulation of neuronal firing by pulse stimulations with different frequencies in rat hippocampus. Biomed Eng Online 2019; 18:79. [PMID: 31337402 PMCID: PMC6651985 DOI: 10.1186/s12938-019-0700-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 07/11/2019] [Indexed: 11/21/2022] Open
Abstract
Background Deep brain stimulation (DBS) has a good prospect for treating many brain diseases. Recent studies have shown that axonal activation induced by pulse stimulations may play an important role in DBS therapies through wide projections of axonal fibers. However, it is undetermined whether the downstream neurons are inhibited or excited by axonal stimulation. The present study addressed the question in rat hippocampus by in vivo experiments. Methods Pulse stimulations with different frequencies (10–400 Hz) were applied to the Schaffer collateral, the afferent fiber of hippocampal CA1 region in anaesthetized rats. Single-unit spikes of interneurons and pyramidal cells in the downstream region of stimulation were recorded and evaluated. Results Stimulations with a lower frequency (10 or 20 Hz) did not change the firing rates of interneurons but decreased the firing rates of pyramidal cells (the principal neurons) significantly. The phase-locked firing of interneurons during these stimulations might increase the efficacy of GABAergic inhibitions on the principal neurons. However, stimulations with a higher frequency (100–400 Hz) increased the firing rates of both types of the neurons significantly. In addition, the increases of interneurons’ firing were greater than the increases of pyramidal cells. Presumably, increase of direct excitation from afferent impulses together with failure of GABAergic inhibition might result in the increase of pyramidal cells’ firing by a higher stimulation frequency. Furthermore, silent periods appeared immediately following the cessation of stimulations, indicating a full control of the neuronal firing by the stimulation pulses during axonal stimulation. Furthermore longer silent periods were associated with higher stimulation frequencies. Conclusions Low-frequency (10–20 Hz) and high-frequency (100–400 Hz) stimulations of afferent axonal fibers exerted opposite effects on principal neurons in rat hippocampus CA1. These results provide new information for advancing deep brain stimulation to treat different brain disorders.
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Affiliation(s)
- Chen Qiu
- Key Laboratory of Biomedical Engineering of Education Ministry, College of Biomedical Engineering and Instrumentation Science, Zhejiang University, Hangzhou, 310027, Zhejiang, China
| | - Zhouyan Feng
- Key Laboratory of Biomedical Engineering of Education Ministry, College of Biomedical Engineering and Instrumentation Science, Zhejiang University, Hangzhou, 310027, Zhejiang, China.
| | - Lvpiao Zheng
- Key Laboratory of Biomedical Engineering of Education Ministry, College of Biomedical Engineering and Instrumentation Science, Zhejiang University, Hangzhou, 310027, Zhejiang, China
| | - Weijian Ma
- Key Laboratory of Biomedical Engineering of Education Ministry, College of Biomedical Engineering and Instrumentation Science, Zhejiang University, Hangzhou, 310027, Zhejiang, China
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Feng Z, Ma W, Wang Z, Qiu C, Hu H. Small Changes in Inter-Pulse-Intervals Can Cause Synchronized Neuronal Firing During High-Frequency Stimulations in Rat Hippocampus. Front Neurosci 2019; 13:36. [PMID: 30766474 PMCID: PMC6365434 DOI: 10.3389/fnins.2019.00036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/15/2019] [Indexed: 01/04/2023] Open
Abstract
Deep brain stimulation (DBS) traditionally utilizes electrical pulse sequences with a constant frequency, i.e., constant inter-pulse-interval (IPI), to treat certain brain disorders in clinic. Stimulation sequences with varying frequency have been investigated recently to improve the efficacy of existing DBS therapy and to develop new treatments. However, the effects of such sequences are inconclusive. The present study tests the hypothesis that stimulations with varying IPI can generate neuronal activity markedly different from the activity induced by stimulations with constant IPI. And, the crucial factor causing the distinction is the relative differences in IPI lengths rather than the absolute lengths of IPI nor the average lengths of IPI. In rat experiments in vivo, responses of neuronal populations to applied stimulation sequences were collected during stimulations with both constant IPI (control) and random IPI. The stimulations were applied in the efferent fibers antidromically (in alveus) or in the afferent fibers orthodromically (in Schaffer collaterals) of pyramidal cells, the principal cells of hippocampal CA1 region. Amplitudes and areas of population spike (PS) waveforms were used to evaluate the neuronal responses induced by different stimulation paradigms. During the periods of both antidromic and orthodromic high-frequency stimulation (HFS), the HFS with random IPI induced synchronous neuronal firing with large PS even if the lengths of random IPI were limited to a small range of 5-10 ms, corresponding to a frequency range 100-200 Hz. The large PS events did not appear during control stimulations with a constant frequency at 100, 200, or 130 Hz (i.e., the mean frequency of HFS with random IPI uniformly distributed within 5-10 ms). Presumably, nonlinear dynamics in neuronal responses to random IPI might cause the generation of synchronous firing under the situation without any long pauses in HFS sequences. The results indicate that stimulations with random IPI can generate salient impulses to brain tissues and modulate the synchronization of neuronal activity, thereby providing potential stimulation paradigms for extending DBS therapy in treating more brain diseases, such as disorders of consciousness and vegetative states.
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Affiliation(s)
- Zhouyan Feng
- Key Lab of Biomedical Engineering for Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Weijian Ma
- Key Lab of Biomedical Engineering for Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Zhaoxiang Wang
- Key Lab of Biomedical Engineering for Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Chen Qiu
- Key Lab of Biomedical Engineering for Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Hanhan Hu
- Key Lab of Biomedical Engineering for Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
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Wang Z, Feng Z, Wei X. Axonal Stimulations With a Higher Frequency Generate More Randomness in Neuronal Firing Rather Than Increase Firing Rates in Rat Hippocampus. Front Neurosci 2018; 12:783. [PMID: 30459545 PMCID: PMC6232943 DOI: 10.3389/fnins.2018.00783] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
Deep brain stimulation (DBS) has been used for treating many brain disorders. Clinical applications of DBS commonly require high-frequency stimulations (HFS, ∼100 Hz) of electrical pulses to obtain therapeutic efficacy. It is not clear whether the electrical energy of HFS functions other than generating firing of action potentials in neuronal elements. To address the question, we investigated the reactions of downstream neurons to pulse sequences with a frequency in the range 50-200 Hz at afferent axon fibers in the hippocampal CA1 region of anesthetized rats. The results show that the mean rates of neuronal firing induced by axonal HFS were similar even for an up to fourfold difference (200:50) in the number and thereby in the energy of electrical pulses delivered. However, HFS with a higher pulse frequency (100 or 200 Hz) generated more randomness in the firing pattern of neurons than a lower pulse frequency (50 Hz), which were quantitatively evaluated by the significant changes of two indexes, namely, the peak coefficients and the duty ratios of excitatory phase of neuronal firing, induced by different frequencies (50-200 Hz). The findings indicate that a large portion of the HFS energy might function to generate a desynchronization effect through a possible mechanism of intermittent depolarization block of neuronal membranes. The present study addresses the demand of high frequency for generating HFS-induced desynchronization in neuronal activity, which may play important roles in DBS therapy.
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Affiliation(s)
- Zhaoxiang Wang
- Key Lab of Biomedical Engineering for Education Ministry, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Zhouyan Feng
- Key Lab of Biomedical Engineering for Education Ministry, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Xuefeng Wei
- Department of Biomedical Engineering, The College of New Jersey, Ewing, NJ, United States
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Abstract
PURPOSE OF REVIEW Posttraumatic seizures (PTS) and posttraumatic epilepsy (PTE) are common and debilitating consequences of traumatic brain injury (TBI). Early PTS result in secondary brain injury by raising intracranial pressure and worsening cerebral edema and metabolic crisis. PTE is a localization-related epilepsy strongly associated with TBI severity, but risk factors for PTE and epileptogenesis are incompletely understood and are active areas of research. Medical management of PTS in adults and children is reviewed. Surgical options for posttraumatic drug-resistant epilepsy are also discussed. RECENT FINDINGS Continuous electroencephalography is indicated for children and adults with TBI and coma because of the high incidence of nonconvulsive seizures, periodic discharges, and associated secondary brain injury in this population. Neuroinflammation is a central component of secondary brain injury and appears to play a key role in epileptogenesis. Levetiracetam is increasingly used for seizure prophylaxis in adults and children, but variability remains. SUMMARY PTS occur commonly after TBI and are associated with secondary brain injury and worse outcomes in adults and children. Current medical and surgical management options for PTS and PTE are reviewed.
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Deeb W, Giordano JJ, Rossi PJ, Mogilner AY, Gunduz A, Judy JW, Klassen BT, Butson CR, Van Horne C, Deny D, Dougherty DD, Rowell D, Gerhardt GA, Smith GS, Ponce FA, Walker HC, Bronte-Stewart HM, Mayberg HS, Chizeck HJ, Langevin JP, Volkmann J, Ostrem JL, Shute JB, Jimenez-Shahed J, Foote KD, Wagle Shukla A, Rossi MA, Oh M, Pourfar M, Rosenberg PB, Silburn PA, de Hemptine C, Starr PA, Denison T, Akbar U, Grill WM, Okun MS. Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies. Front Integr Neurosci 2016; 10:38. [PMID: 27920671 PMCID: PMC5119052 DOI: 10.3389/fnint.2016.00038] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/01/2016] [Indexed: 02/02/2023] Open
Abstract
This paper provides an overview of current progress in the technological advances and the use of deep brain stimulation (DBS) to treat neurological and neuropsychiatric disorders, as presented by participants of the Fourth Annual DBS Think Tank, which was convened in March 2016 in conjunction with the Center for Movement Disorders and Neurorestoration at the University of Florida, Gainesveille FL, USA. The Think Tank discussions first focused on policy and advocacy in DBS research and clinical practice, formation of registries, and issues involving the use of DBS in the treatment of Tourette Syndrome. Next, advances in the use of neuroimaging and electrochemical markers to enhance DBS specificity were addressed. Updates on ongoing use and developments of DBS for the treatment of Parkinson's disease, essential tremor, Alzheimer's disease, depression, post-traumatic stress disorder, obesity, addiction were presented, and progress toward innovation(s) in closed-loop applications were discussed. Each section of these proceedings provides updates and highlights of new information as presented at this year's international Think Tank, with a view toward current and near future advancement of the field.
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Affiliation(s)
- Wissam Deeb
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - James J Giordano
- Department of Neurology, and Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center Washington, DC, USA
| | - Peter J Rossi
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Alon Y Mogilner
- Department of Neurosurgery, Center for Neuromodulation, New York University Langone Medical Center New York, NY, USA
| | - Aysegul Gunduz
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of FloridaGainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of FloridaGainesville, FL, USA
| | - Jack W Judy
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of FloridaGainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of FloridaGainesville, FL, USA
| | | | - Christopher R Butson
- Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah Salt Lake City, UT, USA
| | - Craig Van Horne
- Department of Neurosurgery, University of Kentucky Chandler Medical Center Lexington, KY, USA
| | - Damiaan Deny
- Department of Psychiatry, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA
| | - David Rowell
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland Brisbane, QLD, Australia
| | - Greg A Gerhardt
- Department of Anatomy and Neurobiology, University of Kentucky Chandler Medical Center Lexington, KY, USA
| | - Gwenn S Smith
- Departments of Psychiatry and Behavioral Sciences and Radiology and Radiological Sciences, Johns Hopkins University School of Medicine Baltimore, MD, USA
| | - Francisco A Ponce
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center Phoenix Arizona, AZ, USA
| | - Harrison C Walker
- Department of Neurology and Department of Biomedical Engineering, University of Alabama at Birmingham Birmingham, AL, USA
| | - Helen M Bronte-Stewart
- Departments of Neurology and Neurological Sciences and Neurosurgery, Stanford University Stanford, CA, USA
| | - Helen S Mayberg
- Department of Psychiatry, Emory University School of Medicine Atlanta, GA, USA
| | - Howard J Chizeck
- Electrical Engineering Department, University of WashingtonSeattle, WA, USA; NSF Engineering Research Center for Sensorimotor Neural EngineeringSeattle, WA, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA
| | - Jens Volkmann
- Department of Neurology, University Clinic of Würzburg Würzburg, Germany
| | - Jill L Ostrem
- Department of Neurology, University of California San Francisco San Francisco, CA, USA
| | - Jonathan B Shute
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida Gainesville, FL, USA
| | | | - Kelly D Foote
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of FloridaGainesville, FL, USA; Department of Neurological Sciences, University of FloridaGainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Marvin A Rossi
- Departments of Neurological Sciences, Diagnostic Radiology, and Nuclear Medicine, Rush University Medical Center Chicago, IL, USA
| | - Michael Oh
- Division of Functional Neurosurgery, Department of Neurosurgery, Allegheny General Hospital Pittsburgh, PA, USA
| | - Michael Pourfar
- Department of Neurology, New York University Langone Medical Center New York, NY, USA
| | - Paul B Rosenberg
- Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine Baltimore, MD, USA
| | - Peter A Silburn
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland Brisbane, QLD, Australia
| | - Coralie de Hemptine
- Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco San Francisco, CA, USA
| | - Philip A Starr
- Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco San Francisco, CA, USA
| | | | - Umer Akbar
- Movement Disorders Program, Department of Neurology, Alpert Medical School, Rhode Island Hospital, Brown University Providence, RI, USA
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University Durham, NC, USA
| | - Michael S Okun
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
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14
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Rosenow F, Knake S, Strzelczyk A. Editorial for the in focus issue of Seizure-European Journal of Epilepsy on "Diagnostic and therapeutic use of invasive electrodes in epilepsy-A "highway" to personalized epilepsy treatment". Seizure 2016; 41:189-90. [PMID: 27524461 DOI: 10.1016/j.seizure.2016.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany.
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
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