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Archila-Meléndez ME, Valente G, Gommer ED, Correia JM, Ten Oever S, Peters JC, Reithler J, Hendriks MPH, Cornejo Ochoa W, Schijns OEMG, Dings JTA, Hilkman DMW, Rouhl RPW, Jansma BM, van Kranen-Mastenbroek VHJM, Roberts MJ. Combining Gamma With Alpha and Beta Power Modulation for Enhanced Cortical Mapping in Patients With Focal Epilepsy. Front Hum Neurosci 2020; 14:555054. [PMID: 33408621 PMCID: PMC7779799 DOI: 10.3389/fnhum.2020.555054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/17/2020] [Indexed: 12/03/2022] Open
Abstract
About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping (ESM) is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity (55–200 Hz) recorded with extraoperative electrocorticography (ECoG) during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha (8–12 Hz) and beta (15–25 Hz) bands could further improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy (age: 35.9 ± 9.1 years, range: 22–48, 8 females, 9 right handed) participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model (GLM) approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic (ROC) curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy.
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Affiliation(s)
- Mario E Archila-Meléndez
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Neuroscientific MR-Physics Research Group, Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technische Universität München, Munich, Germany.,Technical University of Munich Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, School of Medicine, Technische Universität München, Munich, Germany
| | - Giancarlo Valente
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center (M-BIC), Maastricht University, Maastricht, Netherlands
| | - Erik D Gommer
- Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands
| | - João M Correia
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Basque Center on Cognition, Brain and Language (BCBL), Donostia-San Sebastian, Spain.,Centre for Biomedical Research (CBMR)/Department of Psychology, Universidade do Algarve, Faro, Portugal
| | - Sanne Ten Oever
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center (M-BIC), Maastricht University, Maastricht, Netherlands
| | - Judith C Peters
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center (M-BIC), Maastricht University, Maastricht, Netherlands.,Department of Vision & Cognition, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, Netherlands
| | - Joel Reithler
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center (M-BIC), Maastricht University, Maastricht, Netherlands.,Department of Vision & Cognition, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), Amsterdam, Netherlands
| | - Marc P H Hendriks
- Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands.,Department of Neurosurgery, Maastricht University Medical Center Maastricht, Maastricht University, Maastricht, Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - William Cornejo Ochoa
- Grupo Pediaciencias, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Olaf E M G Schijns
- Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands.,Department of Neurosurgery, Maastricht University Medical Center Maastricht, Maastricht University, Maastricht, Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Jim T A Dings
- Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands.,Department of Neurosurgery, Maastricht University Medical Center Maastricht, Maastricht University, Maastricht, Netherlands
| | - Danny M W Hilkman
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands.,Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands
| | - Rob P W Rouhl
- Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bernadette M Jansma
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Center (M-BIC), Maastricht University, Maastricht, Netherlands
| | - Vivianne H J M van Kranen-Mastenbroek
- Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands.,Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands.,Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Maastricht, Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Mark J Roberts
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands
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Silverstein BH, Asano E, Sugiura A, Sonoda M, Lee MH, Jeong JW. Dynamic tractography: Integrating cortico-cortical evoked potentials and diffusion imaging. Neuroimage 2020; 215:116763. [PMID: 32294537 DOI: 10.1016/j.neuroimage.2020.116763] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/02/2020] [Accepted: 03/17/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Cortico-cortical evoked potentials (CCEPs) are utilized to identify effective networks in the human brain. Following single-pulse electrical stimulation of cortical electrodes, evoked responses are recorded from distant cortical areas. A negative deflection (N1) which occurs 10-50 ms post-stimulus is considered to be a marker for direct cortico-cortical connectivity. However, with CCEPs alone it is not possible to observe the white matter pathways that conduct the signal or accurately predict N1 amplitude and latency at downstream recoding sites. Here, we develop a new approach, termed "dynamic tractography," which integrates CCEP data with diffusion-weighted imaging (DWI) data collected from the same patients. This innovative method allows greater insights into cortico-cortical networks than provided by each method alone and may improve the understanding of large-scale networks that support cognitive functions. The dynamic tractography model produces several fundamental hypotheses which we investigate: 1) DWI-based pathlength predicts N1 latency; 2) DWI-based pathlength negatively predicts N1 voltage; and 3) fractional anisotropy (FA) along the white matter path predicts N1 propagation velocity. METHODS Twenty-three neurosurgical patients with drug-resistant epilepsy underwent both extraoperative CCEP recordings and preoperative DWI scans. Subdural grids of 3 mm diameter electrodes were used for stimulation and recording, with 98-128 eligible electrodes per patient. CCEPs were elicited by trains of 1 Hz stimuli with an intensity of 5 mA and recorded at a sample rate of 1 kHz. N1 peak and latency were defined as the maximum of a negative deflection within 10-50 ms post-stimulus with a z-score > 5 relative to baseline. Electrodes and DWI were coregistered to construct electrode connectomes for white matter quantification. RESULTS Clinical variables (age, sex, number of anti-epileptic drugs, handedness, and stimulated hemisphere) did not correlate with the key outcome measures (N1 peak amplitude, latency, velocity, or DWI pathlength). All subjects and electrodes were therefore pooled into a group-level analysis to determine overall patterns. As hypothesized, DWI path length positively predicted N1 latency (R2 = 0.81, β = 1.51, p = 4.76e-16) and negatively predicted N1 voltage (R2 = 0.79, β = -0.094, p = 9.30e-15), while FA predicted N1 propagation velocity (R2 = 0.35, β = 48.0, p = 0.001). CONCLUSION We have demonstrated that the strength and timing of the CCEP N1 is dependent on the properties of the underlying white matter network. Integrated CCEP and DWI visualization allows robust localization of intact axonal pathways which effectively interconnect eloquent cortex.
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Affiliation(s)
- Brian H Silverstein
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
| | - Eishi Asano
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA; Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Dept. of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Ayaka Sugiura
- Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Masaki Sonoda
- Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Min-Hee Lee
- Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Translational Imaging Laboratory, Wayne State University, Detroit, MI, USA
| | - Jeong-Won Jeong
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA; Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Dept. of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Translational Imaging Laboratory, Wayne State University, Detroit, MI, USA.
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