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Millán AP, van Straaten ECW, Stam CJ, Nissen IA, Idema S, Van Mieghem P, Hillebrand A. Individualized epidemic spreading models predict epilepsy surgery outcomes: A pseudo-prospective study. Netw Neurosci 2024; 8:437-465. [PMID: 38952815 PMCID: PMC11142635 DOI: 10.1162/netn_a_00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/18/2024] [Indexed: 07/03/2024] Open
Abstract
Epilepsy surgery is the treatment of choice for drug-resistant epilepsy patients, but up to 50% of patients continue to have seizures one year after the resection. In order to aid presurgical planning and predict postsurgical outcome on a patient-by-patient basis, we developed a framework of individualized computational models that combines epidemic spreading with patient-specific connectivity and epileptogeneity maps: the Epidemic Spreading Seizure and Epilepsy Surgery framework (ESSES). ESSES parameters were fitted in a retrospective study (N = 15) to reproduce invasive electroencephalography (iEEG)-recorded seizures. ESSES reproduced the iEEG-recorded seizures, and significantly better so for patients with good (seizure-free, SF) than bad (nonseizure-free, NSF) outcome. We illustrate here the clinical applicability of ESSES with a pseudo-prospective study (N = 34) with a blind setting (to the resection strategy and surgical outcome) that emulated presurgical conditions. By setting the model parameters in the retrospective study, ESSES could be applied also to patients without iEEG data. ESSES could predict the chances of good outcome after any resection by finding patient-specific model-based optimal resection strategies, which we found to be smaller for SF than NSF patients, suggesting an intrinsic difference in the network organization or presurgical evaluation results of NSF patients. The actual surgical plan overlapped more with the model-based optimal resection, and had a larger effect in decreasing modeled seizure propagation, for SF patients than for NSF patients. Overall, ESSES could correctly predict 75% of NSF and 80.8% of SF cases pseudo-prospectively. Our results show that individualised computational models may inform surgical planning by suggesting alternative resections and providing information on the likelihood of a good outcome after a proposed resection. This is the first time that such a model is validated with a fully independent cohort and without the need for iEEG recordings.
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Affiliation(s)
- Ana P. Millán
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, Amsterdam, The Netherlands
- Institute “Carlos I” for Theoretical and Computational Physics, and Electromagnetism and Matter Physics Department, University of Granada, Granada, Spain
| | - Elisabeth C. W. van Straaten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Systems and Network Neurosciences, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Cornelis J. Stam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Ida A. Nissen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, Amsterdam, The Netherlands
| | - Sander Idema
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Systems and Network Neurosciences, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Cancer Biology and Immonology, Amsterdam, The Netherlands
| | - Piet Van Mieghem
- Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, The Netherlands
| | - Arjan Hillebrand
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Systems and Network Neurosciences, Amsterdam, The Netherlands
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2
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Papo D, Buldú JM. Does the brain behave like a (complex) network? I. Dynamics. Phys Life Rev 2024; 48:47-98. [PMID: 38145591 DOI: 10.1016/j.plrev.2023.12.006] [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: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 12/27/2023]
Abstract
Graph theory is now becoming a standard tool in system-level neuroscience. However, endowing observed brain anatomy and dynamics with a complex network structure does not entail that the brain actually works as a network. Asking whether the brain behaves as a network means asking whether network properties count. From the viewpoint of neurophysiology and, possibly, of brain physics, the most substantial issues a network structure may be instrumental in addressing relate to the influence of network properties on brain dynamics and to whether these properties ultimately explain some aspects of brain function. Here, we address the dynamical implications of complex network, examining which aspects and scales of brain activity may be understood to genuinely behave as a network. To do so, we first define the meaning of networkness, and analyse some of its implications. We then examine ways in which brain anatomy and dynamics can be endowed with a network structure and discuss possible ways in which network structure may be shown to represent a genuine organisational principle of brain activity, rather than just a convenient description of its anatomy and dynamics.
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Affiliation(s)
- D Papo
- Department of Neuroscience and Rehabilitation, Section of Physiology, University of Ferrara, Ferrara, Italy; Center for Translational Neurophysiology, Fondazione Istituto Italiano di Tecnologia, Ferrara, Italy.
| | - J M Buldú
- Complex Systems Group & G.I.S.C., Universidad Rey Juan Carlos, Madrid, Spain
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3
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Saggio ML, Jirsa V. Bifurcations and bursting in the Epileptor. PLoS Comput Biol 2024; 20:e1011903. [PMID: 38446814 PMCID: PMC10947678 DOI: 10.1371/journal.pcbi.1011903] [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: 10/30/2023] [Revised: 03/18/2024] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
The Epileptor is a phenomenological model for seizure activity that is used in a personalized large-scale brain modeling framework, the Virtual Epileptic Patient, with the aim of improving surgery outcomes for drug-resistant epileptic patients. Transitions between interictal and ictal states are modeled as bifurcations, enabling the definition of seizure classes in terms of onset/offset bifurcations. This establishes a taxonomy of seizures grounded in their essential underlying dynamics and the Epileptor replicates the activity of the most common class, as observed in patients with focal epilepsy, which is characterized by square-wave bursting properties. The Epileptor also encodes an additional mechanism to account for interictal spikes and spike and wave discharges. Here we use insights from a more generic model for square-wave bursting, based on the Unfolding Theory approach, to guide the bifurcation analysis of the Epileptor and gain a deeper understanding of the model and the role of its parameters. We show how the Epileptor's parameters can be modified to produce activities for other seizures classes of the taxonomy, as observed in patients, so that the large-scale brain models could be further personalized. Some of these classes have already been described in the literature in the Epileptor, others, predicted by the generic model, are new. Finally, we unveil how the interaction with the additional mechanism for spike and wave discharges alters the bifurcation structure of the main burster.
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Affiliation(s)
- Maria Luisa Saggio
- Institut de Neurosciences des Systemes INS UMR1106, AMU, INSERM, Marseille, France
| | - Viktor Jirsa
- Institut de Neurosciences des Systemes INS UMR1106, AMU, INSERM, Marseille, France
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Schoonhoven DN, Coomans EM, Millán AP, van Nifterick AM, Visser D, Ossenkoppele R, Tuncel H, van der Flier WM, Golla SSV, Scheltens P, Hillebrand A, van Berckel BNM, Stam CJ, Gouw AA. Tau protein spreads through functionally connected neurons in Alzheimer's disease: a combined MEG/PET study. Brain 2023; 146:4040-4054. [PMID: 37279597 PMCID: PMC10545627 DOI: 10.1093/brain/awad189] [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: 12/23/2022] [Revised: 03/03/2023] [Accepted: 04/10/2023] [Indexed: 06/08/2023] Open
Abstract
Recent studies on Alzheimer's disease (AD) suggest that tau proteins spread through the brain following neuronal connections. Several mechanisms could be involved in this process: spreading between brain regions that interact strongly (functional connectivity); through the pattern of anatomical connections (structural connectivity); or simple diffusion. Using magnetoencephalography (MEG), we investigated which spreading pathways influence tau protein spreading by modelling the tau propagation process using an epidemic spreading model. We compared the modelled tau depositions with 18F-flortaucipir PET binding potentials at several stages of the AD continuum. In this cross-sectional study, we analysed source-reconstructed MEG data and dynamic 100-min 18F-flortaucipir PET from 57 subjects positive for amyloid-β pathology [preclinical AD (n = 16), mild cognitive impairment (MCI) due to AD (n = 16) and AD dementia (n = 25)]. Cognitively healthy subjects without amyloid-β pathology were included as controls (n = 25). Tau propagation was modelled as an epidemic process (susceptible-infected model) on MEG-based functional networks [in alpha (8-13 Hz) and beta (13-30 Hz) bands], a structural or diffusion network, starting from the middle and inferior temporal lobe. The group-level network of the control group was used as input for the model to predict tau deposition in three stages of the AD continuum. To assess performance, model output was compared to the group-specific tau deposition patterns as measured with 18F-flortaucipir PET. We repeated the analysis by using networks of the preceding disease stage and/or using regions with most observed tau deposition during the preceding stage as seeds. In the preclinical AD stage, the functional networks predicted most of the modelled tau-PET binding potential, with best correlations between model and tau-PET [corrected amplitude envelope correlation (AEC-c) alpha C = 0.584; AEC-c beta C = 0.569], followed by the structural network (C = 0.451) and simple diffusion (C = 0.451). Prediction accuracy declined for the MCI and AD dementia stages, although the correlation between modelled tau and tau-PET binding remained highest for the functional networks (C = 0.384; C = 0.376). Replacing the control-network with the network from the preceding disease stage and/or alternative seeds improved prediction accuracy in MCI but not in the dementia stage. These results suggest that in addition to structural connections, functional connections play an important role in tau spread, and highlight that neuronal dynamics play a key role in promoting this pathological process. Aberrant neuronal communication patterns should be taken into account when identifying targets for future therapy. Our results also suggest that this process is more important in earlier disease stages (preclinical AD/MCI); possibly, in later stages, other processes may be influential.
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Affiliation(s)
- Deborah N Schoonhoven
- Department of Clinical Neurophysiology and MEG Center, Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
| | - Emma M Coomans
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, 1081 HV Amsterdam, The Netherlands
| | - Ana P Millán
- Department of Clinical Neurophysiology and MEG Center, Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, 1081 HV Amsterdam, The Netherlands
| | - Anne M van Nifterick
- Department of Clinical Neurophysiology and MEG Center, Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
| | - Denise Visser
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, 1081 HV Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, 1081 HV Amsterdam, The Netherlands
- Clinical Memory Research Unit, Lund University, 221 00 Lund, Sweden
| | - Hayel Tuncel
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, 1081 HV Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
| | - Sandeep S V Golla
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, 1081 HV Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology and MEG Center, Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, 1081 HV Amsterdam, The Netherlands
- Amsterdam Neuroscience, Systems and Network Neuroscience, 1081 HV Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, 1081 HV Amsterdam, The Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology and MEG Center, Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
| | - Alida A Gouw
- Department of Clinical Neurophysiology and MEG Center, Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, 1081 HZ Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV Amsterdam, The Netherlands
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5
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Vogel JW, Corriveau-Lecavalier N, Franzmeier N, Pereira JB, Brown JA, Maass A, Botha H, Seeley WW, Bassett DS, Jones DT, Ewers M. Connectome-based modelling of neurodegenerative diseases: towards precision medicine and mechanistic insight. Nat Rev Neurosci 2023; 24:620-639. [PMID: 37620599 DOI: 10.1038/s41583-023-00731-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/26/2023]
Abstract
Neurodegenerative diseases are the most common cause of dementia. Although their underlying molecular pathologies have been identified, there is substantial heterogeneity in the patterns of progressive brain alterations across and within these diseases. Recent advances in neuroimaging methods have revealed that pathological proteins accumulate along specific macroscale brain networks, implicating the network architecture of the brain in the system-level pathophysiology of neurodegenerative diseases. However, the extent to which 'network-based neurodegeneration' applies across the wide range of neurodegenerative disorders remains unclear. Here, we discuss the state-of-the-art of neuroimaging-based connectomics for the mapping and prediction of neurodegenerative processes. We review findings supporting brain networks as passive conduits through which pathological proteins spread. As an alternative view, we also discuss complementary work suggesting that network alterations actively modulate the spreading of pathological proteins between connected brain regions. We conclude this Perspective by proposing an integrative framework in which connectome-based models can be advanced along three dimensions of innovation: incorporating parameters that modulate propagation behaviour on the basis of measurable biological features; building patient-tailored models that use individual-level information and allowing model parameters to interact dynamically over time. We discuss promises and pitfalls of these strategies for improving disease insights and moving towards precision medicine.
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Affiliation(s)
- Jacob W Vogel
- Department of Clinical Sciences, SciLifeLab, Lund University, Lund, Sweden.
| | - Nick Corriveau-Lecavalier
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Acadamy, University of Gothenburg, Mölndal and Gothenburg, Sweden
| | - Joana B Pereira
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Neuro Division, Department of Clinical Neurosciences, Karolinska Institute, Stockholm, Sweden
| | - Jesse A Brown
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Anne Maass
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Dani S Bassett
- Departments of Bioengineering, Electrical and Systems Engineering, Physics and Astronomy, Neurology and Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Santa Fe Institute, Santa Fe, NM, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.
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6
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Dallmer-Zerbe I, Jiruska P, Hlinka J. Personalized dynamic network models of the human brain as a future tool for planning and optimizing epilepsy therapy. Epilepsia 2023; 64:2221-2238. [PMID: 37340565 DOI: 10.1111/epi.17690] [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: 03/09/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 06/22/2023]
Abstract
Epilepsy is a common neurological disorder, with one third of patients not responding to currently available antiepileptic drugs. The proportion of pharmacoresistant epilepsies has remained unchanged for many decades. To cure epilepsy and control seizures requires a paradigm shift in the development of new approaches to epilepsy diagnosis and treatment. Contemporary medicine has benefited from the exponential growth of computational modeling, and the application of network dynamics theory to understanding and treating human brain disorders. In epilepsy, the introduction of these approaches has led to personalized epileptic network modeling that can explore the patient's seizure genesis and predict the functional impact of resection on its individual network's propensity to seize. The application of the dynamic systems approach to neurostimulation therapy of epilepsy allows designing stimulation strategies that consider the patient's seizure dynamics and long-term fluctuations in the stability of their epileptic networks. In this article, we review, in a nontechnical fashion suitable for a broad neuroscientific audience, recent progress in personalized dynamic brain network modeling that is shaping the future approach to the diagnosis and treatment of epilepsy.
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Affiliation(s)
- Isa Dallmer-Zerbe
- Department of Complex Systems, Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
- Department of Physiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Premysl Jiruska
- Department of Physiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslav Hlinka
- Department of Complex Systems, Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
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7
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Corona L, Tamilia E, Perry MS, Madsen JR, Bolton J, Stone SSD, Stufflebeam SM, Pearl PL, Papadelis C. Non-invasive mapping of epileptogenic networks predicts surgical outcome. Brain 2023; 146:1916-1931. [PMID: 36789500 PMCID: PMC10151194 DOI: 10.1093/brain/awac477] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/03/2022] [Accepted: 11/30/2022] [Indexed: 02/16/2023] Open
Abstract
Epilepsy is increasingly considered a disorder of brain networks. Studying these networks with functional connectivity can help identify hubs that facilitate the spread of epileptiform activity. Surgical resection of these hubs may lead patients who suffer from drug-resistant epilepsy to seizure freedom. Here, we aim to map non-invasively epileptogenic networks, through the virtual implantation of sensors estimated with electric and magnetic source imaging, in patients with drug-resistant epilepsy. We hypothesize that highly connected hubs identified non-invasively with source imaging can predict the epileptogenic zone and the surgical outcome better than spikes localized with conventional source localization methods (dipoles). We retrospectively analysed simultaneous high-density electroencephalography (EEG) and magnetoencephalography data recorded from 37 children and young adults with drug-resistant epilepsy who underwent neurosurgery. Using source imaging, we estimated virtual sensors at locations where intracranial EEG contacts were placed. On data with and without spikes, we computed undirected functional connectivity between sensors/contacts using amplitude envelope correlation and phase locking value for physiologically relevant frequency bands. From each functional connectivity matrix, we generated an undirected network containing the strongest connections within sensors/contacts using the minimum spanning tree. For each sensor/contact, we computed graph centrality measures. We compared functional connectivity and their derived graph centrality of sensors/contacts inside resection for good (n = 22, ILAE I) and poor (n = 15, ILAE II-VI) outcome patients, tested their ability to predict the epileptogenic zone in good-outcome patients, examined the association between highly connected hubs removal and surgical outcome and performed leave-one-out cross-validation to support their prognostic value. We also compared the predictive values of functional connectivity with those of dipoles. Finally, we tested the reliability of virtual sensor measures via Spearman's correlation with intracranial EEG at population- and patient-level. We observed higher functional connectivity inside than outside resection (P < 0.05, Wilcoxon signed-rank test) for good-outcome patients, on data with and without spikes across different bands for intracranial EEG and electric/magnetic source imaging and few differences for poor-outcome patients. These functional connectivity measures were predictive of both the epileptogenic zone and outcome (positive and negative predictive values ≥55%, validated using leave-one-out cross-validation) outperforming dipoles on spikes. Significant correlations were found between source imaging and intracranial EEG measures (0.4 ≤ rho ≤ 0.9, P < 0.05). Our findings suggest that virtual implantation of sensors through source imaging can non-invasively identify highly connected hubs in patients with drug-resistant epilepsy, even in the absence of frank epileptiform activity. Surgical resection of these hubs predicts outcome better than dipoles.
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Affiliation(s)
- Ludovica Corona
- Jane and John Justin Institute for Mind Health, Cook Children's Health Care System, Fort Worth, TX 76104, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX 76010, USA
| | - Eleonora Tamilia
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health, Cook Children's Health Care System, Fort Worth, TX 76104, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jeffrey Bolton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Scellig S D Stone
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Steve M Stufflebeam
- Athinoula Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Christos Papadelis
- Jane and John Justin Institute for Mind Health, Cook Children's Health Care System, Fort Worth, TX 76104, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX 76010, USA
- School of Medicine, Texas Christian University, Fort Worth, TX 76129, USA
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8
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Jirsa V, Wang H, Triebkorn P, Hashemi M, Jha J, Gonzalez-Martinez J, Guye M, Makhalova J, Bartolomei F. Personalised virtual brain models in epilepsy. Lancet Neurol 2023; 22:443-454. [PMID: 36972720 DOI: 10.1016/s1474-4422(23)00008-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023]
Abstract
Individuals with drug-resistant focal epilepsy are candidates for surgical treatment as a curative option. Before surgery can take place, the patient must have a presurgical evaluation to establish whether and how surgical treatment might stop their seizures without causing neurological deficits. Virtual brains are a new digital modelling technology that map the brain network of a person with epilepsy, using data derived from MRI. This technique produces a computer simulation of seizures and brain imaging signals, such as those that would be recorded with intracranial EEG. When combined with machine learning, virtual brains can be used to estimate the extent and organisation of the epileptogenic zone (ie, the brain regions related to seizure generation and the spatiotemporal dynamics during seizure onset). Virtual brains could, in the future, be used for clinical decision making, to improve precision in localisation of seizure activity, and for surgical planning, but at the moment these models have some limitations, such as low spatial resolution. As evidence accumulates in support of the predictive power of personalised virtual brain models, and as methods are tested in clinical trials, virtual brains might inform clinical practice in the near future.
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Affiliation(s)
- Viktor Jirsa
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France.
| | - Huifang Wang
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | - Paul Triebkorn
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | - Meysam Hashemi
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | - Jayant Jha
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | | | - Maxime Guye
- Centre National de la Recherche Scientifique, Center for Magnetic Resonance in Biology and Medicine, Aix Marseille Université, Marseille, France; Centre d'Exploration Métabolique par Résonance Magnétique, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France
| | - Julia Makhalova
- Centre National de la Recherche Scientifique, Center for Magnetic Resonance in Biology and Medicine, Aix Marseille Université, Marseille, France; Centre d'Exploration Métabolique par Résonance Magnétique, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France; Epileptology and Clinical Neurophysiology Department, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France
| | - Fabrice Bartolomei
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France; Epileptology and Clinical Neurophysiology Department, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France
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