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Hays MA, Daraie AH, Smith RJ, Sarma SV, Crone NE, Kang JY. Network excitability of stimulation-induced spectral responses helps localize the seizure onset zone. Clin Neurophysiol 2024; 166:43-55. [PMID: 39096821 PMCID: PMC11401764 DOI: 10.1016/j.clinph.2024.07.010] [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: 10/09/2023] [Revised: 03/11/2024] [Accepted: 07/19/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE While evoked potentials elicited by single pulse electrical stimulation (SPES) may assist seizure onset zone (SOZ) localization during intracranial EEG (iEEG) monitoring, induced high frequency activity has also shown promising utility. We aimed to predict SOZ sites using induced cortico-cortical spectral responses (CCSRs) as an index of excitability within epileptogenic networks. METHODS SPES was conducted in 27 epilepsy patients undergoing iEEG monitoring and CCSRs were quantified by significant early (10-200 ms) increases in power from 10 to 250 Hz. Using response power as CCSR network connection strengths, graph centrality measures (metrics quantifying each site's influence within the network) were used to predict whether sites were within the SOZ. RESULTS Across patients with successful surgical outcomes, greater CCSR centrality predicted SOZ sites and SOZ sites targeted for surgical treatment with median AUCs of 0.85 and 0.91, respectively. We found that the alignment between predicted and targeted SOZ sites predicted surgical outcome with an AUC of 0.79. CONCLUSIONS These findings indicate that network analysis of CCSRs can be used to identify increased excitability of SOZ sites and discriminate important surgical targets within the SOZ. SIGNIFICANCE CCSRs may supplement traditional passive iEEG monitoring in seizure localization, potentially reducing the need for recording numerous seizures.
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Affiliation(s)
- Mark A Hays
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
| | - Amir H Daraie
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel J Smith
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neuroengineering, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sridevi V Sarma
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA; Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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Isan P, Deslauriers-Gauthier S, Papadopoulo T, Fontaine D, Filipiak P, Almairac F. The effect of common parameters of bipolar stimulation on brain evoked potentials. Clin Neurophysiol 2024; 167:26-36. [PMID: 39260137 DOI: 10.1016/j.clinph.2024.08.019] [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: 03/14/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVE To identify optimal bipolar stimulation parameters for robust generation of brain evoked potentials (BEPs), namely the interelectrode distance (IED) and the intensity of stimulation (IS), in cortical and axonal stimulation. METHODS In 15 patients who underwent awake surgery for brain tumor removal, BEPs were elicited at different values of IED and IS, respectively: 5 mm-5 mA, 5 mm-10 mA, and 10 mm-10 mA. The number of BEPs elicited by stimulation, as well as the delays and amplitudes of the N1 waves were compared between the different groups of stimulation parameters and according to the stimulated brain structure (cortical vs. axonal). RESULTS The amplitudes of N1 increased with the intensity of bipolar stimulation, either in cortical or axonal stimulation, while N1 peak delays were not affected by the stimulation parameters. Furthermore, axonal stimulation produced more N1s than cortical stimulation, with lower latencies. CONCLUSIONS Understanding the relationship between stimulation parameters and BEP is of utmost importance to determine whether the generated N1 waves accurately reflect the underlying structural anatomy. Other factors, such as stimulation frequency or pulse width and shape, may also play a role and warrant further investigation. SIGNIFICANCE This study represents the first step in describing the influence of common bipolar stimulation parameters on robustness of BEPs by examining the impact of IED and IS on the N1 wave.
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Affiliation(s)
- Petru Isan
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, France; UR2CA PIN, Université Côte d'Azur, France; Cronos Team, Centre Inria d'Université Côte d'Azur, France
| | | | | | - Denys Fontaine
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, France; UR2CA PIN, Université Côte d'Azur, France
| | | | - Fabien Almairac
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, France; UR2CA PIN, Université Côte d'Azur, France.
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3
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Massimini M, Corbetta M, Sanchez-Vives MV, Andrillon T, Deco G, Rosanova M, Sarasso S. Sleep-like cortical dynamics during wakefulness and their network effects following brain injury. Nat Commun 2024; 15:7207. [PMID: 39174560 PMCID: PMC11341729 DOI: 10.1038/s41467-024-51586-1] [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: 12/29/2023] [Accepted: 08/07/2024] [Indexed: 08/24/2024] Open
Abstract
By connecting old and recent notions, different spatial scales, and research domains, we introduce a novel framework on the consequences of brain injury focusing on a key role of slow waves. We argue that the long-standing finding of EEG slow waves after brain injury reflects the intrusion of sleep-like cortical dynamics during wakefulness; we illustrate how these dynamics are generated and how they can lead to functional network disruption and behavioral impairment. Finally, we outline a scenario whereby post-injury slow waves can be modulated to reawaken parts of the brain that have fallen asleep to optimize rehabilitation strategies and promote recovery.
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Grants
- The authors thank Dr Ezequiel Mikulan, Dr Silvia Casarotto, Dr Andrea Pigorini, Dr Simone Russo, and Dr Pilleriin Sikka for their help and comments on the manuscript draft and illustrations. This work was financially supported by the following entities: ERC-2022-SYG Grant number 101071900 Neurological Mechanisms of Injury and Sleep-like Cellular Dynamics (NEMESIS); Italian National Recovery and Resilience Plan (NRRP), M4C2, funded by the European Union - NextGenerationEU (Project IR0000011, CUP B51E22000150006, “EBRAINS-Italy”); European Union’s Horizon 2020 Framework Program for Research and Innovation under the Specific Grant Agreement No.945539 (Human Brain Project SGA3); Tiny Blue Dot Foundation; Canadian Institute for Advanced Research (CIFAR), Canada; Italian Ministry for Universities and Research (PRIN 2022); Fondazione Regionale per la Ricerca Biomedica (Regione Lombardia), Project ERAPERMED2019–101, GA 779282; CORTICOMOD PID2020-112947RB-I00 financed by MCIN/ AEI /10.13039/501100011033; Fondazione Cassa di Risparmio di Padova e Rovigo (CARIPARO) Grant Agreement number 55403; Ministry of Health, Italy (RF-2008 -12366899) Brain connectivity measured with high-density electroencephalography: a novel neurodiagnostic tool for stroke- NEUROCONN; BIAL foundation grant (Grant Agreement number 361/18); H2020 European School of Network Neuroscience (euSNN); H2020 Visionary Nature Based Actions For Heath, Wellbeing & Resilience in Cities (VARCITIES); Ministry of Health Italy (RF-2019-12369300): Eye-movement dynamics during free viewing as biomarker for assessment of visuospatial functions and for closed-loop rehabilitation in stroke (EYEMOVINSTROKE).
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Affiliation(s)
- Marcello Massimini
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
| | - Maurizio Corbetta
- Department of Neuroscience and Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
- Veneto Institute of Molecular Medicine (VIMM), Padova, Italy
| | - Maria V Sanchez-Vives
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Institució Catalana de la Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Thomas Andrillon
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Mov'it team, Inserm, CNRS, Paris, France
- Monash Centre for Consciousness and Contemplative Studies, Faculty of Arts, Monash University, Melbourne, VIC, Australia
| | - Gustavo Deco
- Institució Catalana de la Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Center for Brain and Cognition, Computational Neuroscience Group, Barcelona, Spain
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Simone Sarasso
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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4
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Huang Y, Zelmann R, Hadar P, Dezha-Peralta J, Richardson RM, Williams ZM, Cash SS, Keller CJ, Paulk AC. Theta-burst direct electrical stimulation remodels human brain networks. Nat Commun 2024; 15:6982. [PMID: 39143083 PMCID: PMC11324911 DOI: 10.1038/s41467-024-51443-1] [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: 03/06/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024] Open
Abstract
Theta-burst stimulation (TBS), a patterned brain stimulation technique that mimics rhythmic bursts of 3-8 Hz endogenous brain rhythms, has emerged as a promising therapeutic approach for treating a wide range of brain disorders, though the neural mechanism of TBS action remains poorly understood. We investigated the neural effects of TBS using intracranial EEG (iEEG) in 10 pre-surgical epilepsy participants undergoing intracranial monitoring. Here we show that individual bursts of direct electrical TBS at 29 frontal and temporal sites evoked strong neural responses spanning broad cortical regions. These responses exhibited dynamic local field potential voltage changes over the course of stimulation presentations, including either increasing or decreasing responses, suggestive of short-term plasticity. Stronger stimulation augmented the mean TBS response amplitude and spread with more recording sites demonstrating short-term plasticity. TBS responses were stimulation site-specific with stronger TBS responses observed in regions with strong baseline stimulation effective (cortico-cortical evoked potentials) and functional (low frequency phase locking) connectivity. Further, we could use these measures to predict stable and varying (e.g. short-term plasticity) TBS response locations. Future work may integrate pre-treatment connectivity alongside other biophysical factors to personalize stimulation parameters, thereby optimizing induction of neuroplasticity within disease-relevant brain networks.
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Affiliation(s)
- Yuhao Huang
- Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| | - Rina Zelmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Peter Hadar
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaquelin Dezha-Peralta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ziv M Williams
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Palo Alto, CA, USA.
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, USA.
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Stieger JR, Pinheiro-Chagas P, Fang Y, Li J, Lusk Z, Perry CM, Girn M, Contreras D, Chen Q, Huguenard JR, Spreng RN, Edlow BL, Wagner AD, Buch V, Parvizi J. Cross-regional coordination of activity in the human brain during autobiographical self-referential processing. Proc Natl Acad Sci U S A 2024; 121:e2316021121. [PMID: 39078679 PMCID: PMC11317603 DOI: 10.1073/pnas.2316021121] [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: 09/15/2023] [Accepted: 06/10/2024] [Indexed: 07/31/2024] Open
Abstract
For the human brain to operate, populations of neurons across anatomical structures must coordinate their activity within milliseconds. To date, our understanding of such interactions has remained limited. We recorded directly from the hippocampus (HPC), posteromedial cortex (PMC), ventromedial/orbital prefrontal cortex (OFC), and the anterior nuclei of the thalamus (ANT) during two experiments of autobiographical memory processing that are known from decades of neuroimaging work to coactivate these regions. In 31 patients implanted with intracranial electrodes, we found that the presentation of memory retrieval cues elicited a significant increase of low frequency (LF < 6 Hz) activity followed by cross-regional phase coherence of this LF activity before select populations of neurons within each of the four regions increased high-frequency (HF > 70 Hz) activity. The power of HF activity was modulated by memory content, and its onset followed a specific temporal order of ANT→HPC/PMC→OFC. Further, we probed cross-regional causal effective interactions with repeated electrical pulses and found that HPC stimulations cause the greatest increase in LF-phase coherence across all regions, whereas the stimulation of any region caused the greatest LF-phase coherence between that particular region and ANT. These observations support the role of the ANT in gating, and the HPC in synchronizing, the activity of cortical midline structures when humans retrieve self-relevant memories of their past. Our findings offer a fresh perspective, with high temporal fidelity, about the dynamic signaling and underlying causal connections among distant regions when the brain is actively involved in retrieving self-referential memories from the past.
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Affiliation(s)
- James R. Stieger
- Laboratory of Behavioral and Cognitive Neuroscience, Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA94305
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA94305
| | - Pedro Pinheiro-Chagas
- Laboratory of Behavioral and Cognitive Neuroscience, Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA94305
| | - Ying Fang
- School of Psychology, South China Normal University, Guangzhou510631, China
| | - Jian Li
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Zoe Lusk
- Laboratory of Behavioral and Cognitive Neuroscience, Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA94305
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA94305
| | - Claire M. Perry
- Laboratory of Behavioral and Cognitive Neuroscience, Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA94305
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA94305
| | - Manesh Girn
- Montreal Neurological Institute, Department Neurology and Neurosurgery, McGill University, Montreal, QCH3G 1A4, Canada
| | - Diego Contreras
- Department of Neuroscience, University of Pennsylvania, School of Medicine, Philadelphia, PA19104
| | - Qi Chen
- School of Psychology, South China Normal University, Guangzhou510631, China
| | - John R. Huguenard
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA94305
- Wu Tsai Neurosciences Institute, Stanford, CA94305
| | - R. Nathan Spreng
- Montreal Neurological Institute, Department Neurology and Neurosurgery, McGill University, Montreal, QCH3G 1A4, Canada
| | - Brian L. Edlow
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Anthony D. Wagner
- Wu Tsai Neurosciences Institute, Stanford, CA94305
- Department of Psychology, Stanford University, Stanford, CA94305
| | - Vivek Buch
- Department of Neurosurgery, Stanford University, Stanford School of Medicine, Stanford, CA94305
| | - Josef Parvizi
- Laboratory of Behavioral and Cognitive Neuroscience, Human Intracranial Cognitive Electrophysiology Program, Stanford University School of Medicine, Stanford, CA94305
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA94305
- Wu Tsai Neurosciences Institute, Stanford, CA94305
- Department of Neurosurgery, Stanford University, Stanford School of Medicine, Stanford, CA94305
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6
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Andrade Machado R, Meylor J. Cortico-cortical evoked potential and language mapping: A meta-analysis. Epilepsy Behav 2024; 157:109851. [PMID: 38823074 DOI: 10.1016/j.yebeh.2024.109851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/21/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE The purpose of this meta-analysis was to determine the best available evidence for the use of cortico-cortical evoked potential (CCEP) for language mapping. METHODS PubMed/Medline/Google Scholar/Cochrane and Scopus electronic databases were searched for articles using CCEP for language mapping. CCEP data was obtained including the area of the cortex generating CCEP, resection data, and post-resection language outcomes. Inclusion criteria were clinical articles reporting the use of CCEP in language regions of the brain, reporting language outcomes and whether there was final resection of the cortex, studies with more than five patients, and studies in either English or Spanish. Review articles, systematic reviews, meta-analyses, or case series with less than five patients were excluded. RESULTS Seven studies with a total of 59 patients were included in this meta-analysis. The presence of CCEPs from stimulation of Broca's area or posterior perisylvian region in the resection predicts language deficits after surgery. The diagnostic odds ratio shows values greater than 0 perioperatively (0.69-5.82) and after six months (1.38-11), supporting a high likelihood of a language deficit if the presence of CCEPs from stimulation of Broca's area or posterior perisylvian region are included in the resection and vice versa. The True Positive rate varied between 0.38 and 0.87. This effect decreases after six months to 0.61 (0.30-0.86). However, the True Negative rate increased from 0.53 (0.32-0.79) to 0.71 (0.55-0.88). CONCLUSION This meta-analysis supports the utility of CCEP to predict the probability of having long-term language deficits after surgery. .
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Affiliation(s)
| | - Jennifer Meylor
- Medical College of Wisconsin, Department of Neurology, Milwaukee, WI, USA.
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7
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Levinson LH, Sun S, Paschall CJ, Perks KM, Weaver KE, Perlmutter SI, Ko AL, Ojemann JG, Herron JA. Data processing techniques impact quantification of cortico-cortical evoked potentials. J Neurosci Methods 2024; 408:110130. [PMID: 38653381 DOI: 10.1016/j.jneumeth.2024.110130] [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: 07/30/2023] [Revised: 01/16/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Cortico-cortical evoked potentials (CCEPs) are a common tool for probing effective connectivity in intracranial human electrophysiology. As with all human electrophysiology data, CCEP data are highly susceptible to noise. To address noise, filters and re-referencing are often applied to CCEP data, but different processing strategies are used from study to study. NEW METHOD We systematically compare how common average re-referencing and filtering CCEP data impacts quantification. RESULTS We show that common average re-referencing and filters, particularly filters that cut out more frequencies, can significantly impact the quantification of CCEP magnitude and morphology. We identify that high cutoff high pass filters (> 0.5 Hz), low cutoff low pass filters (< 200 Hz), and common average re-referencing impact quantification across subjects. However, we also demonstrate that the presence of noise may impact CCEP quantification, and preprocessing is necessary to mitigate this. We show that filtering is more effective than re-referencing or averaging across trials for reducing most common types of noise. COMPARISON WITH EXISTING METHODS These results suggest that existing CCEP processing methods must be applied with care to maximize noise reduction and minimize changes to the data. We do not test every available processing strategy; rather we demonstrate that processing can influence the results of CCEP studies. We emphasize the importance of reporting all processing methods, particularly re-referencing methods. CONCLUSIONS We propose a general framework for choosing an appropriate processing pipeline for CCEP data, taking into consideration the noise levels of a specific dataset. We suggest that minimal gentle filtering is preferable.
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Affiliation(s)
- L H Levinson
- University of Washington Graduate Program in Neuroscience, 1959 NE Pacific Street, T-47, Seattle, WA 98195-7270, United States.
| | - S Sun
- University of Washington Department of Bioengineering, Box 355061, Seattle, WA 98195-5061, United States
| | - C J Paschall
- University of Washington Department of Bioengineering, Box 355061, Seattle, WA 98195-5061, United States
| | - K M Perks
- University of Washington Graduate Program in Neuroscience, 1959 NE Pacific Street, T-47, Seattle, WA 98195-7270, United States
| | - K E Weaver
- University of Washington Department of Radiology, 1959 NE Pacific Street, Seattle, WA 98195, United States
| | - S I Perlmutter
- University of Washington Department of Physiology and Biophysics, 1705 NE Pacific Street, HSB Room G424, Box 357290, Seattle, WA 98195-7290, United States
| | - A L Ko
- University of Washington Department of Neurological Surgery, Box 356470, 1959 NE Pacific St, Seattle, WA 98195-6470, United States
| | - J G Ojemann
- University of Washington Department of Neurological Surgery, Box 356470, 1959 NE Pacific St, Seattle, WA 98195-6470, United States
| | - J A Herron
- University of Washington Department of Neurological Surgery, Box 356470, 1959 NE Pacific St, Seattle, WA 98195-6470, United States
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8
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Battista F, Esposito A, Muscas G, Della Puppa A. Functional frontal lobectomy in the surgical treatment of pharmacoresistant frontal lobe epilepsy: how I do it. Acta Neurochir (Wien) 2024; 166:299. [PMID: 39020068 PMCID: PMC11254979 DOI: 10.1007/s00701-024-06176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/23/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Frontal lobe epilepsy is pharmacoresistant in 30% of cases, constituting 10-20% of epilepsy surgeries. For cases of no lesional epilepsy (negative MRI), frontal lobectomy is a crucial treatment, historically involving Frontal Anatomical Lobectomy (AFL) with a 33.3% complication risk and 55.7% seizure control. METHODS We describe Frontal Functional Lobectomy (FFL), in which the boundaries are defined on the patient's functional cortico-subcortical areas, recognized with advanced intraoperative technologies such as tractography and navigated transcranial magnetic stimulation (nTMS). CONCLUSIONS The FFL allows for a broader resection with a lower rate of postoperative complications than the AFL.
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Affiliation(s)
- Francesca Battista
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Florence, Italy
| | - Alice Esposito
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Florence, Italy
- University of Florence, School of Human Health Sciences, Firenze, Italia
| | - Giovanni Muscas
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Florence, Italy
| | - Alessandro Della Puppa
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Florence, Italy.
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Alduais A, Alarifi HS, Alfadda H. Using Biosensors to Detect and Map Language Areas in the Brain for Individuals with Traumatic Brain Injury. Diagnostics (Basel) 2024; 14:1535. [PMID: 39061672 PMCID: PMC11275263 DOI: 10.3390/diagnostics14141535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/10/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
The application of biosensors in neurolinguistics has significantly advanced the detection and mapping of language areas in the brain, particularly for individuals with brain trauma. This study explores the role of biosensors in this domain and proposes a conceptual model to guide their use in research and clinical practice. The researchers explored the integration of biosensors in language and brain function studies, identified trends in research, and developed a conceptual model based on cluster and thematic analyses. Using a mixed-methods approach, we conducted cluster and thematic analyses on data curated from Web of Science, Scopus, and SciSpace, encompassing 392 articles. This dual analysis facilitated the identification of research trends and thematic insights within the field. The cluster analysis highlighted Functional Magnetic Resonance Imaging (fMRI) dominance and the importance of neuroplasticity in language recovery. Biosensors such as the Magnes 2500 watt-hour (WH) neuromagnetometer and microwire-based sensors are reliable for real-time monitoring, despite methodological challenges. The proposed model synthesizes these findings, emphasizing biosensors' potential in preoperative assessments and therapeutic customization. Biosensors are vital for non-invasive, precise mapping of language areas, with fMRI and repetitive Transcranial Magnetic Stimulation (rTMS) playing pivotal roles. The conceptual model serves as a strategic framework for employing biosensors and improving neurolinguistic interventions. This research may enhance surgical planning, optimize recovery therapies, and encourage technological advancements in biosensor precision and application protocols.
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Affiliation(s)
- Ahmed Alduais
- Department of Human Sciences (Psychology), University of Verona, 37129 Verona, Italy
| | - Hessah Saad Alarifi
- Department of Educational Administration, College of Education, King Saud University, Riyadh 11362, Saudi Arabia
| | - Hind Alfadda
- Department of Curriculum and Instruction, College of Education, King Saud University, Riyadh 11362, Saudi Arabia;
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10
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Huang H, Ojeda Valencia G, Gregg NM, Osman GM, Montoya MN, Worrell GA, Miller KJ, Hermes D. CARLA: Adjusted common average referencing for cortico-cortical evoked potential data. J Neurosci Methods 2024; 407:110153. [PMID: 38710234 PMCID: PMC11149384 DOI: 10.1016/j.jneumeth.2024.110153] [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: 10/03/2023] [Revised: 02/22/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
Human brain connectivity can be mapped by single pulse electrical stimulation during intracranial EEG measurements. The raw cortico-cortical evoked potentials (CCEP) are often contaminated by noise. Common average referencing (CAR) removes common noise and preserves response shapes but can introduce bias from responsive channels. We address this issue with an adjusted, adaptive CAR algorithm termed "CAR by Least Anticorrelation (CARLA)". CARLA was tested on simulated CCEP data and real CCEP data collected from four human participants. In CARLA, the channels are ordered by increasing mean cross-trial covariance, and iteratively added to the common average until anticorrelation between any single channel and all re-referenced channels reaches a minimum, as a measure of shared noise. We simulated CCEP data with true responses in 0-45 of 50 total channels. We quantified CARLA's error and found that it erroneously included 0 (median) truly responsive channels in the common average with ≤42 responsive channels, and erroneously excluded ≤2.5 (median) unresponsive channels at all responsiveness levels. On real CCEP data, signal quality was quantified with the mean R2 between all pairs of channels, which represents inter-channel dependency and is low for well-referenced data. CARLA re-referencing produced significantly lower mean R2 than standard CAR, CAR using a fixed bottom quartile of channels by covariance, and no re-referencing. CARLA minimizes bias in re-referenced CCEP data by adaptively selecting the optimal subset of non-responsive channels. It showed high specificity and sensitivity on simulated CCEP data and lowered inter-channel dependency compared to CAR on real CCEP data.
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Affiliation(s)
- Harvey Huang
- Mayo Clinic Medical Scientist Training Program, Rochester, MN, USA.
| | | | | | - Gamaleldin M Osman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Division of Child Neurology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Morgan N Montoya
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Gregory A Worrell
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kai J Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dora Hermes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Radiology, Mayo Clinic, Rochester, MN 55901, USA.
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11
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Freund B, Nair D, Bulacio J, Najm I, Taylor K, Moosa AN. Pupillary constriction on stimulation of the parietal cortex-A novel finding. Epileptic Disord 2024. [PMID: 38943530 DOI: 10.1002/epd2.20252] [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: 11/11/2023] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 07/01/2024]
Abstract
Pupillary changes can be an important semiologic feature in focal epilepsy. Though the subcortical networks involving pupillomotor function have been described, cortical generators of pupillary dilation and constriction in humans are not well known. In this report, we describe a case of pupillary constriction occurring during seizures in a patient with drug resistant focal epilepsy. On stereoelectroencephalography, onset was noted within the posterior segment of the right intraparietal sulcus and direct cortical electrical stimulation of these electrode contacts reproduced pupillary constriction associated with habitual seizures. This is the first case report to describe ictal pupillary constriction during SEEG with confirmation of the cortical localization by direct cortical electrical stimulation. The posterior segment of the right intraparietal sulcus localization of pupillary constriction may aid in surgical evaluation patients with drug resistant focal epilepsy.
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Affiliation(s)
- Brin Freund
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Dileep Nair
- Epilepsy Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Juan Bulacio
- Epilepsy Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Imad Najm
- Epilepsy Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kenneth Taylor
- Epilepsy Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ahsan N Moosa
- Epilepsy Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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12
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Lyu D, Stiger J, Lusk Z, Buch V, Parvizi J. Causal Cortical and Thalamic Connections in the Human Brain. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.22.600166. [PMID: 38979261 PMCID: PMC11230252 DOI: 10.1101/2024.06.22.600166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
The brain's functional architecture is intricately shaped by causal connections between its cortical and subcortical structures. Here, we studied 27 participants with 4864 electrodes implanted across the anterior, mediodorsal, and pulvinar thalamic regions, and the cortex. Using data from electrical stimulation procedures and a data-driven approach informed by neurophysiological standards, we dissociated three unique spectral patterns generated by the perturbation of a given brain area. Among these, a novel waveform emerged, marked by delayed-onset slow oscillations in both ipsilateral and contralateral cortices following thalamic stimulations, suggesting a mechanism by which a thalamic site can influence bilateral cortical activity. Moreover, cortical stimulations evoked earlier signals in the thalamus than in other connected cortical areas suggesting that the thalamus receives a copy of signals before they are exchanged across the cortex. Our causal connectivity data can be used to inform biologically-inspired computational models of the functional architecture of the brain.
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Affiliation(s)
- Dian Lyu
- Laboratory of Behavioral and Cognitive Neuroscience, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California USA
| | - James Stiger
- Laboratory of Behavioral and Cognitive Neuroscience, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California USA
| | - Zoe Lusk
- Laboratory of Behavioral and Cognitive Neuroscience, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California USA
| | - Vivek Buch
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California USA
| | - Josef Parvizi
- Laboratory of Behavioral and Cognitive Neuroscience, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California USA
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13
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Hajnal B, Szabó JP, Tóth E, Keller CJ, Wittner L, Mehta AD, Erőss L, Ulbert I, Fabó D, Entz L. Intracortical mechanisms of single pulse electrical stimulation (SPES) evoked excitations and inhibitions in humans. Sci Rep 2024; 14:13784. [PMID: 38877093 PMCID: PMC11178858 DOI: 10.1038/s41598-024-62433-0] [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: 09/13/2023] [Accepted: 05/16/2024] [Indexed: 06/16/2024] Open
Abstract
Cortico-cortical evoked potentials (CCEPs) elicited by single-pulse electric stimulation (SPES) are widely used to assess effective connectivity between cortical areas and are also implemented in the presurgical evaluation of epileptic patients. Nevertheless, the cortical generators underlying the various components of CCEPs in humans have not yet been elucidated. Our aim was to describe the laminar pattern arising under SPES evoked CCEP components (P1, N1, P2, N2, P3) and to evaluate the similarities between N2 and the downstate of sleep slow waves. We used intra-cortical laminar microelectrodes (LMEs) to record CCEPs evoked by 10 mA bipolar 0.5 Hz electric pulses in seven patients with medically intractable epilepsy implanted with subdural grids. Based on the laminar profile of CCEPs, the latency of components is not layer-dependent, however their rate of appearance varies across cortical depth and stimulation distance, while the seizure onset zone does not seem to affect the emergence of components. Early neural excitation primarily engages middle and deep layers, propagating to the superficial layers, followed by mainly superficial inhibition, concluding in a sleep slow wave-like inhibition and excitation sequence.
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Affiliation(s)
- Boglárka Hajnal
- Epilepsy Center, Clinic for Neurosurgery and Neurointervention, Semmelweis University, Budapest, 1145, Hungary
- János Szentágothai Neurosciences Program, Semmelweis University School of PhD Studies, Budapest, 1083, Hungary
| | - Johanna Petra Szabó
- Epilepsy Center, Clinic for Neurosurgery and Neurointervention, Semmelweis University, Budapest, 1145, Hungary
- János Szentágothai Neurosciences Program, Semmelweis University School of PhD Studies, Budapest, 1083, Hungary
- Lendület Laboratory of Systems Neuroscience, HUN-REN Institute of Experimental Medicine, Budapest, 1083, Hungary
| | - Emília Tóth
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Corey J Keller
- Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
- Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine and Feinstein Institute of Medical Research, 300 Community Drive, Manhasset, NY, 11030, USA
- Department of Neuroscience, Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, 94304, USA
| | - Lucia Wittner
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, HUN-REN, Budapest, 1117, Hungary
- Department of Information Technology and Bionics, Péter Pázmány Catholic University, Budapest, 1083, Hungary
| | - Ashesh D Mehta
- Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine and Feinstein Institute of Medical Research, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Loránd Erőss
- Department of Functional Neurosurgery, Clinic for Neurosurgery and Neurointervention, Semmelweis University, Budapest, 1145, Hungary
| | - István Ulbert
- Epilepsy Center, Clinic for Neurosurgery and Neurointervention, Semmelweis University, Budapest, 1145, Hungary
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, HUN-REN, Budapest, 1117, Hungary
- Department of Information Technology and Bionics, Péter Pázmány Catholic University, Budapest, 1083, Hungary
| | - Dániel Fabó
- Epilepsy Center, Clinic for Neurosurgery and Neurointervention, Semmelweis University, Budapest, 1145, Hungary.
| | - László Entz
- Department of Functional Neurosurgery, Clinic for Neurosurgery and Neurointervention, Semmelweis University, Budapest, 1145, Hungary
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14
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Matoba K, Matsumoto R, Shimotake A, Nakae T, Imamura H, Togo M, Yamao Y, Usami K, Kikuchi T, Yoshida K, Matsuhashi M, Kunieda T, Miyamoto S, Takahashi R, Ikeda A. Basal temporal language area revisited in Japanese language with a language function density map. Cereb Cortex 2024; 34:bhae218. [PMID: 38858838 DOI: 10.1093/cercor/bhae218] [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: 04/14/2023] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
We revisited the anatomo-functional characteristics of the basal temporal language area (BTLA), first described by Lüders et al. (1986), using electrical cortical stimulation (ECS) in the context of Japanese language and semantic networks. We recruited 11 patients with focal epilepsy who underwent chronic subdural electrode implantation and ECS mapping with multiple language tasks for presurgical evaluation. A semiquantitative language function density map delineated the anatomo-functional characteristics of the BTLA (66 electrodes, mean 3.8 cm from the temporal tip). The ECS-induced impairment probability was higher in the following tasks, listed in a descending order: spoken-word picture matching, picture naming, Kanji word reading, paragraph reading, spoken-verbal command, and Kana word reading. The anterior fusiform gyrus (FG), adjacent anterior inferior temporal gyrus (ITG), and the anterior end where FG and ITG fuse, were characterized by stimulation-induced impairment during visual and auditory tasks requiring verbal output or not, whereas the middle FG was characterized mainly by visual input. The parahippocampal gyrus was the least impaired of the three gyri in the basal temporal area. We propose that the BTLA has a functional gradient, with the anterior part involved in amodal semantic processing and the posterior part, especially the middle FG in unimodal semantic processing.
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Affiliation(s)
- Kento Matoba
- Division of Neurology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akihiro Shimotake
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takuro Nakae
- Department of Neurosurgery, Shiga General Hospital, 5-4-30 Moriyama, Moriyama, Shiga 524-0022, Japan
| | - Hisaji Imamura
- Department of Neurology, Fukui Red Cross Hospital, 2-4-1, Tsukimi, Fukui, 918-8011, Japan
| | - Masaya Togo
- Division of Neurology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kiyohide Usami
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
- Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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15
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Wang JB, Hassan U, Bruss JE, Oya H, Uitermarkt BD, Trapp NT, Gander PE, Howard MA, Keller CJ, Boes AD. Effects of transcranial magnetic stimulation on the human brain recorded with intracranial electrocorticography. Mol Psychiatry 2024; 29:1228-1240. [PMID: 38317012 DOI: 10.1038/s41380-024-02405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
Transcranial magnetic stimulation (TMS) is increasingly used as a noninvasive technique for neuromodulation in research and clinical applications, yet its mechanisms are not well understood. Here, we present the neurophysiological effects of TMS using intracranial electrocorticography (iEEG) in neurosurgical patients. We first evaluated safety in a gel-based phantom. We then performed TMS-iEEG in 22 neurosurgical participants with no adverse events. We next evaluated intracranial responses to single pulses of TMS to the dorsolateral prefrontal cortex (dlPFC) (N = 10, 1414 electrodes). We demonstrate that TMS is capable of inducing evoked potentials both locally within the dlPFC and in downstream regions functionally connected to the dlPFC, including the anterior cingulate and insular cortex. These downstream effects were not observed when stimulating other distant brain regions. Intracranial dlPFC electrical stimulation had similar timing and downstream effects as TMS. These findings support the safety and promise of TMS-iEEG in humans to examine local and network-level effects of TMS with higher spatiotemporal resolution than currently available methods.
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Affiliation(s)
- Jeffrey B Wang
- Biophysics Graduate Program, Stanford University Medical Center, Stanford, CA, 94305, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Umair Hassan
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, 94305, USA
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Joel E Bruss
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Hiroyuki Oya
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Brandt D Uitermarkt
- Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Nicholas T Trapp
- Department of Psychiatry, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, 52242, USA
| | - Phillip E Gander
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Radiology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Matthew A Howard
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, 94305, USA
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Aaron D Boes
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
- Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
- Department of Psychiatry, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, 52242, USA.
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16
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Giampiccolo D, Matsumoto R. Mapping cortico-cortical evoked potentials to glioma grading and language outcome. Clin Neurophysiol 2024; 161:244-245. [PMID: 38538419 DOI: 10.1016/j.clinph.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Davide Giampiccolo
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Department of Neurosurgery, Institute of Neuroscience, Cleveland Clinic London, Grosvenor Place, London, UK.
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan; Epilepsy Center & Center for Cognitive and Memory Disorders, Kobe University Hospital, Kobe, Japan.
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17
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Seidel K, Wermelinger J, Alvarez-Abut P, Deletis V, Raabe A, Zhang D, Schucht P. Cortico-cortical evoked potentials of language tracts in minimally invasive glioma surgery guided by Penfield stimulation. Clin Neurophysiol 2024; 161:256-267. [PMID: 38521679 DOI: 10.1016/j.clinph.2023.12.136] [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: 08/10/2023] [Revised: 11/19/2023] [Accepted: 12/23/2023] [Indexed: 03/25/2024]
Abstract
OBJECTIVE We investigated the feasibility of recording cortico-cortical evoked potentials (CCEPs) in patients with low- and high-grade glioma. We compared CCEPs during awake and asleep surgery, as well as those stimulated from the functional Broca area and recorded from the functional Wernicke area (BtW), and vice versa (WtB). We also analyzed CCEP properties according to tumor location, histopathology, and aphasia. METHODS We included 20 patients who underwent minimally invasive surgery in an asleep-awake-asleep setting. Strip electrode placement was guided by classical Penfield stimulation of positive language sites and fiber tracking of the arcuate fascicle. CCEPs were elicited with alternating monophasic single pulses of 1.1 Hz frequency and recorded as averaged signals. Intraoperatively, there was no post-processing of the signal. RESULTS Ninety-seven CCEPs from 19 patients were analyzed. There was no significant difference in CCEP properties when comparing awake versus asleep, nor BtW versus WtB. CCEP amplitude and latency were affected by tumor location and histopathology. CCEP features after tumor resection correlated with short- and long-term postoperative aphasia. CONCLUSION CCEP recordings are feasible during minimally invasive surgery. CCEPs might be surrogate markers for altered connectivity of the language tracts. SIGNIFICANCE This study may guide the incorporation of CCEPs into intraoperative neurophysiological monitoring.
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Affiliation(s)
- Kathleen Seidel
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Jonathan Wermelinger
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pablo Alvarez-Abut
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vedran Deletis
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia; Albert Einstein College of Medicine, New York, NY, USA
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Zhang
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philippe Schucht
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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18
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Schmid W, Danstrom IA, Crespo Echevarria M, Adkinson J, Mattar L, Banks GP, Sheth SA, Watrous AJ, Heilbronner SR, Bijanki KR, Alabastri A, Bartoli E. A biophysically constrained brain connectivity model based on stimulation-evoked potentials. J Neurosci Methods 2024; 405:110106. [PMID: 38453060 PMCID: PMC11233030 DOI: 10.1016/j.jneumeth.2024.110106] [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: 11/03/2023] [Revised: 01/24/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Single-pulse electrical stimulation (SPES) is an established technique used to map functional effective connectivity networks in treatment-refractory epilepsy patients undergoing intracranial-electroencephalography monitoring. While the connectivity path between stimulation and recording sites has been explored through the integration of structural connectivity, there are substantial gaps, such that new modeling approaches may advance our understanding of connectivity derived from SPES studies. NEW METHOD Using intracranial electrophysiology data recorded from a single patient undergoing stereo-electroencephalography (sEEG) evaluation, we employ an automated detection method to identify early response components, C1, from pulse-evoked potentials (PEPs) induced by SPES. C1 components were utilized for a novel topology optimization method, modeling 3D electrical conductivity to infer neural pathways from stimulation sites. Additionally, PEP features were compared with tractography metrics, and model results were analyzed with respect to anatomical features. RESULTS The proposed optimization model resolved conductivity paths with low error. Specific electrode contacts displaying high error correlated with anatomical complexities. The C1 component strongly correlated with additional PEP features and displayed stable, weak correlations with tractography measures. COMPARISON WITH EXISTING METHOD Existing methods for estimating neural signal pathways are imaging-based and thus rely on anatomical inferences. CONCLUSIONS These results demonstrate that informing topology optimization methods with human intracranial SPES data is a feasible method for generating 3D conductivity maps linking electrical pathways with functional neural ensembles. PEP-estimated effective connectivity is correlated with but distinguished from structural connectivity. Modeled conductivity resolves connectivity pathways in the absence of anatomical priors.
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Affiliation(s)
- William Schmid
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Isabel A Danstrom
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Maria Crespo Echevarria
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Joshua Adkinson
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Layth Mattar
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Garrett P Banks
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Andrew J Watrous
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Sarah R Heilbronner
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Alessandro Alabastri
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA.
| | - Eleonora Bartoli
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
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19
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van Blooijs D, Blok S, Huiskamp GJM, van Eijsden P, Meijer HGE, Leijten FSS. The effect of propofol on effective brain networks. Clin Neurophysiol 2024; 161:222-230. [PMID: 38522268 DOI: 10.1016/j.clinph.2024.01.012] [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: 06/12/2023] [Revised: 01/02/2024] [Accepted: 01/24/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE We compared the effective networks derived from Single Pulse Electrical Stimulation (SPES) in intracranial electrocorticography (ECoG) of awake epilepsy patients and while under general propofol-anesthesia to investigate the effect of propofol on these brain networks. METHODS We included nine patients who underwent ECoG for epilepsy surgery evaluation. We performed SPES when the patient was awake (SPES-clinical) and repeated this under propofol-anesthesia during the surgery in which the ECoG grids were removed (SPES-propofol). We detected the cortico-cortical evoked potentials (CCEPs) with an automatic detector. We constructed two effective networks derived from SPES-clinical and SPES-propofol. We compared three network measures (indegree, outdegree and betweenness centrality), the N1-peak-latency and amplitude of CCEPs between the two effective networks. RESULTS Fewer CCEPs were observed during SPES-propofol (median: 6.0, range: 0-29) compared to SPES-clinical (median: 10.0, range: 0-36). We found a significant correlation for the indegree, outdegree and betweenness centrality between SPES-clinical and SPES-propofol (respectively rs = 0.77, rs = 0.70, rs = 0.55, p < 0.001). The median N1-peak-latency increased from 22.0 ms during SPES-clinical to 26.4 ms during SPES-propofol. CONCLUSIONS Our findings suggest that the number of effective network connections decreases, but network measures are only marginally affected. SIGNIFICANCE The primary network topology is preserved under propofol.
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Affiliation(s)
- D van Blooijs
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, PO Box 85500, 3584 GA Utrecht, The Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), P.O.box 540, 2130 AM Hoofddorp, The Netherlands.
| | - S Blok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, PO Box 85500, 3584 GA Utrecht, The Netherlands.
| | - G J M Huiskamp
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, PO Box 85500, 3584 GA Utrecht, The Netherlands.
| | - P van Eijsden
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, PO Box 85500, 3584 GA Utrecht, The Netherlands.
| | - H G E Meijer
- Department of Applied Mathematics, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands.
| | - F S S Leijten
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, PO Box 85500, 3584 GA Utrecht, The Netherlands.
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20
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Russo S, Claar L, Marks L, Krishnan G, Furregoni G, Zauli FM, Hassan G, Solbiati M, d’Orio P, Mikulan E, Sarasso S, Rosanova M, Sartori I, Bazhenov M, Pigorini A, Massimini M, Koch C, Rembado I. Thalamic feedback shapes brain responses evoked by cortical stimulation in mice and humans. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.31.578243. [PMID: 38352535 PMCID: PMC10862802 DOI: 10.1101/2024.01.31.578243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Cortical stimulation with single pulses is a common technique in clinical practice and research. However, we still do not understand the extent to which it engages subcortical circuits which contribute to the associated evoked potentials (EPs). Here we find that cortical stimulation generates remarkably similar EPs in humans and mice, with a late component similarly modulated by the subject's behavioral state. We optogenetically dissect the underlying circuit in mice, demonstrating that the late component of these EPs is caused by a thalamic hyperpolarization and rebound. The magnitude of this late component correlates with the bursting frequency and synchronicity of thalamic neurons, modulated by the subject's behavioral state. A simulation of the thalamo-cortical circuit highlights that both intrinsic thalamic currents as well as cortical and thalamic GABAergic neurons contribute to this response profile. We conclude that the cortical stimulation engages cortico-thalamo-cortical circuits highly preserved across different species and stimulation modalities.
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Affiliation(s)
- Simone Russo
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan 20157, Italy
- Department of Philosophy ‘Piero Martinetti’, University of Milan, Milan, Italy
- Brain and Consciousness, Allen Institute, Seattle, United States
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Leslie Claar
- Brain and Consciousness, Allen Institute, Seattle, United States
| | - Lydia Marks
- Brain and Consciousness, Allen Institute, Seattle, United States
| | - Giri Krishnan
- Department of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Giulia Furregoni
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan 20157, Italy
| | - Flavia Maria Zauli
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan 20157, Italy
- Department of Philosophy ‘Piero Martinetti’, University of Milan, Milan, Italy
- ASST Grande Ospedale Metropolitano Niguarda, “C. Munari” Epilepsy Surgery Centre, Department of Neuroscience, Italy
| | - Gabriel Hassan
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan 20157, Italy
- Department of Philosophy ‘Piero Martinetti’, University of Milan, Milan, Italy
| | - Michela Solbiati
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan 20157, Italy
- ASST Grande Ospedale Metropolitano Niguarda, “C. Munari” Epilepsy Surgery Centre, Department of Neuroscience, Italy
| | - Piergiorgio d’Orio
- ASST Grande Ospedale Metropolitano Niguarda, “C. Munari” Epilepsy Surgery Centre, Department of Neuroscience, Italy
- University of Parma, Parma 43121, Italy
| | - Ezequiel Mikulan
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan 20157, Italy
| | - Simone Sarasso
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan 20157, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan 20157, Italy
| | - Ivana Sartori
- ASST Grande Ospedale Metropolitano Niguarda, “C. Munari” Epilepsy Surgery Centre, Department of Neuroscience, Italy
| | - Maxim Bazhenov
- Department of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
- Neurosciences Graduate Program, University of California San Diego, La Jolla, CA, 92093, USA
| | - Andrea Pigorini
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan 20122, Italy
- UOC Maxillo-facial Surgery and dentistry, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan 20157, Italy
- Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan 20122, Italy
- Azrieli Program in Brain, Mind and Consciousness, Canadian Institute for Advanced Research (CIFAR), Toronto, Ontario M5G 1M1, Canada
| | - Christof Koch
- Brain and Consciousness, Allen Institute, Seattle, United States
| | - Irene Rembado
- Brain and Consciousness, Allen Institute, Seattle, United States
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21
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Seas A, Noor MS, Choi KS, Veerakumar A, Obatusin M, Dahill-Fuchel J, Tiruvadi V, Xu E, Riva-Posse P, Rozell CJ, Mayberg HS, McIntyre CC, Waters AC, Howell B. Subcallosal cingulate deep brain stimulation evokes two distinct cortical responses via differential white matter activation. Proc Natl Acad Sci U S A 2024; 121:e2314918121. [PMID: 38527192 PMCID: PMC10998591 DOI: 10.1073/pnas.2314918121] [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: 09/01/2023] [Accepted: 02/20/2024] [Indexed: 03/27/2024] Open
Abstract
Subcallosal cingulate (SCC) deep brain stimulation (DBS) is an emerging therapy for refractory depression. Good clinical outcomes are associated with the activation of white matter adjacent to the SCC. This activation produces a signature cortical evoked potential (EP), but it is unclear which of the many pathways in the vicinity of SCC is responsible for driving this response. Individualized biophysical models were built to achieve selective engagement of two target bundles: either the forceps minor (FM) or cingulum bundle (CB). Unilateral 2 Hz stimulation was performed in seven patients with treatment-resistant depression who responded to SCC DBS, and EPs were recorded using 256-sensor scalp electroencephalography. Two distinct EPs were observed: a 120 ms symmetric response spanning both hemispheres and a 60 ms asymmetrical EP. Activation of FM correlated with the symmetrical EPs, while activation of CB was correlated with the asymmetrical EPs. These results support prior model predictions that these two pathways are predominantly activated by clinical SCC DBS and provide first evidence of a link between cortical EPs and selective fiber bundle activation.
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Affiliation(s)
- Andreas Seas
- Department of Biomedical Engineering, Duke University, Durham, NC27708
- Department of Neurosurgery, Duke University, Durham, NC27708
| | - M. Sohail Noor
- Department of Biomedical Engineering, Duke University, Durham, NC27708
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH10900
| | - Ki Sueng Choi
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY10029
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA30329
| | - Ashan Veerakumar
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA30329
| | - Mosadoluwa Obatusin
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY10029
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA30329
| | - Jacob Dahill-Fuchel
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY10029
| | - Vineet Tiruvadi
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA30329
| | - Elisa Xu
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY10029
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA30329
| | - Christopher J. Rozell
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA30332
| | - Helen S. Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY10029
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA30329
| | - Cameron C. McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC27708
- Department of Neurosurgery, Duke University, Durham, NC27708
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH10900
| | - Allison C. Waters
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY10029
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA30329
| | - Bryan Howell
- Department of Biomedical Engineering, Duke University, Durham, NC27708
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH10900
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22
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Man V, Cockburn J, Flouty O, Gander PE, Sawada M, Kovach CK, Kawasaki H, Oya H, Howard Iii MA, O'Doherty JP. Temporally organized representations of reward and risk in the human brain. Nat Commun 2024; 15:2162. [PMID: 38461343 PMCID: PMC10924934 DOI: 10.1038/s41467-024-46094-1] [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: 05/08/2023] [Accepted: 02/13/2024] [Indexed: 03/11/2024] Open
Abstract
The value and uncertainty associated with choice alternatives constitute critical features relevant for decisions. However, the manner in which reward and risk representations are temporally organized in the brain remains elusive. Here we leverage the spatiotemporal precision of intracranial electroencephalography, along with a simple card game designed to elicit the unfolding computation of a set of reward and risk variables, to uncover this temporal organization. Reward outcome representations across wide-spread regions follow a sequential order along the anteroposterior axis of the brain. In contrast, expected value can be decoded from multiple regions at the same time, and error signals in both reward and risk domains reflect a mixture of sequential and parallel encoding. We further highlight the role of the anterior insula in generalizing between reward prediction error and risk prediction error codes. Together our results emphasize the importance of neural dynamics for understanding value-based decisions under uncertainty.
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Affiliation(s)
- Vincent Man
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, 91125, USA.
| | - Jeffrey Cockburn
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Oliver Flouty
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, 33606, USA
| | - Phillip E Gander
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
- Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Masahiro Sawada
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Christopher K Kovach
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Hiroto Kawasaki
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Hiroyuki Oya
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
- Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Matthew A Howard Iii
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
- Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - John P O'Doherty
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, 91125, USA
- Computation and Neural Systems, California Institute of Technology, Pasadena, CA, 91125, USA
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23
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Kobayashi K, Taylor KN, Shahabi H, Krishnan B, Joshi A, Mackow MJ, Feldman L, Zamzam O, Medani T, Bulacio J, Alexopoulos AV, Najm I, Bingaman W, Leahy RM, Nair DR. Effective connectivity relates seizure outcome to electrode placement in responsive neurostimulation. Brain Commun 2024; 6:fcae035. [PMID: 38390255 PMCID: PMC10882982 DOI: 10.1093/braincomms/fcae035] [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: 09/12/2022] [Revised: 09/06/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024] Open
Abstract
Responsive neurostimulation is a closed-loop neuromodulation therapy for drug resistant focal epilepsy. Responsive neurostimulation electrodes are placed near ictal onset zones so as to enable detection of epileptiform activity and deliver electrical stimulation. There is no standard approach for determining the optimal placement of responsive neurostimulation electrodes. Clinicians make this determination based on presurgical tests, such as MRI, EEG, magnetoencephalography, ictal single-photon emission computed tomography and intracranial EEG. Currently functional connectivity measures are not being used in determining the placement of responsive neurostimulation electrodes. Cortico-cortical evoked potentials are a measure of effective functional connectivity. Cortico-cortical evoked potentials are generated by direct single-pulse electrical stimulation and can be used to investigate cortico-cortical connections in vivo. We hypothesized that the presence of high amplitude cortico-cortical evoked potentials, recorded during intracranial EEG monitoring, near the eventual responsive neurostimulation contact sites is predictive of better outcomes from its therapy. We retrospectively reviewed 12 patients in whom cortico-cortical evoked potentials were obtained during stereoelectroencephalography evaluation and subsequently underwent responsive neurostimulation therapy. We studied the relationship between cortico-cortical evoked potentials, the eventual responsive neurostimulation electrode locations and seizure reduction. Directional connectivity indicated by cortico-cortical evoked potentials can categorize stereoelectroencephalography electrodes as either receiver nodes/in-degree (an area of greater inward connectivity) or projection nodes/out-degree (greater outward connectivity). The follow-up period for seizure reduction ranged from 1.3-4.8 years (median 2.7) after responsive neurostimulation therapy started. Stereoelectroencephalography electrodes closest to the eventual responsive neurostimulation contact site tended to show larger in-degree cortico-cortical evoked potentials, especially for the early latency cortico-cortical evoked potentials period (10-60 ms period) in six out of 12 patients. Stereoelectroencephalography electrodes closest to the responsive neurostimulation contacts (≤5 mm) also had greater significant out-degree in the early cortico-cortical evoked potentials latency period than those further away (≥10 mm) (P < 0.05). Additionally, significant correlation was noted between in-degree cortico-cortical evoked potentials and greater seizure reduction with responsive neurostimulation therapy at its most effective period (P < 0.05). These findings suggest that functional connectivity determined by cortico-cortical evoked potentials may provide additional information that could help guide the optimal placement of responsive neurostimulation electrodes.
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Affiliation(s)
- Katsuya Kobayashi
- Charles Shor Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Kenneth N Taylor
- Charles Shor Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Hossein Shahabi
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA 90007, USA
| | - Balu Krishnan
- Charles Shor Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Anand Joshi
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA 90007, USA
| | - Michael J Mackow
- Charles Shor Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Lauren Feldman
- Charles Shor Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Omar Zamzam
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA 90007, USA
| | - Takfarinas Medani
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA 90007, USA
| | - Juan Bulacio
- Charles Shor Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | | | - Imad Najm
- Charles Shor Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - William Bingaman
- Charles Shor Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Richard M Leahy
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA 90007, USA
| | - Dileep R Nair
- Charles Shor Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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24
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Nagata K, Kunii N, Shimada S, Saito N. Utilizing Excitatory and Inhibitory Activity Derived from Interictal Intracranial Electroencephalography as Potential Biomarkers for Epileptogenicity. Neurol Med Chir (Tokyo) 2024; 64:65-70. [PMID: 38220164 PMCID: PMC10918453 DOI: 10.2176/jns-nmc.2023-0207] [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: 09/05/2023] [Accepted: 10/31/2023] [Indexed: 01/16/2024] Open
Abstract
Epileptogenic zones (EZs), where epileptic seizures cease after resection, are localized by assessing the seizure-onset zone using ictal electroencephalography (EEG). Owing to the difficulty in capturing unpredictable seizures, biomarkers capable of identifying EZs from interictal EEG are anticipated. Recent studies using intracranial EEG have identified several potential candidate biomarkers for epileptogenicity. High-frequency oscillation (HFO) was initially expected to be a robust biomarker of abnormal excitatory activity in the ictogenic region. However, HFO-guided resection failed to improve seizure prognosis. Meanwhile, the regularity of low-gamma oscillations (30-80 Hz) indicates inhibitory interneurons' hypersynchronization, which could be used to localize the EZ. Besides resting-state EEG assessments, evoked potentials elicited by single-pulse electrical stimulation, such as corticocortical evoked potentials (CCEP), became valuable tools for assessing epileptogenic regions. CCEP responses recorded in the cortex remote from the stimulation site indicate functional connectivity, revealing increased internal connectivity within the ictogenic region and elevated inhibitory input from the non-involved regions to the ictogenic region. Conversely, large responses close to the stimulation site reflect local excitability, manifesting as an increased N1 amplitude and overriding HFO. Further research is required to establish whether these novel electrophysiological methods, either individually or in combination, can function as robust biomarkers of epileptogenicity and hold promise for improving seizure prognosis.
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Affiliation(s)
| | - Naoto Kunii
- Department of Neurosurgery, Jichi Medical University
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25
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van den Boom MA, Gregg NM, Valencia GO, Lundstrom BN, Miller KJ, van Blooijs D, Huiskamp GJ, Leijten FS, Worrell GA, Hermes D. ER-detect: a pipeline for robust detection of early evoked responses in BIDS-iEEG electrical stimulation data. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.09.574915. [PMID: 38260687 PMCID: PMC10802406 DOI: 10.1101/2024.01.09.574915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Human brain connectivity can be measured in different ways. Intracranial EEG (iEEG) measurements during single pulse electrical stimulation provide a unique way to assess the spread of electrical information with millisecond precision. To provide a robust workflow to process these cortico-cortical evoked potential (CCEP) data and detect early evoked responses in a fully automated and reproducible fashion, we developed Early Response (ER)-detect. ER-detect is an open-source Python package and Docker application to preprocess BIDS structured iEEG data and detect early evoked CCEP responses. ER-detect can use three response detection methods, which were validated against 14-manually annotated CCEP datasets from two different sites by four independent raters. Results showed that ER-detect's automated detection performed on par with the inter-rater reliability (Cohen's Kappa of ~0.6). Moreover, ER-detect was optimized for processing large CCEP datasets, to be used in conjunction with other connectomic investigations. ER-detect provides a highly efficient standardized workflow such that iEEG-BIDS data can be processed in a consistent manner and enhance the reproducibility of CCEP based connectivity results.
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Affiliation(s)
- Max A. van den Boom
- Department of Physiology and Biomedical Engineering, Mayo Clinic; Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic; Rochester, MN, USA
| | | | | | | | - Kai J. Miller
- Department of Neurosurgery, Mayo Clinic; Rochester, MN, USA
| | - Dorien van Blooijs
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht; Utrecht, NL
- Stichting Epilepsie Instellingen Nederland (SEIN); Zwolle, The Netherlands
| | - Geertjan J.M. Huiskamp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht; Utrecht, NL
| | - Frans S.S. Leijten
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht; Utrecht, NL
| | - Gregory A. Worrell
- Department of Physiology and Biomedical Engineering, Mayo Clinic; Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN; USA
| | - Dora Hermes
- Department of Physiology and Biomedical Engineering, Mayo Clinic; Rochester, MN, USA
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26
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Bonosi L, Torrente A, Brighina F, Tito Petralia CC, Merlino P, Avallone C, Gulino V, Costanzo R, Brunasso L, Iacopino DG, Maugeri R. Corticocortical Evoked Potentials in Eloquent Brain Tumor Surgery. A Systematic Review. World Neurosurg 2024; 181:38-51. [PMID: 37832637 DOI: 10.1016/j.wneu.2023.10.028] [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: 08/29/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
Eloquent brain tumor surgery involves the delicate task of resecting tumors located in regions of the brain responsible for critical functions, such as language, motor control, and sensory perception. Preserving these functions is of paramount importance to maintain the patient's quality of life. Corticocortical evoked potentials (CCEPs) have emerged as a valuable intraoperative monitoring technique that aids in identifying and preserving eloquent cortical areas during surgery. This systematic review aimed to assess the utility of CCEPs in eloquent brain tumor surgery and determine their effectiveness in improving patient outcomes. A comprehensive literature search was conducted using electronic databases, including PubMed/Medline and Scopus. The search strategy identified 11 relevant articles for detailed analysis. The findings of the included studies consistently demonstrated the potential of CCEPs in guiding surgical decision making, minimizing the risk of postoperative neurological deficits, and mapping functional connectivity during surgery. However, further research and standardization are needed to fully establish the clinical benefits and refine the implementation of CCEPs in routine neurosurgical practice.
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Affiliation(s)
- Lapo Bonosi
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, School of Medicine, University of Palermo, Palermo, Italy.
| | - Angelo Torrente
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Cateno Concetto Tito Petralia
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, School of Medicine, University of Palermo, Palermo, Italy
| | - Pietro Merlino
- Department of Neuroscience, Psychology, Pharmacology and Child Health, Neurosurgery Clinic, Careggi University Hospital and University of Florence, Florence, Italy
| | - Chiara Avallone
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, School of Medicine, University of Palermo, Palermo, Italy
| | - Vincenzo Gulino
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, School of Medicine, University of Palermo, Palermo, Italy
| | - Roberta Costanzo
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, School of Medicine, University of Palermo, Palermo, Italy
| | - Lara Brunasso
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, School of Medicine, University of Palermo, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, School of Medicine, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, School of Medicine, University of Palermo, Palermo, Italy
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27
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Xie T, Foutz TJ, Adamek M, Swift JR, Inman CS, Manns JR, Leuthardt EC, Willie JT, Brunner P. Single-pulse electrical stimulation artifact removal using the novel matching pursuit-based artifact reconstruction and removal method (MPARRM). J Neural Eng 2023; 20:066036. [PMID: 38063368 PMCID: PMC10751949 DOI: 10.1088/1741-2552/ad1385] [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: 07/07/2023] [Revised: 11/02/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
Objective.Single-pulse electrical stimulation (SPES) has been widely used to probe effective connectivity. However, analysis of the neural response is often confounded by stimulation artifacts. We developed a novel matching pursuit-based artifact reconstruction and removal method (MPARRM) capable of removing artifacts from stimulation-artifact-affected electrophysiological signals.Approach.To validate MPARRM across a wide range of potential stimulation artifact types, we performed a bench-top experiment in which we suspended electrodes in a saline solution to generate 110 types of real-world stimulation artifacts. We then added the generated stimulation artifacts to ground truth signals (stereoelectroencephalography signals from nine human subjects recorded during a receptive speech task), applied MPARRM to the combined signal, and compared the resultant denoised signal with the ground truth signal. We further applied MPARRM to artifact-affected neural signals recorded from the hippocampus while performing SPES on the ipsilateral basolateral amygdala in nine human subjects.Main results.MPARRM could remove stimulation artifacts without introducing spectral leakage or temporal spread. It accommodated variable stimulation parameters and recovered the early response to SPES within a wide range of frequency bands. Specifically, in the early response period (5-10 ms following stimulation onset), we found that the broadband gamma power (70-170 Hz) of the denoised signal was highly correlated with the ground truth signal (R=0.98±0.02, Pearson), and the broadband gamma activity of the denoised signal faithfully revealed the responses to the auditory stimuli within the ground truth signal with94%±1.47%sensitivity and99%±1.01%specificity. We further found that MPARRM could reveal the expected temporal progression of broadband gamma activity along the anterior-posterior axis of the hippocampus in response to the ipsilateral amygdala stimulation.Significance.MPARRM could faithfully remove SPES artifacts without confounding the electrophysiological signal components, especially during the early-response period. This method can facilitate the understanding of the neural response mechanisms of SPES.
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Affiliation(s)
- Tao Xie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States of America
- National Center for Adaptive Neurotechnologies, St. Louis, MO, United States of America
| | - Thomas J Foutz
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Markus Adamek
- National Center for Adaptive Neurotechnologies, St. Louis, MO, United States of America
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, United States of America
| | - James R Swift
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States of America
- National Center for Adaptive Neurotechnologies, St. Louis, MO, United States of America
| | - Cory S Inman
- Department of Psychology, University of Utah, Salt Lake City, UT, United States of America
| | - Joseph R Manns
- Department of Psychology, Emory University, Atlanta, GA, United States of America
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States of America
- National Center for Adaptive Neurotechnologies, St. Louis, MO, United States of America
| | - Peter Brunner
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States of America
- National Center for Adaptive Neurotechnologies, St. Louis, MO, United States of America
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Dou Y, Xia J, Fu M, Cai Y, Meng X, Zhan Y. Identification of epileptic networks with graph convolutional network incorporating oscillatory activities and evoked synaptic responses. Neuroimage 2023; 284:120439. [PMID: 37939889 DOI: 10.1016/j.neuroimage.2023.120439] [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: 05/11/2023] [Revised: 10/01/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023] Open
Abstract
Stereoelectroencephalography (SEEG) offers unique neural data from in-depth brain structures with fine temporal resolutions to better investigate the origin of epileptic brain activities. Although oscillatory patterns from different frequency bands and functional connectivity computed from the SEEG datasets are employed to study the epileptic zones, direct electrical stimulation-evoked electrophysiological recordings of synaptic responses, namely cortical-cortical evoked potentials (CCEPs), from the same SEEG electrodes are not explored for the localization of epileptic zones. Here we proposed a two-stream model with unsupervised learning and graph convolutional network tailored to the SEEG and CCEP datasets in individual patients to perform localization of epileptic zones. We compared our localization results with the clinically marked electrode sites determined for surgical resections. Our model had good classification capability when compared to other state-of-the-art methods. Furthermore, based on our prediction results we performed group-level brain-area mapping analysis for temporal, frontal and parietal epilepsy patients and found that epileptic and non-epileptic brain networks were distinct in patients with different types of focal epilepsy. Our unsupervised data-driven model provides personalized localization analysis for the epileptic zones. The epileptic and non-epileptic brain areas disclosed by the prediction model provide novel insights into the network-level pathological characteristics of epilepsy.
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Affiliation(s)
- Yonglin Dou
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jing Xia
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Mengmeng Fu
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China
| | - Yunpeng Cai
- Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xianghong Meng
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China.
| | - Yang Zhan
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518055, China.
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Frauscher B, Bartolomei F, Baud MO, Smith RJ, Worrell G, Lundstrom BN. Stimulation to probe, excite, and inhibit the epileptic brain. Epilepsia 2023; 64 Suppl 3:S49-S61. [PMID: 37194746 PMCID: PMC10654261 DOI: 10.1111/epi.17640] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
Direct cortical stimulation has been applied in epilepsy for nearly a century and has experienced a renaissance, given unprecedented opportunities to probe, excite, and inhibit the human brain. Evidence suggests stimulation can increase diagnostic and therapeutic utility in patients with drug-resistant epilepsies. However, choosing appropriate stimulation parameters is not a trivial issue, and is further complicated by epilepsy being characterized by complex brain state dynamics. In this article derived from discussions at the ICTALS 2022 Conference (International Conference on Technology and Analysis for Seizures), we succinctly review the literature on cortical stimulation applied acutely and chronically to the epileptic brain for localization, monitoring, and therapeutic purposes. In particular, we discuss how stimulation is used to probe brain excitability, discuss evidence on the usefulness of stimulation to trigger and stop seizures, review therapeutic applications of stimulation, and finally discuss how stimulation parameters are impacted by brain dynamics. Although research has advanced considerably over the past decade, there are still significant hurdles to optimizing use of this technique. For example, it remains unclear to what extent short timescale diagnostic biomarkers can predict long-term outcomes and to what extent these biomarkers add information to already existing biomarkers from passive electroencephalographic recordings. Further questions include the extent to which closed loop stimulation offers advantages over open loop stimulation, what the optimal closed loop timescales may be, and whether biomarker-informed stimulation can lead to seizure freedom. The ultimate goal of bioelectronic medicine remains not just to stop seizures but rather to cure epilepsy and its comorbidities.
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Affiliation(s)
- Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, France. AP-HM, Service de Neurophysiologie Clinique, Hôpital de la Timone, Marseille, France
| | - Maxime O. Baud
- Sleep-Wake-Epilepsy Center, NeuroTec and Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern
| | - Rachel J. Smith
- University of Alabama at Birmingham, Electrical and Computer Engineering Department, Birmingham, Alabama, US. University of Alabama at Birmingham, Neuroengineering Program, Birmingham, Alabama, US
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, US
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Baş G, Taşkıran E, Arslan S, Kemerdere R, Tanrıöver N. Intraoperative visual evoked potential and subcortico-cortical evoked potential monitoring in diffuse low-grade glioma surgery: a case report. Acta Neurol Belg 2023; 123:2365-2370. [PMID: 36648703 DOI: 10.1007/s13760-023-02186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Gülçin Baş
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey.
| | - Emine Taşkıran
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Serdar Arslan
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
- Department of Radiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Rahşan Kemerdere
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Necmettin Tanrıöver
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
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31
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De Benedictis A, Rossi-Espagnet MC, de Palma L, Sarubbo S, Marras CE. Structural networking of the developing brain: from maturation to neurosurgical implications. Front Neuroanat 2023; 17:1242757. [PMID: 38099209 PMCID: PMC10719860 DOI: 10.3389/fnana.2023.1242757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain "connectome." The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children's neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.
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Affiliation(s)
| | | | - Luca de Palma
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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Novitskaya Y, Dümpelmann M, Schulze-Bonhage A. Physiological and pathological neuronal connectivity in the living human brain based on intracranial EEG signals: the current state of research. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1297345. [PMID: 38107334 PMCID: PMC10723837 DOI: 10.3389/fnetp.2023.1297345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
Over the past decades, studies of human brain networks have received growing attention as the assessment and modelling of connectivity in the brain is a topic of high impact with potential application in the understanding of human brain organization under both physiological as well as various pathological conditions. Under specific diagnostic settings, human neuronal signal can be obtained from intracranial EEG (iEEG) recording in epilepsy patients that allows gaining insight into the functional organisation of living human brain. There are two approaches to assess brain connectivity in the iEEG-based signal: evaluation of spontaneous neuronal oscillations during ongoing physiological and pathological brain activity, and analysis of the electrophysiological cortico-cortical neuronal responses, evoked by single pulse electrical stimulation (SPES). Both methods have their own advantages and limitations. The paper outlines available methodological approaches and provides an overview of current findings in studies of physiological and pathological human brain networks, based on intracranial EEG recordings.
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Affiliation(s)
- Yulia Novitskaya
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Dümpelmann
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Department of Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Schmid W, Danstrom IA, Echevarria MC, Adkinson J, Mattar L, Banks GP, Sheth SA, Watrous AJ, Heilbronner SR, Bijanki KR, Alabastri A, Bartoli E. A biophysically constrained brain connectivity model based on stimulation-evoked potentials. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.03.565525. [PMID: 37986830 PMCID: PMC10659345 DOI: 10.1101/2023.11.03.565525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Single-pulse electrical stimulation (SPES) is an established technique used to map functional effective connectivity networks in treatment-refractory epilepsy patients undergoing intracranial-electroencephalography monitoring. While the connectivity path between stimulation and recording sites has been explored through the integration of structural connectivity, there are substantial gaps, such that new modeling approaches may advance our understanding of connectivity derived from SPES studies. New Method Using intracranial electrophysiology data recorded from a single patient undergoing sEEG evaluation, we employ an automated detection method to identify early response components, C1, from pulse-evoked potentials (PEPs) induced by SPES. C1 components were utilized for a novel topology optimization method, modeling 3D conductivity propagation from stimulation sites. Additionally, PEP features were compared with tractography metrics, and model results were analyzed with respect to anatomical features. Results The proposed optimization model resolved conductivity paths with low error. Specific electrode contacts displaying high error correlated with anatomical complexities. The C1 component strongly correlates with additional PEP features and displayed stable, weak correlations with tractography measures. Comparison with existing methods Existing methods for estimating conductivity propagation are imaging-based and thus rely on anatomical inferences. Conclusions These results demonstrate that informing topology optimization methods with human intracranial SPES data is a feasible method for generating 3D conductivity maps linking electrical pathways with functional neural ensembles. PEP-estimated effective connectivity is correlated with but distinguished from structural connectivity. Modeled conductivity resolves connectivity pathways in the absence of anatomical priors.
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Affiliation(s)
- William Schmid
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston 77005, Texas, USA
| | - Isabel A. Danstrom
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Maria Crespo Echevarria
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Joshua Adkinson
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Layth Mattar
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Garrett P. Banks
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Andrew J. Watrous
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Sarah R. Heilbronner
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Kelly R. Bijanki
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Alessandro Alabastri
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston 77005, Texas, USA
| | - Eleonora Bartoli
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
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Zelmann R, Paulk AC, Tian F, Balanza Villegas GA, Dezha Peralta J, Crocker B, Cosgrove GR, Richardson RM, Williams ZM, Dougherty DD, Purdon PL, Cash SS. Differential cortical network engagement during states of un/consciousness in humans. Neuron 2023; 111:3479-3495.e6. [PMID: 37659409 PMCID: PMC10843836 DOI: 10.1016/j.neuron.2023.08.007] [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: 10/21/2022] [Revised: 06/13/2023] [Accepted: 08/08/2023] [Indexed: 09/04/2023]
Abstract
What happens in the human brain when we are unconscious? Despite substantial work, we are still unsure which brain regions are involved and how they are impacted when consciousness is disrupted. Using intracranial recordings and direct electrical stimulation, we mapped global, network, and regional involvement during wake vs. arousable unconsciousness (sleep) vs. non-arousable unconsciousness (propofol-induced general anesthesia). Information integration and complex processing we`re reduced, while variability increased in any type of unconscious state. These changes were more pronounced during anesthesia than sleep and involved different cortical engagement. During sleep, changes were mostly uniformly distributed across the brain, whereas during anesthesia, the prefrontal cortex was the most disrupted, suggesting that the lack of arousability during anesthesia results not from just altered overall physiology but from a disconnection between the prefrontal and other brain areas. These findings provide direct evidence for different neural dynamics during loss of consciousness compared with loss of arousability.
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Affiliation(s)
- Rina Zelmann
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA.
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA
| | - Fangyun Tian
- Department of Anesthesia, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Britni Crocker
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard-MIT Health Sciences and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ziv M Williams
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick L Purdon
- Department of Anesthesia, Massachusetts General Hospital, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA
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35
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Kulkarni AP, Hwang G, Cook CJ, Mohanty R, Guliani A, Nair VA, Bendlin BB, Meyerand E, Prabhakaran V. Genetic and environmental influence on resting state networks in young male and female adults: a cartographer mapping study. Hum Brain Mapp 2023; 44:5238-5293. [PMID: 36537283 PMCID: PMC10543121 DOI: 10.1002/hbm.25947] [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: 03/18/2021] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 09/07/2023] Open
Abstract
We propose a unique, minimal assumption, approach based on variance analyses (compared with standard approaches) to investigate genetic influence on individual differences on the functional connectivity of the brain using 65 monozygotic and 65 dizygotic healthy young adult twin pairs' low-frequency oscillation resting state functional Magnetic Resonance Imaging (fMRI) data from the Human Connectome Project. Overall, we found high number of genetically-influenced functional (GIF) connections involving posterior to posterior brain regions (occipital/temporal/parietal) implicated in low-level processes such as vision, perception, motion, categorization, dorsal/ventral stream visuospatial, and long-term memory processes, as well as high number across midline brain regions (cingulate) implicated in attentional processes, and emotional responses to pain. We found low number of GIF connections involving anterior to anterior/posterior brain regions (frontofrontal > frontoparietal, frontotemporal, frontooccipital) implicated in high-level processes such as working memory, reasoning, emotional judgment, language, and action planning. We found very low number of GIF connections involving subcortical/noncortical networks such as basal ganglia, thalamus, brainstem, and cerebellum. In terms of sex-specific individual differences, individual differences in males were more genetically influenced while individual differences in females were more environmentally influenced in terms of the interplay of interactions of Task positive networks (brain regions involved in various task-oriented processes and attending to and interacting with environment), extended Default Mode Network (a central brain hub for various processes such as internal monitoring, rumination, and evaluation of self and others), primary sensorimotor systems (vision, audition, somatosensory, and motor systems), and subcortical/noncortical networks. There were >8.5-19.1 times more GIF connections in males than females. These preliminary (young adult cohort-specific) findings suggest that individual differences in the resting state brain may be more genetically influenced in males and more environmentally influenced in females; furthermore, standard approaches may suggest that it is more substantially nonadditive genetics, rather than additive genetics, which contribute to the differences in sex-specific individual differences based on this young adult (male and female) specific cohort. Finally, considering the preliminary cohort-specific results, based on standard approaches, environmental influences on individual differences may be substantially greater than that of genetics, for either sex, frontally and brain-wide. [Correction added on 10 May 2023, after first online publication: added: functional Magnetic Resonance Imaging. Added: individual differences in, twice. Added statement between furthermore … based on standard approaches.].
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Affiliation(s)
- Arman P. Kulkarni
- Department of Biomedical EngineeringUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Gyujoon Hwang
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Cole J. Cook
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Rosaleena Mohanty
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Akhil Guliani
- Department of Computer ScienceUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Veena A. Nair
- Department of RadiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Barbara B. Bendlin
- Department of MedicineUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Elizabeth Meyerand
- Department of Biomedical EngineeringUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Vivek Prabhakaran
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of Computer ScienceUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of NeurologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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36
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Sala F. Intraoperative neurophysiology in pediatric neurosurgery: a historical perspective. Childs Nerv Syst 2023; 39:2929-2941. [PMID: 37776333 PMCID: PMC10613152 DOI: 10.1007/s00381-023-06155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Intraoperative neurophysiology (ION) has been established over the past three decades as a valuable discipline to improve the safety of neurosurgical procedures with the main goal of reducing neurological morbidity. Neurosurgeons have substantially contributed to the development of this field not only by implementing the use and refinement of ION in the operating room but also by introducing novel techniques for both mapping and monitoring of neural pathways. METHODS This review provides a personal perspective on the evolution of ION in a variety of pediatric neurosurgical procedures: from brain tumor to brainstem surgery, from spinal cord tumor to tethered cord surgery. RESULTS AND DISCUSSION The contribution of pediatric neurosurgeons is highlighted showing how our discipline has played a crucial role in promoting ION at the turn of the century. Finally, a view on novel ION techniques and their potential implications for pediatric neurosurgery will provide insights into the future of ION, further supporting the view of a functional, rather than merely anatomical, approach to pediatric neurosurgery.
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Affiliation(s)
- Francesco Sala
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy.
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37
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Ojeda Valencia G, Gregg NM, Huang H, Lundstrom BN, Brinkmann BH, Pal Attia T, Van Gompel JJ, Bernstein MA, In MH, Huston J, Worrell GA, Miller KJ, Hermes D. Signatures of Electrical Stimulation Driven Network Interactions in the Human Limbic System. J Neurosci 2023; 43:6697-6711. [PMID: 37620159 PMCID: PMC10538586 DOI: 10.1523/jneurosci.2201-22.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Stimulation-evoked signals are starting to be used as biomarkers to indicate the state and health of brain networks. The human limbic network, often targeted for brain stimulation therapy, is involved in emotion and memory processing. Previous anatomic, neurophysiological, and functional studies suggest distinct subsystems within the limbic network (Rolls, 2015). Studies using intracranial electrical stimulation, however, have emphasized the similarities of the evoked waveforms across the limbic network. We test whether these subsystems have distinct stimulation-driven signatures. In eight patients (four male, four female) with drug-resistant epilepsy, we stimulated the limbic system with single-pulse electrical stimulation. Reliable corticocortical evoked potentials (CCEPs) were measured between hippocampus and the posterior cingulate cortex (PCC) and between the amygdala and the anterior cingulate cortex (ACC). However, the CCEP waveform in the PCC after hippocampal stimulation showed a unique and reliable morphology, which we term the "limbic Hippocampus-Anterior nucleus of the thalamus-Posterior cingulate, HAP-wave." This limbic HAP-wave was visually distinct and separately decoded from the CCEP waveform in ACC after amygdala stimulation. Diffusion MRI data show that the measured end points in the PCC overlap with the end points of the parolfactory cingulum bundle rather than the parahippocampal cingulum, suggesting that the limbic HAP-wave may travel through fornix, mammillary bodies, and the anterior nucleus of the thalamus (ANT). This was further confirmed by stimulating the ANT, which evoked the same limbic HAP-wave but with an earlier latency. Limbic subsystems have unique stimulation-evoked signatures that may be used in the future to help network pathology diagnosis.SIGNIFICANCE STATEMENT The limbic system is often compromised in diverse clinical conditions, such as epilepsy or Alzheimer's disease, and characterizing its typical circuit responses may provide diagnostic insight. Stimulation-evoked waveforms have been used in the motor system to diagnose circuit pathology. We translate this framework to limbic subsystems using human intracranial stereo EEG (sEEG) recordings that measure deeper brain areas. Our sEEG recordings describe a stimulation-evoked waveform characteristic to the memory and spatial subsystem of the limbic network that we term the "limbic HAP-wave." The limbic HAP-wave follows anatomic white matter pathways from hippocampus to thalamus to the posterior cingulum and shows promise as a distinct biomarker of signaling in the human brain memory and spatial limbic network.
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Affiliation(s)
- Gabriela Ojeda Valencia
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Nicholas M Gregg
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Harvey Huang
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Brian N Lundstrom
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | | | - Tal Pal Attia
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Matt A Bernstein
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Myung-Ho In
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - John Huston
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Gregory A Worrell
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Kai J Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
- Department of Neurologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Dora Hermes
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
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38
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Oane I, Barborica A, Mindruta IR. Cingulate Cortex: Anatomy, Structural and Functional Connectivity. J Clin Neurophysiol 2023; 40:482-490. [PMID: 36930223 DOI: 10.1097/wnp.0000000000000970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY The cingulate cortex is a paired brain region located on the medial wall of each hemisphere. This review explores the anatomy as well as the structural and functional connectivity of the cingulate cortex underlying essential roles this region plays in emotion, autonomic, cognitive, motor control, visual-spatial processing, and memory.
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Affiliation(s)
- Irina Oane
- Epilepsy Monitoring Unit, Neurology Department, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Andrei Barborica
- Physics Department, University of Bucharest, Bucharest, Romania; and
| | - Ioana R Mindruta
- Epilepsy Monitoring Unit, Neurology Department, University Emergency Hospital Bucharest, Bucharest, Romania
- Neurology Department, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
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39
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Giampiccolo D, Cattaneo L, Sala F. Untangling wave characteristics in direct axono-cortical evoked potentials to understand cortico-cortical evoked potentials. Clin Neurophysiol 2023; 153:187-188. [PMID: 37460366 DOI: 10.1016/j.clinph.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Davide Giampiccolo
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Department of Neurosurgery, Institute of Neuroscience, Cleveland Clinic London, Grosvenor Place, London, UK.
| | - Luigi Cattaneo
- Centre for Brain and Mind Sciences (CIMeC), University of Trento, Italy
| | - Francesco Sala
- Department of Neurosurgery, Section of Neuroscience, Biomedicine and Movement - University of Verona, Italy
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40
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Rossel O, Schlosser-Perrin F, Duffau H, Matsumoto R, Mandonnet E, Bonnetblanc F. Short-range axono-cortical evoked-potentials in brain tumor surgery: Waveform characteristics as markers of direct connectivity. Clin Neurophysiol 2023; 153:189-201. [PMID: 37353389 DOI: 10.1016/j.clinph.2023.05.011] [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: 11/14/2022] [Revised: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE Intraoperative measurement of axono-cortical evoked potentials (ACEP) has emerged as a promising tool for studying neural connectivity. However, it is often difficult to determine if the activity recorded by cortical grids is generated by stimulated tracts or by spurious phenomena. This study aimed to identify criteria that would indicate a direct neurophysiological connection between a recording contact and a stimulated pathway. METHODS Electrical stimulation was applied to white matter fascicles within the resection cavity, while the evoked response was recorded at the cortical level in seven patients. RESULTS By analyzing the ACEP recordings, we identified a main epicenter characterized by a very early positive (or negative) evoked response occurring just after the stimulation artifact (<5 ms, |Amplitude| > 100 µV) followed by an early and large negative (or positive) monophasic evoked response (<40 ms; |Amplitude| > 300 µV). The neighboring activity had a different waveform and was attenuated compared to the hot-spot activity. CONCLUSIONS It is possible to distinguish the hotspot with direct connectivity to the stimulated site from neighboring activity using the identified criteria. SIGNIFICANCE The electrogenesis of the ACEP at the hotspot and neighboring activity is discussed.
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Affiliation(s)
| | | | - Hugues Duffau
- Département de Neurochirurgie, Centre Hospitalier Universitaire de Montpellier Gui de Chauliac, Montpellier, France
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Japan
| | - Emmanuel Mandonnet
- Département de Neurochirurgie, Centre Hospitalier Universitaire, Hôpital Lariboisière, Paris, France
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41
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Barbosa DAN, Gattas S, Salgado JS, Kuijper FM, Wang AR, Huang Y, Kakusa B, Leuze C, Luczak A, Rapp P, Malenka RC, Hermes D, Miller KJ, Heifets BD, Bohon C, McNab JA, Halpern CH. An orexigenic subnetwork within the human hippocampus. Nature 2023; 621:381-388. [PMID: 37648849 PMCID: PMC10499606 DOI: 10.1038/s41586-023-06459-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/20/2023] [Indexed: 09/01/2023]
Abstract
Only recently have more specific circuit-probing techniques become available to inform previous reports implicating the rodent hippocampus in orexigenic appetitive processing1-4. This function has been reported to be mediated at least in part by lateral hypothalamic inputs, including those involving orexigenic lateral hypothalamic neuropeptides, such as melanin-concentrating hormone5,6. This circuit, however, remains elusive in humans. Here we combine tractography, intracranial electrophysiology, cortico-subcortical evoked potentials, and brain-clearing 3D histology to identify an orexigenic circuit involving the lateral hypothalamus and converging in a hippocampal subregion. We found that low-frequency power is modulated by sweet-fat food cues, and this modulation was specific to the dorsolateral hippocampus. Structural and functional analyses of this circuit in a human cohort exhibiting dysregulated eating behaviour revealed connectivity that was inversely related to body mass index. Collectively, this multimodal approach describes an orexigenic subnetwork within the human hippocampus implicated in obesity and related eating disorders.
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Affiliation(s)
- Daniel A N Barbosa
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Gattas
- Department of Electrical Engineering and Computer Science, University of California, Irvine, Irvine, CA, USA
| | - Juliana S Salgado
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Fiene Marie Kuijper
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
- Université Paris Cité, Paris, France
- Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Allan R Wang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yuhao Huang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Bina Kakusa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Christoph Leuze
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Artur Luczak
- Canadian Centre for Behavioral Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Paul Rapp
- Department of Military & Emergency Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Robert C Malenka
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Dora Hermes
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kai J Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Boris D Heifets
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer A McNab
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Casey H Halpern
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
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42
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Boerger TF, Pahapill P, Butts AM, Arocho-Quinones E, Raghavan M, Krucoff MO. Large-scale brain networks and intra-axial tumor surgery: a narrative review of functional mapping techniques, critical needs, and scientific opportunities. Front Hum Neurosci 2023; 17:1170419. [PMID: 37520929 PMCID: PMC10372448 DOI: 10.3389/fnhum.2023.1170419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/16/2023] [Indexed: 08/01/2023] Open
Abstract
In recent years, a paradigm shift in neuroscience has been occurring from "localizationism," or the idea that the brain is organized into separately functioning modules, toward "connectomics," or the idea that interconnected nodes form networks as the underlying substrates of behavior and thought. Accordingly, our understanding of mechanisms of neurological function, dysfunction, and recovery has evolved to include connections, disconnections, and reconnections. Brain tumors provide a unique opportunity to probe large-scale neural networks with focal and sometimes reversible lesions, allowing neuroscientists the unique opportunity to directly test newly formed hypotheses about underlying brain structural-functional relationships and network properties. Moreover, if a more complete model of neurological dysfunction is to be defined as a "disconnectome," potential avenues for recovery might be mapped through a "reconnectome." Such insight may open the door to novel therapeutic approaches where previous attempts have failed. In this review, we briefly delve into the most clinically relevant neural networks and brain mapping techniques, and we examine how they are being applied to modern neurosurgical brain tumor practices. We then explore how brain tumors might teach us more about mechanisms of global brain dysfunction and recovery through pre- and postoperative longitudinal connectomic and behavioral analyses.
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Affiliation(s)
- Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Peter Pahapill
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Alissa M. Butts
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
- Mayo Clinic, Rochester, MN, United States
| | - Elsa Arocho-Quinones
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Manoj Raghavan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Max O. Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Biomedical Engineering, Medical College of Wisconsin, Marquette University, Milwaukee, WI, United States
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43
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Wu TQ, Kaboodvand N, McGinn RJ, Veit M, Davey Z, Datta A, Graber KD, Meador KJ, Fisher R, Buch V, Parvizi J. Multisite thalamic recordings to characterize seizure propagation in the human brain. Brain 2023; 146:2792-2802. [PMID: 37137813 PMCID: PMC10316776 DOI: 10.1093/brain/awad121] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 03/23/2023] [Indexed: 05/05/2023] Open
Abstract
Neuromodulation of the anterior nuclei of the thalamus (ANT) has shown to be efficacious in a subset of patients with refractory focal epilepsy. One important uncertainty is to what extent thalamic subregions other than the ANT could be recruited more prominently in the propagation of focal onset seizures. We designed the current study to simultaneously monitor the engagement of the ANT, mediodorsal (MD) and pulvinar (PUL) nuclei during seizures in patients who could be candidates for thalamic neuromodulation. We studied 11 patients with clinical manifestations of presumed temporal lobe epilepsy (TLE) undergoing invasive stereo-encephalography (sEEG) monitoring to confirm the source of their seizures. We extended cortical electrodes to reach the ANT, MD and PUL nuclei of the thalamus. More than one thalamic subdivision was simultaneously interrogated in nine patients. We recorded seizures with implanted electrodes across various regions of the brain and documented seizure onset zones (SOZ) in each recorded seizure. We visually identified the first thalamic subregion to be involved in seizure propagation. Additionally, in eight patients, we applied repeated single pulse electrical stimulation in each SOZ and recorded the time and prominence of evoked responses across the implanted thalamic regions. Our approach for multisite thalamic sampling was safe and caused no adverse events. Intracranial EEG recordings confirmed SOZ in medial temporal lobe, insula, orbitofrontal and temporal neocortical sites, highlighting the importance of invasive monitoring for accurate localization of SOZs. In all patients, seizures with the same propagation network and originating from the same SOZ involved the same thalamic subregion, with a stereotyped thalamic EEG signature. Qualitative visual reviews of ictal EEGs were largely consistent with the quantitative analysis of the corticothalamic evoked potentials, and both documented that thalamic nuclei other than ANT could have the earliest participation in seizure propagation. Specifically, pulvinar nuclei were involved earlier and more prominently than ANT in more than half of the patients. However, which specific thalamic subregion first demonstrated ictal activity could not be reliably predicted based on clinical semiology or lobar localization of SOZs. Our findings document the feasibility and safety of bilateral multisite sampling from the human thalamus. This may allow more personalized thalamic targets to be identified for neuromodulation. Future studies are needed to determine if a personalized thalamic neuromodulation leads to greater improvements in clinical outcome.
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Affiliation(s)
- Teresa Q Wu
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Neda Kaboodvand
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Ryan J McGinn
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Mike Veit
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Zachary Davey
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Anjali Datta
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurosurgery, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Kevin D Graber
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Robert Fisher
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Vivek Buch
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurosurgery, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Josef Parvizi
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurosurgery, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
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44
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Wu D, Schaper FLWVJ, Jin G, Qi L, Du J, Wang X, Wang Y, Xu C, Wang X, Yu T, Fox MD, Ren L. Human anterior thalamic stimulation evoked cortical potentials align with intrinsic functional connectivity. Neuroimage 2023:120243. [PMID: 37353098 DOI: 10.1016/j.neuroimage.2023.120243] [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: 12/19/2022] [Revised: 06/05/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023] Open
Abstract
Characterizing human thalamocortical network is fundamental for understanding a vast array of human behaviors since the thalamus plays a central role in cortico-subcortical communication. Over the past few decades, advances in functional magnetic resonance imaging have allowed for spatial mapping of intrinsic resting-state functional connectivity (RSFC) between both cortical regions and in cortico-subcortical networks. Despite these advances, identifying the electrophysiological basis of human thalamocortical network architecture remains challenging. By leveraging stereoelectroencephalography electrodes temporarily implanted into distributed cortical regions and the anterior nucleus of the thalamus (ANT) of 10 patients with refractory focal epilepsy, we tested whether ANT stimulation evoked cortical potentials align with RSFC from the stimulation site, derived from a normative functional connectome (n=1000). Our study identifies spatial convergence of ANT stimulation evoked cortical potentials and normative RSFC. Other than connections to the Papez circuit, the ANT was found to be closely connected to several distinct higher-order association cortices, including the precuneus, angular gyrus, dorsal lateral prefrontal cortex, and anterior insula. Remarkably, we found that the spatial distribution and magnitude of cortical-evoked responses to single-pulse electrical stimulation of the ANT aligned with the spatial pattern and strength of normative RSFC of the stimulation site. The present study provides electrophysiological evidence that stimulation evoked electrical activity flows along intrinsic brain networks connected on a thalamocortical level.
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Affiliation(s)
- Di Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Clinical Research Center of Epilepsy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; National Center for Neurological Disorders, Beijing 100053, China
| | - Frederic L W V J Schaper
- Center of Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Guangyuan Jin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Clinical Research Center of Epilepsy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; National Center for Neurological Disorders, Beijing 100053, China
| | - Lei Qi
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Clinical Research Center of Epilepsy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; National Center for Neurological Disorders, Beijing 100053, China
| | - Jialin Du
- Department of Pharmacy Phase I Clinical Trial Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiaopeng Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Clinical Research Center of Epilepsy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; National Center for Neurological Disorders, Beijing 100053, China
| | - Yuke Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Cuiping Xu
- National Center for Neurological Disorders, Beijing 100053, China; Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xueyuan Wang
- National Center for Neurological Disorders, Beijing 100053, China; Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Tao Yu
- National Center for Neurological Disorders, Beijing 100053, China; Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Michael D Fox
- Center of Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States; Berenson-Allen Center for Non-invasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA 02115, United States; Martinos Center for Biomedical Imaging, Departments of Neurology and Radiology, Harvard Medical School and Massachusetts General Hospital, Boston, MA 02115, United States; Havard Medical School, Boston, MA 02115, USA
| | - Liankun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Clinical Research Center of Epilepsy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; National Center for Neurological Disorders, Beijing 100053, China; Chinese Institute for Brain Research, Beijing 102206, China.
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45
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Pascarella A, Mikulan E, Sciacchitano F, Sarasso S, Rubino A, Sartori I, Cardinale F, Zauli F, Avanzini P, Nobili L, Pigorini A, Sorrentino A. An in-vivo validation of ESI methods with focal sources. Neuroimage 2023:120219. [PMID: 37307867 DOI: 10.1016/j.neuroimage.2023.120219] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/05/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023] Open
Abstract
Electrophysiological source imaging (ESI) aims at reconstructing the precise origin of brain activity from measurements of the electric field on the scalp. Across laboratories/research centers/hospitals, ESI is performed with different methods, partly due to the ill-posedness of the underlying mathematical problem. However, it is difficult to find systematic comparisons involving a wide variety of methods. Further, existing comparisons rarely take into account the variability of the results with respect to the input parameters. Finally, comparisons are typically performed using either synthetic data, or in-vivo data where the ground-truth is only roughly known. We use an in-vivo high-density EEG dataset recorded during intracranial single pulse electrical stimulation, in which the true sources are substantially dipolar and their locations are precisely known. We compare ten different ESI methods, using their implementation in the MNE-Python package: MNE, dSPM, LORETA, sLORETA, eLORETA, LCMV beamformers, irMxNE, Gamma Map, SESAME and dipole fitting. We perform comparisons under multiple choices of input parameters, to assess the accuracy of the best reconstruction, as well as the impact of such parameters on the localization performance. Best reconstructions often fall within 1 cm from the true source, with most accurate methods hitting an average localization error of 1.2 cm and outperforming least accurate ones erring by 2.5 cm. As expected, dipolar and sparsity-promoting methods tend to outperform distributed methods. For several distributed methods, the best regularization parameter turned out to be the one in principle associated with low SNR, despite the high SNR of the available dataset. Depth weighting played no role for two out of the six methods implementing it. Sensitivity to input parameters varied widely between methods. While one would expect high variability being associated with low localization error at the best solution, this is not always the case, with some methods producing highly variable results and high localization error, and other methods producing stable results with low localization error. In particular, recent dipolar and sparsity-promoting methods provide significantly better results than older distributed methods. As we repeated the tests with "conventional" (32 channels) and dense (64, 128, 256 channels) EEG recordings, we observed little impact of the number of channels on localization accuracy; however, for distributed methods denser montages provide smaller spatial dispersion. Overall findings confirm that EEG is a reliable technique for localization of point sources and therefore reinforce the importance that ESI may have in the clinical context, especially when applied to identify the surgical target in potential candidates for epilepsy surgery.
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Affiliation(s)
| | - Ezequiel Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco",Università degli Studi di Milano, Milan, Italy
| | | | - Simone Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco",Università degli Studi di Milano, Milan, Italy
| | - Annalisa Rubino
- Department of Neurosciences, Center for Epilepsy Surgery "C. Munari", Hospital Niguarda, Milan, Italy
| | - Ivana Sartori
- Department of Neurosciences, Center for Epilepsy Surgery "C. Munari", Hospital Niguarda, Milan, Italy
| | - Francesco Cardinale
- Department of Neurosciences, Center for Epilepsy Surgery "C. Munari", Hospital Niguarda, Milan, Italy
| | - Flavia Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco",Università degli Studi di Milano, Milan, Italy
| | | | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS "G. Gaslini" Institute, Genoa, Italy; DINOGMI, Università degli Studi di Genova, Genoa, Italy
| | - Andrea Pigorini
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Sorrentino
- Department of Mathematics, Università degli Studi di Genova, Genoa, Italy.
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46
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Kang KM, Kim KM, Kim IS, Kim JH, Kang H, Ji SY, Dho YS, Oh H, Park HP, Seo HG, Kim SM, Choi SH, Park CK. Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging for Language Mapping in Brain Tumor Surgery: Validation With Direct Cortical Stimulation and Cortico-Cortical Evoked Potential. Korean J Radiol 2023; 24:553-563. [PMID: 37271209 DOI: 10.3348/kjr.2022.1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging-derived tractography (DTI-t) contribute to the localization of language areas, but their accuracy remains controversial. This study aimed to investigate the diagnostic performance of preoperative fMRI and DTI-t obtained with a simultaneous multi-slice technique using intraoperative direct cortical stimulation (DCS) or corticocortical evoked potential (CCEP) as reference standards. MATERIALS AND METHODS This prospective study included 26 patients (23-74 years; male:female, 13:13) with tumors in the vicinity of Broca's area who underwent preoperative fMRI and DTI-t. A site-by-site comparison between preoperative (fMRI and DTI-t) and intraoperative language mapping (DCS or CCEP) was performed for 226 cortical sites to calculate the sensitivity and specificity of fMRI and DTI-t for mapping Broca's areas. For sites with positive signals on fMRI or DTI-t, the true-positive rate (TPR) was calculated based on the concordance and discordance between fMRI and DTI-t. RESULTS Among 226 cortical sites, DCS was performed in 100 sites and CCEP was performed in 166 sites. The specificities of fMRI and DTI-t ranged from 72.4% (63/87) to 96.8% (122/126), respectively. The sensitivities of fMRI (except for verb generation) and DTI-t were 69.2% (9/13) to 92.3% (12/13) with DCS as the reference standard, and 40.0% (16/40) or lower with CCEP as the reference standard. For sites with preoperative fMRI or DTI-t positivity (n = 82), the TPR was high when fMRI and DTI-t were concordant (81.2% and 100% using DCS and CCEP, respectively, as the reference standards) and low when fMRI and DTI-t were discordant (≤ 24.2%). CONCLUSION fMRI and DTI-t are sensitive and specific for mapping Broca's area compared with DCS and specific but insensitive compared with CCEP. A site with a positive signal on both fMRI and DTI-t represents a high probability of being an essential language area.
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Affiliation(s)
- Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Min Kim
- Department of Neurosurgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | | | - Joo Hyun Kim
- Department of Clinical Science, MR, Philips Healthcare Korea, Seoul, Korea
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - So Young Ji
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun-Sik Dho
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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47
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Bernabei JM, Li A, Revell AY, Smith RJ, Gunnarsdottir KM, Ong IZ, Davis KA, Sinha N, Sarma S, Litt B. Quantitative approaches to guide epilepsy surgery from intracranial EEG. Brain 2023; 146:2248-2258. [PMID: 36623936 PMCID: PMC10232272 DOI: 10.1093/brain/awad007] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/11/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
Over the past 10 years, the drive to improve outcomes from epilepsy surgery has stimulated widespread interest in methods to quantitatively guide epilepsy surgery from intracranial EEG (iEEG). Many patients fail to achieve seizure freedom, in part due to the challenges in subjective iEEG interpretation. To address this clinical need, quantitative iEEG analytics have been developed using a variety of approaches, spanning studies of seizures, interictal periods, and their transitions, and encompass a range of techniques including electrographic signal analysis, dynamical systems modeling, machine learning and graph theory. Unfortunately, many methods fail to generalize to new data and are sensitive to differences in pathology and electrode placement. Here, we critically review selected literature on computational methods of identifying the epileptogenic zone from iEEG. We highlight shared methodological challenges common to many studies in this field and propose ways that they can be addressed. One fundamental common pitfall is a lack of open-source, high-quality data, which we specifically address by sharing a centralized high-quality, well-annotated, multicentre dataset consisting of >100 patients to support larger and more rigorous studies. Ultimately, we provide a road map to help these tools reach clinical trials and hope to improve the lives of future patients.
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Affiliation(s)
- John M Bernabei
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Neuroengineering & Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Adam Li
- Department of Computer Science, Columbia University, New York, NY 10027, USA
| | - Andrew Y Revell
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rachel J Smith
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Neuroengineering Program, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Kristin M Gunnarsdottir
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Ian Z Ong
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kathryn A Davis
- Center for Neuroengineering & Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nishant Sinha
- Center for Neuroengineering & Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sridevi Sarma
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Brian Litt
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Neuroengineering & Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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48
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Miller KJ, Müller KR, Valencia GO, Huang H, Gregg NM, Worrell GA, Hermes D. Canonical Response Parameterization: Quantifying the structure of responses to single-pulse intracranial electrical brain stimulation. PLoS Comput Biol 2023; 19:e1011105. [PMID: 37228169 DOI: 10.1371/journal.pcbi.1011105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Single-pulse electrical stimulation in the nervous system, often called cortico-cortical evoked potential (CCEP) measurement, is an important technique to understand how brain regions interact with one another. Voltages are measured from implanted electrodes in one brain area while stimulating another with brief current impulses separated by several seconds. Historically, researchers have tried to understand the significance of evoked voltage polyphasic deflections by visual inspection, but no general-purpose tool has emerged to understand their shapes or describe them mathematically. We describe and illustrate a new technique to parameterize brain stimulation data, where voltage response traces are projected into one another using a semi-normalized dot product. The length of timepoints from stimulation included in the dot product is varied to obtain a temporal profile of structural significance, and the peak of the profile uniquely identifies the duration of the response. Using linear kernel PCA, a canonical response shape is obtained over this duration, and then single-trial traces are parameterized as a projection of this canonical shape with a residual term. Such parameterization allows for dissimilar trace shapes from different brain areas to be directly compared by quantifying cross-projection magnitudes, response duration, canonical shape projection amplitudes, signal-to-noise ratios, explained variance, and statistical significance. Artifactual trials are automatically identified by outliers in sub-distributions of cross-projection magnitude, and rejected. This technique, which we call "Canonical Response Parameterization" (CRP) dramatically simplifies the study of CCEP shapes, and may also be applied in a wide range of other settings involving event-triggered data.
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Affiliation(s)
- Kai J Miller
- Dept of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, United States of America
- Dept of Biomedical Engineering & Physiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Klaus-Robert Müller
- Google Research, Brain Team, Berlin, Germany
- Machine Learning Group, Department of Computer Science, Berlin Institute of Technology, Berlin, Germany
- Dept of Artificial Intelligence, Korea University, Seoul, Republic of Korea
- Max Planck Institute for Informatics, Saarbrücken, Germany
| | - Gabriela Ojeda Valencia
- Dept of Biomedical Engineering & Physiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Harvey Huang
- Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Nicholas M Gregg
- Dept of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Gregory A Worrell
- Dept of Biomedical Engineering & Physiology, Mayo Clinic, Rochester, Minnesota, United States of America
- Dept of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Dora Hermes
- Dept of Biomedical Engineering & Physiology, Mayo Clinic, Rochester, Minnesota, United States of America
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Andrade-Machado R, Javarayee P, Koop JI, Farias-Moeller R, Kim I, Lew SM. Neural representations of self-perception of voice: An intracortical evoked potential analysis based on an adolescent with right temporal lobe epilepsy. Seizure 2023; 109:1-4. [PMID: 37172443 DOI: 10.1016/j.seizure.2023.04.003] [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: 03/06/2023] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION The neural bases for language perception have been studied elsewhere using Transcranial Magnetic Stimulation, functional Magnetic Resonance Imaging and Direct Cortical Stimulation. However, to our knowledge, there is no previous report about a patient identifying the change in his voice tone, speed, and prosody because of right temporal cortical stimulation. Nor has there been a cortico-cortical evoked potential (CCEP) assessment of the network underlying this process. CASE REPORT We present CCEP from a patient with right focal refractory temporal lobe epilepsy of tumoral etiology who reported changes in the perception of his own speech prosody during stimulation. This report will serve as a complement to the understanding of the neural networks of language and prosody. CONCLUSION The present report shows that right superior temporal gyrus, transverse temporal gyrus, right amygdala, hippocampus, and fusiform gyrus (FG) are part of the neural network subjacent to own human voice perception.
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Affiliation(s)
- Rene Andrade-Machado
- Children's Wisconsin, Neurology Department, Division of Pediatric Neurology. Medical College of Wisconsin, United States.
| | - Pradeep Javarayee
- Children's Wisconsin, Neurology Department, Division of Pediatric Neurology. Medical College of Wisconsin, United States
| | - Jennifer I Koop
- Children's Wisconsin, Neurology Department, Division of Neuropsychology, Medical College of Wisconsin, United States
| | - Raquel Farias-Moeller
- Children's Wisconsin, Neurology Department, Division of Pediatric Neurology. Medical College of Wisconsin, United States
| | - Irene Kim
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Sean M Lew
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
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Almairac F, Parker D, Mondot L, Isan P, Onno M, Papadopoulo T, Filipiak P, Fontaine D, Verma R. Free-water correction DTI-based tractography in brain tumor surgery: assessment with functional and electrophysiological mapping of the white matter. Acta Neurochir (Wien) 2023; 165:1675-1681. [PMID: 37129683 DOI: 10.1007/s00701-023-05608-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
Peritumoral edema prevents fiber tracking from diffusion tensor imaging (DTI). A free-water correction may overcome this drawback, as illustrated in the case of a patient undergoing awake surgery for brain metastasis. The anatomical plausibility and accuracy of tractography with and without free-water correction were assessed with functional mapping and axono-cortical evoked-potentials (ACEPs) as reference methods. The results suggest a potential synergy between corrected DTI-based tractography and ACEPs to reliably identify and preserve white matter tracts during brain tumor surgery.
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Affiliation(s)
- Fabien Almairac
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 06000, Nice, France.
- UR2CA PIN, Université Côte d'Azur, Nice, France.
| | - Drew Parker
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lydiane Mondot
- Neuroradiology department, Pasteur 2 Hospital, University Hospital of Nice, 06000, Nice, France
- UR2CA URRIS, Université Côte d'Azur, Nice, France
| | - Petru Isan
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 06000, Nice, France
- UR2CA PIN, Université Côte d'Azur, Nice, France
| | - Marie Onno
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 06000, Nice, France
| | | | | | - Denys Fontaine
- Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 06000, Nice, France
- UR2CA PIN, Université Côte d'Azur, Nice, France
| | - Ragini Verma
- Diffusion and Connectomics in Precision Healthcare Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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