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Yi D, Yao Y, Wang Y, Chen L. Design, Fabrication, and Implantation of Invasive Microelectrode Arrays as in vivo Brain Machine Interfaces: A Comprehensive Review. JOURNAL OF MANUFACTURING PROCESSES 2024; 126:185-207. [PMID: 39185373 PMCID: PMC11340637 DOI: 10.1016/j.jmapro.2024.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Invasive Microelectrode Arrays (MEAs) have been a significant and useful tool for us to gain a fundamental understanding of how the brain works through high spatiotemporal resolution neuron-level recordings and/or stimulations. Through decades of research, various types of microwire, silicon, and flexible substrate-based MEAs have been developed using the evolving new materials, novel design concepts, and cutting-edge advanced manufacturing capabilities. Surgical implantation of the latest minimal damaging flexible MEAs through the hard-to-penetrate brain membranes introduces new challenges and thus the development of implantation strategies and instruments for the latest MEAs. In this paper, studies on the design considerations and enabling manufacturing processes of various invasive MEAs as in vivo brain-machine interfaces have been reviewed to facilitate the development as well as the state-of-art of such brain-machine interfaces from an engineering perspective. The challenges and solution strategies developed for surgically implanting such interfaces into the brain have also been evaluated and summarized. Finally, the research gaps have been identified in the design, manufacturing, and implantation perspectives, and future research prospects in invasive MEA development have been proposed.
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Affiliation(s)
- Dongyang Yi
- Department of Mechanical and Industrial Engineering, University of Massachusetts Lowell, Lowell, MA 01854
| | - Yao Yao
- Department of Industrial and Systems Engineering, University of Missouri, Columbia, MO 65211
| | - Yi Wang
- Department of Industrial and Systems Engineering, University of Missouri, Columbia, MO 65211
| | - Lei Chen
- Department of Mechanical and Industrial Engineering, University of Massachusetts Lowell, Lowell, MA 01854
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Weiss SA, Sperling MR, Engel J, Liu A, Fried I, Wu C, Doyle W, Mikell C, Mofakham S, Salamon N, Sim MS, Bragin A, Staba R. Simulated resections and RNS placement can optimize post-operative seizure outcomes when guided by fast ripple networks. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.26.24304802. [PMID: 38585730 PMCID: PMC10996761 DOI: 10.1101/2024.03.26.24304802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
In medication-resistant epilepsy, the goal of epilepsy surgery is to make a patient seizure free with a resection/ablation that is as small as possible to minimize morbidity. The standard of care in planning the margins of epilepsy surgery involves electroclinical delineation of the seizure onset zone (SOZ) and incorporation of neuroimaging findings from MRI, PET, SPECT, and MEG modalities. Resecting cortical tissue generating high-frequency oscillations (HFOs) has been investigated as a more efficacious alternative to targeting the SOZ. In this study, we used a support vector machine (SVM), with four distinct fast ripple (FR: 350-600 Hz on oscillations, 200-600 Hz on spikes) metrics as factors. These metrics included the FR resection ratio (RR), a spatial FR network measure, and two temporal FR network measures. The SVM was trained by the value of these four factors with respect to the actual resection boundaries and actual seizure free labels of 18 patients with medically refractory focal epilepsy. Leave one out cross-validation of the trained SVM in this training set had an accuracy of 0.78. We next used a simulated iterative virtual resection targeting the FR sites that were highest rate and showed most temporal autonomy. The trained SVM utilized the four virtual FR metrics to predict virtual seizure freedom. In all but one of the nine patients seizure free after surgery, we found that the virtual resections sufficient for virtual seizure freedom were larger in volume (p<0.05). In nine patients who were not seizure free, a larger virtual resection made five virtually seizure free. We also examined 10 medically refractory focal epilepsy patients implanted with the responsive neurostimulator system (RNS) and virtually targeted the RNS stimulation contacts proximal to sites generating FR at highest rates to determine if the simulated value of the stimulated SOZ and stimulated FR metrics would trend toward those patients with a better seizure outcome. Our results suggest: 1) FR measures can accurately predict whether a resection, defined by the standard of care, will result in seizure freedom; 2) utilizing FR alone for planning an efficacious surgery can be associated with larger resections; 3) when FR metrics predict the standard of care resection will fail, amending the boundaries of the planned resection with certain FR generating sites may improve outcome; and 4) more work is required to determine if targeting RNS stimulation contact proximal to FR generating sites will improve seizure outcome.
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Affiliation(s)
- Shennan Aibel Weiss
- Dept. of Neurology, State University of New York Downstate, Brooklyn, New York 11203, USA
- Dept. of Physiology and Pharmacology, State University of New York Downstate, Brooklyn, New York 11203, USA
- Dept. of Neurology, New York City Health + Hospitals/Kings County, Brooklyn, NY, 11203 USA
| | - Michael R. Sperling
- Dept. of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jerome Engel
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
- Dept. of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
- Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
- Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
| | - Anli Liu
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, 10016 USA
- Neuroscience Institute, NYU Langone Medical Center, New York, NY, 10016 USA
| | - Itzhak Fried
- Dept. of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
| | - Chengyuan Wu
- Dept. of Neuroradiology, Thomas Jefferson University, Philadelphia, PA, 19107, USA
- Dept. of Neurosurgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Werner Doyle
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, 10016 USA
| | - Charles Mikell
- Department of Neurosurgery, State University of New York Stony Brook, Stony Brook, New York 11790, USA
| | - Sima Mofakham
- Department of Neurosurgery, State University of New York Stony Brook, Stony Brook, New York 11790, USA
| | - Noriko Salamon
- Dept. of Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
| | - Myung Shin Sim
- Dept. of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
| | - Anatol Bragin
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
| | - Richard Staba
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
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Alessandri M, Osorio-Forero A, Lüthi A, Chatton JY. The lactate receptor HCAR1: A key modulator of epileptic seizure activity. iScience 2024; 27:109679. [PMID: 38655197 PMCID: PMC11035371 DOI: 10.1016/j.isci.2024.109679] [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: 01/16/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Epilepsy affects millions globally with a significant portion exhibiting pharmacoresistance. Abnormal neuronal activity elevates brain lactate levels, which prompted the exploration of its receptor, the hydroxycarboxylic acid receptor 1 (HCAR1) known to downmodulate neuronal activity in physiological conditions. This study revealed that HCAR1-deficient mice (HCAR1-KO) exhibited lowered seizure thresholds, and increased severity and duration compared to wild-type mice. Hippocampal and whole-brain electrographic seizure analyses revealed increased seizure severity in HCAR1-KO mice, supported by time-frequency analysis. The absence of HCAR1 led to uncontrolled inter-ictal activity in acute hippocampal slices, replicated by lactate dehydrogenase A inhibition indicating that the activation of HCAR1 is closely associated with glycolytic output. However, synthetic HCAR1 agonist administration in an in vivo epilepsy model did not modulate seizures, likely due to endogenous lactate competition. These findings underscore the crucial roles of lactate and HCAR1 in regulating circuit excitability to prevent unregulated neuronal activity and terminate epileptic events.
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Affiliation(s)
- Maxime Alessandri
- Department of Fundamental Neurosciences, University of Lausanne, 1005 Lausanne, Vaud, Switzerland
| | - Alejandro Osorio-Forero
- Department of Fundamental Neurosciences, University of Lausanne, 1005 Lausanne, Vaud, Switzerland
| | - Anita Lüthi
- Department of Fundamental Neurosciences, University of Lausanne, 1005 Lausanne, Vaud, Switzerland
| | - Jean-Yves Chatton
- Department of Fundamental Neurosciences, University of Lausanne, 1005 Lausanne, Vaud, Switzerland
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Sturgill B, Hernandez-Reynoso AG, Druschel LN, Smith TJ, Boucher PE, Hoeferlin GF, Thai TTD, Jiang MS, Hess JL, Alam NN, Menendez DM, Duncan JL, Cogan SF, Pancrazio JJ, Capadona JR. Reactive Amine Functionalized Microelectrode Arrays Provide Short-Term Benefit but Long-Term Detriment to In Vivo Recording Performance. ACS APPLIED BIO MATERIALS 2024; 7:1052-1063. [PMID: 38290529 PMCID: PMC10880090 DOI: 10.1021/acsabm.3c01014] [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: 10/28/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
Intracortical microelectrode arrays (MEAs) are used for recording neural signals. However, indwelling devices result in chronic neuroinflammation, which leads to decreased recording performance through degradation of the device and surrounding tissue. Coating the MEAs with bioactive molecules is being explored to mitigate neuroinflammation. Such approaches often require an intermediate functionalization step such as (3-aminopropyl)triethoxysilane (APTES), which serves as a linker. However, the standalone effect of this intermediate step has not been previously characterized. Here, we investigated the effect of coating MEAs with APTES by comparing APTES-coated to uncoated controls in vivo and ex vivo. First, we measured water contact angles between silicon uncoated and APTES-coated substrates to verify the hydrophilic characteristics of the APTES coating. Next, we implanted MEAs in the motor cortex (M1) of Sprague-Dawley rats with uncoated or APTES-coated devices. We assessed changes in the electrochemical impedance and neural recording performance over a chronic implantation period of 16 weeks. Additionally, histology and bulk gene expression were analyzed to understand further the reactive tissue changes arising from the coating. Results showed that APTES increased the hydrophilicity of the devices and decreased electrochemical impedance at 1 kHz. APTES coatings proved detrimental to the recording performance, as shown by a constant decay up to 16 weeks postimplantation. Bulk gene analysis showed differential changes in gene expression between groups that were inconclusive with regard to the long-term effect on neuronal tissue. Together, these results suggest that APTES coatings are ultimately detrimental to chronic neural recordings. Furthermore, interpretations of studies using APTES as a functionalization step should consider the potential consequences if the final functionalization step is incomplete.
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Affiliation(s)
- Brandon
S. Sturgill
- Department
of Bioengineering, The University of Texas
at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Ana G. Hernandez-Reynoso
- Department
of Bioengineering, The University of Texas
at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Lindsey N. Druschel
- Department
of Biomedical Engineering, Case Western
Reserve University. 10900 Euclid Ave, Cleveland, Ohio 44106, United States
- Advanced
Platform Technology Center, Louis Stokes Cleveland Veterans Affairs
Medical Center, Cleveland, Ohio 44106, United States
| | - Thomas J. Smith
- School
of Behavioral and BrainSciences, The University
of Texas at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Pierce E. Boucher
- Department
of Biomedical Engineering, Case Western
Reserve University. 10900 Euclid Ave, Cleveland, Ohio 44106, United States
- Advanced
Platform Technology Center, Louis Stokes Cleveland Veterans Affairs
Medical Center, Cleveland, Ohio 44106, United States
| | - George F. Hoeferlin
- Department
of Biomedical Engineering, Case Western
Reserve University. 10900 Euclid Ave, Cleveland, Ohio 44106, United States
- Advanced
Platform Technology Center, Louis Stokes Cleveland Veterans Affairs
Medical Center, Cleveland, Ohio 44106, United States
| | - Teresa Thuc Doan Thai
- Department
of Bioengineering, The University of Texas
at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Madison S. Jiang
- School
of Behavioral and BrainSciences, The University
of Texas at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Jordan L. Hess
- School
of Behavioral and BrainSciences, The University
of Texas at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Neeha N. Alam
- Department
of Bioengineering, The University of Texas
at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Dhariyat M. Menendez
- Department
of Biomedical Engineering, Case Western
Reserve University. 10900 Euclid Ave, Cleveland, Ohio 44106, United States
- Advanced
Platform Technology Center, Louis Stokes Cleveland Veterans Affairs
Medical Center, Cleveland, Ohio 44106, United States
| | - Jonathan L. Duncan
- Department
of Biomedical Engineering, Case Western
Reserve University. 10900 Euclid Ave, Cleveland, Ohio 44106, United States
- Advanced
Platform Technology Center, Louis Stokes Cleveland Veterans Affairs
Medical Center, Cleveland, Ohio 44106, United States
| | - Stuart F. Cogan
- Department
of Bioengineering, The University of Texas
at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Joseph J. Pancrazio
- Department
of Bioengineering, The University of Texas
at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Jeffrey R. Capadona
- Department
of Biomedical Engineering, Case Western
Reserve University. 10900 Euclid Ave, Cleveland, Ohio 44106, United States
- Advanced
Platform Technology Center, Louis Stokes Cleveland Veterans Affairs
Medical Center, Cleveland, Ohio 44106, United States
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Agopyan-Miu AH, Merricks EM, Smith EH, McKhann GM, Sheth SA, Feldstein NA, Trevelyan AJ, Schevon CA. Cell-type specific and multiscale dynamics of human focal seizures in limbic structures. Brain 2023; 146:5209-5223. [PMID: 37536281 PMCID: PMC10689922 DOI: 10.1093/brain/awad262] [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: 03/05/2023] [Revised: 06/30/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
The relationship between clinically accessible epileptic biomarkers and neuronal activity underlying the transition to seizure is complex, potentially leading to imprecise delineation of epileptogenic brain areas. In particular, the pattern of interneuronal firing at seizure onset remains under debate, with some studies demonstrating increased firing and others suggesting reductions. Previous study of neocortical sites suggests that seizure recruitment occurs upon failure of inhibition, with intact feedforward inhibition in non-recruited territories. We investigated whether the same principle applies in limbic structures. We analysed simultaneous electrocorticography (ECoG) and neuronal recordings of 34 seizures in a cohort of 19 patients (10 male, 9 female) undergoing surgical evaluation for pharmacoresistant focal epilepsy. A clustering approach with five quantitative metrics computed from ECoG and multiunit data was used to distinguish three types of site-specific activity patterns during seizures, which at times co-existed within seizures. Overall, 156 single units were isolated, subclassified by cell-type and tracked through the seizure using our previously published methods to account for impacts of increased noise and single-unit waveshape changes caused by seizures. One cluster was closely associated with clinically defined seizure onset or spread. Entrainment of high-gamma activity to low-frequency ictal rhythms was the only metric that reliably identified this cluster at the level of individual seizures (P < 0.001). A second cluster demonstrated multi-unit characteristics resembling those in the first cluster, without concomitant high-gamma entrainment, suggesting feedforward effects from the seizure. The last cluster captured regions apparently unaffected by the ongoing seizure. Across all territories, the majority of both excitatory and inhibitory neurons reduced (69.2%) or ceased firing (21.8%). Transient increases in interneuronal firing rates were rare (13.5%) but showed evidence of intact feedforward inhibition, with maximal firing rate increases and waveshape deformations in territories not fully recruited but showing feedforward activity from the seizure, and a shift to burst-firing in seizure-recruited territories (P = 0.014). This study provides evidence for entrained high-gamma activity as an accurate biomarker of ictal recruitment in limbic structures. However, reduced neuronal firing suggested preserved inhibition in mesial temporal structures despite simultaneous indicators of seizure recruitment, in contrast to the inhibitory collapse scenario documented in neocortex. Further study is needed to determine if this activity is ubiquitous to hippocampal seizures or indicates a 'seizure-responsive' state in which the hippocampus is not the primary driver. If the latter, distinguishing such cases may help to refine the surgical treatment of mesial temporal lobe epilepsy.
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Affiliation(s)
- Alexander H Agopyan-Miu
- Department of Neurological Surgery, Columbia University Medical Center, NewYork, NY 10032, USA
| | - Edward M Merricks
- Department of Neurology, Columbia University Medical Center, NewYork, NY 10032, USA
| | - Elliot H Smith
- Department of Neurology, Columbia University Medical Center, NewYork, NY 10032, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, NewYork, NY 10032, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston TX 77030, USA
| | - Neil A Feldstein
- Department of Neurological Surgery, Columbia University Medical Center, NewYork, NY 10032, USA
| | - Andrew J Trevelyan
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Catherine A Schevon
- Department of Neurology, Columbia University Medical Center, NewYork, NY 10032, USA
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Mueller JS, Tescarollo FC, Huynh T, Brenner DA, Valdivia DJ, Olagbegi K, Sangappa S, Chen SC, Sun H. Ictogenesis proceeds through discrete phases in hippocampal CA1 seizures in mice. Nat Commun 2023; 14:6010. [PMID: 37752179 PMCID: PMC10522592 DOI: 10.1038/s41467-023-41711-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
Epilepsy is characterized by spontaneous non-provoked seizures, yet the mechanisms that trigger a seizure and allow its evolution remain underexplored. To dissect out phases of ictogenesis, we evoked hypersynchronous activity with optogenetic stimulation. Focal optogenetic activation of putative excitatory neurons in the mouse hippocampal CA1 reliably evoked convulsive seizures in awake mice. A time-vs-time pulsogram plot characterized the evolution of the EEG pulse response from a light evoked response to induced seizure activity. Our results depict ictogenesis as a stepwise process comprised of three distinctive phases demarcated by two transition points. The induction phase undergoes the first transition to reverberant phase activity, followed by the second transition into the paroxysmal phase or a seizure. Non-seizure responses are confined to either induction or reverberant phases. The pulsogram was then constructed in seizures recorded from a murine model of temporal lobe epilepsy and it depicted a similar reverberance preceding spontaneous seizures. The discovery of these distinct phases of ictogenesis may offer means to abort a seizure before it develops.
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Affiliation(s)
- John-Sebastian Mueller
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08854, USA
| | - Fabio C Tescarollo
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08854, USA
| | - Trong Huynh
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08854, USA
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07103, USA
| | - Daniel A Brenner
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08854, USA
| | - Daniel J Valdivia
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08854, USA
| | - Kanyin Olagbegi
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08854, USA
| | - Sahana Sangappa
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08854, USA
| | - Spencer C Chen
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08854, USA
| | - Hai Sun
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08854, USA.
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Ricci L, Tamilia E, Mercier M, Pepi C, Carfì-Pavia G, De Benedictis A, Assenza G, Di Lazzaro V, Vigevano F, Specchio N, de Palma L. Phase-amplitude coupling between low- and high-frequency activities as preoperative biomarker of focal cortical dysplasia subtypes. Clin Neurophysiol 2023; 150:40-48. [PMID: 37002979 DOI: 10.1016/j.clinph.2023.03.006] [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: 10/17/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE To evaluate whether ictal phase-amplitude coupling (PAC) between high-frequency activity and low-frequency activity could be used as a preoperative biomarker of Focal Cortical Dysplasia (FCD) subtypes. We hypothesize that FCD seizures present unique PAC characteristics that may be linked to their specific histopathological features. METHODS We retrospectively examined 12 children with FCD and refractory epilepsy who underwent successful epilepsy surgery. We identified ictal onsets recorded with stereo-EEG. We estimated the strength of PAC between low-frequencies and high-frequencies for each seizure by means of modulation index. Generalized mixed effect models and receiver operating characteristic (ROC) curve analysis were used to test the association between ictal PAC and FCD subtypes. RESULTS Ictal PAC was significantly higher in patients with FCD type II compared to type I, only on SOZ-electrodes (p < 0.005). No differences in ictal PAC were found on non-SOZ electrodes. Pre-ictal PAC registered on SOZ electrodes predicted FCD histopathology with a classification accuracy > 0.9 (p < 0.05). CONCLUSIONS The correlations between histopathology and neurophysiology provide evidence for the contribution of ictal PAC as a preoperative biomarker of FCD subtypes. SIGNIFICANCE Developed into a proper clinical application, such a technique may help improve clinical management and facilitate the prediction of surgical outcome in patients with FCD undergoing stereo-EEG monitoring.
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Affiliation(s)
- Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Eleonora Tamilia
- Fetal-Neonatal Neuroimaging Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mattia Mercier
- Rare and Complex Epilepsies, Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, 00165 Rome, Italy
| | - Chiara Pepi
- Rare and Complex Epilepsies, Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, 00165 Rome, Italy
| | - Giusy Carfì-Pavia
- Rare and Complex Epilepsies, Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, 00165 Rome, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Federico Vigevano
- Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Nicola Specchio
- Rare and Complex Epilepsies, Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, 00165 Rome, Italy.
| | - Luca de Palma
- Rare and Complex Epilepsies, Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, 00165 Rome, Italy
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8
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Michalak AJ, Greenblatt A, Wu S, Tobochnik S, Dave H, Raghupathi R, Esengul YT, Guerra A, Tao JX, Issa NP, Cosgrove GR, Lega B, Warnke P, Chen HI, Lucas T, Sheth SA, Banks GP, Kwon CS, Feldstein N, Youngerman B, McKhann G, Davis KA, Schevon C. Seizure onset patterns predict outcome after stereo-electroencephalography-guided laser amygdalohippocampotomy. Epilepsia 2023; 64:1568-1581. [PMID: 37013668 PMCID: PMC10247471 DOI: 10.1111/epi.17602] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (stereo-EEG) may miss seizure onset elsewhere. We hypothesized that stereo-EEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control. In this study, we characterized the 2-year outcomes of patients who underwent single-fiber SLAH after stereo-EEG and evaluated whether stereo-EEG SOPs predict postoperative seizure freedom. METHODS This retrospective five-center study included patients with or without mesial temporal sclerosis (MTS) who underwent stereo-EEG followed by single-fiber SLAH between August 2014 and January 2022. Patients with causative hippocampal lesions apart from MTS or for whom the SLAH was considered palliative were excluded. An SOP catalogue was developed based on literature review. The dominant pattern for each patient was used for survival analysis. The primary outcome was 2-year Engel I classification or recurrent seizures before then, stratified by SOP category. RESULTS Fifty-eight patients were included, with a mean follow-up duration of 39 ± 12 months after SLAH. Overall 1-, 2-, and 3-year Engel I seizure freedom probability was 54%, 36%, and 33%, respectively. Patients with SOPs, including low-voltage fast activity or low-frequency repetitive spiking, had a 46% 2-year seizure freedom probability, compared to 0% for patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (log-rank test, p = .00015). SIGNIFICANCE Patients who underwent SLAH after stereo-EEG had a low probability of seizure freedom at 2 years, but SOPs successfully predicted seizure recurrence in a subset of patients. This study provides proof of concept that SOPs distinguish between hippocampal seizure onset and spread and supports using SOPs to improve selection of SLAH candidates.
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Affiliation(s)
- Andrew J. Michalak
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam Greenblatt
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Steven Tobochnik
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Hina Dave
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ramya Raghupathi
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Yasar T. Esengul
- Department of Neurology, University of Toledo College of Medicine, Toledo, OH, USA
| | - Antonio Guerra
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James X. Tao
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Naoum P. Issa
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Garth R. Cosgrove
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Bradley Lega
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter Warnke
- Department of Neurosurgery, University of Chicago, Chicago, NY, USA
| | - H. Isaac Chen
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Timothy Lucas
- Department of Neurosurgery & Biomedical Engineering, Ohio State University; Neurotech Institute, Columbus, OH, USA
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Garrett P. Banks
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Churl-Su Kwon
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Gertrude H Sergievsky Center, New York, NY, USA
| | - Neil Feldstein
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Brett Youngerman
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Guy McKhann
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Kathryn A. Davis
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Catherine Schevon
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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9
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Ueda T, Iimura Y, Mitsuhashi T, Suzuki H, Miao Y, Nishioka K, Tamrakar S, Matsui R, Tanaka T, Otsubo H, Sugano H, Kondo A. Chronological changes in phase-amplitude coupling during epileptic seizures in temporal lobe epilepsy. Clin Neurophysiol 2023; 148:44-51. [PMID: 36796285 DOI: 10.1016/j.clinph.2023.01.014] [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: 09/07/2022] [Revised: 12/25/2022] [Accepted: 01/19/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To analyze chronological changes in phase-amplitude coupling (PAC) and verify whether PAC analysis can diagnose epileptogenic zones during seizures. METHODS We analyzed 30 seizures in 10 patients with mesial temporal lobe epilepsy who had ictal discharges with preictal spiking followed by low-voltage fast activity patterns on intracranial electroencephalography. We used the amplitude of two high-frequency bands (ripples: 80-200 Hz, fast ripples: 200-300 Hz) and the phase of three slow wave bands (0.5-1 Hz, 3-4 Hz, and 4-8 Hz) for modulation index (MI) calculation from 2 minutes before seizure onset to seizure termination. We evaluated the accuracy of epileptogenic zone detection by MI, in which a combination of MI was better for diagnosis and analyzed patterns of chronological changes in MI during seizures. RESULTS MIRipples/3-4 Hz and MIRipples/4-8 Hz in the hippocampus were significantly higher than those in the peripheral regions from seizure onset. Corresponding to the phase on intracranial electroencephalography, MIRipples/3-4 Hz decreased once and subsequently increased again. MIRipples/4-8 Hz showed continuously high values. CONCLUSIONS Continuous measurement of MIRipples/3-4 Hz and MIRipples/4-8 Hz could help identify epileptogenic zones. SIGNIFICANCE PAC analysis of ictal epileptic discharges can help epileptogenic zone identification.
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Affiliation(s)
- Tetsuya Ueda
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan.
| | - Yasushi Iimura
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan.
| | - Takumi Mitsuhashi
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan.
| | - Hiroharu Suzuki
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan.
| | - Yao Miao
- Department of Electronic and Information Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan.
| | - Kazuki Nishioka
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan.
| | - Samantha Tamrakar
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan.
| | - Ryousuke Matsui
- Department of Electronic and Information Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan.
| | - Toshihisa Tanaka
- Department of Electronic and Information Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan.
| | - Hiroshi Otsubo
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan; Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Hidenori Sugano
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan.
| | - Akihide Kondo
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan.
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10
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Shahabi H, Nair DR, Leahy RM. Multilayer brain networks can identify the epileptogenic zone and seizure dynamics. eLife 2023; 12:e68531. [PMID: 36929752 PMCID: PMC10065796 DOI: 10.7554/elife.68531] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/16/2023] [Indexed: 03/18/2023] Open
Abstract
Seizure generation, propagation, and termination occur through spatiotemporal brain networks. In this paper, we demonstrate the significance of large-scale brain interactions in high-frequency (80-200Hz) for the identification of the epileptogenic zone (EZ) and seizure evolution. To incorporate the continuity of neural dynamics, here we have modeled brain connectivity constructed from stereoelectroencephalography (SEEG) data during seizures using multilayer networks. After introducing a new measure of brain connectivity for temporal networks, named multilayer eigenvector centrality (mlEVC), we applied a consensus hierarchical clustering on the developed model to identify the EZ as a cluster of nodes with distinctive brain connectivity in the ictal period. Our algorithm could successfully predict electrodes inside the resected volume as EZ for 88% of participants, who all were seizure-free for at least 12 months after surgery. Our findings illustrated significant and unique desynchronization between EZ and the rest of the brain in the early to mid-seizure. We showed that aging and the duration of epilepsy intensify this desynchronization, which can be the outcome of abnormal neuroplasticity. Additionally, we illustrated that seizures evolve with various network topologies, confirming the existence of different epileptogenic networks in each patient. Our findings suggest not only the importance of early intervention in epilepsy but possible factors that correlate with disease severity. Moreover, by analyzing the propagation patterns of different seizures, we demonstrate the necessity of collecting sufficient data for identifying epileptogenic networks.
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Affiliation(s)
- Hossein Shahabi
- Signal and Image Processing Institute, University of Southern CaliforniaLos AngelesUnited States
| | - Dileep R Nair
- Epilepsy Center, Cleveland Clinic Neurological InstituteClevelandUnited States
| | - Richard M Leahy
- Signal and Image Processing Institute, University of Southern CaliforniaLos AngelesUnited States
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11
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Goldenberg AM, Schmidt S, Mitelman R, Levy DR, Prigge M, Katz Y, Yizhar O, Beck H, Lampl I. Localized chemogenetic silencing of inhibitory neurons: a novel mouse model of focal cortical epileptic activity. Cereb Cortex 2023; 33:2838-2856. [PMID: 35788286 DOI: 10.1093/cercor/bhac245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Focal cortical epilepsies are frequently refractory to available anticonvulsant drug therapies. One key factor contributing to this state is the limited availability of animal models that allow to reliably study focal cortical seizures and how they recruit surrounding brain areas in vivo. In this study, we selectively expressed the inhibitory chemogenetic receptor, hM4D, in GABAergic neurons in focal cortical areas using viral gene transfer. GABAergic silencing using Clozapine-N-Oxide (CNO) demonstrated reliable induction of local epileptiform events in the electroencephalogram signal of awake freely moving mice. Anesthetized mice experiments showed consistent induction of focal epileptiform-events in both the barrel cortex (BC) and the medial prefrontal cortex (mPFC), accompanied by high-frequency oscillations, a known characteristic of human seizures. Epileptiform-events showed propagation indication with favored propagation pathways: from the BC on 1 hemisphere to its counterpart and from the BC to the mPFC, but not vice-versa. Lastly, sensory whisker-pad stimulation evoked BC epileptiform events post-CNO, highlighting the potential use of this model in studying sensory-evoked seizures. Combined, our results show that targeted chemogenetic inhibition of GABAergic neurons using hM4D can serve as a novel, versatile, and reliable model of focal cortical epileptic activity suitable for systematically studying cortical ictogenesis in different cortical areas.
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Affiliation(s)
- Adi Miriam Goldenberg
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Sarah Schmidt
- Institute for Experimental Epileptology and Cognition Research, Life and Brain Center, University of Bonn, Bonn 53105, Germany
| | - Rea Mitelman
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Dana Rubi Levy
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Matthias Prigge
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Yonatan Katz
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Ofer Yizhar
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Heinz Beck
- Institute for Experimental Epileptology and Cognition Research, Life and Brain Center, University of Bonn, Bonn 53105, Germany
| | - Ilan Lampl
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
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12
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Chloride ion dysregulation in epileptogenic neuronal networks. Neurobiol Dis 2023; 177:106000. [PMID: 36638891 DOI: 10.1016/j.nbd.2023.106000] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/25/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
GABA is the major inhibitory neurotransmitter in the mature CNS. When GABAA receptors are activated the membrane potential is driven towards hyperpolarization due to chloride entry into the neuron. However, chloride ion dysregulation that alters the ionic gradient can result in depolarizing GABAergic post-synaptic potentials instead. In this review, we highlight that GABAergic inhibition prevents and restrains focal seizures but then reexamine this notion in the context of evidence that a static and/or a dynamic chloride ion dysregulation, that increases intracellular chloride ion concentrations, promotes epileptiform activity and seizures. To reconcile these findings, we hypothesize that epileptogenic pathologically interconnected neuron (PIN) microcircuits, representing a small minority of neurons, exhibit static chloride dysregulation and should exhibit depolarizing inhibitory post-synaptic potentials (IPSPs). We speculate that chloride ion dysregulation and PIN cluster activation may generate fast ripples and epileptiform spikes as well as initiate the hypersynchronous seizure onset pattern and microseizures. Also, we discuss the genetic, molecular, and cellular players important in chloride dysregulation which regulate epileptogenesis and initiate the low-voltage fast seizure onset pattern. We conclude that chloride dysregulation in neuronal networks appears to be critical for epileptogenesis and seizure genesis, but feed-back and feed-forward inhibitory GABAergic neurotransmission plays an important role in preventing and restraining seizures as well.
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13
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Juan E, Górska U, Kozma C, Papantonatos C, Bugnon T, Denis C, Kremen V, Worrell G, Struck AF, Bateman LM, Merricks EM, Blumenfeld H, Tononi G, Schevon C, Boly M. Distinct signatures of loss of consciousness in focal impaired awareness versus tonic-clonic seizures. Brain 2023; 146:109-123. [PMID: 36383415 PMCID: PMC10582624 DOI: 10.1093/brain/awac291] [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: 10/06/2021] [Revised: 05/17/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022] Open
Abstract
Loss of consciousness is a hallmark of many epileptic seizures and carries risks of serious injury and sudden death. While cortical sleep-like activities accompany loss of consciousness during focal impaired awareness seizures, the mechanisms of loss of consciousness during focal to bilateral tonic-clonic seizures remain unclear. Quantifying differences in markers of cortical activation and ictal recruitment between focal impaired awareness and focal to bilateral tonic-clonic seizures may also help us to understand their different consequences for clinical outcomes and to optimize neuromodulation therapies. We quantified clinical signs of loss of consciousness and intracranial EEG activity during 129 focal impaired awareness and 50 focal to bilateral tonic-clonic from 41 patients. We characterized intracranial EEG changes both in the seizure onset zone and in areas remote from the seizure onset zone with a total of 3386 electrodes distributed across brain areas. First, we compared the dynamics of intracranial EEG sleep-like activities: slow-wave activity (1-4 Hz) and beta/delta ratio (a validated marker of cortical activation) during focal impaired awareness versus focal to bilateral tonic-clonic. Second, we quantified differences between focal to bilateral tonic-clonic and focal impaired awareness for a marker validated to detect ictal cross-frequency coupling: phase-locked high gamma (high-gamma phased-locked to low frequencies) and a marker of ictal recruitment: the epileptogenicity index. Third, we assessed changes in intracranial EEG activity preceding and accompanying behavioural generalization onset and their correlation with electromyogram channels. In addition, we analysed human cortical multi-unit activity recorded with Utah arrays during three focal to bilateral tonic-clonic seizures. Compared to focal impaired awareness, focal to bilateral tonic-clonic seizures were characterized by deeper loss of consciousness, even before generalization occurred. Unlike during focal impaired awareness, early loss of consciousness before generalization was accompanied by paradoxical decreases in slow-wave activity and by increases in high-gamma activity in parieto-occipital and temporal cortex. After generalization, when all patients displayed loss of consciousness, stronger increases in slow-wave activity were observed in parieto-occipital cortex, while more widespread increases in cortical activation (beta/delta ratio), ictal cross-frequency coupling (phase-locked high gamma) and ictal recruitment (epileptogenicity index). Behavioural generalization coincided with a whole-brain increase in high-gamma activity, which was especially synchronous in deep sources and could not be explained by EMG. Similarly, multi-unit activity analysis of focal to bilateral tonic-clonic revealed sustained increases in cortical firing rates during and after generalization onset in areas remote from the seizure onset zone. Overall, these results indicate that unlike during focal impaired awareness, the neural signatures of loss of consciousness during focal to bilateral tonic-clonic consist of paradoxical increases in cortical activation and neuronal firing found most consistently in posterior brain regions. These findings suggest differences in the mechanisms of ictal loss of consciousness between focal impaired awareness and focal to bilateral tonic-clonic and may account for the more negative prognostic consequences of focal to bilateral tonic-clonic.
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Affiliation(s)
- Elsa Juan
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Department of Psychology, University of Amsterdam, Amsterdam, 1018 WS, The Netherlands
| | - Urszula Górska
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Smoluchowski Institute of Physics, Jagiellonian University, 30-348 Krakow, Poland
| | - Csaba Kozma
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Cynthia Papantonatos
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Tom Bugnon
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Colin Denis
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Vaclav Kremen
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, 16000, Czech Republic
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
- Department of Neurology, William S. Middleton Veterans Administration Hospital, Madison, WI 53705, USA
| | - Lisa M Bateman
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Edward M Merricks
- Department of Neurology, Columbia University, New York City, NY 10032, USA
| | - Hal Blumenfeld
- Department of Neurology, Yale School of Medicine, New Haven, CT 06519, USA
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Catherine Schevon
- Department of Neurology, Columbia University, New York City, NY 10032, USA
| | - Melanie Boly
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
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14
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Warsi NM, Mohammad AH, Zhang F, Wong SM, Yan H, Mansouri A, Ibrahim GM. Electrocorticography-Guided Resection Enhances Postoperative Seizure Freedom in Low-Grade Tumor-Associated Epilepsy: A Systematic Review and Meta-Analysis. Neurosurgery 2023; 92:18-26. [PMID: 36519857 DOI: 10.1227/neu.0000000000002182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Low-grade cerebral neoplasms are commonly associated with medically intractable epilepsy. Despite increasing evidence that epileptogenic brain regions commonly extend beyond visible tumor margins, the utility of extended surgical resections leveraging intraoperative electrocorticography (ECoG) remains unclear. OBJECTIVE To determine whether ECoG-guided surgery is associated with improved postoperative seizure control. METHODS We performed a systematic review and meta-analysis encompassing both adult and pediatric populations. The primary outcome measure was postoperative seizure freedom as defined by Engel class I outcome. Class I/II outcome served as a secondary measure. Relevant clinical and operative data were recorded. A random-effects meta-analysis based on the pooled odds ratio (OR) of seizure freedom was performed on studies that reported comparative data between ECoG-guided surgery and lesionectomy. RESULTS A total of 31 studies encompassing 1115 patients with medically refractory epilepsy met inclusion criteria. Seven studies reported comparative data between ECoG-guided surgery and lesionectomy for meta-analysis. Tumor resection guided by ECoG was associated with significantly greater postoperative seizure freedom (OR 3.95, 95% CI 2.32-6.72, P < .0001) and class I/II outcome (OR 5.10, 95% CI 1.97-13.18, P = .0008) compared with lesionectomy. Postoperative adverse events were rare in both groups. CONCLUSION These findings provide support for the utilization of ECoG-guided surgery to improve postoperative seizure freedom in cases of refractory epilepsy associated with low-grade neoplasms. However, this effect may be attenuated in the presence of concomitant cortical dysplasia, highlighting a need for improved presurgical and intraoperative monitoring for these most challenging cases of localization-related epilepsy.
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Affiliation(s)
- Nebras M Warsi
- Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.,Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Amro H Mohammad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | | | - Simeon M Wong
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.,Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Han Yan
- Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Alireza Mansouri
- Penn State Cancer Institute, Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Pennsylvania, USA
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.,Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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15
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Yi D, Yao Y, Wang Y, Chen L. Manufacturing Processes of Implantable Microelectrode Array for In Vivo Neural Electrophysiological Recordings and Stimulation: A State-Of-the-Art Review. JOURNAL OF MICRO- AND NANO-MANUFACTURING 2022; 10:041001. [PMID: 37860671 PMCID: PMC10583290 DOI: 10.1115/1.4063179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/08/2023] [Indexed: 10/21/2023]
Abstract
Electrophysiological recording and stimulation of neuron activities are important for us to understand the function and dysfunction of the nervous system. To record/stimulate neuron activities as voltage fluctuation extracellularly, microelectrode array (MEA) implants are a promising tool to provide high temporal and spatial resolution for neuroscience studies and medical treatments. The design configuration and recording capabilities of the MEAs have evolved dramatically since their invention and manufacturing process development has been a key driving force for such advancement. Over the past decade, since the White House Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) Initiative launched in 2013, advanced manufacturing processes have enabled advanced MEAs with increased channel count and density, access to more brain areas, more reliable chronic performance, as well as minimal invasiveness and tissue reaction. In this state-of-the-art review paper, three major types of electrophysiological recording MEAs widely used nowadays, namely, microwire-based, silicon-based, and flexible MEAs are introduced and discussed. Conventional design and manufacturing processes and materials used for each type are elaborated, followed by a review of further development and recent advances in manufacturing technologies and the enabling new designs and capabilities. The review concludes with a discussion on potential future directions of manufacturing process development to enable the long-term goal of large-scale high-density brain-wide chronic recordings in freely moving animals.
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Affiliation(s)
- Dongyang Yi
- Department of Mechanical and Industrial Engineering, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA 01854
| | - Yao Yao
- Department of Industrial and Systems Engineering, University of Missouri, 416 South 6th Street, Columbia, MO 65211
| | - Yi Wang
- Department of Industrial and Systems Engineering, University of Missouri, E3437C Thomas & Nell Lafferre Hall, 416 South 6th Street, Columbia, MO 65211
| | - Lei Chen
- Department of Mechanical and Industrial Engineering, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA 01854
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16
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Weiss SA, Sheybani L, Seenarine N, Fried I, Wu C, Sharan A, Engel J, Sperling MR, Nir Y, Staba RJ. Delta oscillation coupled propagating fast ripples precede epileptiform discharges in patients with focal epilepsy. Neurobiol Dis 2022; 175:105928. [DOI: 10.1016/j.nbd.2022.105928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
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17
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Tobochnik S, Bateman LM, Akman CI, Anbarasan D, Bazil CW, Bell M, Choi H, Feldstein NA, Kent PF, McBrian D, McKhann GM, Mendiratta A, Pack AM, Sands TT, Sheth SA, Srinivasan S, Schevon CA. Tracking Multisite Seizure Propagation Using Ictal High-Gamma Activity. J Clin Neurophysiol 2022; 39:592-601. [PMID: 34812578 PMCID: PMC8611231 DOI: 10.1097/wnp.0000000000000833] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Spatial patterns of long-range seizure propagation in epileptic networks have not been well characterized. Here, we use ictal high-gamma activity (HGA) as a proxy of intense neuronal population firing to map the spatial evolution of seizure recruitment. METHODS Ictal HGA (80-150 Hz) was analyzed in 13 patients with 72 seizures recorded by stereotactic depth electrodes, using previously validated methods. Distinct spatial clusters of channels with the ictal high-gamma signature were identified, and seizure hubs were defined as stereotypically recruited nonoverlapping clusters. Clusters correlated with asynchronous seizure terminations to provide supportive evidence for independent seizure activity at these sites. The spatial overlap between seizure hubs and interictal ripples was compared. RESULTS Ictal HGA was detected in 71% of seizures and 10% of implanted contacts, enabling tracking of contiguous and noncontiguous seizure recruitment. Multiple seizure hubs were identified in 54% of cases, including 43% of patients thought preoperatively to have unifocal epilepsy. Noncontiguous recruitment was associated with asynchronous seizure termination (odds ratio = 19.7; p = 0.029). Interictal ripples demonstrated greater spatial overlap with ictal HGA in cases with single seizure hubs compared with those with multiple hubs (100% vs. 66% per patient; p = 0.03). CONCLUSIONS Ictal HGA may serve as a useful adjunctive biomarker to distinguish contiguous seizure spread from propagation to remote seizure sites. High-gamma sites were found to cluster in stereotyped seizure hubs rather than being broadly distributed. Multiple hubs were common even in cases that were considered unifocal.
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Affiliation(s)
- Steven Tobochnik
- Brigham and Women’s Hospital, Department of Neurology, Boston, MA
| | - Lisa M. Bateman
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Cigdem I. Akman
- Columbia University Medical Center, Division of Child Neurology, New York, NY
| | | | - Carl W. Bazil
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Michelle Bell
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Hyunmi Choi
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Neil A. Feldstein
- Columbia University Medical Center, Department of Neurological Surgery, New York, NY
| | - Paul F. Kent
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Danielle McBrian
- Columbia University Medical Center, Division of Child Neurology, New York, NY
| | - Guy M. McKhann
- Columbia University Medical Center, Department of Neurological Surgery, New York, NY
| | - Anil Mendiratta
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Alison M. Pack
- Columbia University Medical Center, Department of Neurology, New York, NY
| | - Tristan T. Sands
- Columbia University Medical Center, Division of Child Neurology, New York, NY
| | - Sameer A. Sheth
- Baylor College of Medicine, Department of Neurosurgery, Houston, TX
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18
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Buckmaster PS, Reyes B, Kahn T, Wyeth M. Ventral Hippocampal Formation Is the Primary Epileptogenic Zone in a Rat Model of Temporal Lobe Epilepsy. J Neurosci 2022; 42:7482-7495. [PMID: 35995562 PMCID: PMC9525166 DOI: 10.1523/jneurosci.0429-22.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 01/12/2023] Open
Abstract
Temporal lobe epilepsy is common, but mechanisms of seizure initiation are unclear. We evaluated seizure initiation in female and male rats that had been systemically treated with pilocarpine, a widely used model of temporal lobe epilepsy. Local field potential (LFP) recordings from many brain regions revealed variable sites of earliest recorded seizure activity, but mostly the ventral hippocampal formation. To test whether inactivation of the ventral hippocampal formation would reduce seizures, mini-osmotic pumps were used to continually and focally deliver TTX. High doses of TTX infused unilaterally into the ventral hippocampal formation blocked seizures reversibly but also reduced LFP amplitudes in remote brain regions, indicating distant effects. A lower dose did not reduce LFP amplitudes in remote brain regions but did not reduce seizures when infused unilaterally. Instead, seizures tended to initiate in the contralateral ventral hippocampal formation. Bilateral infusion of the lower dose into the ventral hippocampal formation reduced seizure frequency 85%. Similar bilateral treatment in the amygdala was not effective. Bilateral infusion of the dorsal hippocampus reduced seizure frequency, but only 17%. Together, these findings reveal that the ventral hippocampal formation is a primary bilaterally independent epileptogenic zone, and the dorsal hippocampus is a secondary epileptogenic zone in pilocarpine-treated rats. This is consistent with many human patients, and the results further validate the LFP method for identifying seizure onset zones. Finally, the findings are more consistent with a focal mechanism of ictogenesis rather than one involving a network of interdependent nodes.SIGNIFICANCE STATEMENT To better understand how seizures start, investigators need to know where seizures start in the animal models they study. In the widely used pilocarpine-treated rat model of temporal lobe epilepsy, earliest seizure activity was most frequently recorded in the ventral hippocampal formation. Confirming the primary role of the ventral hippocampal formation, seizure frequency was reduced most effectively when it was inactivated focally, bilaterally, and continually with infused TTX. These findings suggest that the ventral hippocampal formation is the primary site of seizure initiation in this animal model of temporal lobe epilepsy, consistent with findings in many human patients.
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Affiliation(s)
- Paul S Buckmaster
- Departments of Comparative Medicine
- Neurology & Neurological Sciences, Stanford University, Stanford, California 94305
| | - Bianca Reyes
- Departments of Comparative Medicine
- College of Veterinary Medicine, Tuskegee University, Tuskegee, Alabama 36088
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19
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Schlafly ED, Marshall FA, Merricks EM, Eden UT, Cash SS, Schevon CA, Kramer MA. Multiple Sources of Fast Traveling Waves during Human Seizures: Resolving a Controversy. J Neurosci 2022; 42:6966-6982. [PMID: 35906069 PMCID: PMC9464018 DOI: 10.1523/jneurosci.0338-22.2022] [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: 02/16/2022] [Revised: 05/26/2022] [Accepted: 06/18/2022] [Indexed: 11/21/2022] Open
Abstract
During human seizures, organized waves of voltage activity rapidly sweep across the cortex. Two contradictory theories describe the source of these fast traveling waves: either a slowly advancing narrow region of multiunit activity (an ictal wavefront) or a fixed cortical location. Limited observations and different analyses prevent resolution of these incompatible theories. Here we address this disagreement by combining the methods and microelectrode array recordings (N = 11 patients, 2 females, N = 31 seizures) from previous human studies to analyze the traveling wave source. We find, inconsistent with both existing theories, a transient relationship between the ictal wavefront and traveling waves, and multiple stable directions of traveling waves in many seizures. Using a computational model that combines elements of both existing theories, we show that interactions between an ictal wavefront and fixed source reproduce the traveling wave dynamics observed in vivo We conclude that combining both existing theories can generate the diversity of ictal traveling waves.SIGNIFICANCE STATEMENT The source of voltage discharges that propagate across cortex during human seizures remains unknown. Two candidate theories exist, each proposing a different discharge source. Support for each theory consists of observations from a small number of human subject recordings, analyzed with separately developed methods. How the different, limited data and different analysis methods impact the evidence for each theory is unclear. To resolve these differences, we combine the unique, human microelectrode array recordings collected separately for each theory and analyze these combined data with a unified approach. We show that neither existing theory adequately describes the data. We then propose a new theory that unifies existing proposals and successfully reproduces the voltage discharge dynamics observed in vivo.
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Affiliation(s)
- Emily D Schlafly
- Graduate Program in Neuroscience, Boston University, Boston, Massachusetts 02215
| | - François A Marshall
- Department of Mathematics and Statistics & Center for Systems Neuroscience, Boston University, Boston, Massachusetts 02215
| | - Edward M Merricks
- Department of Neurology, Columbia University, New York, New York 10032
| | - Uri T Eden
- Department of Mathematics and Statistics & Center for Systems Neuroscience, Boston University, Boston, Massachusetts 02215
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts 02114
| | | | - Mark A Kramer
- Department of Mathematics and Statistics & Center for Systems Neuroscience, Boston University, Boston, Massachusetts 02215
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20
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Subramanian M, Chiang CC, Couturier NH, Durand DM. Theta waves, neural spikes and seizures can propagate by ephaptic coupling in vivo. Exp Neurol 2022; 354:114109. [PMID: 35551899 PMCID: PMC10214533 DOI: 10.1016/j.expneurol.2022.114109] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/30/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
Electric field coupling has been shown to be responsible for non-synaptic neural activity propagation in hippocampal slices and cortical slices. Epileptiform and slow-wave sleep activity can propagate by electric field coupling without using synaptic connections at speeds of ~0.1 m/s in vitro. However, the characteristics of the events that can propagate using electric field coupling through a volume conductor in vivo have not been studied. Thus, we tested the hypothesis that various types of neural signals such as interictal spikes, theta waves and seizures could propagate in vivo across a transection in the hippocampus. We induced epileptiform activity in 4 rats under anesthesia by injecting 4-aminopyridine in the temporal region of the hippocampus, four recording electrodes were inserted along the longitudinal axis of the hippocampus. A transection was made between the electrodes to study the propagation of the neural activity. Although 54% of the interictal spikes could propagate through the cut, only those spikes with a high amplitude and short duration had a high probability to do so. 70% of seizure events could propagate through the cut but parameters distinguishing between propagating and non-propagating seizure events could not be identified. Theta activity was also observed to propagate at a mean speed of 0.16 ± 0.12 m/s in the characteristic range of propagation using electric field coupling through the transection. The electric field volume conduction mechanism was confirmed by showing that propagation was blocked by placing a dielectric layer within the cut. The speed of propagation was not affected by the transection thereby providing further evidence that various types of neural signals including activity in the theta range can propagate by electric field coupling in-vivo.
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Affiliation(s)
- Muthumeenakshi Subramanian
- Neural Engineering Center, Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Chia-Chu Chiang
- Neural Engineering Center, Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Nicholas H Couturier
- Neural Engineering Center, Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Dominique M Durand
- Neural Engineering Center, Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA.
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21
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Warsi NM, Yan H, Wong SM, Yau I, Breitbart S, Go C, Gorodetsky C, Fasano A, Kalia SK, Rutka JT, Vaughan K, Ibrahim GM. Vagus Nerve Stimulation Modulates Phase-Amplitude Coupling in Thalamic Local Field Potentials. Neuromodulation 2022; 26:601-606. [PMID: 35840521 DOI: 10.1016/j.neurom.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/26/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The antiseizure effects of vagus nerve stimulation (VNS) are thought to be mediated by the modulation of afferent thalamocortical circuitry. Cross-frequency phase-amplitude coupling (PAC) is a mechanism of hierarchical network coordination across multiple spatiotemporal scales. In this study, we leverage local field potential (LFP) recordings from the centromedian (CM) (n = 3) and anterior (ATN) (n = 2) nuclei in five patients with tandem thalamic deep brain stimulation and VNS to study neurophysiological changes in the thalamus in response to VNS. MATERIALS AND METHODS Bipolar LFP data were recorded from contact pairs spanning target nuclei in VNS "on" and "off" states. RESULTS Active VNS was associated with increased PAC between theta, alpha, and beta phase and gamma amplitude in CM (q < 0.05). Within the ATN, PAC changes also were observed, although these were less robust. In both nuclei, active VNS also modulated interhemispheric bithalamic functional connectivity. CONCLUSIONS We report that VNS is associated with enhanced PAC and coordinated interhemispheric interactions within and between thalamic nuclei, respectively. These findings advance understanding of putative neurophysiological effects of acute VNS and contextualize previous animal and human studies showing distributed cortical synchronization after VNS.
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Affiliation(s)
- Nebras M Warsi
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Han Yan
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Simeon M Wong
- Department of Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ivanna Yau
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sara Breitbart
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cristina Go
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kerry Vaughan
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Department of Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.
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22
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Multimodal, Multiscale Insights into Hippocampal Seizures Enabled by Transparent, Graphene-Based Microelectrode Arrays. eNeuro 2022; 9:ENEURO.0386-21.2022. [PMID: 35470227 PMCID: PMC9087744 DOI: 10.1523/eneuro.0386-21.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/21/2022] Open
Abstract
Hippocampal seizures are a defining feature of mesial temporal lobe epilepsy (MTLE). Area CA1 of the hippocampus is commonly implicated in the generation of seizures, which may occur because of the activity of endogenous cell populations or of inputs from other regions within the hippocampal formation. Simultaneously observing activity at the cellular and network scales in vivo remains challenging. Here, we present a novel technology for simultaneous electrophysiology and multicellular calcium imaging of CA1 pyramidal cells (PCs) in mice enabled by a transparent graphene-based microelectrode array (Gr MEA). We examine PC firing at seizure onset, oscillatory coupling, and the dynamics of the seizure traveling wave as seizures evolve. Finally, we couple features derived from both modalities to predict the speed of the traveling wave using bootstrap aggregated regression trees. Analysis of the most important features in the regression trees suggests a transition among states in the evolution of hippocampal seizures.
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23
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Weiss SA, Pastore T, Orosz I, Rubinstein D, Gorniak R, Waldman Z, Fried I, Wu C, Sharan A, Slezak D, Worrell G, Engel J, Sperling MR, Staba RJ. Graph theoretical measures of fast ripples support the epileptic network hypothesis. Brain Commun 2022; 4:fcac101. [PMID: 35620169 PMCID: PMC9128387 DOI: 10.1093/braincomms/fcac101] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/10/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
The epileptic network hypothesis and epileptogenic zone hypothesis are two
theories of ictogenesis. The network hypothesis posits that coordinated activity
among interconnected nodes produces seizures. The epileptogenic zone hypothesis
posits that distinct regions are necessary and sufficient for seizure
generation. High-frequency oscillations, and particularly fast ripples, are
thought to be biomarkers of the epileptogenic zone. We sought to test these
theories by comparing high-frequency oscillation rates and networks in surgical
responders and non-responders, with no appreciable change in seizure frequency
or severity, within a retrospective cohort of 48 patients implanted with
stereo-EEG electrodes. We recorded inter-ictal activity during non-rapid eye
movement sleep and semi-automatically detected and quantified high-frequency
oscillations. Each electrode contact was localized in normalized coordinates. We
found that the accuracy of seizure onset zone electrode contact classification
using high-frequency oscillation rates was not significantly different in
surgical responders and non-responders, suggesting that in non-responders the
epileptogenic zone partially encompassed the seizure onset zone(s)
(P > 0.05). We also found that in the
responders, fast ripple on oscillations exhibited a higher spectral content in
the seizure onset zone compared with the non-seizure onset zone
(P < 1 × 10−5).
By contrast, in the non-responders, fast ripple had a lower spectral content in
the seizure onset zone
(P < 1 × 10−5).
We constructed two different networks of fast ripple with a spectral content
>350 Hz. The first was a rate–distance network that
multiplied the Euclidian distance between fast ripple-generating contacts by the
average rate of fast ripple in the two contacts. The radius of the
rate–distance network, which excluded seizure onset zone nodes,
discriminated non-responders, including patients not offered resection or
responsive neurostimulation due to diffuse multifocal onsets, with an accuracy
of 0.77 [95% confidence interval (CI) 0.56–0.98]. The second fast
ripple network was constructed using the mutual information between the timing
of the events to measure functional connectivity. For most non-responders, this
network had a longer characteristic path length, lower mean local efficiency in
the non-seizure onset zone, and a higher nodal strength among non-seizure onset
zone nodes relative to seizure onset zone nodes. The graphical theoretical
measures from the rate–distance and mutual information networks of 22
non- responsive neurostimulation treated patients was used to train a support
vector machine, which when tested on 13 distinct patients classified
non-responders with an accuracy of 0.92 (95% CI 0.75–1). These
results indicate patients who do not respond to surgery or those not selected
for resection or responsive neurostimulation can be explained by the epileptic
network hypothesis that is a decentralized network consisting of widely
distributed, hyperexcitable fast ripple-generating nodes.
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Affiliation(s)
- Shennan A Weiss
- Dept. of Neurology, State University of New York Downstate, Brooklyn, New York, 11203 USA
- Dept. of Physiology and Pharmacology, State University of New York Downstate, Brooklyn, New York, 11203 USA
- Dept. of Neurology, New York City Health + Hospitals/Kings County, Brooklyn, NY, USA
| | - Tomas Pastore
- Dept. of Computer Science, University of Buenos Aires, Buenos Aires, Argentina
| | - Iren Orosz
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
| | - Daniel Rubinstein
- Depts. of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Richard Gorniak
- Dept. of Neuroradiology, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Zachary Waldman
- Depts. of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Itzhak Fried
- Dept. of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
| | - Chengyuan Wu
- Dept. of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Ashwini Sharan
- Dept. of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Diego Slezak
- Dept. of Computer Science, University of Buenos Aires, Buenos Aires, Argentina
| | - Gregory Worrell
- Dept. of Neurology, Mayo Systems Electrophysiology Laboratory (MSEL), USA
- Dept. of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Jerome Engel
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
| | - Michael R. Sperling
- Depts. of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Richard J Staba
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
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24
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Fujita Y, Yanagisawa T, Fukuma R, Ura N, Oshino S, Kishima H. Abnormal phase-amplitude coupling characterizes the interictal state in epilepsy. J Neural Eng 2022; 19. [PMID: 35385832 DOI: 10.1088/1741-2552/ac64c4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/05/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Diagnosing epilepsy still requires visual interpretation of electroencephalography and magnetoencephalography (MEG) by specialists, which prevents quantification and standardization of diagnosis. Previous studies proposed automated diagnosis by combining various features from electroencephalography and MEG, such as relative power (Power) and functional connectivity. However, the usefulness of interictal phase-amplitude coupling (PAC) in diagnosing epilepsy is still unknown. We hypothesized that resting-state PAC would be different for patients with epilepsy in the interictal state and for healthy participants such that it would improve discrimination between the groups. METHODS We obtained resting-state MEG and magnetic resonance imaging in 90 patients with epilepsy during their preoperative evaluation and in 90 healthy participants. We used the cortical currents estimated from MEG and magnetic resonance imaging to calculate Power in the δ (1-3 Hz), θ (4-7 Hz), α (8-13 Hz), β (13-30 Hz), low γ (35-55 Hz), and high γ (65-90 Hz) bands and functional connectivity in the θ band. PAC was evaluated using the synchronization index (SI) for eight frequency band pairs: the phases of δ, θ, α, and β and the amplitudes of low and high γ. First, we compared the mean SI values for the patients with epilepsy and the healthy participants. Then, using features such as PAC, Power, functional connectivity, and features extracted by deep learning individually or combined, we tested whether PAC improves discrimination accuracy for the two groups. RESULTS The mean SI values were significantly different for the patients with epilepsy and the healthy participants. The SI value difference was highest for θ/low γ in the temporal lobe. Discrimination accuracy was the highest, at 90%, using the combination of PAC and deep learning. SIGNIFICANCE Abnormal PAC characterized the patients with epilepsy in the interictal state compared with the healthy participants, potentially improving the discrimination of epilepsy.
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Affiliation(s)
- Yuya Fujita
- Institute for Advanced co-creation studies, Osaka University, 2-2 Yamadaoka Suita Osaka Japan, Suita, 565-0871, JAPAN
| | - Takufumi Yanagisawa
- Institute for Advanced co-creation studies, Osaka University, 2-2 Yamadaoka Suita Osaka Japan, Suita, 565-0871, JAPAN
| | - Ryohei Fukuma
- Institute for Advanced co-creation studies, Osaka University, 2-2 Yamadaoka Suita Osaka Japan, Suita, 565-0871, JAPAN
| | - Natsuko Ura
- Institute for Advanced co-creation studies, Osaka University, 2-2 Yamadaoka Suita Osaka Japan, Suita, 565-0871, JAPAN
| | - Satoru Oshino
- Department of Neurosurgery, Osaka University Faculty of Medicine Graduate School of Medicine, 2-2 Yamadaoka, suita, Osaka, Japan, Osaka University Graduate School of Medicine, Dept of Neurosurgery, Osaka, Osaka, 5670871, JAPAN
| | - Haruhiko Kishima
- Department of neurosurgery, Osaka University, 2-2, Yamadaoka, Suita, Suita, Osaka, 5650871, JAPAN
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25
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Engineering nonlinear epileptic biomarkers using deep learning and Benford's law. Sci Rep 2022; 12:5397. [PMID: 35354911 PMCID: PMC8967852 DOI: 10.1038/s41598-022-09429-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/22/2022] [Indexed: 12/15/2022] Open
Abstract
In this study, we designed two deep neural networks to encode 16 features for early seizure detection in intracranial EEG and compared them and their frequency responses to 16 widely used engineered metrics to interpret their properties: epileptogenicity index (EI), phase locked high gamma (PLHG), time and frequency domain Cho Gaines distance (TDCG, FDCG), relative band powers, and log absolute band powers (from alpha, beta, theta, delta, low gamma, and high gamma bands). The deep learning models were pretrained for seizure identification on the time and frequency domains of 1 s, single-channel clips of 127 seizures (from 25 different subjects) using "leave-one-out" (LOO) cross validation. Each neural network extracted unique feature spaces that were interpreted using spectral power modulations before being used to train a Random Forest Classifier (RFC) for seizure identification. The Gini Importance of each feature was calculated from the pretrained RFC, enabling the most significant features (MSFs) for each task to be identified. The MSFs were extracted to train another RFC for UPenn and Mayo Clinic's Seizure Detection Kaggle Challenge. They obtained an AUC score of 0.93, demonstrating a transferable method to identify and interpret biomarkers for seizure detection.
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26
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Warsi NM, Yan H, Suresh H, Wong SM, Arski ON, Gorodetsky C, Zhang K, Gouveia FV, Ibrahim GM. The anterior and centromedian thalamus: anatomy, function, and dysfunction in epilepsy. Epilepsy Res 2022; 182:106913. [DOI: 10.1016/j.eplepsyres.2022.106913] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/07/2022] [Accepted: 03/21/2022] [Indexed: 01/21/2023]
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27
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Nunez MD, Charupanit K, Sen-Gupta I, Lopour BA, Lin JJ. Beyond rates: time-varying dynamics of high frequency oscillations as a biomarker of the seizure onset zone. J Neural Eng 2022; 19:10.1088/1741-2552/ac520f. [PMID: 35120337 PMCID: PMC9258635 DOI: 10.1088/1741-2552/ac520f] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/04/2022] [Indexed: 11/11/2022]
Abstract
Objective. High frequency oscillations (HFOs) recorded by intracranial electrodes have generated excitement for their potential to help localize epileptic tissue for surgical resection. However, the number of HFOs per minute (i.e. the HFO 'rate') is not stable over the duration of intracranial recordings; for example, the rate of HFOs increases during periods of slow-wave sleep. Moreover, HFOs that are predictive of epileptic tissue may occur in oscillatory patterns due to phase coupling with lower frequencies. Therefore, we sought to further characterize between-seizure (i.e. 'interictal') HFO dynamics both within and outside the seizure onset zone (SOZ).Approach. Using long-term intracranial EEG (mean duration 10.3 h) from 16 patients, we automatically detected HFOs using a new algorithm. We then fit a hierarchical negative binomial model to the HFO counts. To account for differences in HFO dynamics and rates between sleep and wakefulness, we also fit a mixture model to the same data that included the ability to switch between two discrete brain states that were automatically determined during the fitting process. The ability to predict the SOZ by model parameters describing HFO dynamics (i.e. clumping coefficients and coefficients of variation) was assessed using receiver operating characteristic curves.Main results. Parameters that described HFO dynamics were predictive of SOZ. In fact, these parameters were found to be more consistently predictive than HFO rate. Using concurrent scalp EEG in two patients, we show that the model-found brain states corresponded to (1) non-REM sleep and (2) awake and rapid eye movement sleep. However the brain state most likely corresponding to slow-wave sleep in the second model improved SOZ prediction compared to the first model for only some patients.Significance. This work suggests that delineation of SOZ with interictal data can be improved by the inclusion of time-varying HFO dynamics.
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Affiliation(s)
- Michael D. Nunez
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands,Department of Biomedical Engineering, University of California, Irvine CA, USA,Corresponding author (Michael D. Nunez), (Beth A. Lopour)
| | - Krit Charupanit
- Department of Biomedical Engineering, University of California, Irvine CA, USA,Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Indranil Sen-Gupta
- Neurology, University of California Irvine Medical Center, Orange CA, USA
| | - Beth A. Lopour
- Department of Biomedical Engineering, University of California, Irvine CA, USA,Corresponding author (Michael D. Nunez), (Beth A. Lopour)
| | - Jack J. Lin
- Department of Neurology, University of California, Irvine CA, USA
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28
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Smith EH, Liou JY, Merricks EM, Davis T, Thomson K, Greger B, House P, Emerson RG, Goodman R, McKhann GM, Sheth S, Schevon C, Rolston JD. Human interictal epileptiform discharges are bidirectional traveling waves echoing ictal discharges. eLife 2022; 11:e73541. [PMID: 35050851 PMCID: PMC8813051 DOI: 10.7554/elife.73541] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
Interictal epileptiform discharges (IEDs), also known as interictal spikes, are large intermittent electrophysiological events observed between seizures in patients with epilepsy. Although they occur far more often than seizures, IEDs are less studied, and their relationship to seizures remains unclear. To better understand this relationship, we examined multi-day recordings of microelectrode arrays implanted in human epilepsy patients, allowing us to precisely observe the spatiotemporal propagation of IEDs, spontaneous seizures, and how they relate. These recordings showed that the majority of IEDs are traveling waves, traversing the same path as ictal discharges during seizures, and with a fixed direction relative to seizure propagation. Moreover, the majority of IEDs, like ictal discharges, were bidirectional, with one predominant and a second, less frequent antipodal direction. These results reveal a fundamental spatiotemporal similarity between IEDs and ictal discharges. These results also imply that most IEDs arise in brain tissue outside the site of seizure onset and propagate toward it, indicating that the propagation of IEDs provides useful information for localizing the seizure focus.
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Affiliation(s)
- Elliot H Smith
- Departments of Neurosurgery and Biomedical Engineering, University of UtahSalt Lake CityUnited States
- Department of Neurology, Columbia UniversityNew YorkUnited States
| | - Jyun-you Liou
- Department of Anesthesiology, Weill Cornell MedicineNew York CItyUnited States
| | | | - Tyler Davis
- Departments of Neurosurgery and Biomedical Engineering, University of UtahSalt Lake CityUnited States
| | - Kyle Thomson
- Department of Pharmacology & Toxicology, University of UtahSalt Lake CityUnited States
| | - Bradley Greger
- Department of Bioengineering, Arizona State UniversityTempeUnited States
| | - Paul House
- Neurosurgical Associates, LLCMurrayUnited States
| | | | | | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical CenterNew YorkUnited States
| | - Sameer Sheth
- Department of Neurological Surgery, Baylor College of MedicineHoustonUnited States
| | | | - John D Rolston
- Departments of Neurosurgery and Biomedical Engineering, University of UtahSalt Lake CityUnited States
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29
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Davis TS, Caston RM, Philip B, Charlebois CM, Anderson DN, Weaver KE, Smith EH, Rolston JD. LeGUI: A Fast and Accurate Graphical User Interface for Automated Detection and Anatomical Localization of Intracranial Electrodes. Front Neurosci 2021; 15:769872. [PMID: 34955721 PMCID: PMC8695687 DOI: 10.3389/fnins.2021.769872] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022] Open
Abstract
Accurate anatomical localization of intracranial electrodes is important for identifying the seizure foci in patients with epilepsy and for interpreting effects from cognitive studies employing intracranial electroencephalography. Localization is typically performed by coregistering postimplant computed tomography (CT) with preoperative magnetic resonance imaging (MRI). Electrodes are then detected in the CT, and the corresponding brain region is identified using the MRI. Many existing software packages for electrode localization chain together separate preexisting programs or rely on command line instructions to perform the various localization steps, making them difficult to install and operate for a typical user. Further, many packages provide solutions for some, but not all, of the steps needed for confident localization. We have developed software, Locate electrodes Graphical User Interface (LeGUI), that consists of a single interface to perform all steps needed to localize both surface and depth/penetrating intracranial electrodes, including coregistration of the CT to MRI, normalization of the MRI to the Montreal Neurological Institute template, automated electrode detection for multiple types of electrodes, electrode spacing correction and projection to the brain surface, electrode labeling, and anatomical targeting. The software is written in MATLAB, core image processing is performed using the Statistical Parametric Mapping toolbox, and standalone executable binaries are available for Windows, Mac, and Linux platforms. LeGUI was tested and validated on 51 datasets from two universities. The total user and computational time required to process a single dataset was approximately 1 h. Automatic electrode detection correctly identified 4362 of 4695 surface and depth electrodes with only 71 false positives. Anatomical targeting was verified by comparing electrode locations from LeGUI to locations that were assigned by an experienced neuroanatomist. LeGUI showed a 94% match with the 482 neuroanatomist-assigned locations. LeGUI combines all the features needed for fast and accurate anatomical localization of intracranial electrodes into a single interface, making it a valuable tool for intracranial electrophysiology research.
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Affiliation(s)
- Tyler S Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States
| | - Rose M Caston
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Brian Philip
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Chantel M Charlebois
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Daria Nesterovich Anderson
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States.,Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Kurt E Weaver
- Department of Radiology, University of Washington, Seattle, WA, United States.,Department of Biological Structure, University of Washington, Seattle, WA, United States
| | - Elliot H Smith
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
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30
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Iimura Y, Mitsuhashi T, Suzuki H, Ueda T, Nishioka K, Otsubo H, Sugano H. Delineation of the epileptogenic zone by Phase-amplitude coupling in patients with Bottom of Sulcus Dysplasia. Seizure 2021; 94:23-25. [PMID: 34837729 DOI: 10.1016/j.seizure.2021.11.006] [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: 08/29/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The removal of the bottom of sulcus dysplasia (BOSD) often includes the gyral crown; however, this method has been controversial. We hypothesized that the epileptogenic zone of the BOSD does not include the gyral crown. To reveal the depth and extent of the epileptogenic zone of the BOSD, we applied the two electrophysiological modalities: (1) the occurrence rate (OR) of high-frequency oscillations (HFOs) and (2) modulation index (MI), reflecting the strength of phase-amplitude coupling between HFOs and slow oscillations. METHODS We investigated the ripples [80-200 Hz] and fast ripples [200-300 Hz]) in HFOs and MI (HFOs [80-300 Hz] and slow oscillations [3-4 Hz]). We opened the sulcus at the BOSD and implanted the subdural electrodes directly over the MRI visible lesion. All patients (n = 3) underwent lesionectomy and the gyral crown was preserved. RESULTS Pathological findings demonstrated focal cortical dysplasia type IIb and seizure freedom was achieved. The OR of the HFOs was not significantly different between the BOSD and the gyral crown. In contrast, the MI between HFOs and slow oscillations in the BOSD was significantly higher than that in the gyral crown. CONCLUSION High MI values distinguished the epileptogenic BOSD from the non-epileptogenic gyral crowns. MI could be a more informative biomarker of epileptogenicity than the OR of HFOs in a subset of patients with the BOSD.
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Affiliation(s)
- Yasushi Iimura
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Takumi Mitsuhashi
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Hiroharu Suzuki
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Tetsuya Ueda
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Kazuki Nishioka
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Hiroshi Otsubo
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan; Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Hidenori Sugano
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan.
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31
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Numata-Uematsu Y, Uematsu M, Sakuraba R, Iwasaki M, Osawa S, Jin K, Nakasato N, Kure S. The Onset of Interictal Spike-Related Ripples Facilitates Detection of the Epileptogenic Zone. Front Neurol 2021; 12:724417. [PMID: 34803874 PMCID: PMC8599368 DOI: 10.3389/fneur.2021.724417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Accurate estimation of the epileptogenic zone (EZ) is essential for favorable outcomes in epilepsy surgery. Conventional ictal electrocorticography (ECoG) onset is generally used to detect the EZ but is insufficient in achieving seizure-free outcomes. By contrast, high-frequency oscillations (HFOs) could be useful markers of the EZ. Hence, we aimed to detect the EZ using interictal spikes and investigated whether the onset area of interictal spike-related HFOs was within the EZ. Methods: The EZ is considered to be included in the resection area among patients with seizure-free outcomes after surgery. Using a complex demodulation technique, we developed a method to determine the onset channels of interictal spike-related ripples (HFOs of 80-200 Hz) and investigated whether they are within the resection area. Results: We retrospectively examined 12 serial patients who achieved seizure-free status after focal resection surgery. Using the method that we developed, we determined the onset channels of interictal spike-related ripples and found that for all 12 patients, they were among the resection channels. The onset frequencies of ripples were in the range of 80-150 Hz. However, the ictal onset channels (evaluated based on ictal ECoG patterns) and ripple onset channels coincided in only 3 of 12 patients. Conclusions: Determining the onset area of interictal spike-related ripples could facilitate EZ estimation. This simple method that utilizes interictal ECoG may aid in preoperative evaluation and improve epilepsy surgery outcomes.
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Affiliation(s)
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Rie Sakuraba
- Department of Epileptology, Tohoku University School of Medicine, Sendai, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan.,Department of Neurosurgery, National Center Hospital of Neurology and Psychiatry, Tokyo, Japan
| | - Shinichiro Osawa
- Department of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University School of Medicine, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University School of Medicine, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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32
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Weiss SA, Staba RJ, Sharan A, Wu C, Rubinstein D, Das S, Waldman Z, Orosz I, Worrell G, Engel J, Sperling MR. Accuracy of high-frequency oscillations recorded intraoperatively for classification of epileptogenic regions. Sci Rep 2021; 11:21388. [PMID: 34725412 PMCID: PMC8560764 DOI: 10.1038/s41598-021-00894-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
To see whether acute intraoperative recordings using stereo EEG (SEEG) electrodes can replace prolonged interictal intracranial EEG (iEEG) recording, making the process more efficient and safer, 10 min of iEEG were recorded following electrode implantation in 16 anesthetized patients, and 1-2 days later during non-rapid eye movement (REM) sleep. Ripples on oscillations (RonO, 80-250 Hz), ripples on spikes (RonS), sharp-spikes, fast RonO (fRonO, 250-600 Hz), and fast RonS (fRonS) were semi-automatically detected. HFO power and frequency were compared between the conditions using a generalized linear mixed-effects model. HFO rates were compared using a two-way repeated measures ANOVA with anesthesia type and SOZ as factors. A receiver-operating characteristic (ROC) curve analysis quantified seizure onset zone (SOZ) classification accuracy, and the scalar product was used to assess spatial reliability. Resection of contacts with the highest rate of events was compared with outcome. During sleep, all HFOs, except fRonO, were larger in amplitude compared to intraoperatively (p < 0.01). HFO frequency was also affected (p < 0.01). Anesthesia selection affected HFO and sharp-spike rates. In both conditions combined, sharp-spikes and all HFO subtypes were increased in the SOZ (p < 0.01). However, the increases were larger during the sleep recordings (p < 0.05). The area under the ROC curves for SOZ classification were significantly smaller for intraoperative sharp-spikes, fRonO, and fRonS rates (p < 0.05). HFOs and spikes were only significantly spatially reliable for a subset of the patients (p < 0.05). A failure to resect fRonO areas in the sleep recordings trended the most sensitive and accurate for predicting failure. In summary, HFO morphology is altered by anesthesia. Intraoperative SEEG recordings exhibit increased rates of HFOs in the SOZ, but their spatial distribution can differ from sleep recordings. Recording these biomarkers during non-REM sleep offers a more accurate delineation of the SOZ and possibly the epileptogenic zone.
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Affiliation(s)
- Shennan A Weiss
- Department of Neurology, State University of New York Downstate, Brooklyn, NY, 11203, USA.,Department of Physiology and Pharmacology, State University of New York Downstate, Brooklyn, NY, 11203, USA.,Department of Neurology, New York City Health + Hospitals/Kings County, Brooklyn, NY, USA
| | - Richard J Staba
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Chengyuan Wu
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Daniel Rubinstein
- Department of Neurology and Neuroscience, Thomas Jefferson University, 901 Walnut St. Suite 400, Philadelphia, PA, 19107, USA
| | - Sandhitsu Das
- Penn Image Computing & Science Lab, University of Pennsylvania, Philadelphia, PA, 19143, USA
| | - Zachary Waldman
- Department of Neurology and Neuroscience, Thomas Jefferson University, 901 Walnut St. Suite 400, Philadelphia, PA, 19107, USA
| | - Iren Orosz
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Gregory Worrell
- Department of Neurology, Mayo Systems Electrophysiology Laboratory (MSEL), Rochester, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.,Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Michael R Sperling
- Department of Neurology and Neuroscience, Thomas Jefferson University, 901 Walnut St. Suite 400, Philadelphia, PA, 19107, USA.
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33
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Khuvis S, Hwang ST, Mehta AD. Intracranial EEG Biomarkers for Seizure Lateralization in Rapidly-Bisynchronous Epilepsy After Laser Corpus Callosotomy. Front Neurol 2021; 12:696492. [PMID: 34690909 PMCID: PMC8531267 DOI: 10.3389/fneur.2021.696492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: It has been asserted that high-frequency analysis of intracranial EEG (iEEG) data may yield information useful in localizing epileptogenic foci. Methods: We tested whether proposed biomarkers could predict lateralization based on iEEG data collected prior to corpus callosotomy (CC) in three patients with bisynchronous epilepsy, whose seizures lateralized definitively post-CC. Lateralization data derived from algorithmically-computed ictal phase-locked high gamma (PLHG), high gamma amplitude (HGA), and low-frequency (filtered) line length (LFLL), as well as interictal high-frequency oscillation (HFO) and interictal epileptiform discharge (IED) rate metrics were compared against ground-truth lateralization from post-CC ictal iEEG. Results: Pre-CC unilateral IEDs were more frequent on the more-pathologic side in all subjects. HFO rate predicted lateralization in one subject, but was sensitive to detection threshold. On pre-CC data, no ictal metric showed better predictive power than any other. All post-corpus callosotomy seizures lateralized to the pathological hemisphere using PLHG, HGA, and LFLL metrics. Conclusions: While quantitative metrics of IED rate and ictal HGA, PHLG, and LFLL all accurately lateralize based on post-CC iEEG, only IED rate consistently did so based on pre-CC data. Significance: Quantitative analysis of IEDs may be useful in lateralizing seizure pathology. More work is needed to develop reliable techniques for high-frequency iEEG analysis.
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Affiliation(s)
- Simon Khuvis
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.,Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Sean T Hwang
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - Ashesh D Mehta
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.,Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
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34
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Yamamoto S, Yanagisawa T, Fukuma R, Oshino S, Tani N, Khoo HM, Edakawa K, Kobayashi M, Tanaka M, Fujita Y, Kishima H. Data-driven electrophysiological feature based on deep learning to detect epileptic seizures. J Neural Eng 2021; 18. [PMID: 34479212 DOI: 10.1088/1741-2552/ac23bf] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/03/2021] [Indexed: 01/01/2023]
Abstract
Objective. To identify a new electrophysiological feature characterising the epileptic seizures, which is commonly observed in different types of epilepsy.Methods. We recorded the intracranial electroencephalogram (iEEG) of 21 patients (12 women and 9 men) with multiple types of refractory epilepsy. The raw iEEG signals of the early phase of epileptic seizures and interictal states were classified by a convolutional neural network (Epi-Net). For comparison, the same signals were classified by a support vector machine (SVM) using the spectral power and phase-amplitude coupling. The features learned by Epi-Net were derived by a modified integrated gradients method. We considered the product of powers multiplied by the relative contribution of each frequency amplitude as a data-driven epileptogenicity index (d-EI). We compared the d-EI and other conventional features in terms of accuracy to detect the epileptic seizures. Finally, we compared the d-EI among the electrodes to evaluate its relationship with the resected area and the Engel classification.Results. Epi-Net successfully identified the epileptic seizures, with an area under the receiver operating characteristic curve of 0.944 ± 0.067, which was significantly larger than that of the SVM (0.808 ± 0.253,n =21;p =0.025). The learned iEEG signals were characterised by increased powers of 17-92 Hz and >180 Hz in addition to decreased powers of other frequencies. The proposed d-EI detected them with better accuracy than the other iEEG features. Moreover, the surgical resection of areas with a larger increase in d-EI was observed for all nine patients with Engel class ⩽1, but not for the 4 of 12 patients with Engel class >1, demonstrating the significant association with seizure outcomes.Significance.We derived an iEEG feature from the trained Epi-Net, which identified the epileptic seizures with improved accuracy and might contribute to identification of the epileptogenic zone.
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Affiliation(s)
- Shota Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka 567-0872, Japan.,Institute for Advanced Co-Creation Studies, Osaka University, Suita, Osaka 567-0872, Japan.,Osaka University Hospital Epilepsy Center, Suita, Osaka 567-0872, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka 567-0872, Japan.,Institute for Advanced Co-Creation Studies, Osaka University, Suita, Osaka 567-0872, Japan.,Osaka University Hospital Epilepsy Center, Suita, Osaka 567-0872, Japan
| | - Ryohei Fukuma
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka 567-0872, Japan.,Institute for Advanced Co-Creation Studies, Osaka University, Suita, Osaka 567-0872, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka 567-0872, Japan.,Osaka University Hospital Epilepsy Center, Suita, Osaka 567-0872, Japan
| | - Naoki Tani
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka 567-0872, Japan.,Osaka University Hospital Epilepsy Center, Suita, Osaka 567-0872, Japan
| | - Hui Ming Khoo
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka 567-0872, Japan.,Osaka University Hospital Epilepsy Center, Suita, Osaka 567-0872, Japan
| | - Kohtaroh Edakawa
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka 567-0872, Japan.,Osaka University Hospital Epilepsy Center, Suita, Osaka 567-0872, Japan
| | - Maki Kobayashi
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka 567-0872, Japan.,Osaka University Hospital Epilepsy Center, Suita, Osaka 567-0872, Japan
| | - Masataka Tanaka
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka 567-0872, Japan.,Institute for Advanced Co-Creation Studies, Osaka University, Suita, Osaka 567-0872, Japan.,Osaka University Hospital Epilepsy Center, Suita, Osaka 567-0872, Japan
| | - Yuya Fujita
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka 567-0872, Japan.,Osaka University Hospital Epilepsy Center, Suita, Osaka 567-0872, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka 567-0872, Japan.,Osaka University Hospital Epilepsy Center, Suita, Osaka 567-0872, Japan
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35
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Electrically stimulated auras as a potential biomarker of the epileptogenic zone. Epilepsy Behav 2021; 122:108116. [PMID: 34139619 DOI: 10.1016/j.yebeh.2021.108116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
Abstract
Electrocortical stimulation mapping (ESM) is often performed in patients undergoing stereoelectroencephalography (SEEG) prior to epilepsy surgery, with the goal of identifying functional cortex and preserving it postoperatively. ESM may also evoke a patient's typical seizure semiology. The purpose of this study was to determine whether the sites at which typical auras are evoked during ESM are associated with other known clinical and electrophysiologic biomarkers of the epileptogenic zone: the seizure onset zone (SOZ), the early spread zone (ES), and high-frequency oscillations (HFOs). We found that the sites at which auras were provoked were not consistently associated with known biomarkers (p = 0.09). We conclude that evoked auras during ESM may reflect electrical spread rather than true epileptogenicity, and that a larger study is needed to assess their potential value as independent epileptic biomarkers.
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36
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Khambhati AN, Shafi A, Rao VR, Chang EF. Long-term brain network reorganization predicts responsive neurostimulation outcomes for focal epilepsy. Sci Transl Med 2021; 13:13/608/eabf6588. [PMID: 34433640 DOI: 10.1126/scitranslmed.abf6588] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/12/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022]
Abstract
Responsive neurostimulation (RNS) devices, able to detect imminent seizures and to rapidly deliver electrical stimulation to the brain, are effective in reducing seizures in some patients with focal epilepsy. However, therapeutic response to RNS is often slow, is highly variable, and defies prognostication based on clinical factors. A prevailing view holds that RNS efficacy is primarily mediated by acute seizure termination; yet, stimulations greatly outnumber seizures and occur mostly in the interictal state, suggesting chronic modulation of brain networks that generate seizures. Here, using years-long intracranial neural recordings collected during RNS therapy, we found that patients with the greatest therapeutic benefit undergo progressive, frequency-dependent reorganization of interictal functional connectivity. The extent of this reorganization scales directly with seizure reduction and emerges within the first year of RNS treatment, enabling potential early prediction of therapeutic response. Our findings reveal a mechanism for RNS that involves network plasticity and may inform development of next-generation devices for epilepsy.
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Affiliation(s)
- Ankit N Khambhati
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA.,Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Alia Shafi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA.,Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Vikram R Rao
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94143, USA. .,Department of Neurology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA. .,Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94143, USA
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37
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Sheybani L, Mégevand P, Spinelli L, Bénar CG, Momjian S, Seeck M, Quairiaux C, Kleinschmidt A, Vulliémoz S. Slow oscillations open susceptible time windows for epileptic discharges. Epilepsia 2021; 62:2357-2371. [PMID: 34338315 PMCID: PMC9290693 DOI: 10.1111/epi.17020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022]
Abstract
Objective In patients with epilepsy, interictal epileptic discharges are a diagnostic hallmark of epilepsy and represent abnormal, so‐called “irritative” activity that disrupts normal cognitive functions. Despite their clinical relevance, their mechanisms of generation remain poorly understood. It is assumed that brain activity switches abruptly, unpredictably, and supposedly randomly to these epileptic transients. We aim to study the period preceding these epileptic discharges, to extract potential proepileptogenic mechanisms supporting their expression. Methods We used multisite intracortical recordings from patients who underwent intracranial monitoring for refractory epilepsy, the majority of whom had a mesial temporal lobe seizure onset zone. Our objective was to evaluate the existence of proepileptogenic windows before interictal epileptic discharges. We tested whether the amplitude and phase synchronization of slow oscillations (.5–4 Hz and 4–7 Hz) increase before epileptic discharges and whether the latter are phase‐locked to slow oscillations. Then, we tested whether the phase‐locking of neuronal activity (assessed by high‐gamma activity, 60–160 Hz) to slow oscillations increases before epileptic discharges to provide a potential mechanism linking slow oscillations to interictal activities. Results Changes in widespread slow oscillations anticipate upcoming epileptic discharges. The network extends beyond the irritative zone, but the increase in amplitude and phase synchronization is rather specific to the irritative zone. In contrast, epileptic discharges are phase‐locked to widespread slow oscillations and the degree of phase‐locking tends to be higher outside the irritative zone. Then, within the irritative zone only, we observe an increased coupling between slow oscillations and neuronal discharges before epileptic discharges. Significance Our results show that epileptic discharges occur during vulnerable time windows set up by a specific phase of slow oscillations. The specificity of these permissive windows is further reinforced by the increased coupling of neuronal activity to slow oscillations. These findings contribute to our understanding of epilepsy as a distributed oscillopathy and open avenues for future neuromodulation strategies aiming at disrupting proepileptic mechanisms.
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Affiliation(s)
- Laurent Sheybani
- EEG and Epilepsy Unit / Neurology, Department of Clinical Neuroscience, University Hospitals and Faculty of Medicine of University of Geneva, Geneva, Switzerland
| | - Pierre Mégevand
- EEG and Epilepsy Unit / Neurology, Department of Clinical Neuroscience, University Hospitals and Faculty of Medicine of University of Geneva, Geneva, Switzerland.,Department of Basic Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Spinelli
- EEG and Epilepsy Unit / Neurology, Department of Clinical Neuroscience, University Hospitals and Faculty of Medicine of University of Geneva, Geneva, Switzerland
| | - Christian G Bénar
- Aix-Marseille University, National Institute of Health and Medical Research, Institute of Systems Neurosciences, Marseille, France
| | - Shahan Momjian
- Neurosurgery, Department of Clinical Neuroscience, University Hospitals and Faculty of Medicine of University of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit / Neurology, Department of Clinical Neuroscience, University Hospitals and Faculty of Medicine of University of Geneva, Geneva, Switzerland
| | - Charles Quairiaux
- Functional Brain Mapping Laboratory, Department of Basic Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andreas Kleinschmidt
- EEG and Epilepsy Unit / Neurology, Department of Clinical Neuroscience, University Hospitals and Faculty of Medicine of University of Geneva, Geneva, Switzerland
| | - Serge Vulliémoz
- EEG and Epilepsy Unit / Neurology, Department of Clinical Neuroscience, University Hospitals and Faculty of Medicine of University of Geneva, Geneva, Switzerland
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38
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Iimura Y, Sugano H, Mitsuhashi T, Ueda T, Karagiozov K, Abe S, Otsubo H. Case Report: Subtotal Hemispherotomy Modulates the Epileptic Spasms in Aicardi Syndrome. Front Neurol 2021; 12:683729. [PMID: 34248825 PMCID: PMC8264546 DOI: 10.3389/fneur.2021.683729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/02/2021] [Indexed: 12/02/2022] Open
Abstract
The mechanism of epileptic spasms (ES) in Aicardi syndrome (AS) remains obscure. We compared intraoperative high-frequency oscillations (HFOs) and phase-amplitude coupling (PAC) before and after subtotal hemispherotomy in a 3-month-old girl with drug-resistant ES secondary to AS. Fetal ultrasonography showing corpus callosum agenesis, bilateral ventricular dilatation, and a large choroid plexus cyst confirmed AS diagnosis. Her ES started when she was 1 month old and had ten series of clustered ES per day despite phenobarbital and vitamin B6 treatment. After subtotal hemispherotomy, her ES dramatically improved. We analyzed two intraoperative electrocorticography modalities: (1), occurrence rate (OR) of HFOs; (2), PAC of HFOs and slow wave bands in the frontal, central, and parietal areas. We hypothesized that HFOs and PAC could be the biomarkers for efficacy of subtotal hemispherotomy in AS with ES. PAC in all three areas and OR of HFOs in the frontal and parietal areas significantly decreased, while OR of HFOs in the central area remained unchanged after subtotal hemispherotomy. We have demonstrated the usefulness of evaluating intraoperative HFOs and PAC to assess subtotal hemispherotomy effectiveness in AS patients with ES. Disconnecting the thalamocortical and subcortical pathways in the epileptic network plays a role in controlling ES generation.
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Affiliation(s)
- Yasushi Iimura
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Hidenori Sugano
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Takumi Mitsuhashi
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Tetsuya Ueda
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Shimpei Abe
- Department of Pediatrics, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Hiroshi Otsubo
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan.,Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
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39
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Birk N, Schönberger J, Somerlik-Fuchs KH, Schulze-Bonhage A, Jacobs J. Ictal Occurrence of High-Frequency Oscillations Correlates With Seizure Severity in a Rat Model of Temporal Lobe Epilepsy. Front Hum Neurosci 2021; 15:624620. [PMID: 34168542 PMCID: PMC8217452 DOI: 10.3389/fnhum.2021.624620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Abstract
High-frequency oscillations (HFOs, ripples 80–250 Hz, fast ripples 250–500 Hz) are biomarkers of epileptic tissue. They are most commonly observed over areas generating seizures and increase in occurrence during the ictal compared to the interictal period. It has been hypothesized that their rate correlates with the severity of epilepsy and seizure in affected individuals. In the present study, it was aimed to investigate whether the HFO count mirrors the observed behavioral seizure severity using a kainate rat model for temporal lobe epilepsy. Seizures were selected during the chronic epilepsy phase of this model and classified by behavioral severity according to the Racine scale. Seizures with Racine scale 5&6 were considered generalized and severe. HFOs were marked in 24 seizures during a preictal, ictal, and postictal EEG segment. The duration covered by the HFO during these different segments was analyzed and compared between mild and severe seizures. HFOs were significantly increased during ictal periods (p < 0.001) and significantly decreased during postictal periods (p < 0.03) compared to the ictal segment. Ictal ripples (p = 0.04) as well as fast ripples (p = 0.02) were significantly higher in severe seizures compared to mild seizures. The present study demonstrates that ictal HFO occurrence mirrors seizure severity in a chronic focal epilepsy model in rats. This is similar to recent observations in patients with refractory mesio-temporal lobe epilepsy. Moreover, postictal HFO decrease might reflect postictal inhibition of epileptic activity. Overall results provide additional evidence that HFOs can be used as biomarkers for measuring seizure severity in epilepsy.
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Affiliation(s)
- Nadja Birk
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Freiburg, Germany
| | - Jan Schönberger
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Freiburg, Germany.,Epilepsy Center, Medical Center-University of Freiburg, Freiburg, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | - Julia Jacobs
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Freiburg, Germany.,Department of Paediatrics and Department of Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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40
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Ictal gamma-band interactions localize ictogenic nodes of the epileptic network in focal cortical dysplasia. Clin Neurophysiol 2021; 132:1927-1936. [PMID: 34157635 DOI: 10.1016/j.clinph.2021.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/18/2021] [Accepted: 04/05/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Epilepsy surgery fails in > 30% of patients with focal cortical dysplasia (FCD). The seizure persistence after surgery can be attributed to the inability to precisely localize the tissue with an endogenous potential to generate seizures. In this study, we aimed to identify the critical components of the epileptic network that were actively involved in seizure genesis. METHODS The directed transfer function was applied to intracranial EEG recordings and the effective connectivity was determined with a high temporal and frequency resolution. Pre-ictal network properties were compared with ictal epochs to identify regions actively generating ictal activity and discriminate them from the areas of propagation. RESULTS Analysis of 276 seizures from 30 patients revealed the existence of a seizure-related network reconfiguration in the gamma-band (25-170 Hz; p < 0.005) - ictogenic nodes. Unlike seizure onset zone, resecting the majority of ictogenic nodes correlated with favorable outcomes (p < 0.012). CONCLUSION The prerequisite to successful epilepsy surgery is the accurate identification of brain areas from which seizures arise. We show that in FCD-related epilepsy, gamma-band network markers can reliably identify and distinguish ictogenic areas in macroelectrode recordings, improve intracranial EEG interpretation and better delineate the epileptogenic zone. SIGNIFICANCE Ictogenic nodes localize the critical parts of the epileptogenic tissue and increase the diagnostic yield of intracranial evaluation.
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41
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Davis KA, Jirsa VK, Schevon CA. Wheels Within Wheels: Theory and Practice of Epileptic Networks. Epilepsy Curr 2021; 21:15357597211015663. [PMID: 33988042 PMCID: PMC8512917 DOI: 10.1177/15357597211015663] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Kathryn A. Davis
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Viktor K. Jirsa
- Aix-Marseille Universite, Marseille, Provence-Alpes-Cote d’Azu, France
- INSERM, Paris, Ile-de-France, France
- Institute de Neurosciences des Systemes,
Marseille, Provence-Alpes-Cote d’Azu, France
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42
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Henin S, Shankar A, Borges H, Flinker A, Doyle W, Friedman D, Devinsky O, Buzsáki G, Liu A. Spatiotemporal dynamics between interictal epileptiform discharges and ripples during associative memory processing. Brain 2021; 144:1590-1602. [PMID: 33889945 DOI: 10.1093/brain/awab044] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/16/2020] [Accepted: 12/06/2020] [Indexed: 12/13/2022] Open
Abstract
We describe the spatiotemporal course of cortical high-gamma activity, hippocampal ripple activity and interictal epileptiform discharges during an associative memory task in 15 epilepsy patients undergoing invasive EEG. Successful encoding trials manifested significantly greater high-gamma activity in hippocampus and frontal regions. Successful cued recall trials manifested sustained high-gamma activity in hippocampus compared to failed responses. Hippocampal ripple rates were greater during successful encoding and retrieval trials. Interictal epileptiform discharges during encoding were associated with 15% decreased odds of remembering in hippocampus (95% confidence interval 6-23%). Hippocampal interictal epileptiform discharges during retrieval predicted 25% decreased odds of remembering (15-33%). Odds of remembering were reduced by 25-52% if interictal epileptiform discharges occurred during the 500-2000 ms window of encoding or by 41% during retrieval. During encoding and retrieval, hippocampal interictal epileptiform discharges were followed by a transient decrease in ripple rate. We hypothesize that interictal epileptiform discharges impair associative memory in a regionally and temporally specific manner by decreasing physiological hippocampal ripples necessary for effective encoding and recall. Because dynamic memory impairment arises from pathological interictal epileptiform discharge events competing with physiological ripples, interictal epileptiform discharges represent a promising therapeutic target for memory remediation in patients with epilepsy.
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Affiliation(s)
- Simon Henin
- NYU Langone Health, Department of Neurology, New York, NY 10017, USA.,NYU Langone Health, Comprehensive Epilepsy Center, New York, NY 10016, USA
| | - Anita Shankar
- NYU Langone Health, Department of Neurology, New York, NY 10017, USA.,NYU Langone Health, Comprehensive Epilepsy Center, New York, NY 10016, USA
| | - Helen Borges
- NYU Langone Health, Department of Neurology, New York, NY 10017, USA.,NYU Langone Health, Comprehensive Epilepsy Center, New York, NY 10016, USA
| | - Adeen Flinker
- NYU Langone Health, Department of Neurology, New York, NY 10017, USA.,NYU Langone Health, Comprehensive Epilepsy Center, New York, NY 10016, USA
| | - Werner Doyle
- NYU Langone Health, Comprehensive Epilepsy Center, New York, NY 10016, USA.,NYU Langone Health, Department of Neurosurgery, New York, NY 10016, USA
| | - Daniel Friedman
- NYU Langone Health, Department of Neurology, New York, NY 10017, USA.,NYU Langone Health, Comprehensive Epilepsy Center, New York, NY 10016, USA
| | - Orrin Devinsky
- NYU Langone Health, Department of Neurology, New York, NY 10017, USA.,NYU Langone Health, Comprehensive Epilepsy Center, New York, NY 10016, USA
| | - György Buzsáki
- NYU Langone Health, Department of Neurology, New York, NY 10017, USA.,New York University, Neuroscience Institute, New York, NY 10016, USA
| | - Anli Liu
- NYU Langone Health, Department of Neurology, New York, NY 10017, USA.,NYU Langone Health, Comprehensive Epilepsy Center, New York, NY 10016, USA.,New York University, Neuroscience Institute, New York, NY 10016, USA
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Diamond JM, Diamond BE, Trotta MS, Dembny K, Inati SK, Zaghloul KA. Travelling waves reveal a dynamic seizure source in human focal epilepsy. Brain 2021; 144:1751-1763. [PMID: 33693588 DOI: 10.1093/brain/awab089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/08/2020] [Accepted: 12/23/2020] [Indexed: 11/14/2022] Open
Abstract
Treatment of patients with drug-resistant focal epilepsy relies upon accurate seizure localization. Ictal activity captured by intracranial EEG has traditionally been interpreted to suggest that the underlying cortex is actively involved in seizures. Here, we hypothesize that such activity instead reflects propagated activity from a relatively focal seizure source, even during later time points when ictal activity is more widespread. We used the time differences observed between ictal discharges in adjacent electrodes to estimate the location of the hypothesized focal source and demonstrated that the seizure source, localized in this manner, closely matches the clinically and neurophysiologically determined brain region giving rise to seizures. Moreover, we determined this focal source to be a dynamic entity that moves and evolves over the time course of a seizure. Our results offer an interpretation of ictal activity observed by intracranial EEG that challenges the traditional conceptualization of the seizure source.
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Affiliation(s)
- Joshua M Diamond
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Benjamin E Diamond
- J.P. Morgan AI Research, Corporate and Investment Bank, JP Morgan Chase & Co., New York, NY 10017, USA
| | - Michael S Trotta
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kate Dembny
- Clinical Epilepsy Section, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sara K Inati
- Clinical Epilepsy Section, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
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Scheid BH, Ashourvan A, Stiso J, Davis KA, Mikhail F, Pasqualetti F, Litt B, Bassett DS. Time-evolving controllability of effective connectivity networks during seizure progression. Proc Natl Acad Sci U S A 2021; 118:e2006436118. [PMID: 33495341 PMCID: PMC7865160 DOI: 10.1073/pnas.2006436118] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Over one third of the estimated 3 million people with epilepsy in the United States are medication resistant. Responsive neurostimulation from chronically implanted electrodes provides a promising treatment alternative to resective surgery. However, determining optimal personalized stimulation parameters, including when and where to intervene to guarantee a positive patient outcome, is a major open challenge. Network neuroscience and control theory offer useful tools that may guide improvements in parameter selection for control of anomalous neural activity. Here we use a method to characterize dynamic controllability across consecutive effective connectivity (EC) networks based on regularized partial correlations between implanted electrodes during the onset, propagation, and termination regimes of 34 seizures. We estimate regularized partial correlation adjacency matrices from 1-s time windows of intracranial electrocorticography recordings using the Graphical Least Absolute Shrinkage and Selection Operator (GLASSO). Average and modal controllability metrics calculated from each resulting EC network track the time-varying controllability of the brain on an evolving landscape of conditionally dependent network interactions. We show that average controllability increases throughout a seizure and is negatively correlated with modal controllability throughout. Our results support the hypothesis that the energy required to drive the brain to a seizure-free state from an ictal state is smallest during seizure onset, yet we find that applying control energy at electrodes in the seizure onset zone may not always be energetically favorable. Our work suggests that a low-complexity model of time-evolving controllability may offer insights for developing and improving control strategies targeting seizure suppression.
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Affiliation(s)
- Brittany H Scheid
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
| | - Arian Ashourvan
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
| | - Jennifer Stiso
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA 19104
| | - Kathryn A Davis
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Fadi Mikhail
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Fabio Pasqualetti
- Department of Mechanical Engineering, University of California, Riverside, CA 92521
| | - Brian Litt
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104;
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Electrical & Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, PA 19104
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
- Santa Fe Institute, Santa Fe, NM 87501
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Driscoll N, Rosch RE, Murphy BB, Ashourvan A, Vishnubhotla R, Dickens OO, Johnson ATC, Davis KA, Litt B, Bassett DS, Takano H, Vitale F. Multimodal in vivo recording using transparent graphene microelectrodes illuminates spatiotemporal seizure dynamics at the microscale. Commun Biol 2021; 4:136. [PMID: 33514839 PMCID: PMC7846732 DOI: 10.1038/s42003-021-01670-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/24/2020] [Indexed: 01/21/2023] Open
Abstract
Neurological disorders such as epilepsy arise from disrupted brain networks. Our capacity to treat these disorders is limited by our inability to map these networks at sufficient temporal and spatial scales to target interventions. Current best techniques either sample broad areas at low temporal resolution (e.g. calcium imaging) or record from discrete regions at high temporal resolution (e.g. electrophysiology). This limitation hampers our ability to understand and intervene in aberrations of network dynamics. Here we present a technique to map the onset and spatiotemporal spread of acute epileptic seizures in vivo by simultaneously recording high bandwidth microelectrocorticography and calcium fluorescence using transparent graphene microelectrode arrays. We integrate dynamic data features from both modalities using non-negative matrix factorization to identify sequential spatiotemporal patterns of seizure onset and evolution, revealing how the temporal progression of ictal electrophysiology is linked to the spatial evolution of the recruited seizure core. This integrated analysis of multimodal data reveals otherwise hidden state transitions in the spatial and temporal progression of acute seizures. The techniques demonstrated here may enable future targeted therapeutic interventions and novel spatially embedded models of local circuit dynamics during seizure onset and evolution.
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Affiliation(s)
- Nicolette Driscoll
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Richard E Rosch
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Brendan B Murphy
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Arian Ashourvan
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ramya Vishnubhotla
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA
| | - Olivia O Dickens
- Graduate Group in Biochemistry and Molecular Biophysics, University of Pennsylvania, Philadelphia, PA, USA
| | - A T Charlie Johnson
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn A Davis
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Litt
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Electrical & Systems Engineering, University of Pennsylvania, Philadelphia, PA, USA
- Santa Fe Institute, Santa Fe, NM, USA
| | - Hajime Takano
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Flavia Vitale
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA.
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46
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Sui Y, Tian Y, Ko WKD, Wang Z, Jia F, Horn A, De Ridder D, Choi KS, Bari AA, Wang S, Hamani C, Baker KB, Machado AG, Aziz TZ, Fonoff ET, Kühn AA, Bergman H, Sanger T, Liu H, Haber SN, Li L. Deep Brain Stimulation Initiative: Toward Innovative Technology, New Disease Indications, and Approaches to Current and Future Clinical Challenges in Neuromodulation Therapy. Front Neurol 2021; 11:597451. [PMID: 33584498 PMCID: PMC7876228 DOI: 10.3389/fneur.2020.597451] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/23/2020] [Indexed: 01/17/2023] Open
Abstract
Deep brain stimulation (DBS) is one of the most important clinical therapies for neurological disorders. DBS also has great potential to become a great tool for clinical neuroscience research. Recently, the National Engineering Laboratory for Neuromodulation at Tsinghua University held an international Deep Brain Stimulation Initiative workshop to discuss the cutting-edge technological achievements and clinical applications of DBS. We specifically addressed new clinical approaches and challenges in DBS for movement disorders (Parkinson's disease and dystonia), clinical application toward neurorehabilitation for stroke, and the progress and challenges toward DBS for neuropsychiatric disorders. This review highlighted key developments in (1) neuroimaging, with advancements in 3-Tesla magnetic resonance imaging DBS compatibility for exploration of brain network mechanisms; (2) novel DBS recording capabilities for uncovering disease pathophysiology; and (3) overcoming global healthcare burdens with online-based DBS programming technology for connecting patient communities. The successful event marks a milestone for global collaborative opportunities in clinical development of neuromodulation to treat major neurological disorders.
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Affiliation(s)
- Yanan Sui
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Ye Tian
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Wai Kin Daniel Ko
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Zhiyan Wang
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Fumin Jia
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Andreas Horn
- Charité, Department of Neurology, Movement Disorders and Neuromodulation Unit, University Medicine Berlin, Berlin, Germany
| | - Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ki Sueng Choi
- Department of Psychiatry and Behavioural Science, Emory University, Atlanta, GA, United States.,Department of Radiology, Mount Sinai School of Medicine, New York, NY, United States.,Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, United States
| | - Ausaf A Bari
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Kenneth B Baker
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Andre G Machado
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Tipu Z Aziz
- Department of Neurosurgery, John Radcliffe Hospital, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Erich Talamoni Fonoff
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.,Hospital Sírio-Libanês and Hospital Albert Einstein, São Paulo, Brazil
| | - Andrea A Kühn
- Charité, Department of Neurology, Movement Disorders and Neuromodulation Unit, University Medicine Berlin, Berlin, Germany
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada (IMRIC), Faculty of Medicine, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research (ELSC), The Hebrew University and Department of Neurosurgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Terence Sanger
- University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Hesheng Liu
- Department of Neuroscience, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Suzanne N Haber
- Department of Pharmacology and Physiology, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States.,McLean Hospital and Harvard Medical School, Belmont, MA, United States
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
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47
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Liu H, Tufa U, Zahra A, Chow J, Sivanenthiran N, Cheng C, Liu Y, Cheung P, Lim S, Jin Y, Mao M, Sun Y, Wu C, Wennberg R, Bardakjian B, Carlen PL, Eubanks JH, Song H, Zhang L. Electrographic Features of Spontaneous Recurrent Seizures in a Mouse Model of Extended Hippocampal Kindling. Cereb Cortex Commun 2021; 2:tgab004. [PMID: 34296153 PMCID: PMC8152854 DOI: 10.1093/texcom/tgab004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 01/14/2023] Open
Abstract
Epilepsy is a chronic neurological disorder characterized by spontaneous recurrent seizures (SRS) and comorbidities. Kindling through repetitive brief stimulation of a limbic structure is a commonly used model of temporal lobe epilepsy. Particularly, extended kindling over a period up to a few months can induce SRS, which may simulate slowly evolving epileptogenesis of temporal lobe epilepsy. Currently, electroencephalographic (EEG) features of SRS in rodent models of extended kindling remain to be detailed. We explored this using a mouse model of extended hippocampal kindling. Intracranial EEG recordings were made from the kindled hippocampus and unstimulated hippocampal, neocortical, piriform, entorhinal, or thalamic area in individual mice. Spontaneous EEG discharges with concurrent low-voltage fast onsets were observed from the two corresponding areas in nearly all SRS detected, irrespective of associated motor seizures. Examined in brain slices, epileptiform discharges were induced by alkaline artificial cerebrospinal fluid in the hippocampal CA3, piriform and entorhinal cortical areas of extended kindled mice but not control mice. Together, these in vivo and in vitro observations suggest that the epileptic activity involving a macroscopic network may generate concurrent discharges in forebrain areas and initiate SRS in hippocampally kindled mice.
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Affiliation(s)
- Haiyu Liu
- Departments of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021 China.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Uilki Tufa
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8.,Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario M5S 3H5, Canada
| | - Anya Zahra
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Jonathan Chow
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Nila Sivanenthiran
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Chloe Cheng
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Yapg Liu
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Phinehas Cheung
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Stellar Lim
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Yaozhong Jin
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Min Mao
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Yuqing Sun
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Chiping Wu
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Richard Wennberg
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8.,Department of Medicine, University of Toronto, Toronto, Ontario M2K 1E2, Canada
| | - Berj Bardakjian
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario M5S 3H5, Canada
| | - Peter L Carlen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8.,Department of Medicine, University of Toronto, Toronto, Ontario M2K 1E2, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - James H Eubanks
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8.,Department of Surgery, University of Toronto, Toronto, Ontario M5G 1X5, Canada
| | - Hongmei Song
- Departments of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021 China.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8
| | - Liang Zhang
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8.,Department of Medicine, University of Toronto, Toronto, Ontario M2K 1E2, Canada
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Ibáñez-Molina AJ, Soriano MF, Iglesias-Parro S. Mutual Information of Multiple Rhythms for EEG Signals. Front Neurosci 2021; 14:574796. [PMID: 33381007 PMCID: PMC7768085 DOI: 10.3389/fnins.2020.574796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022] Open
Abstract
Electroencephalograms (EEG) are one of the most commonly used measures to study brain functioning at a macroscopic level. The structure of the EEG time series is composed of many neural rhythms interacting at different spatiotemporal scales. This interaction is often named as cross frequency coupling, and consists of transient couplings between various parameters of different rhythms. This coupling has been hypothesized to be a basic mechanism involved in cognitive functions. There are several methods to measure cross frequency coupling between two rhythms but no single method has been selected as the gold standard. Current methods only serve to explore two rhythms at a time, are computationally demanding, and impose assumptions about the nature of the signal. Here we present a new approach based on Information Theory in which we can characterize the interaction of more than two rhythms in a given EEG time series. It estimates the mutual information of multiple rhythms (MIMR) extracted from the original signal. We tested this measure using simulated and real empirical data. We simulated signals composed of three frequencies and background noise. When the coupling between each frequency component was manipulated, we found a significant variation in the MIMR. In addition, we found that MIMR was sensitive to real EEG time series collected with open vs. closed eyes, and intra-cortical recordings from epileptic and non-epileptic signals registered at different regions of the brain. MIMR is presented as a tool to explore multiple rhythms, easy to compute and without a priori assumptions.
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Seizure Activity Across Scales From Neuronal Population Firing to Clonic Motor Semiology. J Clin Neurophysiol 2020; 37:462-464. [PMID: 32501950 DOI: 10.1097/wnp.0000000000000706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The correlation of clinical semiology with neuronal firing in human seizures has not been well described. Similarly, the neuronal firing patterns underlying high-frequency oscillations during seizures remain controversial. Using implanted subdural electrodes and a microelectrode array in a patient with focal status epilepticus, in which 40 habitual focal motor seizures and 101 subclinical seizures were captured, the authors analyzed the association of EEG, high-frequency oscillations, and multiunit activity to facial motor semiology. The development of ictal high-frequency oscillations in subdural electrodes overlying face motor cortex was temporally associated with clonic facial movements. In representative seizures selected for multiunit analysis, synchronization of neuronal firing in the adjacent microelectrode array aligned with clinical onset and was greater in clinical seizures compared with subclinical seizures. This report demonstrates the electrophysiologic signatures of focal seizures at the level of neuronal firing, high-frequency oscillations, and EEG as they organize from microscale to macroscale, with clinical correlation.
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Gupta K, Grover P, Abel TJ. Current Conceptual Understanding of the Epileptogenic Network From Stereoelectroencephalography-Based Connectivity Inferences. Front Neurol 2020; 11:569699. [PMID: 33324320 PMCID: PMC7724044 DOI: 10.3389/fneur.2020.569699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/13/2020] [Indexed: 11/13/2022] Open
Abstract
Localization of the epileptogenic zone (EZ) is crucial in the surgical treatment of focal epilepsy. Recently, EEG studies have revealed that the EZ exhibits abnormal connectivity, which has led investigators to now consider connectivity as a biomarker to localize the EZ. Further, abnormal connectivity of the EZ may provide an explanation for the impact of focal epilepsy on more widespread brain networks involved in typical cognition and development. Stereo-electroencephalography (sEEG) is a well-established method for localizing the EZ that has recently been applied to examine altered brain connectivity in epilepsy. In this manuscript, we review recent computational methods for identifying the EZ using sEEG connectivity. Findings from previous sEEG studies indicate that during interictal periods, the EZ is prone to seizure generation but concurrently receives inward connectivity preventing seizures. At seizure onset, this control is lost, allowing seizure activity to spread from the EZ. Regulatory areas within the EZ may be important for subsequently ending the seizure. After the seizure, the EZ appears to regain its influence on the network, which may be how it is able to regenerate epileptiform activity. However, more research is needed on the dynamic connectivity of the EZ in order to build a biomarker for EZ localization. Such a biomarker would allow for patients undergoing sEEG to have electrode implantation, localization of the EZ, and resection in a fraction of the time currently needed, preventing patients from having to endure long hospital stays and induced seizures.
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Affiliation(s)
- Kanupriya Gupta
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Pulkit Grover
- Center for the Neural Basis of Cognition, Carnegie Mellon University/University of Pittsburgh, Pittsburgh, PA, United States.,Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Taylor J Abel
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for the Neural Basis of Cognition, Carnegie Mellon University/University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
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