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Del Vecchio M, Bontemps B, Lance F, Gannerie A, Sipp F, Albertini D, Cassani CM, Chatard B, Dupin M, Lachaux JP. Introducing HiBoP: a Unity-based visualization software for large iEEG datasets. J Neurosci Methods 2024; 409:110179. [PMID: 38823595 DOI: 10.1016/j.jneumeth.2024.110179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/02/2024] [Accepted: 05/22/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Intracranial EEG data offer a unique spatio-temporal precision to investigate human brain functions. Large datasets have become recently accessible thanks to new iEEG data-sharing practices and tighter collaboration with clinicians. Yet, the complexity of such datasets poses new challenges, especially regarding the visualization and anatomical display of iEEG. NEW METHOD We introduce HiBoP, a multi-modal visualization software specifically designed for large groups of patients and multiple experiments. Its main features include the dynamic display of iEEG responses induced by tasks/stimulations, the definition of Regions and electrodes Of Interest, and the shift between group-level and individual-level 3D anatomo-functional data. RESULTS We provide a use-case with data from 36 patients to reveal the global cortical dynamics following tactile stimulation. We used HiBoP to visualize high-gamma responses [50-150 Hz], and define three major response components in primary somatosensory and premotor cortices and parietal operculum. COMPARISON WITH EXISTING METHODS(S) Several iEEG softwares are now publicly available with outstanding analysis features. Yet, most were developed in languages (Python/Matlab) chosen to facilitate the inclusion of new analysis by users, rather than the quality of the visualization. HiBoP represents a visualization tool developed with videogame standards (Unity/C#), and performs detailed anatomical analysis rapidly, across multiple conditions, patients, and modalities with an easy export toward third-party softwares. CONCLUSION HiBoP provides a user-friendly environment that greatly facilitates the exploration of large iEEG datasets, and helps users decipher subtle structure/function relationships.
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Affiliation(s)
- Maria Del Vecchio
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma 43125, Italy
| | - Benjamin Bontemps
- Lyon Neuroscience Research Center, EDUWELL team, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon F-69000, France
| | - Florian Lance
- Lyon Neuroscience Research Center, EDUWELL team, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon F-69000, France
| | - Adrien Gannerie
- Lyon Neuroscience Research Center, EDUWELL team, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon F-69000, France
| | - Florian Sipp
- Lyon Neuroscience Research Center, EDUWELL team, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon F-69000, France
| | - Davide Albertini
- Dipartimento di Medicina e Chirurgia, Università di Parma, Via Volturno 39, Parma 43125, Italy
| | - Chiara Maria Cassani
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma 43125, Italy; Department of School of Advanced Studies, University of Camerino, Italy
| | - Benoit Chatard
- Lyon Neuroscience Research Center, EDUWELL team, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon F-69000, France
| | - Maryne Dupin
- Lyon Neuroscience Research Center, EDUWELL team, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon F-69000, France
| | - Jean-Philippe Lachaux
- Lyon Neuroscience Research Center, EDUWELL team, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon F-69000, France.
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Zauli FM, Del Vecchio M, Pigorini A, Russo S, Massimini M, Sartori I, Cardinale F, d'Orio P, Mikulan E. Localizing hidden Interictal Epileptiform Discharges with simultaneous intracerebral and scalp high-density EEG recordings. J Neurosci Methods 2024; 409:110193. [PMID: 38871302 DOI: 10.1016/j.jneumeth.2024.110193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 05/02/2024] [Accepted: 06/08/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Scalp EEG is one of the main tools in the clinical evaluation of epilepsy. In some cases intracranial Interictal Epileptiform Discharges (IEDs) are not visible from the scalp. Recent studies have shown the feasibility of revealing them in the EEG if their timings are extracted from simultaneous intracranial recordings, but their potential for the localization of the epileptogenic zone is not yet well defined. NEW METHOD We recorded simultaneous high-density EEG (HD-EEG) and stereo-electroencephalography (SEEG) during interictal periods in 8 patients affected by drug-resistant focal epilepsy. We identified IEDs in the SEEG and systematically analyzed the time-locked signals on the EEG by means of evoked potentials, topographical analysis and Electrical Source Imaging (ESI). The dataset has been standardized and is being publicly shared. RESULTS Our results showed that IEDs that were not clearly visible at single-trials could be uncovered by averaging, in line with previous reports. They also showed that their topographical voltage distributions matched the position of the SEEG electrode where IEDs had been identified, and that ESI techniques can reconstruct it with an accuracy of ∼2 cm. Finally, the present dataset provides a reference to test the accuracy of different methods and parameters. COMPARISON WITH EXISTING METHODS Our study is the first to systematically compare ESI methods on simultaneously recorded IEDs, and to share a public resource with in-vivo data for their evaluation. CONCLUSIONS Simultaneous HD-EEG and SEEG recordings can unveil hidden IEDs whose origins can be reconstructed using topographical and ESI analyses, but results depend on the selected methods and parameters.
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Affiliation(s)
- Flavia Maria Zauli
- Department of Philosophy "P. Martinetti", Università degli Studi di Milano, Milan, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - Maria Del Vecchio
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Andrea Pigorini
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; UOC Maxillo-facial Surgery and dentistry, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Russo
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Ivana Sartori
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - Francesco Cardinale
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy; Department of Medicine and Surgery, Unit of Neuroscience, Università degli Studi di Parma, Parma, Italy
| | - Piergiorgio d'Orio
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy; Department of Medicine and Surgery, Unit of Neuroscience, Università degli Studi di Parma, Parma, Italy
| | - Ezequiel Mikulan
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
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Klimes P, Nejedly P, Hrtonova V, Cimbalnik J, Travnicek V, Pail M, Peter-Derex L, Hall J, Pana R, Halamek J, Jurak P, Brazdil M, Frauscher B. Interictal stereo-electroencephalography features below 45 Hz are sufficient for correct localization of the epileptogenic zone and postsurgical outcome prediction. Epilepsia 2024. [PMID: 39180407 DOI: 10.1111/epi.18081] [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: 03/19/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE Evidence suggests that the most promising results in interictal localization of the epileptogenic zone (EZ) are achieved by a combination of multiple stereo-electroencephalography (SEEG) biomarkers in machine learning models. These biomarkers usually include SEEG features calculated in standard frequency bands, but also high-frequency (HF) bands. Unfortunately, HF features require extra effort to record, store, and process. Here we investigate the added value of these HF features for EZ localization and postsurgical outcome prediction. METHODS In 50 patients we analyzed 30 min of SEEG recorded during non-rapid eye movement sleep and tested a logistic regression model with three different sets of features. The first model used broadband features (1-500 Hz); the second model used low-frequency features up to 45 Hz; and the third model used HF features above 65 Hz. The EZ localization by each model was evaluated by various metrics including the area under the precision-recall curve (AUPRC) and the positive predictive value (PPV). The differences between the models were tested by the Wilcoxon signed-rank tests and Cliff's Delta effect size. The differences in outcome predictions based on PPV values were further tested by the McNemar test. RESULTS The AUPRC score of the random chance classifier was .098. The models (broad-band, low-frequency, high-frequency) achieved median AUPRCs of .608, .582, and .522, respectively, and correctly predicted outcomes in 38, 38, and 33 patients. There were no statistically significant differences in AUPRC or any other metric between the three models. Adding HF features to the model did not have any additional contribution. SIGNIFICANCE Low-frequency features are sufficient for correct localization of the EZ and outcome prediction with no additional value when considering HF features. This finding allows significant simplification of the feature calculation process and opens the possibility of using these models in SEEG recordings with lower sampling rates, as commonly performed in clinical routines.
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Affiliation(s)
- Petr Klimes
- Institute of Scientific Instruments of the CAS, Brno, Czech Republic
| | - Petr Nejedly
- Institute of Scientific Instruments of the CAS, Brno, Czech Republic
- Department of Neurology, Faculty of Medicine, Brno Epilepsy Center, St. Anne's University Hospital, Member of ERN-EpiCARE, Masaryk University, Brno, Czech Republic
| | | | - Jan Cimbalnik
- Department of Neurology, Faculty of Medicine, Brno Epilepsy Center, St. Anne's University Hospital, Member of ERN-EpiCARE, Masaryk University, Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Vojtech Travnicek
- Institute of Scientific Instruments of the CAS, Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Martin Pail
- Institute of Scientific Instruments of the CAS, Brno, Czech Republic
- Department of Neurology, Faculty of Medicine, Brno Epilepsy Center, St. Anne's University Hospital, Member of ERN-EpiCARE, Masaryk University, Brno, Czech Republic
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France
| | - Jeffery Hall
- Montreal Neurological Hospital, McGill University, Montreal, Quebec, Canada
| | - Raluca Pana
- Montreal Neurological Hospital, McGill University, Montreal, Quebec, Canada
| | - Josef Halamek
- Institute of Scientific Instruments of the CAS, Brno, Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments of the CAS, Brno, Czech Republic
| | - Milan Brazdil
- Department of Neurology, Faculty of Medicine, Brno Epilepsy Center, St. Anne's University Hospital, Member of ERN-EpiCARE, Masaryk University, Brno, Czech Republic
- Behavioral and Social Neuroscience Research Group, CEITEC Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA
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4
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Astner-Rohracher A, Ho A, Archer J, Bartolomei F, Brazdil M, Cacic Hribljan M, Castellano J, Dolezalova I, Fabricius ME, Garcés-Sanchez M, Hammam K, Ikeda A, Ikeda K, Kahane P, Kalamangalam G, Kalss G, Khweileh M, Kobayashi K, Kwan P, Laing JA, Leitinger M, Lhatoo S, Makhalova J, McGonigal A, Mindruta I, Mizera MM, Neal A, Oane I, Parikh P, Perucca P, Pizzo F, Rocamora R, Ryvlin P, San Antonio Arce V, Schuele S, Schulze-Bonhage A, Suller Marti A, Urban A, Villanueva V, Vilella Bertran L, Whatley B, Beniczky S, Trinka E, Zimmermann G, Frauscher B. Prognostic value of the 5-SENSE Score to predict focality of the seizure-onset zone as assessed by stereoelectroencephalography: a prospective international multicentre validation study. BMJ Neurol Open 2024; 6:e000765. [PMID: 39175939 PMCID: PMC11340713 DOI: 10.1136/bmjno-2024-000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/01/2024] [Indexed: 08/24/2024] Open
Abstract
Introduction Epilepsy surgery is the only curative treatment for patients with drug-resistant focal epilepsy. Stereoelectroencephalography (SEEG) is the gold standard to delineate the seizure-onset zone (SOZ). However, up to 40% of patients are subsequently not operated as no focal non-eloquent SOZ can be identified. The 5-SENSE Score is a 5-point score to predict whether a focal SOZ is likely to be identified by SEEG. This study aims to validate the 5-SENSE Score, improve score performance by incorporating auxiliary diagnostic methods and evaluate its concordance with expert decisions. Methods and analysis Non-interventional, observational, multicentre, prospective study including 200 patients with drug-resistant epilepsy aged ≥15 years undergoing SEEG for identification of a focal SOZ and 200 controls at 22 epilepsy surgery centres worldwide. The primary objective is to assess the diagnostic accuracy and generalisability of the 5-SENSE in predicting focality in SEEG in a prospective cohort. Secondary objectives are to optimise score performance by incorporating auxiliary diagnostic methods and to analyse concordance of the 5-SENSE Score with the expert decisions made in the multidisciplinary team discussion. Ethics and dissemination Prospective multicentre validation of the 5-SENSE score may lead to its implementation into clinical practice to assist clinicians in the difficult decision of whether to proceed with implantation. This study will be conducted in accordance with the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (2014). We plan to publish the study results in a peer-reviewed full-length original article and present its findings at scientific conferences. Trial registration number NCT06138808.
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Affiliation(s)
| | - Alyssa Ho
- Neurology, Duke University, Durham, North Carolina, USA
| | - John Archer
- Bladin-Berkovic Comprehensive Epilepsy Program, The University of Melbourne Medicine at Austin Health, Heidelberg, Victoria, Australia
| | - Fabrice Bartolomei
- Service de Neurophysiologie Clinique, INSERM U751, CHU Timone, Marseille, France
- Neurology, Aix-Marseille Universite, Marseille, France
| | - Milan Brazdil
- Neurology, Masaryk University Faculty of Medicine, Brno, Czech Republic
| | | | - James Castellano
- Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Irena Dolezalova
- Neurology, Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - Martin Ejler Fabricius
- Clinical Neurophysiology, Rigshospitalet, Kobenhavn, Denmark
- Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | | | - Kahina Hammam
- Neurology, Aix-Marseille Universite, Marseille, France
| | - Akio Ikeda
- Neurology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Kristin Ikeda
- Neurology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Philippe Kahane
- Neurology, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Gudrun Kalss
- Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mays Khweileh
- Neurology, Duke University, Durham, North Carolina, USA
| | - Katsuya Kobayashi
- Neurology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | | | - Markus Leitinger
- Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Samden Lhatoo
- Neurology, University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - Aileen McGonigal
- Neurosciences, Mater Hospital Brisbane, Brisbane, Queensland, Australia
- UQ Faculty of Medicine, Herston, Queensland, Australia
| | - Iona Mindruta
- Neurology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucuresti, Romania
| | | | - Andrew Neal
- Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Irina Oane
- Neurology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucuresti, Romania
| | - Prachi Parikh
- Neurology, Duke University, Durham, North Carolina, USA
| | | | | | | | - Philippe Ryvlin
- Institute for Child and Adolescent with Epilepsy (IDEE), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Victoria San Antonio Arce
- Epilepsy Centre, University Hospital Freiburg Department of Neurology, Freiburg im Breisgau, Germany
| | - Stephan Schuele
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andreas Schulze-Bonhage
- Epilepsy Centre, University Hospital Freiburg Department of Neurology, Freiburg im Breisgau, Germany
| | - Ana Suller Marti
- Neurology, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Alexandra Urban
- Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | | | - Benjamin Whatley
- Neurology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Sandor Beniczky
- Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Eugen Trinka
- Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Georg Zimmermann
- Biostatistics and Big Medical Data, Paracelsus Medical Private University, Salzburg, Austria
| | - Birgit Frauscher
- Neurology, Duke University, Durham, North Carolina, USA
- Neurology, Montreal Neurological Institute-Hospital, Montreal, Quebec, Canada
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Pigorini A, Avanzini P, Barborica A, Bénar CG, David O, Farisco M, Keller CJ, Manfridi A, Mikulan E, Paulk AC, Roehri N, Subramanian A, Vulliémoz S, Zelmann R. Simultaneous invasive and non-invasive recordings in humans: A novel Rosetta stone for deciphering brain activity. J Neurosci Methods 2024; 408:110160. [PMID: 38734149 DOI: 10.1016/j.jneumeth.2024.110160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/10/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024]
Abstract
Simultaneous noninvasive and invasive electrophysiological recordings provide a unique opportunity to achieve a comprehensive understanding of human brain activity, much like a Rosetta stone for human neuroscience. In this review we focus on the increasingly-used powerful combination of intracranial electroencephalography (iEEG) with scalp electroencephalography (EEG) or magnetoencephalography (MEG). We first provide practical insight on how to achieve these technically challenging recordings. We then provide examples from clinical research on how simultaneous recordings are advancing our understanding of epilepsy. This is followed by the illustration of how human neuroscience and methodological advances could benefit from these simultaneous recordings. We conclude with a call for open data sharing and collaboration, while ensuring neuroethical approaches and argue that only with a true collaborative approach the promises of simultaneous recordings will be fulfilled.
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Affiliation(s)
- Andrea Pigorini
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; UOC Maxillo-facial Surgery and dentistry, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Pietro Avanzini
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | | | - Christian-G Bénar
- Aix Marseille Univ, Inserm, U1106, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Olivier David
- Aix Marseille Univ, Inserm, U1106, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Michele Farisco
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, P.O. Box 256, Uppsala, SE 751 05, Sweden; Science and Society Unit Biogem, Biology and Molecular Genetics Institute, Via Camporeale snc, Ariano Irpino, AV 83031, Italy
| | - Corey J Keller
- Department of Psychiatry & Behavioral Sciences, Stanford University Medical Center, Stanford, CA 94305, USA; Wu Tsai Neurosciences Institute, Stanford University Medical Center, Stanford, CA 94305, USA; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA 94394, USA
| | - Alfredo Manfridi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Ezequiel Mikulan
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Angelique C Paulk
- Department of Neurology and Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nicolas Roehri
- EEG and Epilepsy Unit, Dpt of Clinical Neurosciences, Geneva University Hospitals and University of Geneva, Switzerland
| | - Ajay Subramanian
- Department of Psychiatry & Behavioral Sciences, Stanford University Medical Center, Stanford, CA 94305, USA; Wu Tsai Neurosciences Institute, Stanford University Medical Center, Stanford, CA 94305, USA; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA 94394, USA
| | - Serge Vulliémoz
- EEG and Epilepsy Unit, Dpt of Clinical Neurosciences, Geneva University Hospitals and University of Geneva, Switzerland
| | - Rina Zelmann
- Department of Neurology and Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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6
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Taussig D, Petrescu AM, Herbrecht A, Dussaule C, Nasser G, Aghakhani N, Ancelet C, Bouilleret V. Vasogenic oedema during stereoelectroencephalography: intracranial pattern and late-onset clinical repercussion. J Neurol 2024:10.1007/s00415-024-12577-w. [PMID: 39046522 DOI: 10.1007/s00415-024-12577-w] [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: 04/27/2024] [Revised: 07/01/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
In patients suffering from focal drug-resistant epilepsy, intracranial explorations are the gold standard for identifying the epileptogenic zone and evaluating the possibility of a surgical resection. Amongst them, stereoelectroencephalography (SEEG), using depth electrodes, is a safe procedure. However, complications occur on average in 2% of cases, notably haemorrhages or infections. Vasogenic cerebral oedema constitutes a rarely reported complication. Amongst the 85 patients explored with SEEG between January 2017 and September 2023, three had a clinically and electrophysiologically relevant vasogenic cerebral oedema. In these three patients, the surgical procedure was uneventful. In all three as well, electrodes exploring areas away from the epileptogenic zone recorded some unexpected focal delta slowing with clinically asymptomatic superimposed discharges, a pattern so far only reported in cases of bleeding. Moreover, one patient experienced confusion 10 days after explantation. Post-explantation magnetic resonance imaging showed, in all three patients, a vasogenic oedema that fully resolved a few months later. We did not identify any contributing factors, and there were no particularities concerning the number of electrodes, their implantation site or the recording duration. Focal delta slowing and rhythmic discharges during SEEG can indicate a vasogenic oedema. Clinical consequences can occur after explantation. Evolution is favourable but this misleading pattern must be identified.
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Affiliation(s)
- D Taussig
- Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France.
| | - A M Petrescu
- Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France
| | - A Herbrecht
- Université Paris Saclay-APHP, Neurochirurgie, Le Kremlin Bicêtre, France
| | - C Dussaule
- Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France
| | - G Nasser
- Université Paris Saclay-APHP, Neuroradiologie, Le Kremlin Bicêtre, France
| | - N Aghakhani
- Université Paris Saclay-APHP, Neurochirurgie, Le Kremlin Bicêtre, France
| | - C Ancelet
- Université Paris Saclay-APHP, Neuroradiologie, Le Kremlin Bicêtre, France
| | - V Bouilleret
- Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Orsay, France
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7
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Bustros S, Kaur M, Ritchey E, Szaflarski JP, McGwin GJ, Riley KO, Bentley JN, Memon AA, Jaisani Z. Non-lesional epilepsy does not necessarily convey poor outcomes after invasive monitoring followed by resection or thermal ablation. Neurol Res 2024; 46:653-661. [PMID: 38602305 DOI: 10.1080/01616412.2024.2340879] [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: 03/08/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE We aimed to compare outcomes including seizure-free status at the last follow-up in adult patients with medically refractory focal epilepsy identified as lesional vs. non-lesional based on their magnetic resonance imaging (MRI) findings who underwent invasive evaluation followed by subsequent resection or thermal ablation (LiTT). METHODS We identified 88 adult patients who underwent intracranial monitoring between 2014 and 2021. Of those, 40 received resection or LiTT, and they were dichotomized based on MRI findings, as lesional (N = 28) and non-lesional (N = 12). Patient demographics, seizure characteristics, non-invasive interventions, intracranial monitoring, and surgical variables were compared between the groups. Postsurgical seizure outcome at the last follow-up was rated according to the Engel classification, and postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Statistical analyses employed Fisher's exact test to compare categorical variables, while a t-test was used for continuous variables. RESULTS There were no differences in baseline characteristics between groups except for more often noted PET abnormality in the lesional group (p = 0.0003). 64% of the lesional group and 57% of the non-lesional group received surgical resection or LiTT (p = 0.78). At the last follow-up, 78.5% of the patients with lesional MRI findings achieved Engel I outcomes compared to 66.7% of non-lesional patients (p = 0.45). Kaplan-Meier curves did not show a significant difference in seizure-free duration between both groups after surgical intervention (p = 0.49). SIGNIFICANCE In our sample, the absence of lesion on brain MRI was not associated with worse seizure outcomes in adult patients who underwent invasive intracranial monitoring followed by resection or thermal ablation.
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Affiliation(s)
- Stephanie Bustros
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Manmeet Kaur
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Elizabeth Ritchey
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Division of Neurocritical Care, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Gerald Jr McGwin
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen O Riley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - J Nicole Bentley
- Department of Neurosurgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Adeel A Memon
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| | - Zeenat Jaisani
- Division of Epilepsy, Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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8
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Wang SH, Arnulfo G, Nobili L, Myrov V, Ferrari P, Ciuciu P, Palva S, Palva JM. Neuronal synchrony and critical bistability: Mechanistic biomarkers for localizing the epileptogenic network. Epilepsia 2024; 65:2041-2053. [PMID: 38687176 DOI: 10.1111/epi.17996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Postsurgical seizure freedom in drug-resistant epilepsy (DRE) patients varies from 30% to 80%, implying that in many cases the current approaches fail to fully map the epileptogenic zone (EZ). We aimed to advance a novel approach to better characterize epileptogenicity and investigate whether the EZ encompasses a broader epileptogenic network (EpiNet) beyond the seizure zone (SZ) that exhibits seizure activity. METHODS We first used computational modeling to test putative complex systems-driven and systems neuroscience-driven mechanistic biomarkers for epileptogenicity. We then used these biomarkers to extract features from resting-state stereoelectroencephalograms recorded from DRE patients and trained supervised classifiers to localize the SZ against gold standard clinical localization. To further explore the prevalence of pathological features in an extended brain network outside of the clinically identified SZ, we also used unsupervised classification. RESULTS Supervised SZ classification trained on individual features achieved accuracies of .6-.7 area under the receiver operating characteristic curve (AUC). Combining all criticality and synchrony features further improved the AUC to .85. Unsupervised classification discovered an EpiNet-like cluster of brain regions, in which 51% of brain regions were outside of the SZ. Brain regions in the EpiNet-like cluster engaged in interareal hypersynchrony and locally exhibited high-amplitude bistability and excessive inhibition, which was strikingly similar to the high seizure risk regime revealed by our computational modeling. SIGNIFICANCE The finding that combining biomarkers improves SZ localization accuracy indicates that the novel mechanistic biomarkers for epileptogenicity employed here yield synergistic information. On the other hand, the discovery of SZ-like brain dynamics outside of the clinically defined SZ provides empirical evidence of an extended pathophysiological EpiNet.
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Affiliation(s)
- Sheng H Wang
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
- Le Commissariat à l'énergie atomique et aux énergies alternatives, NeuroSpin, Université Paris-Saclay, Gif-sur-Yvette, France
- Models and Inference for Neuroimaging Data, Inria, Palaiseau, France
| | - Gabriele Arnulfo
- Department of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Member of the European Reference Network EpiCARE, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children's Sciences, University of Genoa, Genoa, Italy
| | - Vladislav Myrov
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Paul Ferrari
- Jack H. Miller Magnetoencephalography Center, Helen DeVos Childrens Hospital, Grand Rapids, Michigan, USA
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, Michigan, USA
| | - Philippe Ciuciu
- Le Commissariat à l'énergie atomique et aux énergies alternatives, NeuroSpin, Université Paris-Saclay, Gif-sur-Yvette, France
- Models and Inference for Neuroimaging Data, Inria, Palaiseau, France
| | - Satu Palva
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Centre for Cognitive Neuroimaging, School of Psychology and Neuroscience, University of Glasgow, Glasgow, UK
- Division of Psychology, Values, Ideologies and Social Contexts of Education, Faculty of Education and Psychology, University of Oulu, Oulu, Finland
| | - J Matias Palva
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
- Centre for Cognitive Neuroimaging, School of Psychology and Neuroscience, University of Glasgow, Glasgow, UK
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9
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Fujita Y, Khoo HM, Kimoto Y, Emura T, Iwata T, Matsuhashi T, Miura S, Yanagisawa T, Hosomi K, Tani N, Oshino S, Hirata M, Kishima H. Accuracy of Boltless Frame-Based Stereo-Electroencephalography Electrode Implantation. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01196. [PMID: 38888309 DOI: 10.1227/ons.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Boltless implantation of stereo-electroencephalography electrode is a useful alternative especially when anchor bolt is not available such as in country with limited resources or is less appropriate such as placement in patients with thin skull or at the occiput area, despite some drawbacks including potential dislodgement. While the accuracy of implantation using anchor bolt is well-studied, data on boltless implantation remain scarce. This study aimed to reveal the accuracy, permissible error for actual placement of electrodes within the grey matter, and delayed electrode dislodgement in boltless implantation. METHODS A total of 120 electrodes were implanted in 15 patients using a Leksell Stereotactic G Frame with each electrode fixed on the scalp using sutures. Target point error was defined as the Euclidean distance between the planned target and the electrode tip on immediate postimplantation computed tomography. Similarly, delayed dislodgement was defined as the Euclidean distance between the electrode tips on immediate postimplantation computed tomography and delayed MRI. The factors affecting accuracy were evaluated using multiple linear regression. The permissible error was defined as the largest target point error that allows the maximum number of planned gray matter electrode contacts to be actually placed within the gray matter as intended. RESULTS The median (IQR) target point error was 2.6 (1.7-3.5) mm, and the permissible error was 3.2 mm. The delayed dislodgement, with a median (IQR) of 2.2 (1.4-3.3) mm, was dependent on temporal muscle penetration (P = 5.0 × 10-4), scalp thickness (P < 5.1 × 10-3), and insertion angle (P = 3.4 × 10-3). CONCLUSION Boltless implantation of stereo-electroencephalography electrode offers an accuracy comparable to those using anchor bolt. During the planning of boltless implantation, target points should be placed within 3.2 mm from the gray-white matter junction and a possible delayed dislodgement of 2.2 mm should be considered.
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Affiliation(s)
- Yuya Fujita
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Hui Ming Khoo
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Yuki Kimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Takuto Emura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Takamitsu Iwata
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Takahiro Matsuhashi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Shimpei Miura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Koichi Hosomi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Naoki Tani
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Masayuki Hirata
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
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Abarrategui B, Pelliccia V, Giovannelli G, Nichelatti M, Valenzano S, Mikulan E, Pigorini A, Revay M, Scarpa P, Tassi L. New stimulation procedures for language mapping in stereo-EEG. Epilepsia 2024; 65:1720-1729. [PMID: 38581367 DOI: 10.1111/epi.17963] [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: 10/11/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE Cortical intracerebral electrical stimulation is an important tool for language mapping in the presurgical work-up of patients with drug-resistant focal epilepsy. Language mapping with stereo-electroencephalography (EEG) is usually performed by high-frequency stimulations (HFS: 50 Hz), whereas low-frequency stimulations (LFS: 1 Hz) are usually considered useful for primary cortices mapping. Little is known in literature about "intermediate" frequencies (IFS: 6-15 Hz). Our objective is to explore the clinical usefulness of IFS in language mapping and identify factors, beyond the electrical parameters, that impact the mapping. METHODS We studied 23 patients submitted to stereo-EEG for presurgical evaluation. Language mapping was performed in the anterior, posterior and/or basal language region of the dominant hemisphere for language. We included all contact positions within these regions stimulated by HFS (50 Hz, 5 s, 1-3 mA) and IFS (6-15 Hz, 15 s, 5 mA). We compared the capability of both stimulation methods to induce a language deficit without afterdischarges (ADs), and we analyzed factors related to clinical examination, region, and stimulation technique by multivariate analysis. RESULTS A total of 211 stimulations (98 HFS, 113 IFS) in 70 cortical sites within the anterior (84 stimulations), posterior (137), and basal language region (60) were included. IFS induced more frequently language deficits not associated to AD compared to HFS (37.1% vs 25.7%, p = .0043), whereas HFS provoked more diffuse AD (34.7% vs 15.0%, p = .001). Investigating multiple language functions increased the probability of revealing a deficit (odds ratio [OR] 3.16, p = .0016), independently of the stimulation method. SIGNIFICANCE IFS are valuable for language mapping, thereby improving the probability of inducing a clinical deficit not accompanied by an AD. The completeness of the clinical examination independently affects the sensitivity of the mapping. IFS are a new tool with potential usefulness for the cortical mapping of other associative cortical regions.
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Affiliation(s)
- Belén Abarrategui
- Neurology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
- Claudio Munari Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Veronica Pelliccia
- Claudio Munari Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ginevra Giovannelli
- Claudio Munari Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - Michele Nichelatti
- Service of Biostatistics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Serena Valenzano
- Center for Neuroscience, University of Camerino, Camerino, Italy
- Department of Biomedical and Clinical Sciences "L. Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Ezequiel Mikulan
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Andrea Pigorini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- UOC Maxillo-facial Surgery and Dentistry, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Revay
- Claudio Munari Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Pina Scarpa
- Department of Neuroscience, Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Tassi
- Claudio Munari Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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11
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Di Giacomo R, Burini A, Chiarello D, Pelliccia V, Deleo F, Garbelli R, de Curtis M, Tassi L, Gnatkovsky V. Ictal fast activity chirps as markers of the epileptogenic zone. Epilepsia 2024; 65:e97-e103. [PMID: 38686942 DOI: 10.1111/epi.17995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024]
Abstract
The identification of the epileptogenic zone (EZ) boundaries is crucial for effective focal epilepsy surgery. We verify the value of a neurophysiological biomarker of focal ictogenesis, characterized by a low-voltage fast-activity ictal pattern (chirp) recorded with intracerebral electrodes during invasive presurgical monitoring (stereoelectroencephalography [SEEG]). The frequency content of SEEG signals was retrospectively analyzed with semiautomatic software in 176 consecutive patients with focal epilepsies that either were cryptogenic or presented with discordant anatomoelectroclinical findings. Fast activity seizure patterns with the spectrographic features of chirps were confirmed by computer-assisted analysis in 95.4% of patients who presented with heterogeneous etiologies and diverse lobar location of the EZ. Statistical analysis demonstrated (1) correlation between seizure outcome and concordance of sublobar regions included in the EZ defined by visual analysis and chirp-generating regions, (2) high concordance in contact-by contact analysis of 68 patients with Engel class Ia outcome, and (3) that discordance between chirp location and the visually outlined EZ correlated with worse seizure outcome. Seizure outcome analysis confirms the fast activity chirp pattern is a reproducible biomarker of the EZ in a heterogeneous group of patients undergoing SEEG.
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Affiliation(s)
- Roberta Di Giacomo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandra Burini
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Clinical Neurology, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Daniela Chiarello
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Francesco Deleo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco de Curtis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Vadym Gnatkovsky
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Epileptology, Universitätsklinikum Bonn, Bonn, Germany
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12
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Han CL, Chou CC, Chen HH, Chen YH, Lin CF, Chen C, Yu HY, Chen YW, Lee CC. Frame-based versus robot-assisted stereo-electro-encephalography for drug-resistant epilepsy. Acta Neurochir (Wien) 2024; 166:85. [PMID: 38361129 DOI: 10.1007/s00701-024-05983-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Stereoelectroencephalography (SEEG) is an effective presurgical invasive evaluation for drug-resistant epilepsies. The introduction of robotic devices provides a simplified, accurate, and safe alternative to the conventional SEEG technique. We report our institutional experience with robot-assisted SEEG and compare its in vivo accuracy, operation efficiency, and safety with the more traditional SEEG workflow. METHODS All patients with medically refractory focal epilepsy who underwent SEEG depth electrode implantation between 2014 and 2022 were included in this study. Technical advancements of the robot-assisted technique are described. Analyses of patient demographics, electrode implantation accuracy, operation time, and procedure-related complications were performed. RESULTS One hundred and sixty-six patients underwent 167 SEEG procedures. The first 141 procedures were performed using a conventional approach involving a Leksell stereotactic system, and the last 26 procedures were robot-assisted. Among the 1726 depth electrodes that were inserted, the median entry point localization error was as follows: conventional (1.0 mm; range, 0.1-33.5 mm) and robot-assisted (1.1 mm; range, 0-4.8 mm) (P = 0.17). The median target point localization error was as follows: conventional (2.8 mm; range, 0.1-49 mm) and robot-assisted (1.8 mm; range, 0-30.3 mm) (P < 0.001). The median operation time was significantly reduced with the robot-assisted workflow (90 min vs. 77.5 min; P < 0.01). Total complication rates were as follows: conventional (17.7%) and robot-assisted (11.5%) (P = 0.57). Major complication rates were 3.5% and 7.7% (P = 0.77), respectively. CONCLUSIONS SEEG is a safe and highly accurate method that provides essential guidance for epilepsy surgery. Implementing SEEG in conjunction with multimodal planning systems and robotic devices can further increase safety margin, surgical efficiency, and accuracy.
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Affiliation(s)
- Chang-Lin Han
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Chen Chou
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Hung Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hsiu Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiang-Yu Yu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Wei Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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13
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Bratu IF, Makhalova J, Garnier E, Villalon SM, Jegou A, Bonini F, Lagarde S, Pizzo F, Trébuchon A, Scavarda D, Carron R, Bénar C, Bartolomei F. Permutation entropy-derived parameters to estimate the epileptogenic zone network. Epilepsia 2024; 65:389-401. [PMID: 38041564 DOI: 10.1111/epi.17849] [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: 10/07/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Quantification of the epileptogenic zone network (EZN) most frequently implies analysis of seizure onset. However, important information can also be obtained from the postictal period, characterized by prominent changes in the EZN. We used permutation entropy (PE), a measure of signal complexity, to analyze the peri-ictal stereoelectroencephalography (SEEG) signal changes with emphasis on the postictal state. We sought to determine the best PE-derived parameter (PEDP) for identifying the EZN. METHODS Several PEDPs were computed retrospectively on SEEG-recorded seizures of 86 patients operated on for drug-resistant epilepsy: mean baseline preictal entropy, minimum ictal entropy, maximum postictal entropy, the ratio between the maximum postictal and the minimum ictal entropy, and the ratio between the maximum postictal and the baseline preictal entropy. The performance of each biomarker was assessed by comparing the identified epileptogenic contacts or brain regions against the EZN defined by clinical analysis incorporating the Epileptogenicity Index and the connectivity epileptogenicity index methods (EZNc), using the receiver-operating characteristic and precision-recall. RESULTS The ratio between the maximum postictal and the minimum ictal entropy (defined as the Permutation Entropy Index [PEI]) proved to be the best-performing PEDP to identify the EZNC . It demonstrated the highest area under the curve (AUC) and F1 score at the contact level (AUC 0.72; F1 0.39) and at the region level (AUC 0.78; F1 0.47). PEI values gradually decreased between the EZN, the propagation network, and the non-involved regions. PEI showed higher performance in patients with slow seizure-onset patterns than in those with fast seizure-onset patterns. The percentage of resected epileptogenic regions defined by PEI was significantly correlated with surgical outcome. SIGNIFICANCE PEI is a promising tool to improve the delineation of the EZN. PEI combines ease and robustness in a routine clinical setting with high sensitivity for seizures without fast activity at seizure onset.
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Affiliation(s)
- Ionuț-Flavius Bratu
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Julia Makhalova
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- APHM, Timone Hospital, CEMEREM, Marseille, France
| | - Elodie Garnier
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Samuel Medina Villalon
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Aude Jegou
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Francesca Bonini
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Stanislas Lagarde
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Francesca Pizzo
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Agnès Trébuchon
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Didier Scavarda
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- APHM Paediatric Neurosurgery Department, Marseille, France
| | - Romain Carron
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- APHM Functional Neurosurgery Department, Marseille, France
| | - Christian Bénar
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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14
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Frauscher B, Mansilla D, Abdallah C, Astner-Rohracher A, Beniczky S, Brazdil M, Gnatkovsky V, Jacobs J, Kalamangalam G, Perucca P, Ryvlin P, Schuele S, Tao J, Wang Y, Zijlmans M, McGonigal A. Learn how to interpret and use intracranial EEG findings. Epileptic Disord 2024; 26:1-59. [PMID: 38116690 DOI: 10.1002/epd2.20190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/21/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
Epilepsy surgery is the therapy of choice for many patients with drug-resistant focal epilepsy. Recognizing and describing ictal and interictal patterns with intracranial electroencephalography (EEG) recordings is important in order to most efficiently leverage advantages of this technique to accurately delineate the seizure-onset zone before undergoing surgery. In this seminar in epileptology, we address learning objective "1.4.11 Recognize and describe ictal and interictal patterns with intracranial recordings" of the International League against Epilepsy curriculum for epileptologists. We will review principal considerations of the implantation planning, summarize the literature for the most relevant ictal and interictal EEG patterns within and beyond the Berger frequency spectrum, review invasive stimulation for seizure and functional mapping, discuss caveats in the interpretation of intracranial EEG findings, provide an overview on special considerations in children and in subdural grids/strips, and review available quantitative/signal analysis approaches. To be as practically oriented as possible, we will provide a mini atlas of the most frequent EEG patterns, highlight pearls for its not infrequently challenging interpretation, and conclude with two illustrative case examples. This article shall serve as a useful learning resource for trainees in clinical neurophysiology/epileptology by providing a basic understanding on the concepts of invasive intracranial EEG.
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Affiliation(s)
- B Frauscher
- Department of Neurology, Duke University Medical Center and Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - D Mansilla
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
- Neurophysiology Unit, Institute of Neurosurgery Dr. Asenjo, Santiago, Chile
| | - C Abdallah
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - A Astner-Rohracher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - S Beniczky
- Danish Epilepsy Centre, Dianalund, Denmark
- Aarhus University, Aarhus, Denmark
| | - M Brazdil
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Member of the ERN-EpiCARE, Brno, Czechia
- Behavioral and Social Neuroscience Research Group, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - V Gnatkovsky
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - J Jacobs
- Department of Paediatrics and Department of Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - G Kalamangalam
- Department of Neurology, University of Florida, Gainesville, Florida, USA
- Wilder Center for Epilepsy Research, University of Florida, Gainesville, Florida, USA
| | - P Perucca
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - P Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - S Schuele
- Department of Neurology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - J Tao
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Y Wang
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Wilder Center for Epilepsy Research, University of Florida, Gainesville, Florida, USA
| | - M Zijlmans
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - A McGonigal
- Department of Neurosciences, Mater Misericordiae Hospital, Brisbane, Queensland, Australia
- Mater Research Institute, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
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15
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Liu Q, Lin Z, Shen Y, Zhu J, Song J, Zhang C, Lu Y, Xu J. Use of Compressed Sensing Accelerated, Low-Velocity Encoded, Isotropic Resolution, Phase Contrast Magnetic Resonance Angiography for SEEG Electrode Implantation. World Neurosurg 2024; 181:e18-e28. [PMID: 36791880 DOI: 10.1016/j.wneu.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE We assessed the feasibility of using compressed sensing accelerated, low-velocity encoded, isotropic resolution phase contrast (CLIP) magnetic resonance angiography (MRA) for avascular trajectory planning of stereoelectroencephalography. METHODS Ten healthy subjects (1 woman and 9 men; age, 33.6 ± 9.0 years) and 20 consecutive patients (12 female patients; age, 22 ± 13.6 years) were enrolled in the present study. The healthy subjects underwent CLIP-MRA, and 3 other phase contrast MRA protocols with conventional parallel imaging (PI) acceleration, including low resolution with twofold PI (PI2), high resolution (HR) with fivefold PI (PI5), and HR-PI2. The patients underwent CLIP-MRA and computed tomography angiography (CTA). The image qualities were evaluated. The numbers and locations of trajectory-vessel conflict detected using CLIP-MRA were noted. RESULTS With similar scan durations, CLIP-MRA achieved higher spatial resolution compared with low resolution with PI2 and detected significantly more branches compared with HR-PI5. With the same spatial resolution, the signal/noise and contrast/noise ratios of CLIP-MRA were higher than those with HR-PI2 with a shorter scan duration. For the 12 adult patients (10 female patients; 28.8 ± 12.7 years), CLIP-MRA had better signal/noise and contrast/noise ratios than CTA. The trajectory had required modification for 14 of the 20 patients (70%), with a proportion of trajectory modification of 10.7% (23 of 215 electrodes). The middle meningeal artery, cortical vessel, and skull vessel were the main vessels with conflict (n = 11, n = 7, and n = 5, respectively). CONCLUSIONS In the present study, CLIP-MRA provided a clear cortical vascular display noninvasively without intravascular contrast and radiation. The middle meningeal artery and diploic and emissary veins were the main conflict vessels and could be clearly displayed using CLIP-MRA but not CTA.
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Affiliation(s)
- Qiangqiang Liu
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China; Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zengping Lin
- United Imaging Healthcare Group, Shanghai, People's Republic of China
| | - Yiwen Shen
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jiachen Zhu
- United Imaging Healthcare Group, Shanghai, People's Republic of China
| | - Jian Song
- Wuhan United Imaging Healthcare Surgical Technology Co., Ltd., Wuhan, People's Republic of China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yong Lu
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jiwen Xu
- Clinical Neuroscience Center Comprehensive Epilepsy Unit, Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China; Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
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16
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Makhalova J, Madec T, Medina Villalon S, Jegou A, Lagarde S, Carron R, Scavarda D, Garnier E, Bénar CG, Bartolomei F. The role of quantitative markers in surgical prognostication after stereoelectroencephalography. Ann Clin Transl Neurol 2023; 10:2114-2126. [PMID: 37735846 PMCID: PMC10646998 DOI: 10.1002/acn3.51900] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/26/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is the reference method in the presurgical exploration of drug-resistant focal epilepsy. However, prognosticating surgery on an individual level is difficult. A quantified estimation of the most epileptogenic regions by searching for relevant biomarkers can be proposed for this purpose. We investigated the performances of ictal (Epileptogenicity Index, EI; Connectivity EI, cEI), interictal (spikes, high-frequency oscillations, HFO [80-300 Hz]; Spikes × HFO), and combined (Spikes × EI; Spikes × cEI) biomarkers in predicting surgical outcome and searched for prognostic factors based on SEEG-signal quantification. METHODS Fifty-three patients operated on following SEEG were included. We compared, using precision-recall, the epileptogenic zone quantified using different biomarkers (EZq ) against the visual analysis (EZC ). Correlations between the EZ resection rates or the EZ extent and surgical prognosis were analyzed. RESULTS EI and Spikes × EI showed the best precision against EZc (0.74; 0.70), followed by Spikes × cEI and cEI, whereas interictal markers showed lower precision. The EZ resection rates were greater in seizure-free than in non-seizure-free patients for the EZ defined by ictal biomarkers and were correlated with the outcome for EI and Spikes × EI. No such correlation was found for interictal markers. The extent of the quantified EZ did not correlate with the prognosis. INTERPRETATION Ictal or combined ictal-interictal markers overperformed the interictal markers both for detecting the EZ and predicting seizure freedom. Combining ictal and interictal epileptogenicity markers improves detection accuracy. Resection rates of the quantified EZ using ictal markers were the only statistically significant determinants for surgical prognosis.
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Affiliation(s)
- Julia Makhalova
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
- Aix Marseille Univ, CNRS, CRMBMMarseilleFrance
| | - Tanguy Madec
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
| | - Samuel Medina Villalon
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
| | - Aude Jegou
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
| | - Stanislas Lagarde
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
| | - Romain Carron
- APHM, Timone Hospital, Functional, and Stereotactic NeurosurgeryMarseilleFrance
| | | | - Elodie Garnier
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
| | | | - Fabrice Bartolomei
- APHM, Timone Hospital, Epileptology and Cerebral RhythmologyMarseilleFrance
- Aix Marseille Univ, INSERM, INS, Inst Neurosci SystMarseilleFrance
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17
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Gotman J. Has recording of seizures become obsolete? Rev Neurol (Paris) 2023; 179:872-876. [PMID: 36906456 DOI: 10.1016/j.neurol.2023.01.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 03/11/2023]
Abstract
Some patients with medically intractable epilepsy are considered for surgical treatment. In some surgical candidates, the investigation includes the placement of intracerebral electrodes and long-term monitoring to find the region of seizure onset. This region is the primary determinant of the surgical resection but about one-third of patients are not offered surgery after electrode implantation and among those operated only about 55% are seizure free after five years. This paper discusses why the primary reliance on the seizure onset maybe suboptimal and may be in part responsible for the relatively low surgical success rate. It also proposes to consider some interictal markers that may have advantages over seizure onset and may be easier to obtain.
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Affiliation(s)
- J Gotman
- Montreal Neurological Institute, McGill University, 3801 University Street, Montréal, Québec H3A 2B4, Canada.
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18
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d'Orio P, Revay M, Bevacqua G, Battista F, Castana L, Squarza S, Chiarello D, Lo Russo G, Sartori I, Cardinale F. Stereo-electroencephalography (SEEG)-Guided Surgery in Epilepsy With Cingulate Gyrus Involvement: Electrode Implantation Strategies and Postoperative Seizure Outcome. J Clin Neurophysiol 2023; 40:516-528. [PMID: 36930225 DOI: 10.1097/wnp.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY Surgical treatment of cingulate gyrus epilepsy is associated with good results on seizures despite its rarity and challenging aspects. Invasive EEG monitoring is often mandatory to assess the epileptogenic zone in these patients. To date, only small surgical series have been published, and a consensus about management of these complex cases did not emerge. The authors retrospectively analyzed a large surgical series of patients in whom at least part of the cingulate gyrus was confirmed as included in the epileptogenic zone by means of stereo-electroencephalography and was thus resected. One hundred twenty-seven patients were selected. Stereo-electroencephalography-guided implantation of intracerebral electrodes was performed in the right hemisphere in 62 patients (48.8%) and in the left hemisphere in 44 patients (34.7%), whereas 21 patients (16.5%) underwent bilateral implantations. The median number of implanted electrodes per patient was 13 (interquartile range 12-15). The median number of electrodes targeting the cingulate gyrus was 4 (interquartile range 3-5). The cingulate gyrus was explored bilaterally in 19 patients (15%). Complication rate was 0.8%. A favorable outcome (Engel class I) was obtained in 54.3% of patients, with a median follow-up of 60 months. The chance to obtain seizure freedom increased in cases in whom histologic diagnosis was type-IIb focal cortical dysplasia or tumor (mostly ganglioglioma or dysembryoplastic neuroepithelial tumor) and with male gender. Higher seizure frequency predicted better outcome with a trend toward significance. Our findings suggest that stereo-electroencephalography is a safe and effective methodology in achieving seizure freedom in complex cases of epilepsy with cingulate gyrus involvement.
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Affiliation(s)
- Piergiorgio d'Orio
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Martina Revay
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppina Bevacqua
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Neurosurgery Unit, Department of Translational Medicine, Ferrara University, Ferrara, Italy
| | - Francesca Battista
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Neurosurgery Clinic, Department of Neuroscience, Psychology, Pharmacology, and Child Health, Careggi University Hospital and University of Florence, Florence, Italy; and
| | - Laura Castana
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Squarza
- Neuroradiology Department, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniela Chiarello
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Lo Russo
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ivana Sartori
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Cardinale
- "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
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19
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Jensen MA, Huang H, Valencia GO, Klassen BT, van den Boom MA, Kaufmann TJ, Schalk G, Brunner P, Worrell GA, Hermes D, Miller KJ. A motor association area in the depths of the central sulcus. Nat Neurosci 2023; 26:1165-1169. [PMID: 37202552 PMCID: PMC10322697 DOI: 10.1038/s41593-023-01346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
Cells in the precentral gyrus directly send signals to the periphery to generate movement and are principally organized as a topological map of the body. We find that movement-induced electrophysiological responses from depth electrodes extend this map three-dimensionally throughout the gyrus. Unexpectedly, this organization is interrupted by a previously undescribed motor association area in the depths of the midlateral aspect of the central sulcus. This 'Rolandic motor association' (RMA) area is active during movements of different body parts from both sides of the body and may be important for coordinating complex behaviors.
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Affiliation(s)
- Michael A Jensen
- Medical Scientist Training Program, Mayo Clinic, Rochester, MN, USA.
- Neurosurgery, Mayo Clinic, Rochester, MN, USA.
| | - Harvey Huang
- Medical Scientist Training Program, Mayo Clinic, Rochester, MN, USA
| | | | | | - Max A van den Boom
- Neurosurgery, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Gerwin Schalk
- Neurosurgery, Mayo Clinic, Rochester, MN, USA
- Chen Frontier Lab for Applied Neurotechnology, Tianqiao and Chrissy Chen Institute, Shanghai, China
- Neurosurgery, Fudan University/Huashan Hospital, Shanghai, China
| | - Peter Brunner
- Neurosurgery, Washington University School of Medicine, St Louis, MO, USA
| | - Gregory A Worrell
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
- Neurology, Mayo Clinic, Rochester, MN, USA
| | - Dora Hermes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kai J Miller
- Neurosurgery, Mayo Clinic, Rochester, MN, USA.
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
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20
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Pascarella A, Mikulan E, Sciacchitano F, Sarasso S, Rubino A, Sartori I, Cardinale F, Zauli F, Avanzini P, Nobili L, Pigorini A, Sorrentino A. An in-vivo validation of ESI methods with focal sources. Neuroimage 2023:120219. [PMID: 37307867 DOI: 10.1016/j.neuroimage.2023.120219] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/05/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023] Open
Abstract
Electrophysiological source imaging (ESI) aims at reconstructing the precise origin of brain activity from measurements of the electric field on the scalp. Across laboratories/research centers/hospitals, ESI is performed with different methods, partly due to the ill-posedness of the underlying mathematical problem. However, it is difficult to find systematic comparisons involving a wide variety of methods. Further, existing comparisons rarely take into account the variability of the results with respect to the input parameters. Finally, comparisons are typically performed using either synthetic data, or in-vivo data where the ground-truth is only roughly known. We use an in-vivo high-density EEG dataset recorded during intracranial single pulse electrical stimulation, in which the true sources are substantially dipolar and their locations are precisely known. We compare ten different ESI methods, using their implementation in the MNE-Python package: MNE, dSPM, LORETA, sLORETA, eLORETA, LCMV beamformers, irMxNE, Gamma Map, SESAME and dipole fitting. We perform comparisons under multiple choices of input parameters, to assess the accuracy of the best reconstruction, as well as the impact of such parameters on the localization performance. Best reconstructions often fall within 1 cm from the true source, with most accurate methods hitting an average localization error of 1.2 cm and outperforming least accurate ones erring by 2.5 cm. As expected, dipolar and sparsity-promoting methods tend to outperform distributed methods. For several distributed methods, the best regularization parameter turned out to be the one in principle associated with low SNR, despite the high SNR of the available dataset. Depth weighting played no role for two out of the six methods implementing it. Sensitivity to input parameters varied widely between methods. While one would expect high variability being associated with low localization error at the best solution, this is not always the case, with some methods producing highly variable results and high localization error, and other methods producing stable results with low localization error. In particular, recent dipolar and sparsity-promoting methods provide significantly better results than older distributed methods. As we repeated the tests with "conventional" (32 channels) and dense (64, 128, 256 channels) EEG recordings, we observed little impact of the number of channels on localization accuracy; however, for distributed methods denser montages provide smaller spatial dispersion. Overall findings confirm that EEG is a reliable technique for localization of point sources and therefore reinforce the importance that ESI may have in the clinical context, especially when applied to identify the surgical target in potential candidates for epilepsy surgery.
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Affiliation(s)
| | - Ezequiel Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco",Università degli Studi di Milano, Milan, Italy
| | | | - Simone Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco",Università degli Studi di Milano, Milan, Italy
| | - Annalisa Rubino
- Department of Neurosciences, Center for Epilepsy Surgery "C. Munari", Hospital Niguarda, Milan, Italy
| | - Ivana Sartori
- Department of Neurosciences, Center for Epilepsy Surgery "C. Munari", Hospital Niguarda, Milan, Italy
| | - Francesco Cardinale
- Department of Neurosciences, Center for Epilepsy Surgery "C. Munari", Hospital Niguarda, Milan, Italy
| | - Flavia Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco",Università degli Studi di Milano, Milan, Italy
| | | | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS "G. Gaslini" Institute, Genoa, Italy; DINOGMI, Università degli Studi di Genova, Genoa, Italy
| | - Andrea Pigorini
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Sorrentino
- Department of Mathematics, Università degli Studi di Genova, Genoa, Italy.
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21
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Corona L, Tamilia E, Perry MS, Madsen JR, Bolton J, Stone SSD, Stufflebeam SM, Pearl PL, Papadelis C. Non-invasive mapping of epileptogenic networks predicts surgical outcome. Brain 2023; 146:1916-1931. [PMID: 36789500 PMCID: PMC10151194 DOI: 10.1093/brain/awac477] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/03/2022] [Accepted: 11/30/2022] [Indexed: 02/16/2023] Open
Abstract
Epilepsy is increasingly considered a disorder of brain networks. Studying these networks with functional connectivity can help identify hubs that facilitate the spread of epileptiform activity. Surgical resection of these hubs may lead patients who suffer from drug-resistant epilepsy to seizure freedom. Here, we aim to map non-invasively epileptogenic networks, through the virtual implantation of sensors estimated with electric and magnetic source imaging, in patients with drug-resistant epilepsy. We hypothesize that highly connected hubs identified non-invasively with source imaging can predict the epileptogenic zone and the surgical outcome better than spikes localized with conventional source localization methods (dipoles). We retrospectively analysed simultaneous high-density electroencephalography (EEG) and magnetoencephalography data recorded from 37 children and young adults with drug-resistant epilepsy who underwent neurosurgery. Using source imaging, we estimated virtual sensors at locations where intracranial EEG contacts were placed. On data with and without spikes, we computed undirected functional connectivity between sensors/contacts using amplitude envelope correlation and phase locking value for physiologically relevant frequency bands. From each functional connectivity matrix, we generated an undirected network containing the strongest connections within sensors/contacts using the minimum spanning tree. For each sensor/contact, we computed graph centrality measures. We compared functional connectivity and their derived graph centrality of sensors/contacts inside resection for good (n = 22, ILAE I) and poor (n = 15, ILAE II-VI) outcome patients, tested their ability to predict the epileptogenic zone in good-outcome patients, examined the association between highly connected hubs removal and surgical outcome and performed leave-one-out cross-validation to support their prognostic value. We also compared the predictive values of functional connectivity with those of dipoles. Finally, we tested the reliability of virtual sensor measures via Spearman's correlation with intracranial EEG at population- and patient-level. We observed higher functional connectivity inside than outside resection (P < 0.05, Wilcoxon signed-rank test) for good-outcome patients, on data with and without spikes across different bands for intracranial EEG and electric/magnetic source imaging and few differences for poor-outcome patients. These functional connectivity measures were predictive of both the epileptogenic zone and outcome (positive and negative predictive values ≥55%, validated using leave-one-out cross-validation) outperforming dipoles on spikes. Significant correlations were found between source imaging and intracranial EEG measures (0.4 ≤ rho ≤ 0.9, P < 0.05). Our findings suggest that virtual implantation of sensors through source imaging can non-invasively identify highly connected hubs in patients with drug-resistant epilepsy, even in the absence of frank epileptiform activity. Surgical resection of these hubs predicts outcome better than dipoles.
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Affiliation(s)
- Ludovica Corona
- Jane and John Justin Institute for Mind Health, Cook Children's Health Care System, Fort Worth, TX 76104, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX 76010, USA
| | - Eleonora Tamilia
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health, Cook Children's Health Care System, Fort Worth, TX 76104, USA
| | - Joseph R Madsen
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jeffrey Bolton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Scellig S D Stone
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Steve M Stufflebeam
- Athinoula Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Christos Papadelis
- Jane and John Justin Institute for Mind Health, Cook Children's Health Care System, Fort Worth, TX 76104, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX 76010, USA
- School of Medicine, Texas Christian University, Fort Worth, TX 76129, USA
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22
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Tiesinga P, Platonov A, Pelliccia V, LoRusso G, Sartori I, Orban GA. Uncovering the fast, directional signal flow through the human temporal pole during semantic processing. Sci Rep 2023; 13:6831. [PMID: 37100843 PMCID: PMC10133264 DOI: 10.1038/s41598-023-33318-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/11/2023] [Indexed: 04/28/2023] Open
Abstract
The temporal pole (TP) plays a central role in semantic memory, yet its neural machinery is unknown. Intracerebral recordings in patients discriminating visually the gender or actions of an actor, yielded gender discrimination responses in the ventrolateral (VL) and tip (T) regions of right TP. Granger causality revealed task-specific signals travelling first forward from VL to T, under control of orbitofrontal cortex (OFC) and neighboring prefrontal cortex, and then, strongly, backwards from T to VL. Many other cortical regions provided inputs to or received outputs from both TP regions, often with longer delays, with ventral temporal afferents to VL signaling the actor's physical appearance. The TP response timing reflected more that of the connections to VL, controlled by OFC, than that of the input leads themselves. Thus, visual evidence for gender categories, collected by VL, activates category labels in T, and consequently, category features in VL, indicating a two-stage representation of semantic categories in TP.
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Affiliation(s)
- P Tiesinga
- Neuroinformatics Department, Faculty of Science, Radboud University, Heyendaalseweg 135, 6525AJ, Nijmegen, The Netherlands.
| | - A Platonov
- Department of Medicine and Surgery, University of Parma, Via Volturno 39/E, 43125, Parma, Italy
| | - V Pelliccia
- Claudio Munari Center for Epilepsy Surgery, Ospedale Niguarda-Ca' Granda, 20162, Milan, Italy
| | - G LoRusso
- Claudio Munari Center for Epilepsy Surgery, Ospedale Niguarda-Ca' Granda, 20162, Milan, Italy
| | - I Sartori
- Claudio Munari Center for Epilepsy Surgery, Ospedale Niguarda-Ca' Granda, 20162, Milan, Italy
| | - G A Orban
- Department of Medicine and Surgery, University of Parma, Via Volturno 39/E, 43125, Parma, Italy.
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23
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Jirsa V, Wang H, Triebkorn P, Hashemi M, Jha J, Gonzalez-Martinez J, Guye M, Makhalova J, Bartolomei F. Personalised virtual brain models in epilepsy. Lancet Neurol 2023; 22:443-454. [PMID: 36972720 DOI: 10.1016/s1474-4422(23)00008-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023]
Abstract
Individuals with drug-resistant focal epilepsy are candidates for surgical treatment as a curative option. Before surgery can take place, the patient must have a presurgical evaluation to establish whether and how surgical treatment might stop their seizures without causing neurological deficits. Virtual brains are a new digital modelling technology that map the brain network of a person with epilepsy, using data derived from MRI. This technique produces a computer simulation of seizures and brain imaging signals, such as those that would be recorded with intracranial EEG. When combined with machine learning, virtual brains can be used to estimate the extent and organisation of the epileptogenic zone (ie, the brain regions related to seizure generation and the spatiotemporal dynamics during seizure onset). Virtual brains could, in the future, be used for clinical decision making, to improve precision in localisation of seizure activity, and for surgical planning, but at the moment these models have some limitations, such as low spatial resolution. As evidence accumulates in support of the predictive power of personalised virtual brain models, and as methods are tested in clinical trials, virtual brains might inform clinical practice in the near future.
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Affiliation(s)
- Viktor Jirsa
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France.
| | - Huifang Wang
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | - Paul Triebkorn
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | - Meysam Hashemi
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | - Jayant Jha
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France
| | | | - Maxime Guye
- Centre National de la Recherche Scientifique, Center for Magnetic Resonance in Biology and Medicine, Aix Marseille Université, Marseille, France; Centre d'Exploration Métabolique par Résonance Magnétique, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France
| | - Julia Makhalova
- Centre National de la Recherche Scientifique, Center for Magnetic Resonance in Biology and Medicine, Aix Marseille Université, Marseille, France; Centre d'Exploration Métabolique par Résonance Magnétique, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France; Epileptology and Clinical Neurophysiology Department, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France
| | - Fabrice Bartolomei
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes (INS) UMR1106, Aix Marseille Université, Marseille, France; Epileptology and Clinical Neurophysiology Department, Assistance Publique - Hôpitaux de Marseille, La Timone University Hospital, Marseille, France
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24
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Thomas J, Kahane P, Abdallah C, Avigdor T, Zweiphenning WJEM, Chabardes S, Jaber K, Latreille V, Minotti L, Hall J, Dubeau F, Gotman J, Frauscher B. A Subpopulation of Spikes Predicts Successful Epilepsy Surgery Outcome. Ann Neurol 2023; 93:522-535. [PMID: 36373178 DOI: 10.1002/ana.26548] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Epileptic spikes are the traditional interictal electroencephalographic (EEG) biomarker for epilepsy. Given their low specificity for identifying the epileptogenic zone (EZ), they are given only moderate attention in presurgical evaluation. This study aims to demonstrate that it is possible to identify specific spike features in intracranial EEG that optimally define the EZ and predict surgical outcome. METHODS We analyzed spike features on stereo-EEG segments from 83 operated patients from 2 epilepsy centers (37 Engel IA) in wakefulness, non-rapid eye movement sleep, and rapid eye movement sleep. After automated spike detection, we investigated 135 spike features based on rate, morphology, propagation, and energy to determine the best feature or feature combination to discriminate the EZ in seizure-free and non-seizure-free patients by applying 4-fold cross-validation. RESULTS The rate of spikes with preceding gamma activity in wakefulness performed better for surgical outcome classification (4-fold area under receiver operating characteristics curve [AUC] = 0.755 ± 0.07) than the seizure onset zone, the current gold standard (AUC = 0.563 ± 0.05, p = 0.015) and the ripple rate, an emerging seizure-independent biomarker (AUC = 0.537 ± 0.07, p = 0.006). Channels with a spike-gamma rate exceeding 1.9/min had an 80% probability of being in the EZ. Combining features did not improve the results. INTERPRETATION Resection of brain regions with high spike-gamma rates in wakefulness is associated with a high probability of achieving seizure freedom. This rate could be applied to determine the minimal number of spiking channels requiring resection. In addition to quantitative analysis, this feature is easily accessible to visual analysis, which could aid clinicians during presurgical evaluation. ANN NEUROL 2023;93:522-535.
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Affiliation(s)
- John Thomas
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Philippe Kahane
- Grenoble Alpes University Hospital Center, Grenoble Alpes University, Inserm, U1216, Grenoble Institute Neurosciences, Grenoble, France
| | - Chifaou Abdallah
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Tamir Avigdor
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Willemiek J E M Zweiphenning
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Stephan Chabardes
- Grenoble Alpes University Hospital Center, Grenoble Alpes University, Inserm, U1216, Grenoble Institute Neurosciences, Grenoble, France
| | - Kassem Jaber
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Véronique Latreille
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Lorella Minotti
- Grenoble Alpes University Hospital Center, Grenoble Alpes University, Inserm, U1216, Grenoble Institute Neurosciences, Grenoble, France
| | - Jeff Hall
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - François Dubeau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Jean Gotman
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Birgit Frauscher
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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25
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Obaid S, Chen JS, Ibrahim GM, Bouthillier A, Dimentberg E, Surbeck W, Guadagno E, Brunette-Clément T, Shlobin NA, Shulkin A, Hale AT, Tomycz LD, Von Lehe M, Perry MS, Chassoux F, Bouilleret V, Taussig D, Fohlen M, Dorfmuller G, Hagiwara K, Isnard J, Oluigbo CO, Ikegaya N, Nguyen DK, Fallah A, Weil AG. Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta-analysis. Epilepsia Open 2023; 8:12-31. [PMID: 36263454 PMCID: PMC9978079 DOI: 10.1002/epi4.12663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022] Open
Abstract
Insular epilepsy (IE) is an increasingly recognized cause of drug-resistant epilepsy amenable to surgery. However, concerns of suboptimal seizure control and permanent neurological morbidity hamper widespread adoption of surgery for IE. We performed a systematic review and individual participant data meta-analysis to determine the efficacy and safety profile of surgery for IE and identify predictors of outcomes. Of 2483 unique citations, 24 retrospective studies reporting on 312 participants were eligible for inclusion. The median follow-up duration was 2.58 years (range, 0-17 years), and 206 (66.7%) patients were seizure-free at last follow-up. Younger age at surgery (≤18 years; HR = 1.70, 95% CI = 1.09-2.66, P = .022) and invasive EEG monitoring (HR = 1.97, 95% CI = 1.04-3.74, P = .039) were significantly associated with shorter time to seizure recurrence. Performing MR-guided laser ablation or radiofrequency ablation instead of open resection (OR = 2.05, 95% CI = 1.08-3.89, P = .028) was independently associated with suboptimal or poor seizure outcome (Engel II-IV) at last follow-up. Postoperative neurological complications occurred in 42.5% of patients, most commonly motor deficits (29.9%). Permanent neurological complications occurred in 7.8% of surgeries, including 5% and 1.4% rate of permanent motor deficits and dysphasia, respectively. Resection of the frontal operculum was independently associated with greater odds of motor deficits (OR = 2.75, 95% CI = 1.46-5.15, P = .002). Dominant-hemisphere resections were independently associated with dysphasia (OR = 13.09, 95% CI = 2.22-77.14, P = .005) albeit none of the observed language deficits were permanent. Surgery for IE is associated with a good efficacy/safety profile. Most patients experience seizure freedom, and neurological deficits are predominantly transient. Pediatric patients and those requiring invasive monitoring or undergoing stereotactic ablation procedures experience lower rates of seizure freedom. Transgression of the frontal operculum should be avoided if it is not deemed part of the epileptogenic zone. Well-selected candidates undergoing dominant-hemisphere resection are more likely to exhibit transient language deficits; however, the risk of permanent deficit is very low.
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Affiliation(s)
- Sami Obaid
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Quebec, Montreal, Canada.,Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Jia-Shu Chen
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Evan Dimentberg
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Quebec, Montreal, Canada.,Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Werner Surbeck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tristan Brunette-Clément
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Quebec, Montreal, Canada.,Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Aidan Shulkin
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Quebec, Montreal, Canada
| | - Andrew T Hale
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Luke D Tomycz
- The Epilepsy Institute of New Jersey, Jersey City, New Jersey, USA
| | - Marec Von Lehe
- Department of Neurosurgery, Brandenburg Medical School, Neuruppin, Germany
| | - Michael Scott Perry
- Comprehensive Epilepsy Program, Jane and John Justin Neuroscience Center, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Francine Chassoux
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Université Paris-Descartes Paris, Paris, France
| | - Viviane Bouilleret
- Université Paris Saclay-APHP, Unité de Neurophysiologie Clinique et d'Épileptologie(UNCE), Le Kremlin Bicêtre, France
| | - Delphine Taussig
- Université Paris Saclay-APHP, Unité de Neurophysiologie Clinique et d'Épileptologie(UNCE), Le Kremlin Bicêtre, France.,Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France
| | - Martine Fohlen
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France
| | - Georg Dorfmuller
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France
| | - Koichi Hagiwara
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Jean Isnard
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery, Lyon, France
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Naoki Ikegaya
- Departments of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Dang K Nguyen
- Division of Neurology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery and Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Quebec, Montreal, Canada.,Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada.,Department of Neuroscience, University of Montreal, Montreal, Quebec, Canada
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26
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Mallela AN, Abou-Al-Shaar H, González-Martínez J. Letter to the Editor. SEEG and subdural grids: differences that go beyond morbidity. J Neurosurg 2023; 138:885-886. [PMID: 36401541 DOI: 10.3171/2022.8.jns221901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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27
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Hadidane S, Lagarde S, Medina-Villalon S, McGonigal A, Laguitton V, Carron R, Scavarda D, Bartolomei F, Trebuchon A. Basal temporal lobe epilepsy: SEEG electroclinical characteristics. Epilepsy Res 2023; 191:107090. [PMID: 36774667 DOI: 10.1016/j.eplepsyres.2023.107090] [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: 04/16/2022] [Revised: 12/16/2022] [Accepted: 01/12/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Temporal lobe epilepsy is the most common type of focal drug-resistant epilepsy. Seizures with predominant involvement of basal temporal regions (BTR) are not well characterized. In this stereo electroencephalography (SEEG) study, we aimed at describing the ictal networks involving BTR and the associated clinical features. METHODS We studied 24 patients explored with SEEG in our center with BTR sampling. We analyzed their seizures using a quantitative method: the "epileptogenicity index". Then we reported the features of the patients with maximal epileptogenicity within BTR, especially ictal network involved, ictal semiology and post-surgical outcome. RESULTS We found that rhinal cortex, parahippocampal cortex and posterior fusiform gyrus were the most epileptogenic structures within the BTR (mean EI: 0.57, 0.55, 0.54 respectively). Three main groups of epileptogenic zone organization were found: anterior (23% of total seizures) posterior (30%) and global (47%, both anterior and posterior). Contralateral spread was found in 35% of left seizures and 20% of right seizures. Naming deficit was more prevalent in left BTR (71% vs 29% in right seizures; p = 0.01) whereas automatic speech production was preferentially represented in right seizures (11% vs 54%; p = 0.001). Surgery was proposed for 11 patients (45.8%), leading to seizure freedom in 72% (Engel Class I). One patient presented post-operative permanent functional deficit. CONCLUSION Basal-temporal lobe epilepsy seems to be a specific entity among the temporal epilepsy spectrum with specific clinical characteristics. Resective surgery can be proposed with good outcomes in a significant proportion of patients and is safe provided that adequate language assessment has been preoperatively made.
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Affiliation(s)
- S Hadidane
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; APHM, Timone Hospital, Epileptology Department, Clinical Neurophysiology, Marseille, France
| | - S Lagarde
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; APHM, Timone Hospital, Epileptology Department, Clinical Neurophysiology, Marseille, France
| | - S Medina-Villalon
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - A McGonigal
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - V Laguitton
- APHM, Timone Hospital, Epileptology Department, Clinical Neurophysiology, Marseille, France
| | - R Carron
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; APHM, Timone Hospital, Stereotactic and Functional Neurosurgery, Marseille, France
| | - D Scavarda
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; APHM, Timone Hospital, Pediatric, Neurosurgery Department, Marseille, France
| | - F Bartolomei
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; APHM, Timone Hospital, Epileptology Department, Clinical Neurophysiology, Marseille, France
| | - A Trebuchon
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; APHM, Timone Hospital, Epileptology Department, Clinical Neurophysiology, Marseille, France; INSERM UMR1106, Institut des Neurosciences des Systèmes, Aix-Marseille Université, Faculté de Médecine Timone, 27, Bd Jean-Moulin, 13385 Marseille Cedex 05, France; Service de Neurophysiologie Clinique, Hôpital de la Timone, 13005 Marseille, France.
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28
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Hashemi M, Vattikonda AN, Jha J, Sip V, Woodman MM, Bartolomei F, Jirsa VK. Amortized Bayesian inference on generative dynamical network models of epilepsy using deep neural density estimators. Neural Netw 2023; 163:178-194. [PMID: 37060871 DOI: 10.1016/j.neunet.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
Whole-brain modeling of epilepsy combines personalized anatomical data with dynamical models of abnormal activities to generate spatio-temporal seizure patterns as observed in brain imaging data. Such a parametric simulator is equipped with a stochastic generative process, which itself provides the basis for inference and prediction of the local and global brain dynamics affected by disorders. However, the calculation of likelihood function at whole-brain scale is often intractable. Thus, likelihood-free algorithms are required to efficiently estimate the parameters pertaining to the hypothetical areas, ideally including the uncertainty. In this study, we introduce the simulation-based inference for the virtual epileptic patient model (SBI-VEP), enabling us to amortize the approximate posterior of the generative process from a low-dimensional representation of whole-brain epileptic patterns. The state-of-the-art deep learning algorithms for conditional density estimation are used to readily retrieve the statistical relationships between parameters and observations through a sequence of invertible transformations. We show that the SBI-VEP is able to efficiently estimate the posterior distribution of parameters linked to the extent of the epileptogenic and propagation zones from sparse intracranial electroencephalography recordings. The presented Bayesian methodology can deal with non-linear latent dynamics and parameter degeneracy, paving the way for fast and reliable inference on brain disorders from neuroimaging modalities.
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29
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MAESAWA S, ISHIZAKI T, MUTOH M, ITO Y, TORII J, TANEI T, NAKATSUBO D, SAITO R. Clinical Impacts of Stereotactic Electroencephalography on Epilepsy Surgery and Associated Issues in the Current Situation in Japan. Neurol Med Chir (Tokyo) 2023; 63:179-190. [PMID: 37005247 DOI: 10.2176/jns-nmc.2022-0271] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Stereotactic electroencephalography (SEEG) is receiving increasing attention as a safe and effective technique in the invasive evaluation for epileptogenic zone (EZ) detection. The main clinical question is whether the use of SEEG truly improves outcomes. Herein, we compared outcomes in our patients after three types of intracranial EEG (iEEG): SEEG, the subdural electrode (SDE), and a combined method using depth and strip electrodes. We present here our preliminary results from two demonstrative cases. Several international reports from large epilepsy centers found the following clinical advantages of SEEG: 1) three-dimensional analysis of structures, including bilateral and multilobar structures; 2) low rate of complications; 3) less pneumoencephalopathy and less patient burden during postoperative course, which allows the initiation of video-EEG monitoring immediately after implantation and does not require resection to be performed in the same hospitalization; and 4) a higher rate of good seizure control after resection. In other words, SEEG more accurately identified the EZ than the SDE method. We obtained similar results in our preliminary experiences under limited conditions. In Japan, as of August 2022, dedicated electrodes and SEEG accessories have not been approved and the use of the robot arm is not widespread. The Japanese medical community is hopeful that these issues will soon be resolved and that the experience with SEEG in Japan will align with that of large epilepsy centers internationally.
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Affiliation(s)
- Satoshi MAESAWA
- Department of Neurosurgery, Nagoya University School of Medicine
| | | | - Manabu MUTOH
- Department of Neurosurgery, Nagoya University School of Medicine
| | - Yoshiki ITO
- Department of Neurosurgery, Nagoya University School of Medicine
| | - Jun TORII
- Department of Neurosurgery, Nagoya University School of Medicine
| | - Takafumi TANEI
- Department of Neurosurgery, Nagoya University School of Medicine
| | | | - Ryuta SAITO
- Department of Neurosurgery, Nagoya University School of Medicine
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30
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A comparison between robot-guided and stereotactic frame-based stereoelectroencephalography (SEEG) electrode implantation for drug-resistant epilepsy. J Robot Surg 2022; 17:1013-1020. [DOI: 10.1007/s11701-022-01504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
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31
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Intermediate stimulation frequencies for language mapping using Stereo-EEG. Clin Neurophysiol 2022; 144:91-97. [PMID: 36327599 DOI: 10.1016/j.clinph.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Identification of eloquent cortices is a prerequisite for the surgical plan but may be challenging, in particular for language areas (LAs), considering the complexity of language function and organization. Electrical intracerebral stimulations (ES) during Stereo-electroencephalography are an essential tool in the localization of LAs and high frequency ES (HFS, 50 Hz) are current gold standard. Low frequencies (1 Hz) are not effective. We aim to investigate different ES frequencies for establishing their utility in localizing LAs. METHODS We implemented an observational and prospective study evaluating frequencies lower than 50 and higher than 1 Hz; indicated as "intermediate" frequencies (IFS) performed at 6, 9 and 12 Hz and lasting 15 seconds. We included ten patients and carried out a standardized protocol comparing IFS to HFS. RESULTS Eighty-six ES were carried out in LAs, positive for a language interference in 61.6% without noteworthy difference between IFS and HFS. Among these, 53.3% IFS vs 21.7% HFS yielded no after-discharge. CONCLUSIONS IFS were similarly effective as HFS, with lower incidence of ADs. Their longer duration facilitated more accurate clinical testing. SIGNIFICANCE Our results are promising, suggesting that IFS can be useful in the study of LAs.
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32
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Zauli FM, Del Vecchio M, Russo S, Mariani V, Pelliccia V, d'Orio P, Sartori I, Avanzini P, Caruana F. The web of laughter: frontal and limbic projections of the anterior cingulate cortex revealed by cortico-cortical evoked potential from sites eliciting laughter. Philos Trans R Soc Lond B Biol Sci 2022; 377:20210180. [PMID: 36126672 PMCID: PMC9489285 DOI: 10.1098/rstb.2021.0180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/02/2022] [Indexed: 12/20/2022] Open
Abstract
According to an evolutionist approach, laughter is a multifaceted behaviour affecting social, emotional, motor and speech functions. Albeit previous studies have suggested that high-frequency electrical stimulation (HF-ES) of the pregenual anterior cingulate cortex (pACC) may induce bursts of laughter-suggesting a crucial contribution of this region to the cortical control of this behaviour-the complex nature of laughter implies that outward connections from the pACC may reach and affect a complex network of frontal and limbic regions. Here, we studied the effective connectivity of the pACC by analysing the cortico-cortical evoked potentials elicited by single-pulse electrical stimulation of pACC sites whose HF-ES elicited laughter in 12 patients. Once these regions were identified, we studied their clinical response to HF-ES, to reveal the specific functional target of pACC representation of laughter. Results reveal that the neural representation of laughter in the pACC interacts with several frontal and limbic regions, including cingulate, orbitofrontal, medial prefrontal and anterior insular regions-involved in interoception, emotion, social reward and motor behaviour. These results offer neuroscientific support to the evolutionist approach to laughter, providing a possible mechanistic explanation of the interplay between this behaviour and emotion regulation, speech production and social interactions. This article is part of the theme issue 'Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience'.
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Affiliation(s)
- F M Zauli
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milan, Italy
- Department of Philosophy 'Piero Martinetti', University of Milan, Milan, Italy
- 'Claudio Munari' Epilepsy Surgery Center, ASST GOM Niguarda, Milan, Italy
| | - M Del Vecchio
- Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy
| | - S Russo
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milan, Italy
- Department of Philosophy 'Piero Martinetti', University of Milan, Milan, Italy
- Allen Institute, Seattle, WA
| | - V Mariani
- Neurology and Stroke Unit Division, Circolo Hospital ASST Settelaghi University of Insubria, Varese, Italy
| | - V Pelliccia
- 'Claudio Munari' Epilepsy Surgery Center, ASST GOM Niguarda, Milan, Italy
| | - P d'Orio
- 'Claudio Munari' Epilepsy Surgery Center, ASST GOM Niguarda, Milan, Italy
- Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma
| | - I Sartori
- 'Claudio Munari' Epilepsy Surgery Center, ASST GOM Niguarda, Milan, Italy
| | - P Avanzini
- Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy
| | - F Caruana
- Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy
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33
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Miller KJ, Fine AL. Decision-making in stereotactic epilepsy surgery. Epilepsia 2022; 63:2782-2801. [PMID: 35908245 PMCID: PMC9669234 DOI: 10.1111/epi.17381] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
Surgery can cure or significantly improve both the frequency and the intensity of seizures in patients with medication-refractory epilepsy. The set of diagnostic and therapeutic interventions involved in the path from initial consultation to definitive surgery is complex and includes a multidisciplinary team of neurologists, neurosurgeons, neuroradiologists, and neuropsychologists, supported by a very large epilepsy-dedicated clinical architecture. In recent years, new practices and technologies have emerged that dramatically expand the scope of interventions performed. Stereoelectroencephalography has become widely adopted for seizure localization; stereotactic laser ablation has enabled more focal, less invasive, and less destructive interventions; and new brain stimulation devices have unlocked treatment of eloquent foci and multifocal onset etiologies. This article articulates and illustrates the full framework for how epilepsy patients are considered for surgical intervention, with particular attention given to stereotactic approaches.
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Affiliation(s)
- Kai J. Miller
- Neurosurgery, Mayo Clinic, 200 First St., Rochester, MN, 55902
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El Hadji S, Bonilauri A, De Momi E, Castana L, Macera A, Berta L, Cardinale F, Baselli G. Validation of SART 3.5D algorithm for cerebrovascular dynamics and artery versus vein classification in presurgical 3D digital subtraction angiographies. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac8c7f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/24/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Classification of arteries and veins in cerebral angiograms can increase the safety of neurosurgical procedures, such as StereoElectroEncephaloGraphy, and aid the diagnosis of vascular pathologies, as arterovenous malformations. We propose a new method for vessel classification using the contrast medium dynamics in rotational digital subtraction angiography (DSA). After 3D DSA and angiogram segmentation, contrast enhanced projections are processed to suppress soft tissue and bone structures attenuation effect and further enhance the CM flow. For each voxel labelled as vessel, a time intensity curve (TIC) is obtained as a linear combination of temporal basis functions whose weights are addressed by simultaneous algebraic reconstruction technique (SART 3.5D), expanded to include dynamics. Each TIC is classified by comparing the areas under the curve in the arterial and venous phases. Clustering is applied to optimize the classification thresholds. On a dataset of 60 patients, a median value of sensitivity (90%), specificity (91%), and accuracy (92%) were obtained with respect to annotated arterial and venous voxels up to branching order 4–5. Qualitative results are also presented about CM arrival time mapping and its distribution in arteries and veins respectively. In conclusion, this study shows a valuable impact, at no protocol extra-cost or invasiveness, concerning surgical planning related to the enhancement of arteries as major organs at risk. Also, it opens a new scope on the pathophysiology of cerebrovascular dynamics and its anatomical relationships.
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Abdallah C, Hedrich T, Koupparis A, Afnan J, Hall JA, Gotman J, Dubeau F, von Ellenrieder N, Frauscher B, Kobayashi E, Grova C. Clinical Yield of Electromagnetic Source Imaging and Hemodynamic Responses in Epilepsy: Validation With Intracerebral Data. Neurology 2022; 98:e2499-e2511. [PMID: 35473762 PMCID: PMC9231837 DOI: 10.1212/wnl.0000000000200337] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Accurate delineation of the seizure-onset zone (SOZ) in focal drug-resistant epilepsy often requires stereo-EEG (SEEG) recordings. Our aims were to propose a truly objective and quantitative comparison between EEG/magnetoencephalography (MEG) source imaging (EMSI), EEG/fMRI responses for similar spikes with primary irritative zone (PIZ) and SOZ defined by SEEG and to evaluate the value of EMSI and EEG/fMRI to predict postsurgical outcome. METHODS We identified patients with drug-resistant epilepsy who underwent EEG/MEG, EEG/fMRI, and subsequent SEEG at the Epilepsy Service from the Montreal Neurological Institute and Hospital. We quantified multimodal concordance within the SEEG channel space as spatial overlap with PIZ/SOZ and distances to the spike-onset, spike maximum amplitude and seizure core intracerebral channels by applying a new methodology consisting of converting EMSI results into SEEG electrical potentials (EMSIe-SEEG) and projecting the most significant fMRI response on the SEEG channels (fMRIp-SEEG). Spatial overlaps with PIZ/SOZ (AUCPIZ, AUCSOZ) were assessed by using the area under the receiver operating characteristic curve (AUC). Here, AUC represents the probability that a randomly picked active contact exhibited higher amplitude when located inside the spatial reference than outside. RESULTS Seventeen patients were included. Mean spatial overlaps with the PIZ and SOZ were 0.71 and 0.65 for EMSIe-SEEG and 0.57 and 0.62 for fMRIp-SEEG. Good EMSIe-SEEG spatial overlap with the PIZ was associated with smaller distance from the maximum EMSIe-SEEG contact to the spike maximum amplitude channel (median distance 14 mm). Conversely, good fMRIp-SEEG spatial overlap with the SOZ was associated with smaller distances from the maximum fMRIp-SEEG contact to the spike-onset and seizure core channels (median distances 10 and 5 mm, respectively). Surgical outcomes were correctly predicted by EEG/MEG in 12 of 15 (80%) patients and EEG/fMRI in 6 of 11(54%) patients. DISCUSSION With the use of a unique quantitative approach estimating EMSI and fMRI results in the reference SEEG channel space, EEG/MEG and EEG/fMRI accurately localized the SOZ and the PIZ. Precisely, EEG/MEG more accurately localized the PIZ, whereas EEG/fMRI was more sensitive to the SOZ. Both neuroimaging techniques provide complementary localization that can help guide SEEG implantation and select good candidates for surgery.
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Affiliation(s)
- Chifaou Abdallah
- From the Multimodal Functional Imaging Lab (C.A., T.H., J.A., C.G.), Biomedical Engineering Department, Montreal Neurological Institute and Hospital (C.A., A.K., J.A., J.A.H., J.G., F.D., N.v.E., B.F., E.K., C.G.), Neurology and Neurosurgery Department, and Analytical Neurophysiology Lab (T.H., B.F.), McGill University; and Multimodal Functional Imaging Lab (C.G.), PERFORM Centre, Department of Physics, Concordia University, Montreal, Quebec, Canada.
| | - Tanguy Hedrich
- From the Multimodal Functional Imaging Lab (C.A., T.H., J.A., C.G.), Biomedical Engineering Department, Montreal Neurological Institute and Hospital (C.A., A.K., J.A., J.A.H., J.G., F.D., N.v.E., B.F., E.K., C.G.), Neurology and Neurosurgery Department, and Analytical Neurophysiology Lab (T.H., B.F.), McGill University; and Multimodal Functional Imaging Lab (C.G.), PERFORM Centre, Department of Physics, Concordia University, Montreal, Quebec, Canada
| | - Andreas Koupparis
- From the Multimodal Functional Imaging Lab (C.A., T.H., J.A., C.G.), Biomedical Engineering Department, Montreal Neurological Institute and Hospital (C.A., A.K., J.A., J.A.H., J.G., F.D., N.v.E., B.F., E.K., C.G.), Neurology and Neurosurgery Department, and Analytical Neurophysiology Lab (T.H., B.F.), McGill University; and Multimodal Functional Imaging Lab (C.G.), PERFORM Centre, Department of Physics, Concordia University, Montreal, Quebec, Canada
| | - Jawata Afnan
- From the Multimodal Functional Imaging Lab (C.A., T.H., J.A., C.G.), Biomedical Engineering Department, Montreal Neurological Institute and Hospital (C.A., A.K., J.A., J.A.H., J.G., F.D., N.v.E., B.F., E.K., C.G.), Neurology and Neurosurgery Department, and Analytical Neurophysiology Lab (T.H., B.F.), McGill University; and Multimodal Functional Imaging Lab (C.G.), PERFORM Centre, Department of Physics, Concordia University, Montreal, Quebec, Canada
| | - Jeffrey Alan Hall
- From the Multimodal Functional Imaging Lab (C.A., T.H., J.A., C.G.), Biomedical Engineering Department, Montreal Neurological Institute and Hospital (C.A., A.K., J.A., J.A.H., J.G., F.D., N.v.E., B.F., E.K., C.G.), Neurology and Neurosurgery Department, and Analytical Neurophysiology Lab (T.H., B.F.), McGill University; and Multimodal Functional Imaging Lab (C.G.), PERFORM Centre, Department of Physics, Concordia University, Montreal, Quebec, Canada
| | - Jean Gotman
- From the Multimodal Functional Imaging Lab (C.A., T.H., J.A., C.G.), Biomedical Engineering Department, Montreal Neurological Institute and Hospital (C.A., A.K., J.A., J.A.H., J.G., F.D., N.v.E., B.F., E.K., C.G.), Neurology and Neurosurgery Department, and Analytical Neurophysiology Lab (T.H., B.F.), McGill University; and Multimodal Functional Imaging Lab (C.G.), PERFORM Centre, Department of Physics, Concordia University, Montreal, Quebec, Canada
| | - Francois Dubeau
- From the Multimodal Functional Imaging Lab (C.A., T.H., J.A., C.G.), Biomedical Engineering Department, Montreal Neurological Institute and Hospital (C.A., A.K., J.A., J.A.H., J.G., F.D., N.v.E., B.F., E.K., C.G.), Neurology and Neurosurgery Department, and Analytical Neurophysiology Lab (T.H., B.F.), McGill University; and Multimodal Functional Imaging Lab (C.G.), PERFORM Centre, Department of Physics, Concordia University, Montreal, Quebec, Canada
| | - Nicolas von Ellenrieder
- From the Multimodal Functional Imaging Lab (C.A., T.H., J.A., C.G.), Biomedical Engineering Department, Montreal Neurological Institute and Hospital (C.A., A.K., J.A., J.A.H., J.G., F.D., N.v.E., B.F., E.K., C.G.), Neurology and Neurosurgery Department, and Analytical Neurophysiology Lab (T.H., B.F.), McGill University; and Multimodal Functional Imaging Lab (C.G.), PERFORM Centre, Department of Physics, Concordia University, Montreal, Quebec, Canada
| | - Birgit Frauscher
- From the Multimodal Functional Imaging Lab (C.A., T.H., J.A., C.G.), Biomedical Engineering Department, Montreal Neurological Institute and Hospital (C.A., A.K., J.A., J.A.H., J.G., F.D., N.v.E., B.F., E.K., C.G.), Neurology and Neurosurgery Department, and Analytical Neurophysiology Lab (T.H., B.F.), McGill University; and Multimodal Functional Imaging Lab (C.G.), PERFORM Centre, Department of Physics, Concordia University, Montreal, Quebec, Canada
| | - Eliane Kobayashi
- From the Multimodal Functional Imaging Lab (C.A., T.H., J.A., C.G.), Biomedical Engineering Department, Montreal Neurological Institute and Hospital (C.A., A.K., J.A., J.A.H., J.G., F.D., N.v.E., B.F., E.K., C.G.), Neurology and Neurosurgery Department, and Analytical Neurophysiology Lab (T.H., B.F.), McGill University; and Multimodal Functional Imaging Lab (C.G.), PERFORM Centre, Department of Physics, Concordia University, Montreal, Quebec, Canada
| | - Christophe Grova
- From the Multimodal Functional Imaging Lab (C.A., T.H., J.A., C.G.), Biomedical Engineering Department, Montreal Neurological Institute and Hospital (C.A., A.K., J.A., J.A.H., J.G., F.D., N.v.E., B.F., E.K., C.G.), Neurology and Neurosurgery Department, and Analytical Neurophysiology Lab (T.H., B.F.), McGill University; and Multimodal Functional Imaging Lab (C.G.), PERFORM Centre, Department of Physics, Concordia University, Montreal, Quebec, Canada
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Makhalova J, Medina Villalon S, Wang H, Giusiano B, Woodman M, Bénar C, Guye M, Jirsa V, Bartolomei F. Virtual Epileptic Patient brain modeling: relationships with seizure onset and surgical outcome. Epilepsia 2022; 63:1942-1955. [PMID: 35604575 PMCID: PMC9543509 DOI: 10.1111/epi.17310] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Abstract
Objective The virtual epileptic patient (VEP) is a large‐scale brain modeling method based on virtual brain technology, using stereoelectroencephalography (SEEG), anatomical data (magnetic resonance imaging [MRI] and connectivity), and a computational neuronal model to provide computer simulations of a patient's seizures. VEP has potential interest in the presurgical evaluation of drug‐resistant epilepsy by identifying regions most likely to generate seizures. We aimed to assess the performance of the VEP approach in estimating the epileptogenic zone and in predicting surgical outcome. Methods VEP modeling was retrospectively applied in a cohort of 53 patients with pharmacoresistant epilepsy and available SEEG, T1‐weighted MRI, and diffusion‐weighted MRI. Precision recall was used to compare the regions identified as epileptogenic by VEP (EZVEP) to the epileptogenic zone defined by clinical analysis incorporating the Epileptogenicity Index (EI) method (EZC). In 28 operated patients, we compared the VEP results and clinical analysis with surgical outcome. Results VEP showed a precision of 64% and a recall of 44% for EZVEP detection compared to EZC. There was a better concordance of VEP predictions with clinical results, with higher precision (77%) in seizure‐free compared to non‐seizure‐free patients. Although the completeness of resection was significantly correlated with surgical outcome for both EZC and EZVEP, there was a significantly higher number of regions defined as epileptogenic exclusively by VEP that remained nonresected in non‐seizure‐free patients. Significance VEP is the first computational model that estimates the extent and organization of the epileptogenic zone network. It is characterized by good precision in detecting epileptogenic regions as defined by a combination of visual analysis and EI. The potential impact of VEP on improving surgical prognosis remains to be exploited. Analysis of factors limiting the performance of the actual model is crucial for its further development.
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Affiliation(s)
- Julia Makhalova
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France.,Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Timone Hospital, CEMEREM, Marseille, France
| | - Samuel Medina Villalon
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France.,Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Huifang Wang
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Bernard Giusiano
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,APHM, Public Health Department, Marseille, France
| | - Marmaduke Woodman
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Christian Bénar
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Maxime Guye
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France.,Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Timone Hospital, CEMEREM, Marseille, France
| | - Viktor Jirsa
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France.,Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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Parmigiani S, Mikulan EP, Russo S, Sarasso S, Zauli FM, Rubino A, Cattani A, Fecchio M, Giampiccolo D, Lanzone J, D'Orio P, Del Vecchio M, Avanzini P, Nobili L, Sartori I, Massimini M, Pigorini A. Simultaneous stereo-EEG and high-density scalp EEG recordings to study the effects of intracerebral stimulation parameters. Brain Stimul 2022; 15:664-675. [PMID: 35421585 DOI: 10.1016/j.brs.2022.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cortico-cortical evoked potentials (CCEPs) recorded by stereo-electroencephalography (SEEG) are a valuable tool to investigate brain reactivity and effective connectivity. However, invasive recordings are spatially sparse since they depend on clinical needs. This sparsity hampers systematic comparisons across-subjects, the detection of the whole-brain effects of intracortical stimulation, as well as their relationships to the EEG responses evoked by non-invasive stimuli. OBJECTIVE To demonstrate that CCEPs recorded by high-density electroencephalography (hd-EEG) provide additional information with respect SEEG alone and to provide an open, curated dataset to allow for further exploration of their potential. METHODS The dataset encompasses SEEG and hd-EEG recordings simultaneously acquired during Single Pulse Electrical Stimulation (SPES) in drug-resistant epileptic patients (N = 36) in whom stimulations were delivered with different physical, geometrical, and topological parameters. Differences in CCEPs were assessed by amplitude, latency, and spectral measures. RESULTS While invasively and non-invasively recorded CCEPs were generally correlated, differences in pulse duration, angle and stimulated cortical area were better captured by hd-EEG. Further, intracranial stimulation evoked site-specific hd-EEG responses that reproduced the spectral features of EEG responses to transcranial magnetic stimulation (TMS). Notably, SPES, albeit unperceived by subjects, elicited scalp responses that were up to one order of magnitude larger than the responses typically evoked by sensory stimulation in awake humans. CONCLUSIONS CCEPs can be simultaneously recorded with SEEG and hd-EEG and the latter provides a reliable descriptor of the effects of SPES as well as a common reference to compare the whole-brain effects of intracortical stimulation to those of non-invasive transcranial or sensory stimulations in humans.
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Affiliation(s)
- S Parmigiani
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - E P Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - S Russo
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Philosophy "Piero Martinetti", Università degli Studi di Milano, Milan, Italy
| | - S Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy
| | - F M Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Philosophy "Piero Martinetti", Università degli Studi di Milano, Milan, Italy
| | - A Rubino
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - A Cattani
- Department of Mathematics & Statistics, Boston University, Boston, MA, USA
| | - M Fecchio
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - D Giampiccolo
- Department of Neurosurgery, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Institute of Neurosciences, Cleveland Clinic London, London, UK
| | - J Lanzone
- Department of Systems Medicine, Neuroscience, University of Rome Tor Vergata, Rome, Italy; Istituti Clinici Scientifici Maugeri, IRCCS, Neurorehabilitation Department of Milano Institute, Milan, Italy
| | - P D'Orio
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy; Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - M Del Vecchio
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - P Avanzini
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - L Nobili
- Child Neuropsychiatry, IRCCS Istituto G. Gaslini, Genova, Italy
| | - I Sartori
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - M Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy; Azrieli Program in Brain, Mind and Consciousness, Canadian Institute for Advanced Research, Toronto, Canada
| | - A Pigorini
- Department of Biomedical and Clinical Sciences "L. Sacco" Università degli Studi di Milano, Milan, Italy; Department of Biomedical, V, Università degli Studi di Milano, Milan, Italy.
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Nagahama Y, Alexander AL, O'Neill BR. Intracranial pressure monitoring during stereoelectroencephalography implantation: a technical note. J Neurosurg Pediatr 2022; 29:454-457. [PMID: 35061987 DOI: 10.3171/2021.12.peds21490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/09/2021] [Indexed: 11/06/2022]
Abstract
Stereoelectroencephalography (SEEG) has become increasingly employed as a critical component of epilepsy workups for patients with drug-resistant epilepsy when information from noninvasive studies is not conclusive and sufficient to guide epilepsy surgery. Although exceedingly rare, clinically significant hemorrhagic complications can be caused during SEEG implantation procedures. Intracranial hemorrhage (ICH) can be difficult to recognize due to the minimally invasive nature of SEEG. The authors describe their technique using a commercially available intraparenchymal intracranial pressure (ICP) monitor as a method for early intraoperative detection of ICH during SEEG implantation. Between May 2019 and July 2021, 18 pediatric patients underwent SEEG implantation at a single, freestanding children's hospital with the use of an ICP monitor during the procedure. No patients experienced complications resulting from this technique. The authors have relayed their rationale for ICP monitor use during SEEG, the technical considerations, and the safety profile. In addition, they have reported an illustrative case in which the ICP monitor proved crucial in early detection of ICH during SEEG implantation.
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Affiliation(s)
- Yasunori Nagahama
- 1Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora.,2Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado; and.,3Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Allyson L Alexander
- 1Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora.,2Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado; and
| | - Brent R O'Neill
- 1Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora.,2Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado; and
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Menghi V, Bisulli F, Cardinale F, Vignatelli L, Zenesini C, Mai R, Proserpio P, Francione S, Sartori I, Tinuper P, Nobili L. Predictors of hyperkinetic seizures. Epilepsy Behav 2022; 129:108629. [PMID: 35272206 DOI: 10.1016/j.yebeh.2022.108629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify predisposing factors for hyperkinetic seizure occurrence in a representative cohort of surgically treated patients with drug-resistant focal epilepsy. METHODS We retrospectively recruited all seizure-free patients after epilepsy surgery with a postoperative follow-up ≥12 months. Patients were classified as presenting with hyperkinetic seizures if at least 2 episodes occurred during their disease history, based on clear-cut anamnestic description and/or video-EEG/stereo-EEG recordings. We performed univariable and multivariable logistic regression models to study the association between the occurrence of hyperkinetic seizures and some predictors. RESULTS From a pool of 1758 consecutive patients who underwent surgery from 1996 to 2017, we identified 974 seizure-free cases. Considering at least 1-year follow-up, 937 cases were included (511 males, 91 patients with hyperkinetic seizures). Variables significantly associated with an increased risk of hyperkinetic seizure occurrence were (1) presence of epilepsy with sleep-related seizures (SRE) (P < 0.001); (2) histological diagnosis of type II focal cortical dysplasia (FCD) (P < 0.001); (3) resection including the frontal lobe (P = 0.002) (4) duration of epilepsy at surgery (P < 0.001) and (5) high seizure frequency at surgery (weekly: P = 0.02 - daily: P = 0.05). A resection including the occipital lobe reduced the risk of hyperkinetic seizures (P = 0.05). About 63% of patients had hyperkinetic seizure onset before 12 years and it was rarely reported before 5 years of age. SIGNIFICANCE Our findings underlie the role of SRE, type II FCD and frontal epileptogenic zone as predictors of hyperkinetic seizure occurrence and highlight an age-dependent effect in favoring hyperkinetic manifestations.
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Affiliation(s)
- Veronica Menghi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; Neurology Unit, Rimini "Infermi" Hospital-AUSL Romagna, Rimini, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy (Reference Center for Rare and Complex Epilepsies-EpiCARE), Italy
| | | | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy (Reference Center for Rare and Complex Epilepsies-EpiCARE), Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy (Reference Center for Rare and Complex Epilepsies-EpiCARE), Italy
| | - Roberto Mai
- Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Paola Proserpio
- Centre of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | | | - Ivana Sartori
- Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy (Reference Center for Rare and Complex Epilepsies-EpiCARE), Italy
| | - Lino Nobili
- IRCCS, Child Neuropsychiatry, Istituto G. Gaslini, Italy (Reference Center for Rare and Complex Epilepsies-EpiCARE), Italy; DINOGMI, University of Genoa, Genoa, Italy.
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Michele R, Ivana S, Maria DV, Luca B, Domenico L, Maria ZF, Alessandro DB, Silvio S, Khalid AO, Valeria M, Pietro A. Tracing in vivo the dorsal loop of the optic radiation: convergent perspectives from tractography and electrophysiology compared to a neuroanatomical ground truth. Brain Struct Funct 2022; 227:1357-1370. [PMID: 35320828 DOI: 10.1007/s00429-021-02430-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/12/2021] [Indexed: 01/18/2023]
Abstract
The temporo-parietal junction (TPJ) is a cortical area contributing to a multiplicity of visual, language-related, and cognitive functions. In line with this functional richness, also the organization of the underlying white matter is highly complex and includes several bundles. The few studies tackling the outcome and neurological burdens of surgical operations addressing TPJ document the presence of language disturbances and visual field damages, with the latter hardly recovered in time. This observation advocates for identifying and functionally monitoring the optic radiation (OR) bundles that cross the white matter below the TPJ. In the present study, we adopted a multimodal approach to address the anatomo-functional correlates of the OR's dorsal loop. In particular, we combined cadavers' dissection with tractographic and electrophysiological data collected in drug-resistant epileptic patients explored by stereoelectroencephalography (SEEG). Cadaver dissection allowed us to appreciate the course and topography of the dorsal loop. More surprisingly, both tractographic and electrophysiological observations converged on a unitary picture highly coherent with the data obtained by neuroanatomical observation. The combination of diverse and multimodal observations allows overcoming the limitations intrinsic to single methodologies, defining a unitary picture which makes it possible to investigate the dorsal loop both presurgically and at the individual patient level, ultimately contributing to limit the postsurgical damages. Notwithstanding, such a combined approach could serve as a model of investigation for future neuroanatomical inquiries tackling white matter fibers anatomy and function through SEEG-derived neurophysiological data.
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Affiliation(s)
- Rizzi Michele
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy
| | - Sartori Ivana
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy.
| | - Del Vecchio Maria
- Institute of Neuroscience, National Research Council of Italy, Parma, Italy
| | - Berta Luca
- Department of Medical Physics, ASST GOM Niguarda, Milan, Italy
| | - Lizio Domenico
- Department of Medical Physics, ASST GOM Niguarda, Milan, Italy
| | - Zauli Flavia Maria
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - De Benedictis Alessandro
- Department of Neurosciences, Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sarubbo Silvio
- Department of Neurosurgery, Ospedale Santa Chiara, Trento, Italy
| | - Al-Orabi Khalid
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy
| | - Mariani Valeria
- Neurology and Stroke Unit, ASST Sette Laghi-Ospedale di Circolo, Varese, Italy
| | - Avanzini Pietro
- Institute of Neuroscience, National Research Council of Italy, Parma, Italy
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41
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Kassiri J, Elliott C, Liu N, Narvacan K, Wheatly M, Sinclair D. Safety and Efficacy of Stereoelectroencephalography in Pediatric Epilepsy Surgery. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1743192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractStereoelectroencephalography (SEEG) is the preoperative assessment of choice when the epileptogenic zone (EZ) is unclear in patients requiring surgery for severe, drug-refractory epilepsy. There are relatively little data on the safety and efficacy of SEEG in the pediatric epilepsy population. We, therefore, investigated the insertional complications, rate of successful identification of the EZ, and long-term seizure outcomes following surgery after SEEG in children. This was a retrospective study of drug-resistant pediatric epilepsy patients treated with surgery between 2005 and 2020 and who underwent presurgical SEEG. Rationale for and coverage of SEEG, identification of the EZ, and ultimate seizure outcome following SEEG-tailored resections were collected and analyzed. Thirty patients (15 male, mean age: 12.4 ± 5 years) who underwent SEEG were studied. SEEG-related complications occurred in one case (3%). A total of 190 multicontact electrodes (mean: 7.0 ± 2.5 per patient) were implanted across 30 insertions capturing 440 electrographic seizures (mean: 17.5 ± 27.6 per patient). The most common rationale for SEEG was normal magnetic resonance imaging with surface EEG that failed to identify the EZ (17/30; 57%). SEEG identified a putative EZ in all cases, resulting in SEEG-tailored resections in 25/30 (83%). Freedom from disabling seizures was achieved following resections in 20/25 cases (80%) with 5.9 ± 4.0 years of postoperative follow-up. SEEG is a safe and effective way to identify the EZ in the presurgical evaluation of children with refractory epilepsy and permits effective and long-lasting SEEG-tailored resections.
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Affiliation(s)
- Janani Kassiri
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
- Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
| | - Cameron Elliott
- Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Natarie Liu
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
- Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
| | - Karl Narvacan
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Matt Wheatly
- Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - D.Barry Sinclair
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
- Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
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Pelliccia V, Avanzini P, Rizzi M, Caruana F, Tassi L, Francione S, Gozzo F, Mariani V, d'Orio P, Castana L, Mai R, Terzaghi M, Nobili L, Sartori I. Association Between Semiology and Anatomo-Functional Localization in Patients With Cingulate Epilepsy: A Cohort Study. Neurology 2022; 98:e2211-e2223. [PMID: 35190463 DOI: 10.1212/wnl.0000000000200145] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cingulate epilepsy (CE) is a rare and challenging type of focal epilepsy, due to the polymorphic semiology of the seizures, mimicking other types of epilepsy, and the limited utility of scalp-EEG. METHODS We selected consecutive drug-resistant subjects with CE who were seizure-free after surgery, with seizure onset zone (SOZ) confirmed in the CC (cingulate cortex) by histology and/or SEEG. We analysed subjective and objective ictal manifestations using video recordings and correlated semeiology with anatomical CC subregions (anterior, anterior middle, posterior middle and posterior) localization of SOZ. RESULTS We analysed 122 seizures in 57 patients. Seizures were globally characterized by complex behaviors, typically natural seeming and often accompanied by emotional components.All objective ictal variables considered (pronation of the body or getting up from a lying/sitting position, tonic/dystonic posturing, hand movements, asymmetry, vocalizations, fluidity and repetitiveness of motor manifestations, awareness and emotional and autonomic components) were differently distributed among CC subregions (p<.05) Along the rostro-caudal axis fluidity and repetitiveness of movement, vocalizations, body pronation and emotional components decrease anterior-posteriorly, while tonic/dystonic postures, signs of lateralization and awareness increase.Vestibular and asymmetric somatosensory, somatosensory and epigastric and enteroceptive/autonomic symptoms were distributed differently among CC subregions (p<.05). Along the rostro-caudal axis vestibular, somatosensory and somatosensory asymmetric symptoms increase anterior-posterior. DISCUSSION CE is characterized by a spectrum of semeiological manifestations with a topographic distribution. CE semiology could indicate which cingulate sector is mainly involved.
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Affiliation(s)
- Veronica Pelliccia
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Michele Rizzi
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Stefano Francione
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Francesca Gozzo
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Piergiorgio d'Orio
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.,CNR Institute of Neuroscience, Parma, Italy
| | - Laura Castana
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Roberto Mai
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.,Child Neuropsychiatry Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Ivana Sartori
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
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43
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Cui D, Gao R, Xu C, Yan H, Zhang X, Yu T, Zhang G. Ictal onset stereoelectroencephalography patterns in temporal lobe epilepsy: type, distribution, and prognostic value. Acta Neurochir (Wien) 2022; 164:555-563. [PMID: 35041086 DOI: 10.1007/s00701-022-05122-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the different ictal onset stereoelectroencephalography patterns (IOPs) in patients with drug-resistant temporal lobe epilepsy (TLE). We examined whether the IOPs relate to different TLE subtypes, MRI findings, and underlying pathologies, and we evaluated their prognostic value for predicting the surgical outcome. METHODS We retrospectively analyzed data from patients with TLE who underwent stereoelectroencephalography (SEEG) monitoring followed by surgical resection between January 2018 and January 2020. The SEEG recordings were independently analyzed by two epileptologists. RESULTS Forty-five patients were included in the study, and 61seizures were analyzed. Five IOPs were identified: low voltage fast activity (LVFA; 44.3%), spike-and-wave activity (16.4%), low frequency high-amplitude periodic spikes (LFPS; 18%), a burst of high-amplitude polyspikes (8.2%), and rhythmic sharp activity at ≤ 13 Hz (13.1%). Thirty-two patients were found to have a single IOP, while the other 13 patients had two or more IOPs. All five IOPs were found to occur in the medial temporal lobe epilepsy (MTLE), while four IOPs occurred in the lateral temporal lobe epilepsy (LTLE). The LFPS was a common IOP that could distinguish MTLE from LTLE (x2 = 7.046, p = 0.011). Among the MTLE patients, the LFPS was exclusively seen in cases of hippocampal sclerosis (x2 = 5.058, p = 0.038), while the LVFA was associated with nonspecific histology (x2 = 6.077, p = 0.023). The IOPs were not found to differ according to whether the MRI scans were positive or negative. After surgery, patients achieved the higher seizure-free rate at 81.8% and 77.8%, respectively, if the LFPS and LVFA were the predominant patterns. Multiple IOPs or a negative MRI did not indicate a poor prognosis. CONCLUSIONS Five distinct IOPs were identified in the patients with TLE. The differences found have important clinical implications and could provide complementary information for surgical decision-making, especially in MRI-negative patients.
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Affiliation(s)
- Deqiu Cui
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Runshi Gao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Cuiping Xu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Hao Yan
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiaohua Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
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44
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McGonigal A. Frontal lobe seizures: overview and update. J Neurol 2022; 269:3363-3371. [PMID: 35006387 DOI: 10.1007/s00415-021-10949-0] [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: 12/16/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/27/2022]
Abstract
Frontal lobe seizures (FLS) are debilitating for patients, highly diverse and often challenging for clinicians to evaluate. Frontal lobe epilepsy is the second most common localization for focal epilepsy, and if pharmacoresistant, can be amenable to resective surgery. Detailed study of frontal seizure semiology in conjunction with careful anatomical and electrophysiological correlation based on intracerebral recording with stereoelectroencephalography (SEEG) has allowed demonstration that ictal motor semiology reflects a hierarchical rostro-caudal axis of frontal lobe functional organization, thus helping with presurgical localization. Main semiological features allowing distinction between different frontal sublobar regions include motor signs and emotional signs. Frontal lobe seizure semiology also represents a valuable source of in vivo human behavioral data from a neuroscientific perspective. Advances in defining underlying etiologies of FLE are likely to be crucial for appropriate selection and exploration of potential surgical candidates, which could improve upon current surgical outcomes. Future research on investigating the genetic basis of epilepsies and relation to structural substrate (e.g. focal cortical dysplasia) and seizure organization and expression, could permit a "genotype-phenotype" approach that could be complementary to anatomical electroclinical correlations in better defining the spectrum of FLS. This could help with optimizing patient selection and prognostication with regards to therapeutic choices.
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Affiliation(s)
- Aileen McGonigal
- Clinical Neurophysiology, Timone Hospital, APHM, Marseille, France. .,Inserm, INS, Institut de Neurosciences Des Systèmes, Aix Marseille Univ, Marseille, France.
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45
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Kim W, Shen MY, Provenzano FA, Lowenstein DB, McBrian DK, Mandel AM, Sands TT, Riviello JJ, McKhann GM, Feldstein NA, Akman CI. The role of stereo-electroencephalography to localize the epileptogenic zone in children with nonlesional brain magnetic resonance imaging. Epilepsy Res 2022; 179:106828. [PMID: 34920378 DOI: 10.1016/j.eplepsyres.2021.106828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/06/2021] [Accepted: 11/19/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aimed to assess the clinical outcome and outcome predictive factors in pediatric epilepsy patients evaluated with stereo-electroencephalography (SEEG). METHODS Thirty-eight patients who underwent SEEG implantation at the Pediatric Epilepsy Center in New York Presbyterian Hospital between June 2014 and December 2019 were enrolled for retrospective chart review. Postoperative seizure outcomes were evaluated in patients with at least 12-months follow up. Meta-analysis was conducted via electronic literature search of data reported from 2000 to 2020 to evaluate significant surgical outcome predictors for SEEG evaluation in the pediatric population. RESULTS In the current case series of 25 postsurgical patients with long-term follow up, 16 patients (64.0%) were seizure free. An additional 7 patients (28.0%) showed significant seizure improvement and 2 patients (8.0%) showed no change in seizure activity. Patients with nonlesional magnetic resonance imaging (MRI) achieved seizure freedom in 50% (5/10) of cases. By comparison, 73% (11/15) of patients with lesional MRI achieved seizure freedom. Out of 12 studies, 158 pediatric patients were identified for inclusion in a meta-analysis of the effectiveness of SEEG. Seizure freedom was reported 54.4% (n = 86/158) of patients at last follow up. Among patients with nonlesional MRI, 45% (n = 24) achieved seizure freedom compared with patients with lesional MRI findings (61.2%, n:= 60) (p = 0.02). The risk for seizure recurrence was 2.15 times higher [95% confidence interval [CI] 1.06-4.37, p = 0.033] in patients diagnosed with nonlesional focal epilepsy compared to those with lesional epilepsy [ 1.49 (95% CI 1.06-2.114, p = 0.021]. CONCLUSION Evaluation by SEEG implantation in pediatric epilepsy is effective in localizing the epileptogenic zone with favorable outcome. Presence of a non-lesional brain MRI was associated with lower chances of seizure freedom. Further research is warranted to improve the efficacy of SEEG in localizing the epileptogenic zone in pediatric patients with non-lesional brain MRI.
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Affiliation(s)
- Woojoong Kim
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - Min Y Shen
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - Frank A Provenzano
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, USA
| | - Daniel B Lowenstein
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - Danielle K McBrian
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - Arthur M Mandel
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - Tristan T Sands
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA
| | - James J Riviello
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, Columbia-Presbyterian, New York, USA
| | - Neil A Feldstein
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Columbia University Medical Center, Columbia-Presbyterian, New York, USA
| | - Cigdem I Akman
- Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA.
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Minkin K, Gabrovski K, Karazapryanov P, Milenova Y, Sirakov S, Dimova P. Theoretical stereoelectroencephalography density on the brain convexity. Epilepsy Res 2022; 179:106845. [PMID: 34968894 DOI: 10.1016/j.eplepsyres.2021.106845] [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: 09/28/2021] [Revised: 12/05/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Invasive electroencephalography (EEG) remains the "gold standard" for diagnosing the epileptogenic zone in patients with drug-resistant epilepsy and discrepancies between seizure semiology, video-EEG and magnetic resonance imaging (MRI) findings. However, the possibilities of stereoelectroencephalography (SEEG) to explore the brain surface remain a matter of debate and subdural EEG (SDEEG) is still preferred in some centers for cases when the supposed epileptogenic zone is on the brain convexity. The aim of our study was to evaluate the theoretical safe SEEG coverage on the brain convexity and to compare the theoretical SEEG cortical density with the usual SDEEG density. MATERIALS AND METHODS Our material included 10 hemispheres in 5 patients, who had been already investigated with SEEG for drug-resistant epilepsy. We translated our previously described technique in a theoretical model in an attempt to calculate the maximal number of avascular windows for each cerebral hemisphere. The distance between every entry point and the other entry points for each hemisphere was calculated using a mathematical formula. Subsequently, the theoretical SEEG coverage on the brain convexity was described using the maximal, minimal and average distances between each entry point and the closest 4 neighboring points. This type of measurement allows a direct comparison between SEEG and SDEEG in their ability to explore the brain convexity. RESULTS Ten hemispheres had 1328 safe entry points with a safety margin of 2.5 mm and a minimal distance of 2.5 mm between 2 entry points (average number of entry points: 132.8 (SD ± 5). The number of entry points in the explored 10 hemispheres varied from 104 to 156. The average distance between each entry point and its 4 neighbors was 11.47 mm. The maximal distance between two entry points in these 10 hemispheres was ranging from 20.28 to 27.23 mm (average: 24.67 mm). The closest entry points for the explored hemispheres were at an average distance of 4.67 mm (range: 2.82 - 5.96 mm). The average convexity surface was 223.68 cm2 (range: 204.63-238.77 cm2). The safe electrode density without electrode collision on the cortical surface was ranging from 0.46 to 0.69 electrodes per cm2 (average: 0.59 electrodes per cm2) (SD ± 0.023). CONCLUSION The theoretical SEEG cortical density is comparable with the usual SDEEG density. These findings, combined with the better safety profile of SEEG and the possibilities to explore deep cortical structures, explain the progressive shift from SDEEG to SEEG during the last years.
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Affiliation(s)
- Krasimir Minkin
- Department of Neurosurgery, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
| | - Kaloyan Gabrovski
- Department of Neurosurgery, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
| | - Petar Karazapryanov
- Department of Neurosurgery, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
| | - Yoana Milenova
- Department of Neurology, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
| | - Stanimir Sirakov
- Department of Interventional Radiology, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
| | - Petia Dimova
- Department of Neurosurgery, University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria, "Akad. Ivan Geshov" blvd, 15, Sofia 1000, Bulgaria.
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Diab E, Lefranc M, Perin B, Szurhaj W. Delayed intracerebral hemorrhage during stereo-electroencephalography: Electroencephalographic pattern. Neurophysiol Clin 2021; 52:178-181. [PMID: 34980545 DOI: 10.1016/j.neucli.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/11/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Eva Diab
- Department of Clinical Neurophysiology, CHU Amiens Picardie, Amiens, France.
| | - Michel Lefranc
- Department of Neurosurgery, CHU Amiens Picardie, Amiens, France; Research Unit in Robotic Surgery (GRECO), CHU Amiens Picardie, Amiens, France
| | - Bertille Perin
- Department of Clinical Neurophysiology, CHU Amiens Picardie, Amiens, France
| | - William Szurhaj
- Department of Clinical Neurophysiology, CHU Amiens Picardie, Amiens, France; Research Unit UR-7516 (CHIMERE), CHU Amiens Picardie, Amiens, France
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Del Vecchio M, Fossataro C, Zauli FM, Sartori I, Pigorini A, d'Orio P, Abarrategui B, Russo S, Mikulan EP, Caruana F, Rizzolatti G, Garbarini F, Avanzini P. Tonic somatosensory responses and deficits of tactile awareness converge in the parietal operculum. Brain 2021; 144:3779-3787. [PMID: 34633436 PMCID: PMC8719842 DOI: 10.1093/brain/awab384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/13/2021] [Accepted: 09/18/2021] [Indexed: 01/02/2023] Open
Abstract
Although clinical neuroscience and the neuroscience of consciousness have long sought mechanistic explanations of tactile-awareness disorders, mechanistic insights are rare, mainly because of the difficulty of depicting the fine-grained neural dynamics underlying somatosensory processes. Here, we combined the stereo-EEG responses to somatosensory stimulation with the lesion mapping of patients with a tactile-awareness disorder, namely tactile extinction. Whereas stereo-EEG responses present different temporal patterns, including early/phasic and long-lasting/tonic activities, tactile-extinction lesion mapping co-localizes only with the latter. Overlaps are limited to the posterior part of the perisylvian regions, suggesting that tonic activities may play a role in sustaining tactile awareness. To assess this hypothesis further, we correlated the prevalence of tonic responses with the tactile-extinction lesion mapping, showing that they follow the same topographical gradient. Finally, in parallel with the notion that visuotactile stimulation improves detection in tactile-extinction patients, we demonstrated an enhancement of tonic responses to visuotactile stimuli, with a strong voxel-wise correlation with the lesion mapping. The combination of these results establishes tonic responses in the parietal operculum as the ideal neural correlate of tactile awareness.
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Affiliation(s)
- Maria Del Vecchio
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, 43125 Parma, Italy
| | - Carlotta Fossataro
- MANIBUS Laboratory, Department of Psychology, University of Turin, 10124 Turin, Italy
| | - Flavia Maria Zauli
- Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco,' Università degli Studi di Milano, 20157 Milano, Italy
| | - Ivana Sartori
- Centro per la Chirurgia dell'Epilessia 'Claudio Munari,' Ospedale Ca' Granda-Niguarda, 20162 Milano, Italy
| | - Andrea Pigorini
- Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco,' Università degli Studi di Milano, 20157 Milano, Italy
| | - Piergiorgio d'Orio
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, 43125 Parma, Italy.,Centro per la Chirurgia dell'Epilessia 'Claudio Munari,' Ospedale Ca' Granda-Niguarda, 20162 Milano, Italy
| | - Belen Abarrategui
- Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco,' Università degli Studi di Milano, 20157 Milano, Italy
| | - Simone Russo
- Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco,' Università degli Studi di Milano, 20157 Milano, Italy
| | - Ezequiel Pablo Mikulan
- Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco,' Università degli Studi di Milano, 20157 Milano, Italy
| | - Fausto Caruana
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, 43125 Parma, Italy
| | - Giacomo Rizzolatti
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, 43125 Parma, Italy.,Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, 43125 Parma, Italy
| | - Francesca Garbarini
- MANIBUS Laboratory, Department of Psychology, University of Turin, 10124 Turin, Italy.,Neuroscience Institute of Turin (NIT), 10124 Turin, Italy
| | - Pietro Avanzini
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, 43125 Parma, Italy
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Klimes P, Peter-Derex L, Hall J, Dubeau F, Frauscher B. Spatio-temporal spike dynamics predict surgical outcome in adult focal epilepsy. Clin Neurophysiol 2021; 134:88-99. [PMID: 34991017 DOI: 10.1016/j.clinph.2021.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We hypothesized that spatio-temporal dynamics of interictal spikes reflect the extent and stability of epileptic sources and determine surgical outcome. METHODS We studied 30 consecutive patients (14 good outcome). Spikes were detected in prolonged stereo-electroencephalography recordings. We quantified the spatio-temporal dynamics of spikes using the variance of the spike rate, line length and skewness of the spike distribution, and related these features to outcome. We built a logistic regression model, and compared its performance to traditional markers. RESULTS Good outcome patients had more dominant and stable sources than poor outcome patients as expressed by a higher variance of spike rates, a lower variance of line length, and a lower variance of positive skewness (ps < 0.05). The outcome was correctly predicted in 80% of patients. This was better or non-inferior to predictions based on a focal lesion (p = 0.016), focal seizure-onset zone, or complete resection (ps > 0.05). In the five patients where traditional markers failed, spike distribution predicted the outcome correctly. The best results were achieved by 18-h periods or longer. CONCLUSIONS Analysis of spike dynamics shows that surgery outcome depends on strong, single and stable sources. SIGNIFICANCE Our quantitative method has the potential to be a reliable predictor of surgical outcome.
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Affiliation(s)
- Petr Klimes
- Analytical Neurophysiology Lab, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic.
| | - Laure Peter-Derex
- Analytical Neurophysiology Lab, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France; Lyon Neuroscience Research Center, Lyon, France
| | - Jeff Hall
- Montreal Neurological Hospital, McGill University, Montreal, Quebec, Canada
| | - François Dubeau
- Montreal Neurological Hospital, McGill University, Montreal, Quebec, Canada
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
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Varotto G, Susi G, Tassi L, Gozzo F, Franceschetti S, Panzica F. Comparison of Resampling Techniques for Imbalanced Datasets in Machine Learning: Application to Epileptogenic Zone Localization From Interictal Intracranial EEG Recordings in Patients With Focal Epilepsy. Front Neuroinform 2021; 15:715421. [PMID: 34867255 PMCID: PMC8641296 DOI: 10.3389/fninf.2021.715421] [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: 05/26/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022] Open
Abstract
Aim: In neuroscience research, data are quite often characterized by an imbalanced distribution between the majority and minority classes, an issue that can limit or even worsen the prediction performance of machine learning methods. Different resampling procedures have been developed to face this problem and a lot of work has been done in comparing their effectiveness in different scenarios. Notably, the robustness of such techniques has been tested among a wide variety of different datasets, without considering the performance of each specific dataset. In this study, we compare the performances of different resampling procedures for the imbalanced domain in stereo-electroencephalography (SEEG) recordings of the patients with focal epilepsies who underwent surgery. Methods: We considered data obtained by network analysis of interictal SEEG recorded from 10 patients with drug-resistant focal epilepsies, for a supervised classification problem aimed at distinguishing between the epileptogenic and non-epileptogenic brain regions in interictal conditions. We investigated the effectiveness of five oversampling and five undersampling procedures, using 10 different machine learning classifiers. Moreover, six specific ensemble methods for the imbalanced domain were also tested. To compare the performances, Area under the ROC curve (AUC), F-measure, Geometric Mean, and Balanced Accuracy were considered. Results: Both the resampling procedures showed improved performances with respect to the original dataset. The oversampling procedure was found to be more sensitive to the type of classification method employed, with Adaptive Synthetic Sampling (ADASYN) exhibiting the best performances. All the undersampling approaches were more robust than the oversampling among the different classifiers, with Random Undersampling (RUS) exhibiting the best performance despite being the simplest and most basic classification method. Conclusions: The application of machine learning techniques that take into consideration the balance of features by resampling is beneficial and leads to more accurate localization of the epileptogenic zone from interictal periods. In addition, our results highlight the importance of the type of classification method that must be used together with the resampling to maximize the benefit to the outcome.
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Affiliation(s)
- Giulia Varotto
- Epilepsy Unit, Bioengineering Group, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Neurophysiopathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gianluca Susi
- Universidad Complutense de Madrid-Universidad Politécnica de Madrid (UPM-UCM) Laboratory of Cognitive and Computational Neuroscience, Center of Biomedical Technology, Technical University of Madrid, Madrid, Spain.,Department of Experimental Psychology, Cognitive Processes and Logopedy, Complutense University of Madrid, Madrid, Spain
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Francesca Gozzo
- "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Silvana Franceschetti
- Neurophysiopathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ferruccio Panzica
- Clinical Engineering, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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