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Tan X, Zhu R, Xie Y, Chai Y. Suppression of absence seizures by using different stimulations in a reduced corticothalamic-basal ganglion-pedunculopontine nucleus model. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:20468-20485. [PMID: 38124561 DOI: 10.3934/mbe.2023905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Coupled neural network models are playing an increasingly important part in the modulation of absence seizures today. However, it is currently unclear how basal ganglia, corticothalamic network and pedunculopontine nucleus can coordinate with each other to develop a whole coupling circuit, theoretically. In addition, it is still difficult to select effective parameters of electrical stimulation on the regulation of absence seizures in clinical trials. Therefore, to develop a coupled model and reduce computation cost, a new model constructed by a simplified basal ganglion, two corticothalamic circuits and a pedunculopontine nucleus was proposed. Further, to seek better inhibition therapy, three electrical stimulations, high frequency stimulation (HFS), 1:0 coordinate reset stimulation (CRS) and 3:2 CRS, were applied to the thalamic reticular nucleus (RE) in the first corticothalamic circuit in the coupled model. The simulation results revealed that increasing the frequency and pulse width of an electrical stimulation within a certain range can also suppress seizures. Under the same parameters of electrical stimulation, the inhibitory effect of HFS on seizures was better than that of 1:0 CRS and 3:2 CRS. The research established a reduced corticothalamic-basal ganglion-pedunculopontine nucleus model, which lays a theoretical foundation for future optimal parameters selection of electrical stimulation. We hope that the findings will provide new insights into the role of theoretical models in absence seizures.
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Affiliation(s)
- Xiaolong Tan
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai 201306, China
| | - Rui Zhu
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai 201306, China
| | - Yan Xie
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai 201306, China
| | - Yuan Chai
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai 201306, China
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Jiang JW, Narasimhan S, Johnson GW, González HFJ, Doss DJ, Shless JS, Paulo DL, Terry DP, Chang C, Morgan VL, Englot DJ. Abnormal functional connectivity of the posterior hypothalamus and other arousal regions in surgical temporal lobe epilepsy. J Neurosurg 2023; 139:640-650. [PMID: 36807210 PMCID: PMC10432570 DOI: 10.3171/2023.1.jns221452] [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: 07/28/2022] [Accepted: 01/05/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE This study sought to characterize resting-state functional MRI (fMRI) connectivity patterns of the posterior hypothalamus (pHTH) and the nucleus basalis of Meynert (NBM) in surgical patients with mesial temporal lobe epilepsy (mTLE), and to investigate potential correlations between functional connectivity of these arousal regions and neurocognitive performance. METHODS The study evaluated resting-state fMRI in 60 patients with preoperative mTLE and in 95 healthy controls. The authors first conducted voxel-wise connectivity analyses seeded from the pHTH, combined anterior and tuberal hypothalamus (atHTH; i.e., the rest of the hypothalamus), and the NBM ipsilateral (ipsiNBM) and contralateral (contraNBM) to the epileptogenic zone. Based on these results, the authors included the pHTH, ipsiNBM, and frontoparietal neocortex in a network-based statistic (NBS) analysis to elucidate a network that best distinguishes patients from controls. The connections involving the pHTH and ipsiNBM from this network were included in age-corrected pairwise region of interest (ROI) analysis, along with connections between arousal structures, including the pHTH, ipsiNBM, and brainstem arousal regions. Finally, patient functional connectivity was correlated with clinical neurocognitive testing scores for IQ as well as attention and concentration tests. RESULTS The voxel-wise analysis demonstrated that the pHTH, when compared with the atHTH, showed more widespread functional connectivity decreases in surgical mTLE patients when compared with controls. It was also observed that the ipsiNBM, but not the contraNBM, showed decreased functional connectivity in mTLE. The NBS analysis uncovered a perturbed network of frontoparietal regions, the pHTH, and ipsiNBM that distinguishes patients from controls. Age-corrected ROI analysis revealed functional connectivity decreases between the pHTH and bilateral superior frontal gyri, medial orbitofrontal cortices, rostral anterior cingulate cortices, and inferior parietal cortices in mTLE when compared with controls. For the ipsiNBM, there was reduced connectivity with bilateral medial orbitofrontal and rostral anterior cingulate cortices. Age-corrected ROI analysis also demonstrated upstream connectivity decreases from controls between the pHTH and the brainstem arousal regions, cuneiform/subcuneiform (CSC) nuclei, and ventral tegmental area, as well as the ipsiNBM and CSC nuclei. Reduced functional connectivity was also detected between the pHTH and ipsiNBM. Lastly, neurocognitive test scores for attention and concentration were found to be positively correlated with the functional connectivity between the pHTH and ipsiNBM, suggesting worse performance associated with connectivity perturbations. CONCLUSIONS This study demonstrated perturbed resting-state functional connectivity of arousal regions in surgical mTLE and is one of the first investigations to demonstrate decreased functional connectivity of the pHTH with frontoparietal regions and other arousal regions. Connectivity disturbances in arousal regions may contribute to neurocognitive deficits in surgical mTLE patients.
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Affiliation(s)
- Jasmine W. Jiang
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Saramati Narasimhan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Graham W. Johnson
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Hernán F. J. González
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Derek J. Doss
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Jared S. Shless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Danika L. Paulo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Douglas P. Terry
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | - Catie Chang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Victoria L. Morgan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Neurology, Vanderbilt University Medical Center, Nashville
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville
| | - Dario J. Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
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González HFJ, Narasimhan S, Goodale SE, Johnson GW, Doss DJ, Paulo DL, Morgan VL, Chang C, Englot DJ. Arousal and salience network connectivity alterations in surgical temporal lobe epilepsy. J Neurosurg 2023; 138:810-820. [PMID: 35901709 PMCID: PMC10127440 DOI: 10.3171/2022.5.jns22837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It is poorly understood why patients with mesial temporal lobe epilepsy (TLE) have cognitive deficits and brain network changes that extend beyond the temporal lobe, including altered extratemporal intrinsic connectivity networks (ICNs). However, subcortical arousal structures project broadly to the neocortex, are affected by TLE, and thus may contribute to these widespread network effects. The authors' objective was to examine functional connectivity (FC) patterns between subcortical arousal structures and neocortical ICNs, possible neurocognitive relationships, and FC changes after epilepsy surgery. METHODS The authors obtained resting-state functional magnetic resonance imaging (fMRI) in 50 adults with TLE and 50 controls. They compared nondirected FC (correlation) and directed FC (Granger causality laterality index) within the salience network, default mode network, and central executive network, as well as between subcortical arousal structures; these 3 ICNs were also compared between patients and controls. They also used an fMRI-based vigilance index to relate alertness to arousal center FC. Finally, fMRI was repeated in 29 patients > 12 months after temporal lobe resection. RESULTS Nondirected FC within the salience (p = 0.042) and default mode (p = 0.0008) networks, but not the central executive network (p = 0.79), was decreased in patients in comparison with controls (t-tests, corrected). Nondirected FC between the salience network and subcortical arousal structures (nucleus basalis of Meynert, thalamic centromedian nucleus, and brainstem pedunculopontine nucleus) was reduced in patients in comparison with controls (p = 0.0028-0.015, t-tests, corrected), and some of these connectivity abnormalities were associated with lower processing speed index, verbal comprehension, and full-scale IQ. Interestingly, directed connectivity measures suggested a loss of top-down influence from the salience network to the arousal nuclei in patients. After resection, certain FC patterns between the arousal nuclei and salience network moved toward control values in the patients, suggesting that some postoperative recovery may be possible. Although an fMRI-based vigilance measure suggested that patients exhibited reduced alertness over time, FC abnormalities between the salience network and arousal structures were not influenced by the alertness levels during the scans. CONCLUSIONS FC abnormalities between subcortical arousal structures and ICNs, such as the salience network, may be related to certain neurocognitive deficits in TLE patients. Although TLE patients demonstrated vigilance abnormalities, baseline FC perturbations between the arousal and salience networks are unlikely to be driven solely by alertness level, and some may improve after surgery. Examination of the arousal network and ICN disturbances may improve our understanding of the downstream clinical effects of TLE.
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Affiliation(s)
- Hernán F. J. González
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saramati Narasimhan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah E. Goodale
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Graham W. Johnson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Derek J. Doss
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Danika L. Paulo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Victoria L. Morgan
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Departments of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Catie Chang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Departments of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dario J. Englot
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Departments of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Departments of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee
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Bartoňová M, Tournier JD, Bartoň M, Říha P, Vojtíšek L, Mareček R, Doležalová I, Rektor I. White matter alterations in MR-negative temporal and frontal lobe epilepsy using fixel-based analysis. Sci Rep 2023; 13:19. [PMID: 36593331 PMCID: PMC9807578 DOI: 10.1038/s41598-022-27233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
This study focuses on white matter alterations in pharmacoresistant epilepsy patients with no visible lesions in the temporal and frontal lobes on clinical MRI (i.e. MR-negative) with lesions confirmed by resective surgery. The aim of the study was to extend the knowledge about group-specific neuropathology in MR-negative epilepsy. We used the fixel-based analysis (FBA) that overcomes the limitations of traditional diffusion tensor image analysis, mainly within-voxel averaging of multiple crossing fibres. Group-wise comparisons of fixel parameters between healthy controls (N = 100) and: (1) frontal lobe epilepsy (FLE) patients (N = 9); (2) temporal lobe epilepsy (TLE) patients (N = 13) were performed. A significant decrease of the cross-section area of the fixels in the superior longitudinal fasciculus was observed in the FLE. Results in TLE reflected widespread atrophy of limbic, thalamic, and cortico-striatal connections and tracts directly connected to the temporal lobe (such as the anterior commissure, inferior fronto-occipital fasciculus, uncinate fasciculus, splenium of corpus callosum, and cingulum bundle). Alterations were also observed in extratemporal connections (brainstem connection, commissural fibres, and parts of the superior longitudinal fasciculus). To our knowledge, this is the first study to use an advanced FBA method not only on the datasets of MR-negative TLE patients, but also MR-negative FLE patients, uncovering new common tract-specific alterations on the group level.
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Affiliation(s)
- Michaela Bartoňová
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic ,grid.10267.320000 0001 2194 0956Brno Epilepsy Center, First Department of Neurology, St. Anne’s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jacques-Donald Tournier
- grid.13097.3c0000 0001 2322 6764Centre for Medical Engineering, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764Centre for the Developing Brain, King’s College London, London, UK
| | - Marek Bartoň
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Pavel Říha
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic ,grid.10267.320000 0001 2194 0956Brno Epilepsy Center, First Department of Neurology, St. Anne’s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lubomír Vojtíšek
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Radek Mareček
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Irena Doležalová
- grid.10267.320000 0001 2194 0956Brno Epilepsy Center, First Department of Neurology, St. Anne’s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivan Rektor
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic ,grid.10267.320000 0001 2194 0956Brno Epilepsy Center, First Department of Neurology, St. Anne’s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Amplitude synchronization of spontaneous activity of medial and lateral temporal gyri reveals altered thalamic connectivity in patients with temporal lobe epilepsy. Sci Rep 2022; 12:18389. [PMID: 36319701 PMCID: PMC9626490 DOI: 10.1038/s41598-022-23297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/29/2022] [Indexed: 12/02/2022] Open
Abstract
In this study, we examined whether amplitude synchronization of medial (MTL) and lateral (LTL) temporal lobes can detect unique alterations in patients with MTL epilepsy (mTLE) with mesial temporal sclerosis (MTS). This was a retrospective study of preoperative resting-state fMRI (rsfMRI) data from 31 patients with mTLE with MTS (age 23-69) and 16 controls (age 21-35). fMRI data were preprocessed based on a multistep preprocessing pipeline and registered to a standard space. Using each subject's T1-weighted scan, the MTL and LTL were automatically segmented, manually revised and then fit to a standard space using a symmetric normalization registration algorithm. Dual regression analysis was applied on preprocessed rsfMRI data to detect amplitude synchronization of medial and lateral temporal segments with the rest of the brain. We calculated the overlapped volume ratio of synchronized voxels within specific target regions including the thalamus (total and bilateral). A general linear model was used with Bonferroni correction for covariates of epilepsy duration and age of patient at scan to statistically compare synchronization in patients with mTLE with MTS and controls, as well as with respect to whether patients remained seizure-free (SF) or not (NSF) after receiving epilepsy surgery. We found increased ipsilateral positive connectivity between the LTLs and the thalamus and contralateral negative connectivity between the MTLs and the thalamus in patients with mTLE with MTS compared to controls. We also found increased asymmetry of functional connectivity between temporal lobe subregions and the thalamus in patients with mTLE with MTS, with increased positive connectivity between the LTL and the lesional-side thalamus as well as increased negative connectivity between the MTL and the nonlesional-side thalamus. This asymmetry was also seen in NSF patients but was not seen in SF patients and controls. Amplitude synchronization was an effective method to detect functional connectivity alterations in patients with mTLE with MTS. Patients with mTLE with MTS overall showed increased temporal-thalamic connectivity. There was increased functional involvement of the thalamus in MTS, underscoring its role in seizure spread. Increased functional thalamic asymmetry patterns in NSF patients may have a potential role in prognosticating patient response to surgery. Elucidating regions with altered functional connectivity to temporal regions can improve understanding of the involvement of different regions in the disease to potentially target for intervention or use for prognosis for surgery. Future studies are needed to examine the effectiveness of using patient-specific abnormalities in patterns to predict surgical outcome.
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de Bézenac CE, Adan G, Weber B, Keller SS. Association of Epilepsy Surgery With Changes in Imaging-Defined Brain Age. Neurology 2021; 97:e554-e563. [PMID: 34261787 PMCID: PMC8424496 DOI: 10.1212/wnl.0000000000012289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 05/03/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To determine whether surgery in patients with mesial temporal lobe epilepsy (mTLE) is associated with reduced brain-predicted age as a neural marker overall brain health, we compared brain-predicted and chronologic age difference (brain age gap estimation [BrainAGE]) in patients before and after surgery with healthy controls. Methods We acquired 3D T1-weighted MRI scans for 48 patients with mTLE before and after temporal lobe surgery to estimate brain age using a gaussian processes regression model. We examined BrainAGE before and after surgery controlling for brain volume change, comparing patients to 37 age- and sex-matched controls. Results Preoperatively, patients showed an increased BrainAGE of more than 7 years compared to controls. However, surgery was associated with a mean BrainAGE reduction of 5 years irrespective of whether or not surgery resulted in complete seizure freedom. We observed a lateralization effect as patients with left mTLE had BrainAGE values that more closely resembled control group values following surgery. Conclusions Our findings suggest that while morphologic brain alterations linked to accelerated aging have been observed in mTLE, surgery may be associated with changes that reverse such alterations in some patients. This work highlights the advantages of resective surgery on overall brain health in patients with refractory focal epilepsy.
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Affiliation(s)
- Christophe E de Bézenac
- From the Department of Pharmacology and Therapeutics (C.E.d.B., G.A., S.S.K.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool; The Walton Centre NHS Foundation Trust (C.E.d.B., G.A., S.S.K.), Liverpool, UK; and Institute of Experimental Epileptology and Cognition Research (B.W.), University of Bonn, Germany.
| | - Guleed Adan
- From the Department of Pharmacology and Therapeutics (C.E.d.B., G.A., S.S.K.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool; The Walton Centre NHS Foundation Trust (C.E.d.B., G.A., S.S.K.), Liverpool, UK; and Institute of Experimental Epileptology and Cognition Research (B.W.), University of Bonn, Germany
| | - Bernd Weber
- From the Department of Pharmacology and Therapeutics (C.E.d.B., G.A., S.S.K.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool; The Walton Centre NHS Foundation Trust (C.E.d.B., G.A., S.S.K.), Liverpool, UK; and Institute of Experimental Epileptology and Cognition Research (B.W.), University of Bonn, Germany
| | - Simon S Keller
- From the Department of Pharmacology and Therapeutics (C.E.d.B., G.A., S.S.K.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool; The Walton Centre NHS Foundation Trust (C.E.d.B., G.A., S.S.K.), Liverpool, UK; and Institute of Experimental Epileptology and Cognition Research (B.W.), University of Bonn, Germany
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Jaseja H. Pedunculopontine Nucleus--Rapid Eye Movement Sleep--Electroencephalogram--Desynchronization (PRED) Axis in the Evolution of Epilepsy: A Novel Concept. J Epilepsy Res 2021; 11:1-5. [PMID: 34395217 PMCID: PMC8357554 DOI: 10.14581/jer.21001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/28/2021] [Accepted: 03/07/2021] [Indexed: 11/03/2022] Open
Abstract
Epilepsy is one of the commonest and oldest neurological diseases in the history of mankind, the exact pathophysiology of the evolution of which still remains elusive. The intimate and intriguing relation between epilepsy and sleep has been known for a long time. Rapid eye movement sleep (REMS) is well documented to exert potent antiepileptic action in human epilepsies and the underlying mechanism of which is largely based on its property to induce widespread electroencephalogram (EEG)-desynchronization. The pedunculopontine nucleus (PPN) owing to its property to enhance REMS has recently been under study for its potential role in intractable epilepsy (IE) and has been proposed as a novel deep brain stimulation target in IE. This brief paper unfolds the existing role of PPN, REMS, and EEG-desynchronization (PRED) in the evolution of epilepsy in an axial manner, the realization and comprehension of which is likely to open new avenues for further understanding of epileptogenesis, improved treatment of epilepsy and reducing the risk of IE.
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González HFJ, Narasimhan S, Johnson GW, Wills KE, Haas KF, Konrad PE, Chang C, Morgan VL, Rubinov M, Englot DJ. Role of the Nucleus Basalis as a Key Network Node in Temporal Lobe Epilepsy. Neurology 2021; 96:e1334-e1346. [PMID: 33441453 DOI: 10.1212/wnl.0000000000011523] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine whether the nucleus basalis of Meynert (NBM) may be a key network structure of altered functional connectivity in temporal lobe epilepsy (TLE), we examined fMRI with network-based analyses. METHODS We acquired resting-state fMRI in 40 adults with TLE and 40 matched healthy control participants. We calculated functional connectivity of NBM and used multiple complementary network-based analyses to explore the importance of NBM in TLE networks without biasing our results by our approach. We compared patients to controls and examined associations of network properties with disease metrics and neurocognitive testing. RESULTS We observed marked decreases in connectivity between NBM and the rest of the brain in patients with TLE (0.91 ± 0.88, mean ± SD) vs controls (1.96 ± 1.13, p < 0.001, t test). Larger decreases in connectivity between NBM and fronto-parietal-insular regions were associated with higher frequency of consciousness-impairing seizures (r = -0.41, p = 0.008, Pearson). A core network of altered nodes in TLE included NBM ipsilateral to the epileptogenic side and bilateral limbic structures. Furthermore, normal community affiliation of ipsilateral NBM was lost in patients, and this structure displayed the most altered clustering coefficient of any node examined (3.46 ± 1.17 in controls vs 2.23 ± 0.93 in patients). Abnormal connectivity between NBM and subcortical arousal community was associated with modest neurocognitive deficits. Finally, a logistic regression model incorporating connectivity properties of ipsilateral NBM successfully distinguished patients from control datasets with moderately high accuracy (78%). CONCLUSIONS These results suggest that while NBM is rarely studied in epilepsy, it may be one of the most perturbed network nodes in TLE, contributing to widespread neural effects in this disabling disorder.
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Affiliation(s)
- Hernán F J González
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA.
| | - Saramati Narasimhan
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Graham W Johnson
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Kristin E Wills
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Kevin F Haas
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Peter E Konrad
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Catie Chang
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Victoria L Morgan
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Mikail Rubinov
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Dario J Englot
- From the Departments of Biomedical Engineering (H.F.J.G., G.W.J., P.E.K., C.C., V.L.M., M.R., D.J.E.) and Electrical Engineering and Computer Science (C.C., V.L.M., M.R., D.J.E.), Vanderbilt University; Departments of Neurological Surgery (S.N., K.E.W., P.E.K., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), and Neurology (K.F.H.) and Vanderbilt University Institute of Imaging Science (H.F.J.G., S.N., G.W.J., K.E.W., C.C., V.L.M., D.J.E.), Vanderbilt University Medical Center, Nashville, TN; and Department of Psychology (M.R.), Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
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People with mesial temporal lobe epilepsy have altered thalamo-occipital brain networks. Epilepsy Behav 2020; 115:107645. [PMID: 33334720 PMCID: PMC7882020 DOI: 10.1016/j.yebeh.2020.107645] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
While temporal lobe epilepsy (TLE) is a focal epilepsy, previous work demonstrates that TLE causes widespread brain-network disruptions. Impaired visuospatial attention and learning in TLE may be related to thalamic arousal nuclei connectivity. Our prior preliminary work in a smaller patient cohort suggests that patients with TLE demonstrate abnormal functional connectivity between central lateral (CL) thalamic nucleus and medial occipital lobe. Others have shown pulvinar connectivity disturbances in TLE, but it is incompletely understood how TLE affects pulvinar subnuclei. Also, the effects of epilepsy surgery on thalamic functional connectivity remains poorly understood. In this study, we examine the effects of TLE on functional connectivity of two key thalamic arousal-nuclei: lateral pulvinar (PuL) and CL. We evaluate resting-state functional connectivity of the PuL and CL in 40 patients with TLE and 40 controls using fMRI. In 25 patients, postoperative images (>1 year) were also compared with preoperative images. Compared to controls, patients with TLE exhibit loss of normal positive connectivity between PuL and lateral occipital lobe (p < 0.05), and a loss of normal negative connectivity between CL and medial occipital lobe (p < 0.01, paired t-tests). FMRI amplitude of low-frequency fluctuation (ALFF) in TLE trended higher in ipsilateral PuL (p = 0.06), but was lower in the lateral occipital (p < 0.01) and medial occipital lobe in patients versus controls (p < 0.05, paired t-tests). More abnormal ALFF in the ipsilateral lateral occipital lobe is associated with worse preoperative performance on Rey Complex Figure Test Immediate (p < 0.05, r = 0.381) and Delayed scores (p < 0.05, r = 0.413, Pearson's Correlations). After surgery, connectivity between PuL and lateral occipital lobe remains abnormal in patients (p < 0.01), but connectivity between CL and medial occipital lobe improves and is no longer different from control values (p > 0.05, ANOVA, post hoc Fischer's LSD). In conclusion, thalamic arousal nuclei exhibit abnormal connectivity with occipital lobe in TLE, and some connections may improve after surgery. Studying thalamic arousal centers may help explain distal network disturbances in TLE.
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10
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Kundu B, Davis TS, Philip B, Smith EH, Arain A, Peters A, Newman B, Butson CR, Rolston JD. A systematic exploration of parameters affecting evoked intracranial potentials in patients with epilepsy. Brain Stimul 2020; 13:1232-1244. [PMID: 32504827 PMCID: PMC7494632 DOI: 10.1016/j.brs.2020.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Brain activity is constrained by and evolves over a network of structural and functional connections. Corticocortical evoked potentials (CCEPs) have been used to measure this connectivity and to discern brain areas involved in both brain function and disease. However, how varying stimulation parameters influences the measured CCEP across brain areas has not been well characterized. OBJECTIVE To better understand the factors that influence the amplitude of the CCEPs as well as evoked gamma-band power (70-150 Hz) resulting from single-pulse stimulation via cortical surface and depth electrodes. METHODS CCEPs from 4370 stimulation-response channel pairs were recorded across a range of stimulation parameters and brain regions in 11 patients undergoing long-term monitoring for epilepsy. A generalized mixed-effects model was used to model cortical response amplitudes from 5 to 100 ms post-stimulation. RESULTS Stimulation levels <5.5 mA generated variable CCEPs with low amplitude and reduced spatial spread. Stimulation at ≥5.5 mA yielded a reliable and maximal CCEP across stimulation-response pairs over all regions. These findings were similar when examining the evoked gamma-band power. The amplitude of both measures was inversely correlated with distance. CCEPs and evoked gamma power were largest when measured in the hippocampus compared with other areas. Larger CCEP size and evoked gamma power were measured within the seizure onset zone compared with outside this zone. CONCLUSION These results will help guide future stimulation protocols directed at quantifying network connectivity across cognitive and disease states.
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Affiliation(s)
- Bornali Kundu
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Tyler S Davis
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Brian Philip
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Elliot H Smith
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Amir Arain
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Angela Peters
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Blake Newman
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Christopher R Butson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - John D Rolston
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA.
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11
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Englot DJ, Morgan VL, Chang C. Impaired vigilance networks in temporal lobe epilepsy: Mechanisms and clinical implications. Epilepsia 2020; 61:189-202. [PMID: 31901182 DOI: 10.1111/epi.16423] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022]
Abstract
Mesial temporal lobe epilepsy (mTLE) is a neurological disorder in which patients suffer from frequent consciousness-impairing seizures, broad neurocognitive deficits, and diminished quality of life. Although seizures in mTLE originate focally in the hippocampus or amygdala, mTLE patients demonstrate cognitive deficits that extend beyond temporal lobe function-such as decline in executive function, cognitive processing speed, and attention-as well as diffuse decreases in neocortical metabolism and functional connectivity. Given prior observations that mTLE patients exhibit impairments in vigilance, and that seizures may disrupt the activity and long-range connectivity of subcortical brain structures involved in vigilance regulation, we propose that subcortical activating networks underlying vigilance play a critical role in mediating the widespread neural and cognitive effects of focal mTLE. Here, we review evidence for impaired vigilance in mTLE, examine clinical implications and potential network underpinnings, and suggest neuroimaging strategies for determining the relationship between vigilance, brain connectivity, and neurocognition in patients and healthy controls.
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Affiliation(s)
- Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Victoria L Morgan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Catie Chang
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
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12
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González HFJ, Chakravorti S, Goodale SE, Gupta K, Claassen DO, Dawant B, Morgan VL, Englot DJ. Thalamic arousal network disturbances in temporal lobe epilepsy and improvement after surgery. J Neurol Neurosurg Psychiatry 2019; 90:1109-1116. [PMID: 31123139 PMCID: PMC6744309 DOI: 10.1136/jnnp-2019-320748] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The effects of temporal lobe epilepsy (TLE) on subcortical arousal structures remain incompletely understood. Here, we evaluate thalamic arousal network functional connectivity in TLE and examine changes after epilepsy surgery. METHODS We examined 26 adult patients with TLE and 26 matched control participants and used resting-state functional MRI (fMRI) to measure functional connectivity between the thalamus (entire thalamus and 19 bilateral thalamic nuclei) and both neocortex and brainstem ascending reticular activating system (ARAS) nuclei. Postoperative imaging was completed for 19 patients >1 year after surgery and compared with preoperative baseline. RESULTS Before surgery, patients with TLE demonstrated abnormal thalamo-occipital functional connectivity, losing the normal negative fMRI correlation between the intralaminar central lateral (CL) nucleus and medial occipital lobe seen in controls (p < 0.001, paired t-test). Patients also had abnormal connectivity between ARAS and CL, lower ipsilateral intrathalamic connectivity, and smaller ipsilateral thalamic volume compared with controls (p < 0.05 for each, paired t-tests). Abnormal brainstem-thalamic connectivity was associated with impaired visuospatial attention (ρ = -0.50, p = 0.02, Spearman's rho) while lower intrathalamic connectivity and volume were related to higher frequency of consciousness-sparing seizures (p < 0.02, Spearman's rho). After epilepsy surgery, patients with improved seizures showed partial recovery of thalamo-occipital and brainstem-thalamic connectivity, with values more closely resembling controls (p < 0.01 for each, analysis of variance). CONCLUSIONS Overall, patients with TLE demonstrate impaired connectivity in thalamic arousal networks that may be involved in visuospatial attention, but these disturbances may partially recover after successful epilepsy surgery. Thalamic arousal network dysfunction may contribute to morbidity in TLE.
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Affiliation(s)
- Hernán F J González
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA .,Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Srijata Chakravorti
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Sarah E Goodale
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.,Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kanupriya Gupta
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benoit Dawant
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Victoria L Morgan
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.,Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dario J Englot
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.,Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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