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Wu S, Issa NP, Rose SL, Haider HA, Nordli DR, Towle VL, Warnke PC, Tao JX. Depth versus surface: A critical review of subdural and depth electrodes in intracranial electroencephalographic studies. Epilepsia 2024; 65:1868-1878. [PMID: 38722693 DOI: 10.1111/epi.18002] [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: 01/02/2024] [Revised: 04/05/2024] [Accepted: 04/24/2024] [Indexed: 07/17/2024]
Abstract
Intracranial electroencephalographic (IEEG) recording, using subdural electrodes (SDEs) and stereoelectroencephalography (SEEG), plays a pivotal role in localizing the epileptogenic zone (EZ). SDEs, employed for superficial cortical seizure foci localization, provide information on two-dimensional seizure onset and propagation. In contrast, SEEG, with its three-dimensional sampling, allows exploration of deep brain structures, sulcal folds, and bihemispheric networks. SEEG offers the advantages of fewer complications, better tolerability, and coverage of sulci. Although both modalities allow electrical stimulation, SDE mapping can tessellate cortical gyri, providing the opportunity for a tailored resection. With SEEG, both superficial gyri and deep sulci can be stimulated, and there is a lower risk of afterdischarges and stimulation-induced seizures. Most systematic reviews and meta-analyses have addressed the comparative effectiveness of SDEs and SEEG in localizing the EZ and achieving seizure freedom, although discrepancies persist in the literature. The combination of SDEs and SEEG could potentially overcome the limitations inherent to each technique individually, better delineating seizure foci. This review describes the strengths and limitations of SDE and SEEG recordings, highlighting their unique indications in seizure localization, as evidenced by recent publications. Addressing controversies in the perceived usefulness of the two techniques offers insights that can aid in selecting the most suitable IEEG in clinical practice.
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Affiliation(s)
- Shasha Wu
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Sandra L Rose
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Hiba A Haider
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Douglas R Nordli
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Vernon L Towle
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
| | - James X Tao
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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2
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Caston RM, Smith EH, Davis TS, Singh H, Rahimpour S, Rolston JD. Characterization of spatiotemporal dynamics of binary and graded tonic pain in humans using intracranial recordings. PLoS One 2023; 18:e0292808. [PMID: 37844101 PMCID: PMC10578592 DOI: 10.1371/journal.pone.0292808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
Pain is a complex experience involving sensory, emotional, and cognitive aspects, and multiple networks manage its processing in the brain. Examining how pain transforms into a behavioral response can shed light on the networks' relationships and facilitate interventions to treat chronic pain. However, studies using high spatial and temporal resolution methods to investigate the neural encoding of pain and its psychophysical correlates have been limited. We recorded from intracranial stereo-EEG (sEEG) electrodes implanted in sixteen different brain regions of twenty patients who underwent psychophysical pain testing consisting of a tonic thermal stimulus to the hand. Broadband high-frequency local field potential amplitude (HFA; 70-150 Hz) was isolated to investigate the relationship between the ongoing neural activity and the resulting psychophysical pain evaluations. Two different generalized linear mixed-effects models (GLME) were employed to assess the neural representations underlying binary and graded pain psychophysics. The first model examined the relationship between HFA and whether the patient responded "yes" or "no" to whether the trial was painful. The second model investigated the relationship between HFA and how painful the stimulus was rated on a visual analog scale. GLMEs revealed that HFA in the inferior temporal gyrus (ITG), superior frontal gyrus (SFG), and superior temporal gyrus (STG) predicted painful responses at stimulus onset. An increase in HFA in the orbitofrontal cortex (OFC), SFG, and striatum predicted pain responses at stimulus offset. Numerous regions, including the anterior cingulate cortex, hippocampus, IFG, MTG, OFC, and striatum, predicted the pain rating at stimulus onset. However, only the amygdala and fusiform gyrus predicted increased pain ratings at stimulus offset. We characterized the spatiotemporal representations of binary and graded painful responses during tonic pain stimuli. Our study provides evidence from intracranial recordings that the neural encoding of psychophysical pain changes over time during a tonic thermal stimulus, with different brain regions being predictive of pain at the beginning and end of the stimulus.
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Affiliation(s)
- Rose M. Caston
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States of America
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, United States of America
| | - Elliot H. Smith
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, United States of America
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, Utah, United States of America
| | - Tyler S. Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, United States of America
| | - Hargunbir Singh
- Department of Neurosurgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shervin Rahimpour
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States of America
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, United States of America
| | - John D. Rolston
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States of America
- Department of Neurosurgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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3
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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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Caston RM, Smith EH, Davis TS, Singh H, Rahimpour S, Rolston JD. Characterization of spatiotemporal dynamics of binary and graded tonic pain in humans using intracranial recordings. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.08.531576. [PMID: 36945412 PMCID: PMC10028876 DOI: 10.1101/2023.03.08.531576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Pain is a complex experience involving sensory, emotional, and cognitive aspects, and multiple networks manage its processing in the brain. Examining how pain transforms into a behavioral response can shed light on the networks' relationships and facilitate interventions to treat chronic pain. However, studies using high spatial and temporal resolution methods to investigate the neural encoding of pain and its psychophysical correlates have been limited. We recorded from intracranial stereo-EEG (sEEG) electrodes implanted in sixteen different brain regions of twenty patients who underwent psychophysical pain testing consisting of a tonic thermal stimulus to the hand. Broadband high-frequency local field potential amplitude (HFA; 70-150 Hz) was isolated to investigate the relationship between the ongoing neural activity and the resulting psychophysical pain evaluations. Two different generalized linear mixed-effects models (GLME) were employed to assess the neural representations underlying binary and graded pain psychophysics. The first model examined the relationship between HFA and whether the patient responded "yes" or "no" to whether the trial was painful. The second model investigated the relationship between HFA and how painful the stimulus was rated on a visual analog scale. GLMEs revealed that HFA in the inferior temporal gyrus (ITG), superior frontal gyrus (SFG), and superior temporal gyrus (STG) predicted painful responses at stimulus onset. An increase in HFA in the orbitofrontal cortex (OFC), SFG, and striatum predicted pain responses at stimulus offset. Numerous regions including the anterior cingulate cortex, hippocampus, IFG, MTG, OFC, and striatum, predicted the pain rating at stimulus onset. However, only the amygdala and fusiform gyrus predicted increased pain ratings at stimulus offset. We characterized the spatiotemporal representations of binary and graded painful responses during tonic pain stimuli. Our study provides evidence from intracranial recordings that the neural encoding of psychophysical pain changes over time during a tonic thermal stimulus, with different brain regions being predictive of pain at the beginning and end of the stimulus.
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Affiliation(s)
- Rose M Caston
- Department of Biomedical Engineering, University of Utah, 84112
- Department of Neurosurgery, University of Utah, 84112
| | - Elliot H Smith
- Department of Neurosurgery, University of Utah, 84112
- Interdepartmental Program in Neuroscience, University of Utah, 84112
| | - Tyler S Davis
- Department of Neurosurgery, University of Utah, 84112
| | - Hargunbir Singh
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 02115
| | - Shervin Rahimpour
- Department of Biomedical Engineering, University of Utah, 84112
- Department of Neurosurgery, University of Utah, 84112
| | - John D Rolston
- Department of Biomedical Engineering, University of Utah, 84112
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 02115
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Ross MN, Larson EW, Shahin MN, Yaghi NK, Mazur-Hart DJ, Mitchell A, Mulcahy F, Ernst LD, Collins KL, Selden NR, Raslan AM. A Method of Intraoperative Registration Verification to Prevent Accuracy Errors in Robot-Assisted Stereotactic Electroencephalography Electrode Placement. World Neurosurg 2023; 171:1-4. [PMID: 36563849 DOI: 10.1016/j.wneu.2022.12.075] [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: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Robotic-assisted stereotactic electroencephalography (sEEG) electrode placement is increasingly common at specialized epilepsy centers. High accuracy and low complication rates are essential to realizing the benefits of sEEG surgery. The aim of this study was to describe for the first time in the literature a method for a stereotactic registration checkpoint to verify intraoperative accuracy during robotic-assisted sEEG and to report our institutional experience with this technique. METHODS All cases performed with this technique since the adoption of robotic-assisted sEEG at our institution were retrospectively reviewed. RESULTS In 4 of 111 consecutive sEEG operations, use of the checkpoint detected an intraoperative registration error, which was addressed before completion of sEEG electrode placement. CONCLUSIONS The use of a registration checkpoint in robotic-assisted sEEG surgery is a simple technique that can prevent electrode misplacement and improve the safety profile of this procedure.
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Affiliation(s)
- Miner N Ross
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
| | - Erik W Larson
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Maryam N Shahin
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nasser K Yaghi
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - David J Mazur-Hart
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Ann Mitchell
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Faye Mulcahy
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Lia D Ernst
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kelly L Collins
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nathan R Selden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
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Abel TJ, Muthiah N, Hect JL, Gonzalez-Martinez J, Salehi A, Smyth MD, Smith KJ. Cost-effectiveness of invasive monitoring strategies in epilepsy surgery. J Neurosurg 2022:1-7. [PMID: 36585866 DOI: 10.3171/2022.11.jns221744] [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: 07/27/2022] [Accepted: 11/17/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Drug-resistant epilepsy occurs in up to 40% of patients with epilepsy who may be considered for epilepsy surgery. For drug-resistant focal epilepsy, up to 50% of patients require invasive monitoring prior to surgery. Of the most common invasive monitoring strategies (subdural electrodes [SDEs] and stereo-electroencephalography [sEEG]), the most cost-effective strategy is unknown despite substantial differences in morbidity profiles. METHODS Using data collected from an internationally representative sample published in available systematic reviews and meta-analyses, this economic evaluation study employs a decision analysis model to simulate the risks and benefits of SDE and sEEG invasive monitoring strategies. In this model, patients faced differing risks of morbidity, mortality, resection, and seizure freedom depending on which invasive monitoring strategy they underwent. A range of cost values was obtained from a recently published single-center cost-utility analysis. The model considers a base case simulation of a characteristic patient with drug-resistant epilepsy using clinical parameters obtained from systematic reviews of invasive monitoring available in the literature. The main outcome measure was the probability of a positive outcome after invasive monitoring, which was defined as improvement in seizures without a complication. Cost-effectiveness was measured using an incremental cost-effectiveness ratio (ICER). RESULTS Invasive monitoring with sEEG had an increased cost of $274 and increased probability of effectiveness of 0.02 compared with SDEs, yielding an ICER of $12,630 per positive outcome obtained. Sensitivity analyses varied parameters widely and revealed consistent model results across the range of clinical parameters reported in the literature. One-way sensitivity analyses revealed that invasive monitoring strategy costs were the most influential parameter for model outcome. CONCLUSIONS In this analysis, based on available observational data and estimates of complication costs, invasive monitoring with either SDEs or sEEG was nearly equivalent in terms of cost-effectiveness.
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Affiliation(s)
- Taylor J Abel
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh.,Departments of2Bioengineering and
| | - Nallammai Muthiah
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh
| | - Jasmine L Hect
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh
| | - Jorge Gonzalez-Martinez
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh
| | - Afshin Salehi
- 3Department of Neurosurgery, University of Nebraska, Omaha, Nebraska; and
| | - Matthew D Smyth
- 4Department of Neurosurgery, Johns Hopkins All Children's Hospital, Tampa, Florida
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Hunsaker JC, Scoville JP, Joyce E, Harper J, Kurudza E, Sweney M, Bollo RJ, Rolston JD. Stereotactic electroencephalography is associated with reduced opioid and nonsteroidal anti-inflammatory drug use when compared with subdural grids: a pediatric case series. J Clin Neurosci 2022; 101:180-185. [DOI: 10.1016/j.jocn.2022.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/18/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
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8
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Oluigbo CO, Gaillard WD, Koubeissi MZ. The End Justifies the Means-A Call for Nuance in the Increasing Nationwide Adoption of Stereoelectroencephalography Over Subdural Electrode Monitoring in the Surgical Evaluation of Intractable Epilepsy. JAMA Neurol 2022; 79:221-222. [PMID: 35040868 DOI: 10.1001/jamaneurol.2021.4994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Chima O Oluigbo
- Department of Neurosurgery, Children's National Hospital, Washington, DC
| | | | - Mohamad Z Koubeissi
- Department of Neurology, The George Washington University Hospital, Washington, DC
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Anderson DN, Charlebois CM, Smith EH, Arain AM, Davis TS, Rolston JD. Probabilistic comparison of gray and white matter coverage between depth and surface intracranial electrodes in epilepsy. Sci Rep 2021; 11:24155. [PMID: 34921176 PMCID: PMC8683494 DOI: 10.1038/s41598-021-03414-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/23/2021] [Indexed: 11/20/2022] Open
Abstract
In this study, we quantified the coverage of gray and white matter during intracranial electroencephalography in a cohort of epilepsy patients with surface and depth electrodes. We included 65 patients with strip electrodes (n = 12), strip and grid electrodes (n = 24), strip, grid, and depth electrodes (n = 7), or depth electrodes only (n = 22). Patient-specific imaging was used to generate probabilistic gray and white matter maps and atlas segmentations. Gray and white matter coverage was quantified using spherical volumes centered on electrode centroids, with radii ranging from 1 to 15 mm, along with detailed finite element models of local electric fields. Gray matter coverage was highly dependent on the chosen radius of influence (RoI). Using a 2.5 mm RoI, depth electrodes covered more gray matter than surface electrodes; however, surface electrodes covered more gray matter at RoI larger than 4 mm. White matter coverage and amygdala and hippocampal coverage was greatest for depth electrodes at all RoIs. This study provides the first probabilistic analysis to quantify coverage for different intracranial recording configurations. Depth electrodes offer increased coverage of gray matter over other recording strategies if the desired signals are local, while subdural grids and strips sample more gray matter if the desired signals are diffuse.
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Affiliation(s)
- Daria Nesterovich Anderson
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA. .,Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, USA.
| | - Chantel M Charlebois
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Elliot H Smith
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Amir M Arain
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Tyler S Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA. .,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
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