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Catenoix H, Bourdillon P, Guénot M, Isnard J. The combination of stereo-EEG and radiofrequency ablation. Epilepsy Res 2018; 142:117-120. [DOI: 10.1016/j.eplepsyres.2018.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 11/07/2017] [Accepted: 01/09/2018] [Indexed: 11/28/2022]
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Abstract
Various neurostimulation modalities have emerged in the field of epilepsy. Despite the fact that delivery of an electrical current to the hyperexcitable epileptic brain might, at first, seem contradictory, neurostimulation has become an established therapeutic option with a promising efficacy and adverse effects profile. In "responsive" neurostimulation the strategy is to interfere as early as possible with the accumulation of seizure activity to prematurely abort or even prevent an upcoming seizure. The design of technology required for responsive stimulation is more challenging compared with devices for open-loop neurostimulation. The achievement of therapeutic success is dependent on adequate sensing and stimulation algorithms and a fast coupling between both. The benefits of delivering current only at the time of an approaching seizure merit further investigation. Current experience with responsive neurostimulation in epilepsy is still limited, but seems promising.
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Affiliation(s)
- Sofie Carrette
- a Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University, Department of Neurology , Ghent University Hospital, Institute for Neuroscience , Ghent , Belgium
| | - Paul Boon
- a Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University, Department of Neurology , Ghent University Hospital, Institute for Neuroscience , Ghent , Belgium
| | - Mathieu Sprengers
- a Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University, Department of Neurology , Ghent University Hospital, Institute for Neuroscience , Ghent , Belgium
| | - Robrecht Raedt
- a Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University, Department of Neurology , Ghent University Hospital, Institute for Neuroscience , Ghent , Belgium
| | - Kristl Vonck
- a Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University, Department of Neurology , Ghent University Hospital, Institute for Neuroscience , Ghent , Belgium
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Panuccio G, Guez A, Vincent R, Avoli M, Pineau J. Adaptive control of epileptiform excitability in an in vitro model of limbic seizures. Exp Neurol 2013; 241:179-83. [PMID: 23313899 DOI: 10.1016/j.expneurol.2013.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 12/17/2012] [Accepted: 01/01/2013] [Indexed: 10/27/2022]
Abstract
Deep brain stimulation (DBS) is a promising tool for treating drug-resistant epileptic patients. Currently, the most common approach is fixed-frequency stimulation (periodic pacing) by means of stimulating devices that operate under open-loop control. However, a drawback of this DBS strategy is the impossibility of tailoring a personalized treatment, which also limits the optimization of the stimulating apparatus. Here, we propose a novel DBS methodology based on a closed-loop control strategy, developed by exploiting statistical machine learning techniques, in which stimulation parameters are adapted to the current neural activity thus allowing for seizure suppression that is fine-tuned on the individual scale (adaptive stimulation). By means of field potential recording from adult rat hippocampus-entorhinal cortex (EC) slices treated with the convulsant drug 4-aminopyridine we determined the effectiveness of this approach compared to low-frequency periodic pacing, and found that the closed-loop stimulation strategy: (i) has similar efficacy as low-frequency periodic pacing in suppressing ictal-like events but (ii) is more efficient than periodic pacing in that it requires less electrical pulses. We also provide evidence that the closed-loop stimulation strategy can alternatively be employed to tune the frequency of a periodic pacing strategy. Our findings indicate that the adaptive stimulation strategy may represent a novel, promising approach to DBS for individually-tailored epilepsy treatment.
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Affiliation(s)
- Gabriella Panuccio
- Montreal Neurological Institute, Department of Neurology & Neurosurgery, McGill University, 3801 University Street, Montreal, QC, Canada H3A 2B4
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Wu C, Sperling MR, Falowski SM, Chitale AV, Werner-Wasik M, Evans JJ, Andrews DW, Sharan AD. Radiosurgery for the treatment of dominant hemisphere periventricular heterotopia and intractable epilepsy in a series of three patients. EPILEPSY & BEHAVIOR CASE REPORTS 2012; 1:1-6. [PMID: 25688044 PMCID: PMC4150677 DOI: 10.1016/j.ebcr.2012.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 10/06/2012] [Indexed: 11/26/2022]
Abstract
Periventricular heterotopia (PVH) is a neuronal migration disorder characterized by masses of gray matter located along the lateral ventricles that commonly cause epilepsy. The benefit of surgical resection of the PVH has been demonstrated in case reports to date; however, the location of the PVH in the paratrigonal region of the lateral ventricles can present significant surgical challenges. Noninvasive modalities of ablating this epileptogenic focus must therefore be considered. We present a small series of three patients who underwent stereotactic radiosurgery (SRS) for inoperable unilateral dominant hemisphere PVHs in order to illustrate the potential benefits and risks of this treatment modality. A total dose of 37.5–65 Gy resulted in seizure freedom for at least 14 months at the time of their last follow-up, even in patients harboring a second independent epileptic focus. Whether intracranial electrode recording truly offers added value is therefore uncertain. The two patients who received higher radiation doses suffered from symptomatic radiation necrosis and associated cerebral edema, requiring further medical intervention, and persistent monocular visual loss in one patient. While a longer interval prior to re-treatment may have been attempted, neither patient demonstrated radiographic findings typically associated with seizure remission. Refractory epilepsy due to PVH may be successfully treated with radiation therapy; but further work is needed to define the optimal dosing parameters in order to lower toxicity to normal tissue.
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Affiliation(s)
- Chengyuan Wu
- Thomas Jefferson University Hospitals, Department of Neurological Surgery, 909 Walnut Street, Third Floor, Philadelphia, PA, USA
| | - Michael R Sperling
- Thomas Jefferson University, Department of Neurology, Philadelphia, PA, USA
| | - Steven M Falowski
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - Ameet V Chitale
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - Maria Werner-Wasik
- Thomas Jefferson University, Department of Radiation Oncology, Philadelphia, PA, USA
| | - James J Evans
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - David W Andrews
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
| | - Ashwini D Sharan
- Thomas Jefferson University, Department of Neurological Surgery, Philadelphia, PA, USA
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Aziz JNY, Karakiewicz R, Genov R, Bardakjian BL, Derchansky M, Carlen PL. Towards real-time in-implant epileptic seizure prediction. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2008; 2006:5476-9. [PMID: 17947144 DOI: 10.1109/iembs.2006.259737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present an architecture of an epileptic seizure prediction system suitable for an implantable implementation. The microsystem comprises a neural interface, a spectral analysis processor and an artificial neural network (ANN). The neural interface and the spectral analysis processor have been prototyped in a 0.35 microm CMOS technology with experimental results are presented. The wavelet-based artificial neural network predicts the onsets of seizure up to two minutes before their occurrence in an in-vitro epilepsy model using a mouse hippocampal brain slice with recurrent spontaneous seizures.
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Affiliation(s)
- Joseph N Y Aziz
- Department of Electrical & Computer Engineering, University of Toronto, ON, Canada
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Schiller Y, Bankirer Y. Cellular Mechanisms Underlying Antiepileptic Effects of Low- and High-Frequency Electrical Stimulation in Acute Epilepsy in Neocortical Brain Slices In Vitro. J Neurophysiol 2007; 97:1887-902. [PMID: 17151229 DOI: 10.1152/jn.00514.2006] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Approximately 30% of epilepsy patients suffer from drug-resistant epilepsy. Direct electrical stimulation of the epileptogenic zone is a potential new treatment modality for this devastating disease. In this study, we investigated the effect of two electrical stimulation paradigms, sustained low-frequency stimulation and short trains of high-frequency stimulation, on epileptiform discharges in neocortical brain slices treated with either bicuculline or magnesium-free extracellular solution. Sustained low-frequency stimulation (5–30 min of 0.1- to 5-Hz stimulation) prevented both interictal-like discharges and seizure-like events in an intensity-, frequency-, and distance-dependent manner. Short trains of high-frequency stimulation (1–5 s of 25- to 200-Hz stimulation) prematurely terminated seizure-like events in a frequency-, intensity-, and duration-dependent manner. Roughly one half the seizures terminated within the 100-Hz stimulation train ( P < 0.01 compared with control), whereas the remaining seizures were significantly shortened by 53 ± 21% ( P < 0.01). Regarding the cellular mechanisms underlying the antiepileptic effects of electrical stimulation, both low- and high-frequency stimulation markedly depressed excitatory postsynaptic potentials (EPSPs). The EPSP amplitude decreased by 75 ± 3% after 10-min, 1-Hz stimulation and by 86 ± 6% after 1-s, 100-Hz stimulation. Moreover, partial pharmacological blockade of ionotropic glutamate receptors was sufficient to suppress epileptiform discharges and enhance the antiepileptic effects of stimulation. In conclusion, this study showed that both low- and high-frequency electrical stimulation possessed antiepileptic effects in the neocortex in vitro, established the parameters determining the antiepileptic efficacy of both stimulation paradigms, and suggested that the antiepileptic effects of stimulation were mediated mostly by short-term synaptic depression of excitatory neurotransmission.
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Affiliation(s)
- Yitzhak Schiller
- Department of Neurology, Rambam Medical Center, 1 Efron St., Haifa 31096, Israel.
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Abstract
Advances in understanding of both the causes and consequences of epilepsy have been paralleled by a number of recent reports and clinical guidelines highlighting the complexities involved in both diagnosing and treating epilepsy. We review recent developments, including comments on the evolution of clinical guidelines, anti-epileptic drugs, epilepsy surgery and new treatment approaches in development. Epilepsy genetics and emerging evidence on mechanisms of drug resistance in epilepsy will also be discussed. Issues with respect to pregnancy and epilepsy are considered, together with more recently identified dilemmas including bone health in epilepsy and whether seizures themselves cause brain damage. Imaging in epilepsy has recently been reviewed elsewhere, and will not be discussed.
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Affiliation(s)
- Andrew R C Kelso
- Epilepsy Group, Centre for Clinical Neurosciences, St George's University of London, UK
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