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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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Monney J, Dallaire SE, Stoutah L, Fanda L, Mégevand P. Voxeloc: A time-saving graphical user interface for localizing and visualizing stereo-EEG electrodes. J Neurosci Methods 2024; 407:110154. [PMID: 38697518 DOI: 10.1016/j.jneumeth.2024.110154] [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: 10/16/2023] [Revised: 03/26/2024] [Accepted: 04/27/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Thanks to its unrivalled spatial and temporal resolutions and signal-to-noise ratio, intracranial EEG (iEEG) is becoming a valuable tool in neuroscience research. To attribute functional properties to cortical tissue, it is paramount to be able to determine precisely the localization of each electrode with respect to a patient's brain anatomy. Several software packages or pipelines offer the possibility to localize manually or semi-automatically iEEG electrodes. However, their reliability and ease of use may leave to be desired. NEW METHOD Voxeloc (voxel electrode locator) is a Matlab-based graphical user interface to localize and visualize stereo-EEG electrodes. Voxeloc adopts a semi-automated approach to determine the coordinates of each electrode contact, the user only needing to indicate the deep-most contact of each electrode shaft and another point more proximally. RESULTS With a deliberately streamlined functionality and intuitive graphical user interface, the main advantages of Voxeloc are ease of use and inter-user reliability. Additionally, oblique slices along the shaft of each electrode can be generated to facilitate the precise localization of each contact. Voxeloc is open-source software and is compatible with the open iEEG-BIDS (Brain Imaging Data Structure) format. COMPARISON WITH EXISTING METHODS Localizing full patients' iEEG implants was faster using Voxeloc than two comparable software packages, and the inter-user agreement was better. CONCLUSIONS Voxeloc offers an easy-to-use and reliable tool to localize and visualize stereo-EEG electrodes. This will contribute to democratizing neuroscience research using iEEG.
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Affiliation(s)
- Jonathan Monney
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Shannon E Dallaire
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Dalhousie University, Halifax, Canada
| | - Lydia Stoutah
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Université Paris-Saclay, Paris, France
| | - Lora Fanda
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pierre Mégevand
- Clinical Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Basic Neuroscience department, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Neurology division, Geneva University Hospitals, Geneva, Switzerland.
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Jaber K, Avigdor T, Mansilla D, Ho A, Thomas J, Abdallah C, Chabardes S, Hall J, Minotti L, Kahane P, Grova C, Gotman J, Frauscher B. A spatial perturbation framework to validate implantation of the epileptogenic zone. Nat Commun 2024; 15:5253. [PMID: 38897997 PMCID: PMC11187199 DOI: 10.1038/s41467-024-49470-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: 11/17/2023] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Stereo-electroencephalography (SEEG) is the gold standard to delineate surgical targets in focal drug-resistant epilepsy. SEEG uses electrodes placed directly into the brain to identify the seizure-onset zone (SOZ). However, its major constraint is limited brain coverage, potentially leading to misidentification of the 'true' SOZ. Here, we propose a framework to assess adequate SEEG sampling by coupling epileptic biomarkers with their spatial distribution and measuring the system's response to a perturbation of this coupling. We demonstrate that the system's response is strongest in well-sampled patients when virtually removing the measured SOZ. We then introduce the spatial perturbation map, a tool that enables qualitative assessment of the implantation coverage. Probability modelling reveals a higher likelihood of well-implanted SOZs in seizure-free patients or non-seizure free patients with incomplete SOZ resections, compared to non-seizure-free patients with complete resections. This highlights the framework's value in sparing patients from unsuccessful surgeries resulting from poor SEEG coverage.
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Affiliation(s)
- Kassem Jaber
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA
| | - Tamir Avigdor
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
| | - Daniel Mansilla
- Neurophysiology Unit, Institute of Neurosurgery Dr. Asenjo, Santiago, Chile
| | - Alyssa Ho
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - John Thomas
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA
| | - Chifaou Abdallah
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
| | - Stephan Chabardes
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Jeff Hall
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
| | - Lorella Minotti
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Philippe Kahane
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Christophe Grova
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, School of Health, Department of Physics, Concordia University, Montréal, QC, Canada
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Jean Gotman
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada.
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA.
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.
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Reecher HM, Bearden DJ, Koop JI, Berl MM, Patrick KE, Ailion AS. The changing landscape of electrical stimulation language mapping with subdural electrodes and stereoelectroencephalography for pediatric epilepsy: A literature review and commentary. Epilepsia 2024. [PMID: 38787551 DOI: 10.1111/epi.18009] [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: 01/26/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
Electrical stimulation mapping (ESM) is used to locate the brain areas supporting language directly within the human cortex to minimize the risk of functional decline following epilepsy surgery. ESM is completed by utilizing subdural grid or depth electrodes (stereo-electroencephalography [sEEG]) in combination with behavioral evaluation of language. Despite technological advances, there is no standardized method of assessing language during pediatric ESM. To identify current clinical practices for pediatric ESM of language, we surveyed neuropsychologists in the Pediatric Epilepsy Research Consortium. Results indicated that sEEG is used for functional mapping at >80% of participating epilepsy surgery centers (n = 13/16) in the United States. However, >65% of sites did not report a standardized protocol to map language. Survey results indicated a clear need for practice recommendations regarding ESM of language. We then utilized PubMed/Medline and PsychInfo to identify 42 articles that reported on ESM of language, of which 18 met inclusion criteria, which included use of ESM/signal recording to localize language regions in children (<21 years) and a detailed account of the procedure and language measures used, and region-specific language localization outcomes. Articles were grouped based on the language domain assessed, language measures used, and the brain regions involved. Our review revealed the need for evidence-based clinical guidelines for pediatric language paradigms during ESM and a standardized language mapping protocol as well as standardized reporting of brain regions in research. Relevant limitations and future directions are discussed with a focus on considerations for pediatric language mapping.
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Affiliation(s)
- Hope M Reecher
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Donald J Bearden
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jennifer I Koop
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Department of Neuropsychology, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Madison M Berl
- Department of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Kristina E Patrick
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Neuroscience, Seattle Children's Hospital, Seattle, Washington, USA
| | - Alyssa S Ailion
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Kheder A, Al-Ramadhani R, Bhalla S, Dickey A, Alwaki A, Chern J, Pederson N, Gedela S. Mapping the Central Sulcus Extraoperatively Using Stereoelectroencephalography: A New Application of an Established Method. J Clin Neurophysiol 2024; 41:322-325. [PMID: 36961735 DOI: 10.1097/wnp.0000000000001009] [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: 03/25/2023] Open
Abstract
PURPOSE Central sulcus localization is undertaken intraoperatively with subdural electrodes through a phase reversal technique using somatosensory evoked potentials from sensorimotor cortices. Extraoperative central sulcus localization using stereoelectroencephalography has not been described previously. METHODS Six pediatric patients (aged 12-18 years, 50% females) were investigated with stereoelectroencephalography. Peripheral median and posterior tibial nerve stimulation were performed while recording somatosensory evoked potentials from stereoelectroencephalography electrodes. RESULTS Central sulcus was successfully localized by this novel method, and this was further supplemented by cortical stimulation data. CONCLUSIONS This is the first report of somatosensory evoked potentials gained using stereoelectroencephalography in primary motor and sensory cortices. This can further supplement other data for safe surgical resection in the eloquent cortex.
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Affiliation(s)
- Ammar Kheder
- Department of Neurology, Emory University School of Medicine, Atlanta, GeorgiaU.S.A
- Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A
- Emory and Children's Pediatric Institute, Atlanta, Georgia, U.S.A.; and
| | - Ruba Al-Ramadhani
- University of Pittsburgh Medical Center Children's Hospital, Pittsburgh, Pennsylvania, U.S.A
| | - Sonam Bhalla
- Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A
- Emory and Children's Pediatric Institute, Atlanta, Georgia, U.S.A.; and
| | - Adam Dickey
- Department of Neurology, Emory University School of Medicine, Atlanta, GeorgiaU.S.A
| | - Abdulrahman Alwaki
- Department of Neurology, Emory University School of Medicine, Atlanta, GeorgiaU.S.A
| | - Joshua Chern
- Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A
| | - Nigel Pederson
- Department of Neurology, Emory University School of Medicine, Atlanta, GeorgiaU.S.A
| | - Satyanarayana Gedela
- Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A
- Emory and Children's Pediatric Institute, Atlanta, Georgia, U.S.A.; and
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Tojima M, Shimotake A, Neshige S, Okada T, Kobayashi K, Usami K, Matsuhashi M, Honda M, Takeyama H, Hitomi T, Yoshida T, Yokoyama A, Fushimi Y, Ueno T, Yamao Y, Kikuchi T, Namiki T, Arakawa Y, Takahashi R, Ikeda A. Specific consistency score for rational selection of epilepsy resection surgery candidates. Epilepsia 2024; 65:1322-1332. [PMID: 38470337 DOI: 10.1111/epi.17945] [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: 12/08/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE Degree of indication for epilepsy surgery is determined by taking multiple factors into account. This study aimed to investigate the usefulness of the Specific Consistency Score (SCS), a proposed score for focal epilepsy to rate the indication for epilepsy focal resection. METHODS This retrospective cohort study included patients considered for resective epilepsy surgery in Kyoto University Hospital from 2011 to 2022. Plausible epileptic focus was tentatively defined. Cardinal findings were scored based on specificity and consistency with the estimated laterality and lobe. The total points represented SCS. The association between SCS and the following clinical parameters was assessed by univariate and multivariate analysis: (1) probability of undergoing resective epilepsy surgery, (2) good postoperative seizure outcome (Engel I and II or Engel I only), and (3) lobar concordance between the noninvasively estimated focus and intracranial electroencephalographic (EEG) recordings. RESULTS A total of 131 patients were evaluated. Univariate analysis revealed higher SCS in the (1) epilepsy surgery group (8.4 [95% confidence interval (CI) = 7.8-8.9] vs. 4.9 [95% CI = 4.3-5.5] points; p < .001), (2) good postoperative seizure outcome group (Engel I and II; 8.7 [95% CI = 8.2-9.3] vs. 6.4 [95% CI = 4.5-8.3] points; p = .008), and (3) patients whose focus defined by intracranial EEG matched the noninvasively estimated focus (8.3 [95% CI = 7.3-9.2] vs. 5.4 [95% CI = 3.5-7.3] points; p = .004). Multivariate analysis revealed areas under the curve of .843, .825, and .881 for Parameters 1, 2, and 3, respectively. SIGNIFICANCE SCS provides a reliable index of good indication for resective epilepsy surgery and can be easily available in many institutions not necessarily specializing in epilepsy.
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Affiliation(s)
- Maya Tojima
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Shimotake
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichiro Neshige
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tadashi Okada
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kiyohide Usami
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Honda
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirofumi Takeyama
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takefumi Hitomi
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Yoshida
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Atsushi Yokoyama
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tsukasa Ueno
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Namiki
- Department of Mathematics, Faculty of Science, Hokkaido University, Sapporo, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Wong GM, McCray A, Hom K, Teti S, Cohen NT, Gaillard WD, Oluigbo CO. Outcomes of stereoelectroencephalography following failed epilepsy surgery in children. Childs Nerv Syst 2024:10.1007/s00381-024-06420-w. [PMID: 38652142 DOI: 10.1007/s00381-024-06420-w] [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: 10/15/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Stereoelectroencephalography (SEEG) is valuable for delineating the seizure onset zone (SOZ) in pharmacoresistant epilepsy when non-invasive presurgical techniques are inconclusive. Secondary epilepsy surgery after initial failure is challenging and there is limited research on SEEG following failed epilepsy surgery in children. OBJECTIVE The objective of this manuscript is to present the outcomes of children who underwent SEEG after failed epilepsy surgery. METHODS In this single-institution retrospective study, demographics, previous surgery data, SEEG characteristics, management, and follow-up were analyzed for pediatric patients who underwent SEEG after unsuccessful epilepsy surgery between August 2016 and February 2023. RESULTS Fifty three patients underwent SEEG investigation during this period. Of this, 13 patients were identified who had unsuccessful initial epilepsy surgery (24%). Of these 13 patients, six patients (46%) experienced unsuccessful resective epilepsy surgery that targeted the temporal lobe, six patients (46%) underwent surgery involving the frontal lobe, and one patient (8%) had laser interstitial thermal therapy (LITT) of the right insula. SEEG in two thirds of patients (4/6) with initial failed temporal resections revealed expanded SOZ to include the insula. All 13 patients (100%) had a subsequent surgery after SEEG which was either LITT (54%) or surgical resection (46%). After the subsequent surgery, a favorable outcome (Engel class I/II) was achieved by eight patients (62%), while five patients experienced an unfavorable outcome (Engel class III/IV, 38%). Of the six patients with secondary surgical resection, four patients (67%) had favorable outcomes, while of the seven patients with LITT, two patients (29%) had favorable outcomes (Engel I/II). Average follow-up after the subsequent surgery was 37 months ±23 months. CONCLUSION SEEG following initial failed resective epilepsy surgery may help guide next steps at identifying residual epileptogenic cortex and is associated with favorable seizure control outcomes.
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Affiliation(s)
- Georgia M Wong
- Department of Neurological Surgery, Georgetown University School of Medicine, Washington, DC, USA.
| | - Ashley McCray
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA
| | - Kara Hom
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
| | - Saige Teti
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA
| | - Nathan T Cohen
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - William D Gaillard
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA.
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Patel M, Mittal AK, Joshi V, Agrawal M, Babu Varthya S, Saini L, Saravanan A, Anil A, Rajial T, Panda S, Bhaskar S, Tiwari S, Singh K. Evaluation of Utility of Invasive Electroencephalography for Definitive Surgery in Patients with Drug-Resistant Epilepsy: A Systematic Review and Meta-Analysis. World Neurosurg 2024:S1878-8750(24)00652-1. [PMID: 38649027 DOI: 10.1016/j.wneu.2024.04.079] [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: 01/18/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
When noninvasive tests are unable to define the epileptogenic zone in patients, intracranial electroencephalography (iEEG) is a method of localizing the epileptogenic zone. Compared with noninvasive evaluations, it offers more precise information about patterns of epileptiform activity, which results in useful diagnostic information that supports surgical decision-making. The primary aim of the present study was to assess the utility of iEEG for definitive surgery for patients with drug-resistant epilepsy. Online databases such as PubMed, Medline, Embase, Scopus, Cochrane Library, Web of Science, and IEEE Xplore were searched for MeSH terms and free-text keywords. The ROBINS I (risk of bias in non-randomized studies - of interventions) critical appraisal tool was used for quality assessment. The prevalence from different studies was pooled together using the inverse variance heterogeneity method. Egger's regression analysis and funnel plot were used to evaluate publication bias. The systematic review included 18 studies, and the meta-analysis included 10 studies to estimate the prevalence of seizure freedom (Engel class I) in patients undergoing surgery after iEEG. A total of 526 patients were included in the meta-analysis. The follow-up period ranged from 1 to 10 years. The overall pooled estimate of the prevalence of seizure freedom (Engel class I) for patients undergoing surgery after iEEG was 53% (95% confidence interval, 44%-62%). The results additionally demonstrated that 12 studies had a moderate risk of bias and 6 had a low risk. Future studies are crucial to enhance our understanding of iEEG to guide patient choices and unravel their implications.
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Affiliation(s)
- Mamta Patel
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Amit K Mittal
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Vibha Joshi
- Department of CMFM, All India Institute of Medical Sciences, Jodhpur, India
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Shoban Babu Varthya
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Lokesh Saini
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Aswini Saravanan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhishek Anil
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Tanuja Rajial
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India.
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9
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Wong SM, Arski ON, Ibrahim GM. An automated algorithm for stereoelectroencephalography electrode localization and labelling. Seizure 2024; 117:293-297. [PMID: 38608341 DOI: 10.1016/j.seizure.2024.04.002] [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: 01/23/2024] [Revised: 03/12/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE Stereoelectroencephalography (sEEG) is increasingly utilized for localization of seizure foci, functional mapping, and neurocognitive research due to its ability to target deep and difficult to reach anatomical locations and to study in vivo brain function with a high signal-to-noise ratio. The research potential of sEEG is constrained by the need for accurate localization of the implanted electrodes in a common template space for group analyses. METHODS We present an algorithm to automate the grouping of sEEG electrodes by trajectories, labelled by target and insertion point. This algorithm forms the core of a pipeline that fully automates the entire process of electrode localization in standard space, using raw CT and MRI images to produce atlas labelled MNI coordinates. RESULTS Across 196 trajectories from 20 patients, the pipeline successfully processed 190 trajectories with localizations within 0.25±0.55 mm of the manual annotation by two reviewers. Six electrode trajectories were not directly identified due to metal artifacts and locations were interpolated based on the first and last contact location and the number of contacts in that electrode as listed in the surgical record. CONCLUSION We introduce our algorithm and pipeline for automatically localizing, grouping, and classifying sEEG electrodes from raw CT and MRI. Our algorithm adds to existing pipelines and toolboxes for electrode localization by automating the manual step of marking and grouping electrodes, thereby expedites the analyses of sEEG data, particularly in large datasets.
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Affiliation(s)
- Simeon M Wong
- Neurosciences and Mental Health, Hospital for Sick Children, 686 Bay St, Toronto, Ontario, M5G 0A4, Canada; Institute of Biomedical Engineering, University of Toronto, 164 College St, Toronto, Ontario, M5S 3E2, Canada; Division of Neurosurgery, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1×8, Canada
| | - Olivia N Arski
- Neurosciences and Mental Health, Hospital for Sick Children, 686 Bay St, Toronto, Ontario, M5G 0A4, Canada
| | - George M Ibrahim
- Neurosciences and Mental Health, Hospital for Sick Children, 686 Bay St, Toronto, Ontario, M5G 0A4, Canada; Institute of Biomedical Engineering, University of Toronto, 164 College St, Toronto, Ontario, M5S 3E2, Canada; Division of Neurosurgery, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1×8, Canada; Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada.
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10
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Blenkmann AO, Leske SL, Llorens A, Lin JJ, Chang EF, Brunner P, Schalk G, Ivanovic J, Larsson PG, Knight RT, Endestad T, Solbakk AK. Anatomical registration of intracranial electrodes. Robust model-based localization and deformable smooth brain-shift compensation methods. J Neurosci Methods 2024; 404:110056. [PMID: 38224783 DOI: 10.1016/j.jneumeth.2024.110056] [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: 05/23/2023] [Revised: 11/27/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Intracranial electrodes are typically localized from post-implantation CT artifacts. Automatic algorithms localizing low signal-to-noise ratio artifacts and high-density electrode arrays are missing. Additionally, implantation of grids/strips introduces brain deformations, resulting in registration errors when fusing post-implantation CT and pre-implantation MR images. Brain-shift compensation methods project electrode coordinates to cortex, but either fail to produce smooth solutions or do not account for brain deformations. NEW METHODS We first introduce GridFit, a model-based fitting approach that simultaneously localizes all electrodes' CT artifacts in grids, strips, or depth arrays. Second, we present CEPA, a brain-shift compensation algorithm combining orthogonal-based projections, spring-mesh models, and spatial regularization constraints. RESULTS We tested GridFit on ∼6000 simulated scenarios. The localization of CT artifacts showed robust performance under difficult scenarios, such as noise, overlaps, and high-density implants (<1 mm errors). Validation with data from 20 challenging patients showed 99% accurate localization of the electrodes (3160/3192). We tested CEPA brain-shift compensation with data from 15 patients. Projections accounted for simple mechanical deformation principles with < 0.4 mm errors. The inter-electrode distances smoothly changed across neighbor electrodes, while changes in inter-electrode distances linearly increased with projection distance. COMPARISON WITH EXISTING METHODS GridFit succeeded in difficult scenarios that challenged available methods and outperformed visual localization by preserving the inter-electrode distance. CEPA registration errors were smaller than those obtained for well-established alternatives. Additionally, modeling resting-state high-frequency activity in five patients further supported CEPA. CONCLUSION GridFit and CEPA are versatile tools for registering intracranial electrode coordinates, providing highly accurate results even in the most challenging implantation scenarios. The methods are implemented in the iElectrodes open-source toolbox.
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Affiliation(s)
- Alejandro Omar Blenkmann
- Department of Psychology, University of Oslo, Norway; RITMO Centre for Interdisciplinary Studies in Rhythm, Time, and Motion, University of Oslo, Norway.
| | - Sabine Liliana Leske
- Department of Musicology, University of Oslo, Norway; RITMO Centre for Interdisciplinary Studies in Rhythm, Time, and Motion, University of Oslo, Norway; Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway
| | - Anaïs Llorens
- Department of Psychology, University of Oslo, Norway; Department of Psychology and the Helen Wills Neuroscience Institute, University of California, Berkeley, USA; Université de Franche-Comté, SUPMICROTECH, CNRS, Institut FEMTO-ST, 25000 Besançon, France; Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team TURC, 75014 Paris, France
| | - Jack J Lin
- Department of Neurology and Center for Mind and Brain, University of California, Davis, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Peter Brunner
- Department of Neurology, Albany Medical College, Albany, NY, USA; National Center for Adaptive Neurotechnologies, Albany, NY, USA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gerwin Schalk
- Department of Neurology, Albany Medical College, Albany, NY, USA; National Center for Adaptive Neurotechnologies, Albany, NY, USA; Tianqiao and Chrissy Chen Institute, Chen Frontier Lab for Applied Neurotechnology, Shanghai, China; Fudan University/Huashan Hospital, Department of Neurosurgery, Shanghai, China
| | | | | | - Robert Thomas Knight
- Department of Psychology and the Helen Wills Neuroscience Institute, University of California, Berkeley, USA
| | - Tor Endestad
- Department of Psychology, University of Oslo, Norway; RITMO Centre for Interdisciplinary Studies in Rhythm, Time, and Motion, University of Oslo, Norway; Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway
| | - Anne-Kristin Solbakk
- Department of Psychology, University of Oslo, Norway; RITMO Centre for Interdisciplinary Studies in Rhythm, Time, and Motion, University of Oslo, Norway; Department of Neurosurgery, Oslo University Hospital, Norway; Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway
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11
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Huang Q, Xie P, Zhou J, Ding H, Liu Z, Li T, Guan Y, Wang M, Wang J, Teng P, Zhu M, Ma K, Wu H, Luan G, Zhai F. Predictors of seizure outcomes in stereo-electroencephalography-guided radio-frequency thermocoagulation for MRI-negative epilepsy. Ther Adv Chronic Dis 2024; 15:20406223241236258. [PMID: 38496233 PMCID: PMC10943718 DOI: 10.1177/20406223241236258] [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: 02/22/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Background One-third of intractable epilepsy patients have no visually identifiable focus for neurosurgery based on imaging tests [magnetic resonance imaging (MRI)-negative cases]. Stereo-electroencephalography-guided radio-frequency thermocoagulation (SEEG-guided RF-TC) is utilized in the clinical treatment of epilepsy to lower the incidence of complications post-open surgery. Objective This study aimed to identify prognostic factors and long-term seizure outcomes in SEEG-guided RF-TC for patients with MRI-negative epilepsy. Design This was a single-center retrospective cohort study. Methods We included 30 patients who had undergone SEEG-guided RF-TC at Sanbo Brain Hospital, Capital Medical University, from April 2015 to December 2019. The probability of remaining seizure-free and the plotted survival curves were analyzed. Prognostic factors were analyzed using log-rank tests in univariate analysis and the Cox regression model in multivariate analysis. Results With a mean time of 31.07 ± 2.64 months (median 30.00, interquartile range: 18.00-40.00 months), 11 out of 30 patients (36.7%) were classified as International League Against Epilepsy class 1 in the last follow-up. The mean time of remaining seizure-free was 21.33 ± 4.55 months [95% confidence interval (CI) 12.41-30.25], and the median time was 3.00 ± 0.54 months (95% CI 1.94-4.06). Despite falling in the initial year, the probability of remaining seizure-free gradually stabilizes in the subsequent years. The patients were more likely to obtain seizure freedom when the epileptogenic zone was located in the insular lobe or with one focus on the limbic system (p = 0.034, hazard ratio 5.019, 95% CI 1.125-22.387). Conclusion Our findings may be applied to guide individualized surgical interventions and help clinicians make better decisions.
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Affiliation(s)
- Qi Huang
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Pandeng Xie
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Jian Zhou
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Haoran Ding
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Zhao Liu
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Tianfu Li
- Department of Brain Institute, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Yuguang Guan
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Mengyang Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Jing Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Pengfei Teng
- Department of Magnetoencephalography, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Mingwang Zhu
- Department of Radiology, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Kaiqiang Ma
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Han Wu
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Guoming Luan
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
| | - Feng Zhai
- Department of Neurosurgery, Center of Epilepsy, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
- Department of Functional Neurosurgery, Neurological Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
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12
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Ilyas A, Vilella L, Restrepo CE, Johnson J, Pati S, Lacuey N, Lhatoo S, Thompson SA, Tandon N. The value of additional electrodes when stereo-electroencephalography is inconclusive. Epilepsia 2024; 65:641-650. [PMID: 38265418 DOI: 10.1111/epi.17885] [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: 05/03/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Stereo-electroencephalography (SEEG) is the preferred method for intracranial localization of the seizure-onset zone (SOZ) in drug-resistant focal epilepsy. Occasionally SEEG evaluation fails to confirm the pre-implantation hypothesis. This leads to a decision tree regarding whether the addition of SEEG electrodes (two-step SEEG - 2sSEEG) or placement of subdural electrodes (SDEs) after SEEG (SEEG2SDE) would help. There is a dearth of literature encompassing this scenario, and here we aimed to characterize outcomes following unplanned two-step intracranial EEG (iEEG). METHODS All 225 adult SEEG cases over 8 years at our institution were reviewed to extract patient data and outcomes following a two-step evaluation. Three raters independently quantified benefits of additional intracranial electrodes. The relationship between two-step iEEG benefit and clinical outcome was then analyzed. RESULTS Fourteen patients underwent 2sSEEG and nine underwent SEEG2SDE. In the former cohort, the second SEEG procedure was performed for these reasons-precise localization of the SOZ (36%); defining margins of eloquent cortex (21%); and broadening coverage in the setting of non-localizable seizure onsets (43% of cases). Sixty-four percent of 2sSEEG cases were consistently deemed beneficial (Light's κ = 0.80). 2sSEEG performed for the first two indications was much more beneficial than when onsets were not localizable (100% vs 17%, p = .02). In the SEEG2SDE cohort, SDEs identified the SOZ and enabled delineation of margins relative to eloquent cortex in all cases. SIGNIFICANCE The two-step iEEG is useful if the initial evaluation is broadly concordant with the original electroclinical hypothesis, where it can clarify onset zones or delineate safe surgical margins; however, it provides minimal benefit when the implantation hypothesis is erroneous, and we recommend that 2sSEEG not be generally utilized in such cases. SDE implantation after SEEG minimizes the need for SDEs and is helpful in delineating surgical boundaries relative to ictal-onset zones and eloquent cortex.
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Affiliation(s)
- Adeel Ilyas
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Laura Vilella
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Neurology, McGovern Medical School at UT Health Houston, Houston, Texas, USA
| | - Carlos E Restrepo
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jessica Johnson
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Memorial Hermann Hospital, Texas Medical Center, Houston, Texas, USA
| | - Sandipan Pati
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Neurology, McGovern Medical School at UT Health Houston, Houston, Texas, USA
- Memorial Hermann Hospital, Texas Medical Center, Houston, Texas, USA
| | - Nuria Lacuey
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Neurology, McGovern Medical School at UT Health Houston, Houston, Texas, USA
- Memorial Hermann Hospital, Texas Medical Center, Houston, Texas, USA
| | - Samden Lhatoo
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Neurology, McGovern Medical School at UT Health Houston, Houston, Texas, USA
- Memorial Hermann Hospital, Texas Medical Center, Houston, Texas, USA
| | - Stephen A Thompson
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Neurology, McGovern Medical School at UT Health Houston, Houston, Texas, USA
- Memorial Hermann Hospital, Texas Medical Center, Houston, Texas, USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Memorial Hermann Hospital, Texas Medical Center, Houston, Texas, USA
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13
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Biagioli N, Morandi S, Vaudano AE, Pugnaghi M, Moriconi E, Pavesi G, Tramontano V, Meletti S. Intraoperative ECoG in bottom-of-the-sulcus syndrome using a novel flexible strip electrode. Epileptic Disord 2024. [PMID: 38420724 DOI: 10.1002/epd2.20211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/09/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
The recording of epileptiform discharges from bottom-of-sulcus focal cortical dysplasia (BOSD) is often difficult during intraoperative electrocorticography (ECoG) due to the deep localization. We describe the use in this scenario of a new-generation electrode strip with high flexibility, easily adapted to cortical gyri and sulci. A right-handed 20-year-old male with drug-resistant focal epilepsy due to BOSD of the inferior frontal gyrus and daily focal aware seizures was evaluated for epilepsy surgery. Based on electroclinical and neuroimaging results, a focal cortectomy guided by ECoG was proposed. ECoG recordings were performed with new-generation cortical strips (Wise Cortical Strip; WCS®) and standard cortical strips. ECoG, performed on the convexity of the frontal cortical surface, recorded only sporadic spikes with both types of strips. Then, after microsurgical trans-sulcal dissection, WCS was molded along the sulcal surface of the suspected BOSD based on 3D-imaging reconstruction, showing continuous/subcontinuous 3-4-Hz rhythmic spike activity from the deepest electrode. Registration after resection of the BOSD did not show any epileptiform activity. Pathology showed dysmorphic neurons and gliosis. No surgical complications occurred. The patient is seizure-free after 12 months. This single case experience shows that highly flexible electrode strips with adaptability to cortical gyrations can identify IEDs originating from deep location and could therefore be useful in cases of bottom of the sulcus dysplasia.
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Affiliation(s)
- Niccolò Biagioli
- Department of Biomedical Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Sofia Morandi
- Clinical Neurophysiology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Anna Elisabetta Vaudano
- Department of Biomedical Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
- Clinical Neurophysiology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Matteo Pugnaghi
- Neurology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
- Clinical Neurophysiology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Elisa Moriconi
- Neurosurgery Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Giacomo Pavesi
- Neurosurgery Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Vincenzo Tramontano
- Clinical Neurophysiology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
| | - Stefano Meletti
- Department of Biomedical Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
- Clinical Neurophysiology Unit, Head and Neck Neuroscience Department, AOU, Modena, Italy
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14
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Kullmann A, Akberali F, Van Gompel JJ, McGovern RA, Marsh WR, Kridner D, Diaz-Botia CA, Park MC. Implantation accuracy of novel polyimide stereotactic electroencephalographic depth electrodes-a human cadaveric study. FRONTIERS IN MEDICAL TECHNOLOGY 2024; 6:1320762. [PMID: 38456122 PMCID: PMC10917981 DOI: 10.3389/fmedt.2024.1320762] [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: 10/12/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Stereoelectroencephalography (sEEG) is a minimally invasive procedure that uses depth electrodes stereotactically implanted into brain structures to map the origin and propagation of seizures in epileptic patients. Implantation accuracy of sEEG electrodes plays a critical role in the safety and efficacy of the procedure. This study used human cadaver heads, simulating clinical practice, to evaluate (1) neurosurgeon's ability to implant a new thin-film polyimide sEEG electrode according to the instructions for use (IFU), and (2) implantation accuracy. Methods Four neurosurgeons (users) implanted 24 sEEG electrodes into two cadaver heads with the aid of the ROSA robotic system. Usability was evaluated using a questionnaire that assessed completion of all procedure steps per IFU and user errors. For implantation accuracy evaluation, planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative computer tomography (CT) images. Implantation accuracy was quantified using the Euclidean distance for entry point error (EPE) and target point error (TPE). Results All sEEG electrodes were successfully placed following the IFU without user errors, and post-implant survey of users showed favorable handling characteristics. The EPE was 1.28 ± 0.86 mm and TPE was 1.61 ± 0.89 mm. Long trajectories (>50 mm) had significantly larger EPEs and TPEs than short trajectories (<50 mm), and no differences were found between orthogonal and oblique trajectories. Accuracies were similar or superior to those reported in the literature when using similar experimental conditions, and in the same range as those reported in patients. Discussion The results demonstrate that newly developed polyimide sEEG electrodes can be implanted as accurately as similar devices in the marker without user errors when following the IFU in a simulated clinical environment. The human cadaver ex-vivo test system provided a realistic test system, owing to the size, anatomy and similarity of tissue composition to that of the live human brain.
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Affiliation(s)
- Aura Kullmann
- NeuroOne Medical Technologies, Eden Prairie, MN, United States
| | | | | | - Robert A. McGovern
- Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis, MN, United States
| | - W. Richard Marsh
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Debra Kridner
- NeuroOne Medical Technologies, Eden Prairie, MN, United States
| | | | - Michael C. Park
- Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis, MN, United States
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, United States
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15
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Kaewborisutsakul A, Chernov M, Yokosako S, Kubota Y. Usefulness of Robotic Stereotactic Assistance (ROSA ®) Device for Stereoelectroencephalography Electrode Implantation: A Systematic Review and Meta-analysis. Neurol Med Chir (Tokyo) 2024; 64:71-86. [PMID: 38220166 PMCID: PMC10918457 DOI: 10.2176/jns-nmc.2023-0119] [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: 05/29/2023] [Accepted: 10/17/2023] [Indexed: 01/16/2024] Open
Abstract
The aim of this study was to systematically review and meta-analyze the efficiency and safety of using the Robotic Stereotactic Assistance (ROSA®) device (Zimmer Biomet; Warsaw, IN, USA) for stereoelectroencephalography (SEEG) electrode implantation in patients with drug-resistant epilepsy. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was carried out. Overall, 855 nonduplicate relevant articles were determined, and 15 of them were selected for analysis. The benefits of the ROSA® device use in terms of electrode placement accuracy, as well as operative time length, perioperative complications, and seizure outcomes, were evaluated. Studies that were included reported on a total of 11,257 SEEG electrode implantations. The limited number of comparative studies hindered the comprehensive evaluation of the electrode implantation accuracy. Compared with frame-based or navigation-assisted techniques, ROSA®-assisted SEEG electrode implantation provided significant benefits for reduction of both overall operative time (mean difference [MD], -63.45 min; 95% confidence interval [CI] from -88.73 to -38.17 min; P < 0.00001) and operative time per implanted electrode (MD, -8.79 min; 95% CI from -14.37 to -3.21 min; P = 0.002). No significant differences existed in perioperative complications and seizure outcomes after the application of the ROSA® device and other techniques for electrode implantation. To conclude, the available evidence shows that the ROSA® device is an effective and safe surgical tool for trajectory-guided SEEG electrode implantation in patients with drug-resistant epilepsy, offering benefits for saving operative time and neither increasing the risk of perioperative complications nor negatively impacting seizure outcomes.
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Affiliation(s)
- Anukoon Kaewborisutsakul
- Neurological Surgery Unit, Division of Surgery, Faculty of Medicine, Prince of Songkla University
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Mikhail Chernov
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Suguru Yokosako
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
| | - Yuichi Kubota
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center
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16
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Kagawa K, Iida K, Hashizume A, Seyama G, Okamura A, Askoro R, Horie N. Retained Intracerebral Depth Electrode after Stereotactic Electroencephalography Monitoring: A Case Report. NMC Case Rep J 2024; 11:49-53. [PMID: 38454914 PMCID: PMC10918211 DOI: 10.2176/jns-nmc.2023-0242] [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: 10/18/2023] [Accepted: 12/13/2023] [Indexed: 03/09/2024] Open
Abstract
Stereotactic electroencephalography (SEEG) is an increasingly popular surgical modality for localizing the epileptogenic zone. Robot-guided stereotactic electrode placement has been covered in Japan by National Health Insurance since 2020. However, several surgical devices, such as the anchor bolt (a thin, hollow, metal shaft that serves as a guide screw or fixing for each electrode), have not been approved. A 14-year-old female who underwent SEEG for intractable epilepsy and required additional surgery to remove a retained depth electrode from the skull after the SEEG monitoring was finished. She had uncontrolled focal seizures consisting of nausea and laryngeal constriction at the onset. After a comprehensive presurgical evaluation, robot-guided stereotactic electrode implantation was performed to evaluate her seizures by SEEG. Nine depth electrodes were implanted through the twist drill hole. The electrodes were sutured to her skin for fixation without anchor bolts. When we attempted to remove the electrodes after 8 days of SEEG monitoring, one of the electrodes was retained. The retained electrode was removed through an additional skin incision and a small craniectomy under general anesthesia. We confirmed narrowing of the twist drill hole pathway in the internal table of the skull due to osteogenesis, which locked the electrode. This complication might be avoided if an anchor bolt had been used. This case report prompts the approval of the anchor bolts to avoid difficulty in electrode removal. Moreover, approval of a depth electrode with a thinner diameter and more consistent hardness is needed.
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Affiliation(s)
- Kota Kagawa
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Koji Iida
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Akira Hashizume
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Go Seyama
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Akitake Okamura
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Rofat Askoro
- Epilepsy Center, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
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17
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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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18
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Alsallom F, Simon MV. Pediatric Intraoperative Neurophysiologic Mapping and Monitoring in Brain Surgery. J Clin Neurophysiol 2024; 41:96-107. [PMID: 38306217 DOI: 10.1097/wnp.0000000000001054] [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: 02/04/2024] Open
Abstract
SUMMARY Similar to adults, children undergoing brain surgery can significantly benefit from intraoperative neurophysiologic mapping and monitoring. Although young brains present the advantage of increased plasticity, during procedures in close proximity to eloquent regions, the risk of irreversible neurological compromise remains and can be lowered further by these techniques. More so, pathologies specific to the pediatric population, such as neurodevelopmental lesions, often result in medically refractory epilepsy. Thus, their successful surgical treatment also relies on accurate demarcation and resection of the epileptogenic zone, processes in which intraoperative electrocorticography is often employed. However, stemming from the development and maturation of the central and peripheral nervous systems as the child grows, intraoperative neurophysiologic testing in this population poses methodologic and interpretative challenges even to experienced clinical neurophysiologists. For example, it is difficult to perform awake craniotomies and language testing in the majority of pediatric patients. In addition, children may be more prone to intraoperative seizures and exhibit afterdischarges more frequently during functional mapping using electrical cortical stimulation because of high stimulation thresholds needed to depolarize immature cortex. Moreover, choice of anesthetic regimen and doses may be different in pediatric patients, as is the effect of these drugs on immature brain; these factors add additional complexity in terms of interpretation and analysis of neurophysiologic recordings. Below, we are describing the modalities commonly used during intraoperative neurophysiologic testing in pediatric brain surgery, with emphasis on age-specific clinical indications, methodology, and challenges.
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Affiliation(s)
- Faisal Alsallom
- King Fahad Medical City, KFMC Neurosciences Center, Riyadh, Saudi Arabia; and
| | - Mirela V Simon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, U.S.A
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19
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Yang J, Shen L, Long Q, Li W, Zhang W, Chen Q, Han B. Electrical stimulation induced self-related auditory hallucinations correlate with oscillatory power change in the default mode network. Cereb Cortex 2024; 34:bhad473. [PMID: 38061695 DOI: 10.1093/cercor/bhad473] [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: 08/25/2023] [Revised: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 01/19/2024] Open
Abstract
Self-related information is crucial in our daily lives, which has led to the proposal that there is a specific brain mechanism for processing it. Neuroimaging studies have consistently demonstrated that the default mode network (DMN) is strongly associated with the representation and processing of self-related information. However, the precise relationship between DMN activity and self-related information, particularly in terms of neural oscillations, remains largely unknown. We electrically stimulated the superior temporal and fusiform areas, using stereo-electroencephalography to investigate neural oscillations associated with elicited self-related auditory hallucinations. Twenty-two instances of auditory hallucinations were recorded and categorized into self-related and other-related conditions. Comparing oscillatory power changes within the DMN between self-related and other-related auditory hallucinations, we discovered that self-related hallucinations are associated with significantly stronger positive power changes in both alpha and gamma bands compared to other-related hallucinations. To ensure the validity of our findings, we conducted controlled analyses for factors of familiarity and clarity, which revealed that the observed effects within the DMN remain independent of these factors. These results underscore the significance of the functional role of the DMN during the processing of self-related auditory hallucinations and shed light on the relationship between self-related perception and neural oscillatory activity.
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Affiliation(s)
- Jing Yang
- Center for Studies of Psychological Application, South China Normal University, No.55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
| | - Lu Shen
- Center for Studies of Psychological Application, South China Normal University, No.55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
| | - Qiting Long
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
| | - Wenjie Li
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
| | - Wei Zhang
- Department of Neurology, Beijing Tsinghua Changgung Hospital, Litang Road No. 168, Changping District, 102218, Beijing, China
- Epilepsy Center, Shanghai Neuromedical Center, Gulang Road No. 378, Putuo District, 200331, Shanghai, China
| | - Qi Chen
- Center for Studies of Psychological Application, South China Normal University, No.55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
| | - Biao Han
- Center for Studies of Psychological Application, South China Normal University, No.55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
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20
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Alekseev IM, Pekov ZZ, Pedyash NV, Zuev AA. [Safety of robot-assisted implantation of deep electrodes for invasive stereo-EEG monitoring]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:28-38. [PMID: 38334728 DOI: 10.17116/neiro20248801128] [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: 02/10/2024]
Abstract
Robot-assisted implantation of deep electrodes for stereo-EEG monitoring has become popular in recent years in patients with drug-resistant epilepsy. However, there are still few data on safety of this technique. OBJECTIVE To assess the incidence of complications in patients with drug-resistant epilepsy undergoing robot-assisted implantation of stereo-EEG electrodes. MATERIAL AND METHODS We retrospectively studied the results of implantation of stereo-EEG electrodes in 187 patients with drug-resistant epilepsy. All patients underwent non-invasive preoperative examination (video-EEG, MRI, PET, SPECT, MEG). In case of insufficient data, stereo-EEG monitoring was prescribed. We determined electrode insertion trajectory using a robotic station and MR images. Implantation of electrodes was carried out using a Rosa robot (Medtech, France). All patients underwent invasive EEG monitoring after implantation. RESULTS There were 11.25±3 electrodes per a patient. Implantation of one electrode took 7.5±4.9 min. Postoperative MRI revealed electrode malposition in 2.3% of cases. None was associated with complications. The complication rate per electrode was 0.6%. Complications affected stereo-EEG monitoring only in 3 cases (1.6%). The mortality rate was 0.5%. Bilateral implantation (p=0.005), insular (p=0.040) and occipital (p=0.045) deep electrode implantation were associated with lower incidence of complications. Longer duration of the procedure influenced the incidence of electrode placement in the lateral ventricle (p=0.028), and implantation in the frontal lobe was more often associated with epidural placement of electrodes (p=0.039). CONCLUSION Robot-assisted implantation of stereo-EEG electrodes is a safe procedure with minimal risk of complications. Rare electrode malposition does not usually affect invasive monitoring.
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Affiliation(s)
- I M Alekseev
- Pirogov National Medical Surgical Center, Moscow, Russia
| | - Zh Zh Pekov
- Pirogov National Medical Surgical Center, Moscow, Russia
| | - N V Pedyash
- Pirogov National Medical Surgical Center, Moscow, Russia
| | - A A Zuev
- Pirogov National Medical Surgical Center, Moscow, Russia
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21
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Shevchenko AM, Pogosbekyan EL, Batalov AI, Tyurina AN, Fadeeva LM, Agrba SB, Pronin IN. [Focal cortical dysplasia: visual assessment of MRI and MR morphometry data]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:45-51. [PMID: 38881015 DOI: 10.17116/neiro20248803145] [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: 06/18/2024]
Abstract
OBJECTIVE Assessing the diagnostic significance of MR morphometry in determining the localization of focal cortical dysplasias (FCD). MATERIAL AND METHODS The study included 13 children after surgery for drug-resistant epilepsy caused by FCD type II and stable postoperative remission of seizures (Engel class IA, median follow-up 56 months). We analyzed the results of independent expert assessment of native MR data by three radiologists (HARNESS protocol) and MR morphometry data regarding accuracy of FCD localization. We considered 2 indicators, i.e. local cortical thickening and gray-white matter blurring. RESULTS FCD detection rate was higher after MR morphometry compared to visual analysis of native MR data using the HARNESS protocol. MR morphometry also makes it possible to more often identify gray-white matter blurring as a sign often missed by radiologists (p<0.05). CONCLUSION MR morphometry is an additional non-invasive method for assessing the localization of FCD.
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Affiliation(s)
| | | | - A I Batalov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A N Tyurina
- Burdenko Neurosurgical Center, Moscow, Russia
| | - L M Fadeeva
- Burdenko Neurosurgical Center, Moscow, Russia
| | - S B Agrba
- Burdenko Neurosurgical Center, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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22
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Westin K, Beniczky S, Pfeiffer C, Hämäläinen M, Lundqvist D. On the clinical utility of on-scalp MEG: A modeling study of epileptic activity source estimation. Clin Neurophysiol 2023; 156:143-155. [PMID: 37951041 DOI: 10.1016/j.clinph.2023.10.006] [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: 10/12/2022] [Revised: 10/06/2023] [Accepted: 10/21/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE Epilepsy surgery requires localization of the seizure onset zone (SOZ). Today this can only be achieved by intracranial electroencephalography (iEEG). The iEEG electrode placement is guided by findings from non-invasive modalities that cannot themselves detect SOZ-generated initial seizure activity. On scalp magnetoencephalography (osMEG), with sensors placed on the scalp, demonstrates higher sensitivity than conventional MEG (convMEG) and could potentially detect early seizure activity. Here, we modeled EEG, convMEG and osMEG to compare the modalities' ability to localize SOZ activity and to detect epileptic spikes. METHODS We modeled seizure propagation within ten epileptic networks located in the mesial and lateral temporal lobe; basal, dorsal, central and frontopolar frontal lobe; parietal and occipital lobe as well as insula and cingulum. The networks included brain regions often involved in focal epilepsy. 128-channel osMEG, convMEG, EEG and combined osMEG + EEG and convMEG + EEG were modeled, and the SOZ source estimation accuracy was quantified and compared using Student's t-test. RESULTS OsMEG was significantly (p-value <0.01) better than both convMEG and EEG at detecting the earliest SOZ-generated seizure activity and epileptic spikes, and better at localizing seizure activity from all epileptic networks (p < 0.01). CONCLUSIONS Our modeling results clearly show that osMEG has an unsurpassed potential to detect both epileptic spikes and seizure activity from all simulated anatomical sites. SIGNIFICANCE No clinically available non-invasive technique can detect SOZ activity from all brain regions. Our study indicates that osMEG has the potential to become an important clinical tool, improving both non-invasive SOZ localization and iEEG electrode placement accuracy.
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Affiliation(s)
- Karin Westin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Clinical Neurophysiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark and Danish Epilepsy Centre, Dianalund, Denmark
| | - Christoph Pfeiffer
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Matti Hämäläinen
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Espoo, Finland
| | - Daniel Lundqvist
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Eelbode C, Spinelli L, Corniola M, Momjian S, Seeck M, Schaller K, Mégevand P. Implantation and reimplantation of intracranial EEG electrodes in patients considering epilepsy surgery. Epilepsia Open 2023; 8:1622-1627. [PMID: 37873557 PMCID: PMC10690689 DOI: 10.1002/epi4.12846] [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: 04/20/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
In patients with drug-resistant epilepsy who are considering surgery, intracranial EEG (iEEG) helps delineate the putative epileptogenic zone. In a minority of patients, iEEG fails to identify seizure onsets. In such cases, it might be worthwhile to reimplant more iEEG electrodes. The consequences of such a strategy for the patient are unknown. We matched 12 patients in whom the initially implanted iEEG electrodes did not delineate the seizure onset zone precisely enough to offer resective surgery, and in whom additional iEEG electrodes were implanted during the same inpatient stay, to controls who did not undergo reimplantation. Seven cases and eight controls proceeded to resective surgery. No intracranial infection occurred. One control suffered an intracranial hemorrhage. Three cases and two controls suffered from a post-operative neurological or neuropsychological deficit. We found no difference in post-operative seizure control between cases and controls. Compared to an ILAE score of 5 (ie, stable seizure frequency in the absence of resective surgery), cases showed significant improvement. Reimplantation of iEEG electrodes can offer the possibility of resective epilepsy surgery to patients in whom the initial iEEG investigation was inconclusive, without compromising on the risk of complications or seizure control.
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Affiliation(s)
- Céline Eelbode
- Neurology divisionGeneva University HospitalsGenevaSwitzerland
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
| | - Laurent Spinelli
- Neurology divisionGeneva University HospitalsGenevaSwitzerland
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
| | - Marco Corniola
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
- Neurosurgery DivisionGeneva University HospitalsGenevaSwitzerland
- Neurosurgery DivisionRennes University HospitalRennesFrance
- INSERM UMR 1099 LTSI, University of RennesRennesFrance
| | - Shahan Momjian
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
- Neurosurgery DivisionGeneva University HospitalsGenevaSwitzerland
| | - Margitta Seeck
- Neurology divisionGeneva University HospitalsGenevaSwitzerland
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
| | - Karl Schaller
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
- Neurosurgery DivisionGeneva University HospitalsGenevaSwitzerland
| | - Pierre Mégevand
- Neurology divisionGeneva University HospitalsGenevaSwitzerland
- Clinical Neuroscience DepartmentUniversity of Geneva, Faculty of MedicineGenevaSwitzerland
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24
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Bottan JS, Alshahrani A, Gilmore G, Steven DA, Burneo JG, Lau JC, McLachlan RS, Parrent AG, MacDougall KW, Diosy DC, Mirsattari SM, Suller Marti A. Lack of spontaneous typical seizures during intracranial monitoring with stereo-electroencephalography. Epileptic Disord 2023; 25:833-844. [PMID: 37792454 DOI: 10.1002/epd2.20165] [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: 11/27/2022] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE In the presurgical evaluation of patients with drug-resistant epilepsy (DRE), occasionally, patients do not experience spontaneous typical seizures (STS) during a stereo-electroencephalography (SEEG) study, which limits its effectiveness. We sought to identify risk factors for patients who did not have STS during SEEG and to analyze the clinical outcomes for this particular set of patients. METHODS We conducted a retrospective analysis of all patients with DRE who underwent depth electrode implantation and SEEG recordings between January 2013 and December 2018. RESULTS SEEG was performed in 155 cases during this period. 11 (7.2%) did not experience any clinical seizures (non-STS group), while 143 experienced at least one patient-typical seizure during admission (STS group). No significant differences were found between STS and non-STS groups in terms of patient demographics, lesional/non-lesional epilepsy ratio, pre-SEEG seizure frequency, number of ASMs used, electrographic seizures or postoperative seizure outcome in those who underwent resective surgery. Statistically significant differences were found in the average number of electrodes implanted (7.0 in the non-STS group vs. 10.2 in STS), days in Epilepsy Monitoring Unit (21.8 vs. 12.8 days) and the number of cases that underwent resective surgery following SEEG (27.3% vs. 60.8%), respectively. The three non-STS patients (30%) who underwent surgery, all had their typical seizures triggered during ECS studies. Three cases were found to have psychogenic non-epileptic seizures. None of the patients in the non-STS group were offered neurostimulation devices. Five of the non-STS patients experienced transient seizure improvement following SEEG. SIGNIFICANCE We were unable to identify any factors that predicted lack of seizures during SEEG recordings. Resective surgery was only offered in cases where ECS studies replicated patient-typical seizures. Larger datasets are required to be able to identify factors that predict which patients will fail to develop seizures during SEEG.
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Affiliation(s)
- Juan S Bottan
- Section of Neurosurgery, Hospital General de Niños "Pedro De Elizalde", Ciudad Autónoma de Buenos Aires, Argentina
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ashwaq Alshahrani
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Greydon Gilmore
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David A Steven
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Neuroepidemiology Unit, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jonathan C Lau
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Richard S McLachlan
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrew G Parrent
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Keith W MacDougall
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David C Diosy
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ana Suller Marti
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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25
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Rizzi M, Castelli N, Cojazzi V, Innocenti N, Levi V, Didato G, Marucci G, Garbelli R, Nazzi V. 3D4K exoscope in epilepsy surgery: a seminal experience. Acta Neurochir (Wien) 2023; 165:3921-3925. [PMID: 37945998 DOI: 10.1007/s00701-023-05885-z] [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: 08/11/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVES To report the progressive introduction of the exoscope (EX) from surface lesionectomy to antero-mesial temporal lobectomy (AMTL) in an epilepsy surgery practice. METHODS We describe a population of ten consecutive patients undergoing EX surgery, with a minimum follow-up of 6 months, that was compared to a similar population of patients referred to operative microscopic surgery (OM). RESULTS All surgeries were performed with the use of EX or OM alone. Transient neurological complications for surgery in eloquent regions were recorded in one patient for each population. Nine and seven patients undergoing, respectively, EX and OM surgery resulted in Engel class Ia (90% vs. 70%). The mean duration of EX and OM surgery resulted in 265.5 and 237.9 min, respectively, with a mean of 308.3 and 253.3 min for AMTL cases, respectively. CONCLUSIONS This preliminary study revealed that ORBEYE EX can be safe and effective in different types of epilepsy surgeries. The transition from OM to EX is fast, even though it is slower for the more challenging mesial temporal structure removal. Ergonomic and operative team interaction is improved by the use of EX. Our data need to be confirmed by larger studies.
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Affiliation(s)
- Michele Rizzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nicolò Castelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Vittoria Cojazzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Niccolò Innocenti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Didato
- Clinical and Experimental Epileptology and Sleep Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gianluca Marucci
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rita Garbelli
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vittoria Nazzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Pérez Hinestroza J, Mazo C, Trujillo M, Herrera A. MRI and CT Fusion in Stereotactic Electroencephalography (SEEG). Diagnostics (Basel) 2023; 13:3420. [PMID: 37998556 PMCID: PMC10670384 DOI: 10.3390/diagnostics13223420] [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: 05/30/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 11/25/2023] Open
Abstract
Epilepsy is a neurological disorder characterized by spontaneous recurrent seizures. While 20% to 30% of epilepsy cases are untreatable with Anti-Epileptic Drugs, some of these cases can be addressed through surgical intervention. The success of such interventions greatly depends on accurately locating the epileptogenic tissue, a task achieved using diagnostic techniques like Stereotactic Electroencephalography (SEEG). SEEG utilizes multi-modal fusion to aid in electrode localization, using pre-surgical resonance and post-surgical computer tomography images as inputs. To ensure the absence of artifacts or misregistrations in the resultant images, a fusion method that accounts for electrode presence is required. We proposed an image fusion method in SEEG that incorporates electrode segmentation from computed tomography as a sampling mask during registration to address the fusion problem in SEEG. The method was validated using eight image pairs from the Retrospective Image Registration Evaluation Project (RIRE). After establishing a reference registration for the MRI and identifying eight points, we assessed the method's efficacy by comparing the Euclidean distances between these reference points and those derived using registration with a sampling mask. The results showed that the proposed method yielded a similar average error to the registration without a sampling mask, but reduced the dispersion of the error, with a standard deviation of 0.86 when a mask was used and 5.25 when no mask was used.
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Affiliation(s)
- Jaime Pérez Hinestroza
- Multimedia and Computer Vision Group, Universidad del Valle, Cali 760042, Colombia; (C.M.); (M.T.); (A.H.)
| | - Claudia Mazo
- Multimedia and Computer Vision Group, Universidad del Valle, Cali 760042, Colombia; (C.M.); (M.T.); (A.H.)
- School of Computing, Faculty of Engineering and Computing, Glasnevin Campus, Dublin City University, 9 Dublin, Ireland
| | - Maria Trujillo
- Multimedia and Computer Vision Group, Universidad del Valle, Cali 760042, Colombia; (C.M.); (M.T.); (A.H.)
| | - Alejandro Herrera
- Multimedia and Computer Vision Group, Universidad del Valle, Cali 760042, Colombia; (C.M.); (M.T.); (A.H.)
- Clinica Imbanaco Grupo Quironsalud, Cali 760042, Colombia
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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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Männlin J, San Antonio-Arce V, Reinacher PC, Scheiwe C, Shah MJ, Urbach H, Schulze-Bonhage A. Safety profile of subdural and depth electrode implantations in invasive EEG exploration of drug-resistant focal epilepsy. Seizure 2023; 110:21-27. [PMID: 37302157 DOI: 10.1016/j.seizure.2023.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
PURPOSE To analyze the safety profile of subdural and depth electrode implantation in a large monocentric cohort of patients of all ages undergoing intracranial EEG exploration because of drug resistant focal epilepsy diagnosed and implanted by a constant team of epileptologists and neurosurgeons. METHODS We retrospectively analyzed data from 452 implantations in 420 patients undergoing invasive presurgical evaluation at the Freiburg Epilepsy Center from 1999 to 2019 (n = 160 subdural electrodes, n = 156 depth electrodes and n = 136 combination of both approaches). Complications were classified as hemorrhage with or without clinical manifestations, infection-associated and other complications. Furthermore, possible risk factors (age, duration of invasive monitoring, number of electrode contacts used) and changes in complication rates during the study period were analyzed. RESULTS The most frequent complications in both implantation groups were hemorrhages. Subdural electrode explorations caused significantly more symptomatic hemorrhages and required more operative interventions (SDE 9.9%, DE 0.3%, p < 0.05). Hemorrhage risk was higher for grids with 64 contacts than for smaller grids (p < 0.05). The infection rate was very low (0,2%). A transient neurological deficit occurred in 8.8% of all implantations and persisted for at least 3 months in 1.3%. Transient, but not persistent neurological deficits were more common in patients with implanted subdural electrodes than in the depth electrode group. CONCLUSION The use of subdural electrodes was associated with a higher risk of hemorrhage and transient neurological symptoms. However persistent deficits were rare with either approach, demonstrating that intracranial investigations using either subdural electrodes or depth electrodes carry acceptable risks in patients with drug-resistant focal epilepsy.
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Affiliation(s)
- Julia Männlin
- Freiburg Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg im Breisgau 79106, Germany.
| | - Victoria San Antonio-Arce
- Freiburg Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg im Breisgau 79106, Germany; Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE, Germany
| | - Peter Christoph Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg im Breisgau 79106, Germany; Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg im Breisgau 79106, Germany
| | - Mukesch Johannes Shah
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg im Breisgau 79106, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg im Breisgau 79106, Germany
| | - Andreas Schulze-Bonhage
- Freiburg Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg im Breisgau 79106, Germany; Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE, Germany.
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Joris V, Ribeiro-Vaz JG, Finet P, El Tahry R, Elkaim LM, Raftopoulos C, Ferrao-Santos S. Stereoelectroencephalography Implantation Using Frameless Neuronavigation and Varioguide: Prospective Analysis of Accuracy and Safety in a Case Series of 11 Patients. World Neurosurg 2023; 174:e62-e71. [PMID: 36871656 DOI: 10.1016/j.wneu.2023.02.116] [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: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Stereoencephalography (SEEG) is becoming a widespread diagnostic procedure for drug-resistant epilepsy investigation. Techniques include frame-based and robot-assisted implantation, and more recently, frameless neuronavigated systems (FNSs). Despite its recent use, the accuracy and safety of FNS are still under investigation. OBJECTIVE To assess in a prospective study the accuracy and safety of a specific FNS use for SEEG implantation. METHODS Twelve patients who underwent SEEG implantation using FNS (Varioguide [Brainlab]) were included in this study. Data were collected prospectively and included demographic data, postoperative complications, functional results, and implantation characteristics (i.e., duration and number of electrodes). Further analysis included accuracy at entry point and target using measurements of the euclidean distance between planned and actual trajectories. RESULTS Eleven patients underwent SEEG-FNS implantation from May 2019 to March 2020. One patient did not undergo surgery because of a bleeding disorder. The mean target deviation was 4.06 mm, and mean entry point deviation was 4.2 mm, with insular electrodes significantly more deviated. Results excluding insular electrodes showed a mean target deviation of 3.66 mm and a mean entry point deviation of 3.77 mm. No severe complications occurred; a few mild to moderate adverse events were reported (1 superficial infection, 1 seizure cluster, and 3 transient neurologic impairments). The mean implantation duration by electrodes was 18.5 minutes. CONCLUSIONS Implantation of depth electrodes for SEEG using FNS seems to be safe, but larger prospective studies are needed to validate these results. Accuracy is sufficient for noninsular trajectories but warrant caution for insular trajectories with statistically significantly less accuracy.
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Affiliation(s)
- Vincent Joris
- Department of Neurosurgery, Cliniques Universitaires St-Luc, Woluwe-St-Lambert, Belgium.
| | | | - Patrice Finet
- Department of Neurosurgery, Cliniques Universitaires St-Luc, Woluwe-St-Lambert, Belgium
| | - Riëm El Tahry
- Department of Neurology, Cliniques Universitaires St-Luc, Woluwe-St-Lambert, Belgium
| | - Lior M Elkaim
- Division of Neurology and Neurosurgery, McGill University, McGill University Health Center, Montreal, Quebec, Canada
| | - Christian Raftopoulos
- Department of Neurosurgery, Cliniques Universitaires St-Luc, Woluwe-St-Lambert, Belgium
| | - Susana Ferrao-Santos
- Department of Neurology, Cliniques Universitaires St-Luc, Woluwe-St-Lambert, Belgium
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Firestone E, Sonoda M, Kuroda N, Sakakura K, Jeong JW, Lee MH, Wada K, Takayama Y, Iijima K, Iwasaki M, Miyazaki T, Asano E. Sevoflurane-induced high-frequency oscillations, effective connectivity and intraoperative classification of epileptic brain areas. Clin Neurophysiol 2023; 150:17-30. [PMID: 36989866 PMCID: PMC10192072 DOI: 10.1016/j.clinph.2023.03.004] [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: 10/24/2022] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To determine how sevoflurane anesthesia modulates intraoperative epilepsy biomarkers on electrocorticography, including high-frequency oscillation (HFO) effective connectivity (EC), and to investigate their relation to epileptogenicity and anatomical white matter. METHODS We studied eight pediatric drug-resistant focal epilepsy patients who achieved seizure control after invasive monitoring and resective surgery. We visualized spatial distributions of the electrocorticography biomarkers at an oxygen baseline, three time-points while sevoflurane was increasing, and at a plateau of 2 minimum alveolar concentration (MAC) sevoflurane. HFO EC was combined with diffusion-weighted imaging, in dynamic tractography. RESULTS Intraoperative HFO EC diffusely increased as a function of sevoflurane concentration, although most in epileptogenic sites (defined as those included in the resection); their ability to classify epileptogenicity was optimized at sevoflurane 2 MAC. HFO EC could be visualized on major white matter tracts, as a function of sevoflurane level. CONCLUSIONS The results strengthened the hypothesis that sevoflurane-activated HFO biomarkers may help intraoperatively localize the epileptogenic zone. SIGNIFICANCE Our results help characterize how HFOs at non-epileptogenic and epileptogenic networks respond to sevoflurane. It may be warranted to establish a normative HFO atlas incorporating the modifying effects of sevoflurane and major white matter pathways, as critical reference in epilepsy presurgical evaluation.
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Affiliation(s)
- Ethan Firestone
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center,Wayne State University, Detroit, MI 48201, USA; Department of Physiology, Wayne State University, Detroit, MI 48201, USA
| | - Masaki Sonoda
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center,Wayne State University, Detroit, MI 48201, USA; Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama 2360004, Japan
| | - Naoto Kuroda
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center,Wayne State University, Detroit, MI 48201, USA; Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai 9808575, Japan
| | - Kazuki Sakakura
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center,Wayne State University, Detroit, MI 48201, USA; Department of Neurosurgery, University of Tsukuba, Tsukuba 3058575, Japan
| | - Jeong-Won Jeong
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center,Wayne State University, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA
| | - Min-Hee Lee
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center,Wayne State University, Detroit, MI 48201, USA
| | - Keiko Wada
- Department of Anesthesiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan; Department of Anesthesiology and Critical Care, Yokohama City University Graduate School of Medicine, Yokohama 2360004, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama 2360004, Japan; Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan
| | - Tomoyuki Miyazaki
- Department of Anesthesiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan; Department of Physiology, Yokohama City University Graduate School of Medicine, Yokohama 2360004, Japan
| | - Eishi Asano
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center,Wayne State University, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
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Jiang X, Liu X, Liu Y, Wang Q, Li B, Zhang L. Epileptic seizures detection and the analysis of optimal seizure prediction horizon based on frequency and phase analysis. Front Neurosci 2023; 17:1191683. [PMID: 37260846 PMCID: PMC10228742 DOI: 10.3389/fnins.2023.1191683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 06/02/2023] Open
Abstract
Changes in the frequency composition of the human electroencephalogram are associated with the transitions to epileptic seizures. Cross-frequency coupling (CFC) is a measure of neural oscillations in different frequency bands and brain areas, and specifically phase-amplitude coupling (PAC), a form of CFC, can be used to characterize these dynamic transitions. In this study, we propose a method for seizure detection and prediction based on frequency domain analysis and PAC combined with machine learning. We analyzed two databases, the Siena Scalp EEG database and the CHB-MIT database, and used the frequency features and modulation index (MI) for time-dependent quantification. The extracted features were fed to a random forest classifier for classification and prediction. The seizure prediction horizon (SPH) was also analyzed based on the highest-performing band to maximize the time for intervention and treatment while ensuring the accuracy of the prediction. Under comprehensive consideration, the results demonstrate that better performance could be achieved at an interval length of 5 min with an average accuracy of 85.71% and 95.87% for the Siena Scalp EEG database and the CHB-MIT database, respectively. As for the adult database, the combination of PAC analysis and classification can be of significant help for seizure detection and prediction. It suggests that the rarely used SPH also has a major impact on seizure detection and prediction and further explorations for the application of PAC are needed.
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Affiliation(s)
- Ximiao Jiang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Xiaotong Liu
- Department of Dynamics and Control, Beihang University, Beijing, China
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Qingyun Wang
- Department of Dynamics and Control, Beihang University, Beijing, China
| | - Bao Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Liyuan Zhang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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Wu S, Wang Q, Zhai H, Zhang Y, Xu D, Yan G, Wu R. γ-Aminobutyric acid as a biomarker of the lateralizing and monitoring drug effect in patients with magnetic resonance imaging-negative temporal lobe epilepsy. Front Neurosci 2023; 17:1184440. [PMID: 37255748 PMCID: PMC10225511 DOI: 10.3389/fnins.2023.1184440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/21/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Despite verifying proton magnetic resonance spectroscopy (1H-MRS) for focal localization in magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE), it is necessary to illustrate metabolic changes and screen for effective biomarkers for monitoring therapeutic effect. We used 1H-MRS to investigate the role of metabolic levels in MRI-negative TLE. Materials and methods Thirty-seven patients (n = 37, 14 women) and 20 healthy controls (n = 20, 11 women) were investigated by 1H-MRS. We compared the metabolite level changes in the epileptic and contralateral sides on the mesial temporal and dorsolateral prefrontal cortices and analyzed their association with clinical symptoms. Results γ-Aminobutyric acid (GABA) levels were significantly lower on the epileptic side (2.292 ± 0.890) than in the contralateral side (2.662 ± 0.742, p = 0.029*) in patients on the mesial temporal lobe. N-acetylaspartate (NAA) levels were significantly lower on the epileptic side (7.284 ± 1.314) than on the contralateral side (7.655 ± 1.549, p = 0.034*). NAA + N-acetylaspartylglutamate levels were significantly lower on the epileptic side (7.668 ± 1.406) than on the contralateral side (8.086 ± 1.675, p = 0.032*). Glutamate levels were significantly lower on the epileptic side (7.773 ± 1.428) than on the contralateral side (8.245 ± 1.616, p = 0.040*). Moreover, a significant negative correlation was found between GABA levels in the epileptic mesial temporal lobe and tonic-clonic seizure frequency (r = -0.338, p = 0.046*). Conclusion γ-Aminobutyric acid (GABA) is a potential biomarker for lateralization and monitoring seizure frequency in MRI-negative TLE.
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Affiliation(s)
- Shuohua Wu
- Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
- Department of Medical Imaging, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Qianqi Wang
- Department of Basic Medical Sciences, School of Medicine, Xiamen University, Xiamen, China
| | - Huige Zhai
- Center of Morphological Experiment, Medical College of Yanbian University, Jilin, China
| | - Yiwen Zhang
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Dongyuan Xu
- Center of Morphological Experiment, Medical College of Yanbian University, Jilin, China
| | - Gen Yan
- Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Renhua Wu
- Department of Medical Imaging, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
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Blenkmann AO, Leske SL, Llorens A, Lin JJ, Chang E, Brunner P, Schalk G, Ivanovic J, Larsson PG, Knight RT, Endestad T, Solbakk AK. Anatomical registration of intracranial electrodes. Robust model-based localization and deformable smooth brain-shift compensation methods. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.08.539503. [PMID: 37214984 PMCID: PMC10197594 DOI: 10.1101/2023.05.08.539503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Precise electrode localization is important for maximizing the utility of intracranial EEG data. Electrodes are typically localized from post-implantation CT artifacts, but algorithms can fail due to low signal-to-noise ratio, unrelated artifacts, or high-density electrode arrays. Minimizing these errors usually requires time-consuming visual localization and can still result in inaccurate localizations. In addition, surgical implantation of grids and strips typically introduces non-linear brain deformations, which result in anatomical registration errors when post-implantation CT images are fused with the pre-implantation MRI images. Several projection methods are currently available, but they either fail to produce smooth solutions or do not account for brain deformations. To address these shortcomings, we propose two novel algorithms for the anatomical registration of intracranial electrodes that are almost fully automatic and provide highly accurate results. We first present GridFit, an algorithm that simultaneously localizes all contacts in grids, strips, or depth arrays by fitting flexible models to the electrodes' CT artifacts. We observed localization errors of less than one millimeter (below 8% relative to the inter-electrode distance) and robust performance under the presence of noise, unrelated artifacts, and high-density implants when we ran ~6000 simulated scenarios. Furthermore, we validated the method with real data from 20 intracranial patients. As a second registration step, we introduce CEPA, a brain-shift compensation algorithm that combines orthogonal-based projections, spring-mesh models, and spatial regularization constraints. When tested with real data from 15 patients, anatomical registration errors were smaller than those obtained for well-established alternatives. Additionally, CEPA accounted simultaneously for simple mechanical deformation principles, which is not possible with other available methods. Inter-electrode distances of projected coordinates smoothly changed across neighbor electrodes, while changes in inter-electrode distances linearly increased with projection distance. Moreover, in an additional validation procedure, we found that modeling resting-state high-frequency activity (75-145 Hz ) in five patients further supported our new algorithm. Together, GridFit and CEPA constitute a versatile set of tools for the registration of subdural grid, strip, and depth electrode coordinates that provide highly accurate results even in the most challenging implantation scenarios. The methods presented here are implemented in the iElectrodes open-source toolbox, making their use simple, accessible, and straightforward to integrate with other popular toolboxes used for analyzing electrophysiological data.
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Affiliation(s)
- Alejandro Omar Blenkmann
- Department of Psychology, University of Oslo, Norway
- RITMO Centre for Interdisciplinary Studies in Rhythm, Time, and Motion, University of Oslo, Norway
| | - Sabine Liliana Leske
- Department of Musicology, University of Oslo, Norway
- RITMO Centre for Interdisciplinary Studies in Rhythm, Time, and Motion, University of Oslo, Norway
| | - Anaïs Llorens
- Department of Psychology, University of Oslo, Norway
- Department of Psychology and the Helen Wills Neuroscience Institute, University of California, Berkeley, USA
| | - Jack J. Lin
- Department of Neurology and Center for Mind and Brain, University of California, Davis, USA
| | - Edward Chang
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Peter Brunner
- Department of Neurology, Albany Medical College, Albany, NY, USA
- National Center for Adaptive Neurotechnologies, Albany, NY, USA
| | - Gerwin Schalk
- Department of Neurology, Albany Medical College, Albany, NY, USA
- National Center for Adaptive Neurotechnologies, Albany, NY, USA
- Tianqiao and Chrissy Chen Institute, Chen Frontier Lab for Applied Neurotechnology, Shanghai, China
- Fudan University/Huashan Hospital, Department of Neurosurgery, Shanghai, China
| | | | | | - Robert Thomas Knight
- Department of Psychology and the Helen Wills Neuroscience Institute, University of California, Berkeley, USA
| | - Tor Endestad
- Department of Psychology, University of Oslo, Norway
- RITMO Centre for Interdisciplinary Studies in Rhythm, Time, and Motion, University of Oslo, Norway
- Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway
| | - Anne-Kristin Solbakk
- Department of Psychology, University of Oslo, Norway
- RITMO Centre for Interdisciplinary Studies in Rhythm, Time, and Motion, University of Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Norway
- Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway
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Jawata A, Nicolás von E, Jean-Marc L, Giovanni P, Giorgio A, Zhengchen C, Tanguy H, Chifaou A, Hassan K, Birgit F, Jean G, Christophe G. Validating MEG source imaging of resting state oscillatory patterns with an intracranial EEG atlas. Neuroimage 2023; 274:120158. [PMID: 37149236 DOI: 10.1016/j.neuroimage.2023.120158] [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: 10/03/2022] [Revised: 03/27/2023] [Accepted: 05/04/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Magnetoencephalography (MEG) is a widely used non-invasive tool to estimate brain activity with high temporal resolution. However, due to the ill-posed nature of the MEG source imaging (MSI) problem, the ability of MSI to identify accurately underlying brain sources along the cortical surface is still uncertain and requires validation. METHOD We validated the ability of MSI to estimate the background resting state activity of 45 healthy participants by comparing it to the intracranial EEG (iEEG) atlas (https://mni-open-ieegatlas. RESEARCH mcgill.ca/). First, we applied wavelet-based Maximum Entropy on the Mean (wMEM) as an MSI technique. Next, we converted MEG source maps into intracranial space by applying a forward model to the MEG-reconstructed source maps, and estimated virtual iEEG (ViEEG) potentials on each iEEG channel location; we finally quantitatively compared those with actual iEEG signals from the atlas for 38 regions of interest in the canonical frequency bands. RESULTS The MEG spectra were more accurately estimated in the lateral regions compared to the medial regions. The regions with higher amplitude in the ViEEG than in the iEEG were more accurately recovered. In the deep regions, MEG-estimated amplitudes were largely underestimated and the spectra were poorly recovered. Overall, our wMEM results were similar to those obtained with minimum norm or beamformer source localization. Moreover, the MEG largely overestimated oscillatory peaks in the alpha band, especially in the anterior and deep regions. This is possibly due to higher phase synchronization of alpha oscillations over extended regions, exceeding the spatial sensitivity of iEEG but detected by MEG. Importantly, we found that MEG-estimated spectra were more comparable to spectra from the iEEG atlas after the aperiodic components were removed. CONCLUSION This study identifies brain regions and frequencies for which MEG source analysis is likely to be reliable, a promising step towards resolving the uncertainty in recovering intracerebral activity from non-invasive MEG studies.
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Affiliation(s)
- Afnan Jawata
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, Québec, H3A 2B4, Canada; Integrated Program in Neuroscience, McGill University, Montréal, Québec H3A 1A1, Canada; Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montréal, Québec H3A 2B4, Canada.
| | - Ellenrieder Nicolás von
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montréal, Québec H3A 2B4, Canada
| | - Lina Jean-Marc
- Centre De Recherches En Mathématiques, Montréal, Québec H3C 3J7, Canada; Electrical Engineering Department, École De Technologie Supérieure, Montréal, Québec H3C 1K3, Canada
| | - Pellegrino Giovanni
- Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Arcara Giorgio
- Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Cai Zhengchen
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montréal, Québec H3A 2B4, Canada
| | - Hedrich Tanguy
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, Québec, H3A 2B4, Canada
| | - Abdallah Chifaou
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, Québec, H3A 2B4, Canada
| | - Khajehpour Hassan
- Physics Department and PERFORM Centre, Concordia University, Montréal, Québec H4B 1R6, Canada
| | - Frauscher Birgit
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montréal, Québec H3A 2B4, Canada
| | - Gotman Jean
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montréal, Québec H3A 2B4, Canada
| | - Grova Christophe
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, Québec, H3A 2B4, Canada; Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montréal, Québec H3A 2B4, Canada; Centre De Recherches En Mathématiques, Montréal, Québec H3C 3J7, Canada; Physics Department and PERFORM Centre, Concordia University, Montréal, Québec H4B 1R6, Canada.
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Barborica A, Mindruta I, López-Madrona VJ, Alario FX, Trébuchon A, Donos C, Oane I, Pistol C, Mihai F, Bénar CG. Studying memory processes at different levels with simultaneous depth and surface EEG recordings. Front Hum Neurosci 2023; 17:1154038. [PMID: 37082152 PMCID: PMC10110965 DOI: 10.3389/fnhum.2023.1154038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
Investigating cognitive brain functions using non-invasive electrophysiology can be challenging due to the particularities of the task-related EEG activity, the depth of the activated brain areas, and the extent of the networks involved. Stereoelectroencephalographic (SEEG) investigations in patients with drug-resistant epilepsy offer an extraordinary opportunity to validate information derived from non-invasive recordings at macro-scales. The SEEG approach can provide brain activity with high spatial specificity during tasks that target specific cognitive processes (e.g., memory). Full validation is possible only when performing simultaneous scalp SEEG recordings, which allows recording signals in the exact same brain state. This is the approach we have taken in 12 subjects performing a visual memory task that requires the recognition of previously viewed objects. The intracranial signals on 965 contact pairs have been compared to 391 simultaneously recorded scalp signals at a regional and whole-brain level, using multivariate pattern analysis. The results show that the task conditions are best captured by intracranial sensors, despite the limited spatial coverage of SEEG electrodes, compared to the whole-brain non-invasive recordings. Applying beamformer source reconstruction or independent component analysis does not result in an improvement of the multivariate task decoding performance using surface sensor data. By analyzing a joint scalp and SEEG dataset, we investigated whether the two types of signals carry complementary information that might improve the machine-learning classifier performance. This joint analysis revealed that the results are driven by the modality exhibiting best individual performance, namely SEEG.
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Affiliation(s)
- Andrei Barborica
- Department of Physics, University of Bucharest, Bucharest, Romania
- *Correspondence: Andrei Barborica
| | - Ioana Mindruta
- Epilepsy Monitoring Unit, Department of Neurology, Emergency University Hospital Bucharest, Bucharest, Romania
- Department of Neurology, Medical Faculty, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | | | | | - Agnès Trébuchon
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- APHM, Timone Hospital, Functional and Stereotactic Neurosurgery, Marseille, France
| | - Cristian Donos
- Department of Physics, University of Bucharest, Bucharest, Romania
| | - Irina Oane
- Epilepsy Monitoring Unit, Department of Neurology, Emergency University Hospital Bucharest, Bucharest, Romania
| | | | - Felicia Mihai
- Department of Physics, University of Bucharest, Bucharest, Romania
| | - Christian G. Bénar
- Aix Marseille University, INSERM, INS, Institute of Neuroscience System, Marseille, France
- Christian G. Bénar
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Miron G, Müller PM, Holtkamp M, Meisel C. Prediction of epilepsy surgery outcome using foramen ovale EEG - A machine learning approach. Epilepsy Res 2023; 191:107111. [PMID: 36857943 DOI: 10.1016/j.eplepsyres.2023.107111] [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: 12/01/2022] [Revised: 01/20/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Patients with drug-resistant focal epilepsy may benefit from ablative or resective surgery. In presurgical work-up, intracranial EEG markers have been shown to be useful in identification of the seizure onset zone and prediction of post-surgical seizure freedom. However, in most cases, implantation of depth or subdural electrodes is performed, exposing patients to increased risks of complications. METHODS We analysed EEG data recorded from a minimally invasive approach utilizing foramen ovale (FO) and epidural peg electrodes using a supervised machine learning approach to predict post-surgical seizure freedom. Power-spectral EEG features were incorporated in a logistic regression model predicting one-year post-surgical seizure freedom. The prediction model was validated using repeated 5-fold cross-validation and compared to outcome prediction based on clinical and scalp EEG variables. RESULTS Forty-seven patients (26 patients with post-surgical 1-year seizure freedom) were included in the study, with 31 having FO and 27 patients having peg onset seizures. The area under the receiver-operating curve for post-surgical seizure freedom (Engel 1A) prediction in patients with FO onset seizures was 0.74 ± 0.23 using electrophysiology features, compared to 0.66 ± 0.22 for predictions based on clinical and scalp EEG variables (p < 0.001). The most important features for prediction were spectral power in the gamma and high gamma ranges. EEG data from peg electrodes was not informative in predicting post-surgical outcomes. CONCLUSION In this hypothesis-generating study, a data-driven approach based on EEG features derived from FO electrodes recordings outperformed the predictive ability based solely on clinical and scalp EEG variables. Pending validation in future studies, this method may provide valuable post-surgical prognostic information while minimizing risks of more invasive diagnostic approaches.
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Affiliation(s)
- Gadi Miron
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Paul Manuel Müller
- Computational Neurology, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Meisel
- Computational Neurology, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany; Bernstein Center for Computational Neuroscience, Berlin, Germany; Center for Stroke Research Berlin, Berlin, Germany; NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Nahvi M, Ardeshir G, Ezoji M, Tafakhori A, Shafiee S, Babajani-Feremi A. An application of dynamical directed connectivity of ictal intracranial EEG recordings in seizure onset zone localization. J Neurosci Methods 2023; 386:109775. [PMID: 36596400 DOI: 10.1016/j.jneumeth.2022.109775] [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: 04/17/2022] [Revised: 11/26/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Identification of the seizure onset zone (SOZ) is a challenging task in epilepsy surgery. Patients with epilepsy have an altered brain network, allowing connectivity-based analyses to have a great potential in SOZ identification. We investigated a dynamical directed connectivity analysis utilizing ictal intracranial electroencephalographic (iEEG) recordings and proposed an algorithm for SOZ identification based on grouping iEEG contacts. NEW METHODS Granger Causality was used for directed connectivity analysis in this study. The intracranial contacts were grouped into visually detected contacts (VDCs), which were identified as SOZ by epileptologists, and non-resected contacts (NRCs). The intragroup and intergroup directed connectivity for VDCs and NRCs were calculated around seizure onset. We then proposed an algorithm for SOZ identification based on the cross-correlation of intragroup outflow and inflow of SOZ candidate contacts. RESULTS Our results revealed that the intragroup connectivity of VDCs (VDC→VDC) was significantly larger than the intragroup connectivity of NRCs (NRC→NRC) and the intergroup connectivity between NRCs and VDCs (NRC→VDC) around seizure onset. We found that the proposed algorithm had 90.1 % accuracy for SOZ identification in the seizure-free patients. COMPARISON WITH EXISTING METHODS The existing connectivity-based methods for SOZ identification often use either outflow or inflow. In this study, SOZ contacts were identified by integrating outflow and inflow based on the cross correlation between these two measures. CONCLUSIONS The proposed group-based dynamical connectivity analysis in this study can aid our understanding of underlying seizure network and may be used to assist in identifying the SOZ contacts before epilepsy surgery.
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Affiliation(s)
| | | | - Mehdi Ezoji
- Babol Noshirvani University of Technology, Babol, Iran
| | - Abbas Tafakhori
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sajad Shafiee
- Department of Neurosurgery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Babajani-Feremi
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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Kutafina E, Becker S, Namer B. Measuring pain and nociception: Through the glasses of a computational scientist. Transdisciplinary overview of methods. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1099282. [PMID: 36926544 PMCID: PMC10013045 DOI: 10.3389/fnetp.2023.1099282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/04/2023] [Indexed: 02/12/2023]
Abstract
In a healthy state, pain plays an important role in natural biofeedback loops and helps to detect and prevent potentially harmful stimuli and situations. However, pain can become chronic and as such a pathological condition, losing its informative and adaptive function. Efficient pain treatment remains a largely unmet clinical need. One promising route to improve the characterization of pain, and with that the potential for more effective pain therapies, is the integration of different data modalities through cutting edge computational methods. Using these methods, multiscale, complex, and network models of pain signaling can be created and utilized for the benefit of patients. Such models require collaborative work of experts from different research domains such as medicine, biology, physiology, psychology as well as mathematics and data science. Efficient work of collaborative teams requires developing of a common language and common level of understanding as a prerequisite. One of ways to meet this need is to provide easy to comprehend overviews of certain topics within the pain research domain. Here, we propose such an overview on the topic of pain assessment in humans for computational researchers. Quantifications related to pain are necessary for building computational models. However, as defined by the International Association of the Study of Pain (IASP), pain is a sensory and emotional experience and thus, it cannot be measured and quantified objectively. This results in a need for clear distinctions between nociception, pain and correlates of pain. Therefore, here we review methods to assess pain as a percept and nociception as a biological basis for this percept in humans, with the goal of creating a roadmap of modelling options.
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Affiliation(s)
- Ekaterina Kutafina
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Faculty of Applied Mathematics, AGH University of Science and Technology, Krakow, Poland
| | - Susanne Becker
- Clinical Psychology, Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Barbara Namer
- Junior Research Group Neuroscience, Interdisciplinary Center for Clinical Research Within the Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Institute of Physiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Goel K, Pek V, Shlobin NA, Chen JS, Wang A, Ibrahim GM, Hadjinicolaou A, Roessler K, Dudley RW, Nguyen DK, El-Tahry R, Fallah A, Weil AG. Clinical utility of intraoperative electrocorticography for epilepsy surgery: A systematic review and meta-analysis. Epilepsia 2023; 64:253-265. [PMID: 36404579 DOI: 10.1111/epi.17472] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
Despite the widespread use of intraoperative electrocorticography (iECoG) during resective epilepsy surgery, there are conflicting data on its overall efficacy and inability to predict benefit per pathology. Given the heterogeneity of iECoG use in resective epilepsy surgery, it is important to assess the utility of interictal-based iECoG. This individual patient data (IPD) meta-analysis seeks to identify the benefit of iECoG during resective epilepsy surgery in achieving seizure freedom for various pathologies. Embase, Scopus, and PubMed were searched from inception to January 31, 2021 using the following terms: "ecog", "electrocorticography", and "epilepsy". Articles were included if they reported seizure freedom at ≥12-month follow-up in cohorts with and without iECoG for epilepsy surgery. Non-English articles, noncomparative iECoG cohorts, and studies with <10% iECoG use were excluded. This meta-analysis followed the PRISMA 2020 guidelines. The primary outcome was seizure freedom at last follow-up and time to seizure recurrence, if applicable. Forest plots with random effects modeling assessed the relationship between iECoG use and seizure freedom. Cox regression of IPD was performed to identify predictors of longer duration of seizure freedom. Kaplan-Meier curves with log-rank test were created to visualize differences in time to seizure recurrence. Of 7504 articles identified, 18 were included for study-level analysis. iECoG was not associated with higher seizure freedom at the study level (relative risk = 1.09, 95% confidence interval [CI] = 0.96-1.23, p = .19, I2 = 64%), but on IPD (n = 7 studies, 231 patients) iECoG use was independently associated with more favorable seizure outcomes (hazard ratio = 0.47, 95% CI = .23-.95, p = .037). In Kaplan-Meier analysis of specific pathologies, iECoG use was significantly associated with longer seizure freedom only for focal cortical dysplasia (FCD; p < .001) etiology. Number needed to treat for iECoG was 8.8, and for iECoG in FCD it was 4.7. We show iECoG seizure freedom is not achieved uniformly across centers. iECoG is particularly beneficial for FCD etiology in improving seizure freedom.
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Affiliation(s)
- Keshav Goel
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Valérie Pek
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jia-Shu Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Andrew Wang
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, Los Angeles, California, USA
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Aristides Hadjinicolaou
- Division of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
- Brain and Development Research Axis, Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Roy W Dudley
- Division of Pediatric Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Dang K Nguyen
- Department of Neurology, University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Riëm El-Tahry
- Saint Luc University Hospital, Brussels, Belgium
- Institute of Neuroscience, Neurology pole, Catholic University of Louvain, Brussels, Belgium
| | - Aria Fallah
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Brain and Development Research Axis, Sainte-Justine Research Centre, Montreal, Quebec, Canada
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Centre, Montreal, Quebec, Canada
- Department of Neuroscience, University of Montreal, Montreal, Quebec, Canada
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Shelyagin IS, Akimova PO, Stefanov SZ, Sufianov RA. Predictors of surgical outcomes in patients with drug-resistant temporal lobe epilepsy. SECHENOV MEDICAL JOURNAL 2023. [DOI: 10.47093/2218-7332.2022.13.3.24-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Aim. To identify predictors of surgical outcomes in patients with drug-resistant temporal lobe epilepsy in a multivariate model.Materials and methods. Aretrospective study included 69 patients with drug-resistant temporal lobe epilepsy who underwent microsurgical anterior temporal lobectomy. The study included 31 (45%) men and 38 (55%) women. The median age was 28 (21; 36). Surgical treatment outcomes were assessed at 6, 12, 36, and 60 months after surgical intervention according to the Engel Epilepsy Surgery Outcome Scale. Logistic regression equations were calculated, a ROC curve was constructed, and odds ratio (OR) with 95% confidence interval (CI), sensitivity, specificity, area under the ROC curve (AUC) were calculated.Results. In all assessed time periods, 88.3–93.0% of patients had outcomes consistent with Engel classes I and II. The distribution of patients by outcome classes did not change statistically significantly over the entire follow-up period. There were the following predictors of high efficacy of surgical treatment at 6 months after surgery: relatively shorter duration of active disease course (OR 0.719, 95%, CI: 0.437–0.966, p < 0.05), absence of status epilepticus (OR 0.048, 95% CI: 0.002–0.472, p < 0.05), absence of subdominant foci of irritative activity (OR 0.123, 95% CI: 0.012–0.845, p < 0.01), presence of mesial temporal sclerosis (OR 1008, 95% CI: 21.59–1310851, p < 0.01), a relatively longer resection margin on the temporal lobe (OR 637.32, 95% CI: 5.43–1960062, p < 0.05), lateralization of epileptogenic zone in subdominant hemisphere (OR 0.103, 95% CI 0.004–0.937, p = 0.0532). AUC was 0.957 (0.917–0.997), p < 0.0001; sensitivity 87.5%, and specificity 82.8%.Conclusion. Independent predictors of the efficacy of microsurgical anterior temporal lobectomy in patients with drug-resistant temporal lobe epilepsy are the following: shorter duration of active disease course, absence of status epilepticus in the history, absence of subdominant foci, presence of mesial temporal sclerosis, a relatively longer resection margin on the temporal lobe, and lateralization of the epileptogenic zone in the temporal lobe of the subdominant hemisphere.
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Affiliation(s)
- I. S. Shelyagin
- Tyumen State Medical University; Federal Centre of Neurosurgery
| | | | | | - R. A. Sufianov
- Sechenov First Moscow State Medical University (Sechenov University)
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Coorg R, Seto ES. Invasive Epilepsy Monitoring: The Switch from Subdural Electrodes to Stereoelectroencephalography. JOURNAL OF PEDIATRIC EPILEPSY 2023. [DOI: 10.1055/s-0042-1760105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractStereoelectroencephalography (SEEG) has experienced an explosion in use due to a shifting understanding of epileptic networks and wider application of minimally invasive epilepsy surgery techniques. Both subdural electrode (SDE) monitoring and SEEG serve important roles in defining the epileptogenic zone, limiting functional deficits, and formulating the most effective surgical plan. Strengths of SEEG include the ability to sample difficult to reach, deep structures of the brain without a craniotomy and without disrupting the dura. SEEG is complementary to minimally invasive epilepsy treatment options and may reduce the treatment gap in patients who are hesitant about craniotomy and surgical resection. Understanding the strengths and limitations of SDE monitoring and SEEG allows epileptologists to choose the best modality of invasive monitoring for each patient living with drug-resistant seizures.
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Affiliation(s)
- Rohini Coorg
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas, United States
| | - Elaine S. Seto
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas, United States
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Flanary J, Daly SR, Bakker C, Herman AB, Park MC, McGovern R, Walczak T, Henry T, Netoff TI, Darrow DP. Reliability of visual review of intracranial electroencephalogram in identifying the seizure onset zone: A systematic review and implications for the accuracy of automated methods. Epilepsia 2023; 64:6-16. [PMID: 36300659 PMCID: PMC10099245 DOI: 10.1111/epi.17446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 01/21/2023]
Abstract
Visual review of intracranial electroencephalography (iEEG) is often an essential component for defining the zone of resection for epilepsy surgery. Unsupervised approaches using machine and deep learning are being employed to identify seizure onset zones (SOZs). This prompts a more comprehensive understanding of the reliability of visual review as a reference standard. We sought to summarize existing evidence on the reliability of visual review of iEEG in defining the SOZ for patients undergoing surgical workup and understand its implications for algorithm accuracy for SOZ prediction. We performed a systematic literature review on the reliability of determining the SOZ by visual inspection of iEEG in accordance with best practices. Searches included MEDLINE, Embase, Cochrane Library, and Web of Science on May 8, 2022. We included studies with a quantitative reliability assessment within or between observers. Risk of bias assessment was performed with QUADAS-2. A model was developed to estimate the effect of Cohen kappa on the maximum possible accuracy for any algorithm detecting the SOZ. Two thousand three hundred thirty-eight articles were identified and evaluated, of which one met inclusion criteria. This study assessed reliability between two reviewers for 10 patients with temporal lobe epilepsy and found a kappa of .80. These limited data were used to model the maximum accuracy of automated methods. For a hypothetical algorithm that is 100% accurate to the ground truth, the maximum accuracy modeled with a Cohen kappa of .8 ranged from .60 to .85 (F-2). The reliability of reviewing iEEG to localize the SOZ has been evaluated only in a small sample of patients with methodologic limitations. The ability of any algorithm to estimate the SOZ is notably limited by the reliability of iEEG interpretation. We acknowledge practical limitations of rigorous reliability analysis, and we propose design characteristics and study questions to further investigate reliability.
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Affiliation(s)
- James Flanary
- Department of SurgeryWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Samuel R. Daly
- Department of NeurosurgeryBaylor Scott and White HealthTempleTexasUSA
| | - Caitlin Bakker
- Dr John Archer LibraryUniversity of ReginaReginaSaskatchewanCanada
| | | | - Michael C. Park
- Department of NeurosurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Robert McGovern
- Department of NeurosurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Thaddeus Walczak
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Thomas Henry
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Theoden I. Netoff
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - David P. Darrow
- Department of NeurosurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
- Department of NeurosurgeryHennepin County Medical CenterMinneapolisMinnesotaUSA
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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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Implantation of Intracranial Electrodes Predicts Worse Outcome in Mesial Temporal Lobe Epilepsy. World Neurosurg 2023; 169:e245-e250. [PMID: 36332773 DOI: 10.1016/j.wneu.2022.10.116] [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: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Anteromesial resection is an effective method for treating seizures arising from the medial temporal lobe, as these cases are often the most straightforward and have the best outcomes. Nevertheless, some patients who go on to have a mesial resection are recommended to have an implantation of electrodes before surgery. Whether the need for such an implant alters the rate of seizure freedom is not well-studied in this particular subgroup of epilepsy patients. METHODS We performed a retrospective review of consecutive anteromesial surgeries for medial temporal lobe epilepsy performed between 2005 and 2020. Of a total of 39 patients, 19 required electrode implantation (electrode group) and 20 did not (no-electrode group). The primary outcomes assessed were reduction in seizure frequency and Engel score. Complication rates were also compared. RESULTS Postresection seizure frequency reduction was nonsignificantly higher in the no-electrode group (97.0 ± 10.3%) than in the electrode group (88.5 ± 23.7%, P = 0.15). The rate of Engel I outcome was nonsignificantly higher in the no-electrode group (84.2%) than in the electrode group (65.0%, P = 0.17). Major complication rates were nonsignificantly higher in the no-electrode group (15.8 ± 1.9%) than in the electrode group (5.0 ± 1.1%, P = 0.26). Power analysis revealed that 74 patients would need to be included in each group to reach statistical significance. CONCLUSIONS Although not statistically significant, our study showed a trend for improved seizure control if a decision was made not to implant electrodes prior to potentially curative anteromesial resection. Engel I outcome in this group reached approximately 85%. A larger multi-instiutional study may be required to reach statistical significance.
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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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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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Tasci G, Loh HW, Barua PD, Baygin M, Tasci B, Dogan S, Tuncer T, Palmer EE, Tan RS, Acharya UR. Automated accurate detection of depression using twin Pascal’s triangles lattice pattern with EEG Signals. Knowl Based Syst 2022. [DOI: 10.1016/j.knosys.2022.110190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Lagarde S, Bénar CG, Wendling F, Bartolomei F. Interictal Functional Connectivity in Focal Refractory Epilepsies Investigated by Intracranial EEG. Brain Connect 2022; 12:850-869. [PMID: 35972755 PMCID: PMC9807250 DOI: 10.1089/brain.2021.0190] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: Focal epilepsies are diseases of neuronal excitability affecting macroscopic networks of cortical and subcortical neural structures. These networks ("epileptogenic networks") can generate pathological electrophysiological activities during seizures, and also between seizures (interictal period). Many works attempt to describe these networks by using quantification methods, particularly based on the estimation of statistical relationships between signals produced by brain regions, namely functional connectivity (FC). Results: FC has been shown to be greatly altered during seizures and in the immediate peri-ictal period. An increasing number of studies have shown that FC is also altered during the interictal period depending on the degree of epileptogenicity of the structures. Furthermore, connectivity values could be correlated with other clinical variables including surgical outcome. Significance: This leads to a conceptual change and to consider epileptic areas as both hyperexcitable and abnormally connected. These data open the door to the use of interictal FC as a marker of epileptogenicity and as a complementary tool for predicting the effect of surgery. Aim: In this article, we review the available data concerning interictal FC estimated from intracranial electroencephalograhy (EEG) in focal epilepsies and discuss it in the light of data obtained from other modalities (EEG imaging) and modeling studies.
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Affiliation(s)
- Stanislas Lagarde
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Epileptology and Cerebral Rythmology, APHM, Timone Hospital, Marseille, France.,Address correspondence to: Stanislas Lagarde, Department of Epileptology and Cerebral Rythmology, APHM, Timone Hospital, 264 Rue Saint-Pierre, 13005 Marseille, France
| | | | | | - Fabrice Bartolomei
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Epileptology and Cerebral Rythmology, APHM, Timone Hospital, Marseille, France
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Petrosyan A, Voskoboinikov A, Sukhinin D, Makarova A, Skalnaya A, Arkhipova N, Sinkin M, Ossadtchi A. Speech decoding from a small set of spatially segregated minimally invasive intracranial EEG electrodes with a compact and interpretable neural network. J Neural Eng 2022; 19. [PMID: 36356309 DOI: 10.1088/1741-2552/aca1e1] [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: 06/07/2022] [Accepted: 11/10/2022] [Indexed: 11/12/2022]
Abstract
Objective. Speech decoding, one of the most intriguing brain-computer interface applications, opens up plentiful opportunities from rehabilitation of patients to direct and seamless communication between human species. Typical solutions rely on invasive recordings with a large number of distributed electrodes implanted through craniotomy. Here we explored the possibility of creating speech prosthesis in a minimally invasive setting with a small number of spatially segregated intracranial electrodes.Approach. We collected one hour of data (from two sessions) in two patients implanted with invasive electrodes. We then used only the contacts that pertained to a single stereotactic electroencephalographic (sEEG) shaft or an electrocorticographic (ECoG) stripe to decode neural activity into 26 words and one silence class. We employed a compact convolutional network-based architecture whose spatial and temporal filter weights allow for a physiologically plausible interpretation.Mainresults. We achieved on average 55% accuracy using only six channels of data recorded with a single minimally invasive sEEG electrode in the first patient and 70% accuracy using only eight channels of data recorded for a single ECoG strip in the second patient in classifying 26+1 overtly pronounced words. Our compact architecture did not require the use of pre-engineered features, learned fast and resulted in a stable, interpretable and physiologically meaningful decision rule successfully operating over a contiguous dataset collected during a different time interval than that used for training. Spatial characteristics of the pivotal neuronal populations corroborate with active and passive speech mapping results and exhibit the inverse space-frequency relationship characteristic of neural activity. Compared to other architectures our compact solution performed on par or better than those recently featured in neural speech decoding literature.Significance. We showcase the possibility of building a speech prosthesis with a small number of electrodes and based on a compact feature engineering free decoder derived from a small amount of training data.
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Affiliation(s)
- Artur Petrosyan
- Center for Bioelectric Interfaces, Higher School of Economics, Moscow, Russia
| | | | - Dmitrii Sukhinin
- Center for Bioelectric Interfaces, Higher School of Economics, Moscow, Russia
| | - Anna Makarova
- Center for Bioelectric Interfaces, Higher School of Economics, Moscow, Russia
| | | | | | - Mikhail Sinkin
- Moscow State University of Medicine and Dentistry, Scientific Research Institute of First Aid to them. N.V. Sklifosovsky, Moscow, Russia
| | - Alexei Ossadtchi
- Center for Bioelectric Interfaces, Higher School of Economics, Moscow, Russia.,Artificial Intelligence Research Institute, AIRI, Moscow, Russia
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Miron G, Müller PM, Holtkamp M. Diagnostic and prognostic value of EEG patterns recorded on foramen ovale and epidural peg electrodes. Clin Neurophysiol 2022; 143:107-115. [DOI: 10.1016/j.clinph.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 11/03/2022]
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