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Pease M, Gupta K, Moshé SL, Correa DJ, Galanopoulou AS, Okonkwo DO, Gonzalez-Martinez J, Shutter L, Diaz-Arrastia R, Castellano JF. Insights into epileptogenesis from post-traumatic epilepsy. Nat Rev Neurol 2024; 20:298-312. [PMID: 38570704 DOI: 10.1038/s41582-024-00954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
Post-traumatic epilepsy (PTE) accounts for 5% of all epilepsies. The incidence of PTE after traumatic brain injury (TBI) depends on the severity of injury, approaching one in three in groups with the most severe injuries. The repeated seizures that characterize PTE impair neurological recovery and increase the risk of poor outcomes after TBI. Given this high risk of recurrent seizures and the relatively short latency period for their development after injury, PTE serves as a model disease to understand human epileptogenesis and trial novel anti-epileptogenic therapies. Epileptogenesis is the process whereby previously normal brain tissue becomes prone to recurrent abnormal electrical activity, ultimately resulting in seizures. In this Review, we describe the clinical course of PTE and highlight promising research into epileptogenesis and treatment using animal models of PTE. Clinical, imaging, EEG and fluid biomarkers are being developed to aid the identification of patients at high risk of PTE who might benefit from anti-epileptogenic therapies. Studies in preclinical models of PTE have identified tractable pathways and novel therapeutic strategies that can potentially prevent epilepsy, which remain to be validated in humans. In addition to improving outcomes after TBI, advances in PTE research are likely to provide therapeutic insights that are relevant to all epilepsies.
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Affiliation(s)
- Matthew Pease
- Department of Neurosurgery, Indiana University, Bloomington, IN, USA.
| | - Kunal Gupta
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Solomon L Moshé
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
- Department of Paediatrics, Albert Einstein College of Medicine, New York, NY, USA
| | - Daniel J Correa
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Aristea S Galanopoulou
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lori Shutter
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
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Weiss SA, Fried I, Engel J, Sperling MR, Wong RKS, Nir Y, Staba RJ. Fast ripples reflect increased excitability that primes epileptiform spikes. Brain Commun 2023; 5:fcad242. [PMID: 37869578 PMCID: PMC10587774 DOI: 10.1093/braincomms/fcad242] [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: 04/19/2023] [Revised: 07/08/2023] [Accepted: 09/07/2023] [Indexed: 10/24/2023] Open
Abstract
The neuronal circuit disturbances that drive inter-ictal and ictal epileptiform discharges remain elusive. Using a combination of extra-operative macro-electrode and micro-electrode inter-ictal recordings in six pre-surgical patients during non-rapid eye movement sleep, we found that, exclusively in the seizure onset zone, fast ripples (200-600 Hz), but not ripples (80-200 Hz), frequently occur <300 ms before an inter-ictal intra-cranial EEG spike with a probability exceeding chance (bootstrapping, P < 1e-5). Such fast ripple events are associated with higher spectral power (P < 1e-10) and correlated with more vigorous neuronal firing than solitary fast ripple (generalized linear mixed-effects model, P < 1e-9). During the intra-cranial EEG spike that follows a fast ripple, action potential firing is lower than during an intra-cranial EEG spike alone (generalized linear mixed-effects model, P < 0.05), reflecting an inhibitory restraint of intra-cranial EEG spike initiation. In contrast, ripples do not appear to prime epileptiform spikes. We next investigated the clinical significance of pre-spike fast ripple in a separate cohort of 23 patients implanted with stereo EEG electrodes, who underwent resections. In non-rapid eye movement sleep recordings, sites containing a high proportion of fast ripple preceding intra-cranial EEG spikes correlate with brain areas where seizures begin more than solitary fast ripple (P < 1e-5). Despite this correlation, removal of these sites does not guarantee seizure freedom. These results are consistent with the hypothesis that fast ripple preceding EEG spikes reflect an increase in local excitability that primes EEG spike discharges preferentially in the seizure onset zone and that epileptogenic brain regions are necessary, but not sufficient, for initiating inter-ictal epileptiform discharges.
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Affiliation(s)
- Shennan A Weiss
- Department of Neurology, State University of New York Downstate, Brooklyn, NY 11203, USA
- Department of Physiology and Pharmacology, State University of New York Downstate, Brooklyn, NY 11203, USA
- Department of Neurology, New York City Health + Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Itzhak Fried
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Jerome Engel
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Michael R Sperling
- Departments of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Robert K S Wong
- Department of Physiology and Pharmacology, State University of New York Downstate, Brooklyn, NY 11203, USA
| | - Yuval Nir
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
- The Sieratzki-Sagol Center for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Richard J Staba
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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Di Sapia R, Rizzi M, Moro F, Lisi I, Caccamo A, Ravizza T, Vezzani A, Zanier ER. ECoG spiking activity and signal dimension are early predictive measures of epileptogenesis in a translational mouse model of traumatic brain injury. Neurobiol Dis 2023; 185:106251. [PMID: 37536383 DOI: 10.1016/j.nbd.2023.106251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
The latency between traumatic brain injury (TBI) and the onset of epilepsy (PTE) represents an opportunity for counteracting epileptogenesis. Antiepileptogenesis trials are hampered by the lack of sensitive biomarkers that allow to enrich patient's population at-risk for PTE. We aimed to assess whether specific ECoG signals predict PTE in a clinically relevant mouse model with ∼60% epilepsy incidence. TBI was provoked in adult CD1 male mice by controlled cortical impact on the left parieto-temporal cortex, then mice were implanted with two perilesional cortical screw electrodes and two similar electrodes in the hemisphere contralateral to the lesion site. Acute seizures and spikes/sharp waves were ECoG-recorded during 1 week post-TBI. These early ECoG events were analyzed according to PTE incidence as assessed by measuring spontaneous recurrent seizures (SRS) at 5 months post-TBI. We found that incidence, number and duration of acute seizures during 3 days post-TBI were similar in PTE mice and mice not developing epilepsy (No SRS mice). Control mice with cortical electrodes (naïve, n = 5) or with electrodes and craniotomy (sham, n = 5) exhibited acute seizures but did not develop epilepsy. The daily number of spikes/sharp waves at the perilesional electrodes was increased similarly in PTE (n = 15) and No SRS (n = 8) mice vs controls (p < 0.05, n = 10) from day 2 post-injury. Differently, the daily number of spikes/sharp waves at both contralateral electrodes showed a progressive increase in PTE mice vs No SRS and control mice. In particular, spikes number was higher in PTE vs No SRS mice (p < 0.05) at 6 and 7 days post-TBI, and this measure predicted epilepsy development with high accuracy (AUC = 0.77, p = 0.03; CI 0.5830-0.9670). The cut-off value was validated in an independent cohort of TBI mice (n = 12). The daily spike number at the contralateral electrodes showed a circadian distribution in PTE mice which was not observed in No SRS mice. Analysis of non-linear dynamics at each electrode site showed changes in dimensionality during 4 days post-TBI. This measure yielded the best discrimination between PTE and No SRS mice (p < 0.01) at the cortical electrodes contralateral to injury. Data show that epileptiform activity contralateral to the lesion site has the the highest predictive value for PTE in this model reinforcing the hypothesis that the hemisphere contralateral to the lesion core may drive epileptogenic networks after TBI.
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Affiliation(s)
- Rossella Di Sapia
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Massimo Rizzi
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Federico Moro
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Ilaria Lisi
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Alessia Caccamo
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Teresa Ravizza
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Annamaria Vezzani
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
| | - Elisa R Zanier
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
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Weiss SA, Fried I, Engel J, Sperling MR, Wong RK, Nir Y, Staba RJ. Fast ripples reflect increased excitability that primes epileptiform spikes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.26.23287702. [PMID: 37034609 PMCID: PMC10081394 DOI: 10.1101/2023.03.26.23287702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The neuronal circuit disturbances that drive interictal and ictal epileptiform discharges remains elusive. Using a combination of extraoperative macro- and micro-electrode interictal recordings in six presurgical patients during non-rapid eye movement (REM) sleep we found that, exclusively in the seizure onset zone, fast ripples (FR; 200-600Hz), but not ripples (80-200 Hz), frequently occur <300 msec before an interictal intracranial EEG (iEEG) spike with a probability exceeding chance (bootstrapping, p<1e-5). Such FR events are associated with higher spectral power (p<1e-10) and correlated with more vigorous neuronal firing than solitary FR (generalized linear mixed-effects model, GLMM, p<1e-3) irrespective of FR power. During the iEEG spike that follows a FR, action potential firing is lower than during a iEEG spike alone (GLMM, p<1e-10), reflecting an inhibitory restraint of iEEG spike initiation. In contrast, ripples do not appear to prime epileptiform spikes. We next investigated the clinical significance of pre-spike FR in a separate cohort of 23 patients implanted with stereo EEG electrodes who underwent resections. In non-REM sleep recordings, sites containing a high proportion of FR preceding iEEG spikes correlate with brain areas where seizures begin more than solitary FR (p<1e-5). Despite this correlation, removal of these sites does not guarantee seizure freedom. These results are consistent with the hypothesis that FR preceding EEG spikes reflect an increase in local excitability that primes EEG spike discharges preferentially in the seizure onset zone and that epileptogenic brain regions are necessary, but not sufficient, for initiating interictal epileptiform discharges.
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Affiliation(s)
- Shennan A Weiss
- Dept. of Neurology, State University of New York Downstate, Brooklyn, New York, 11203 USA
- Dept. of Physiology and Pharmacology, State University of New York Downstate, Brooklyn, New York, 11203 USA
- Dept. of Neurology, New York City Health + Hospitals/Kings County, Brooklyn, NY, USA
| | - Itzhak Fried
- Dept. of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
| | - Jerome Engel
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
- Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
| | - Michael R. Sperling
- Depts. of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, USA
| | - Robert K.S. Wong
- Dept. of Physiology and Pharmacology, State University of New York Downstate, Brooklyn, New York, 11203 USA
| | - Yuval Nir
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
- The Sieratzki-Sagol Center for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Richard J Staba
- Dept. of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, 90095, USA
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Chloride ion dysregulation in epileptogenic neuronal networks. Neurobiol Dis 2023; 177:106000. [PMID: 36638891 DOI: 10.1016/j.nbd.2023.106000] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/25/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
GABA is the major inhibitory neurotransmitter in the mature CNS. When GABAA receptors are activated the membrane potential is driven towards hyperpolarization due to chloride entry into the neuron. However, chloride ion dysregulation that alters the ionic gradient can result in depolarizing GABAergic post-synaptic potentials instead. In this review, we highlight that GABAergic inhibition prevents and restrains focal seizures but then reexamine this notion in the context of evidence that a static and/or a dynamic chloride ion dysregulation, that increases intracellular chloride ion concentrations, promotes epileptiform activity and seizures. To reconcile these findings, we hypothesize that epileptogenic pathologically interconnected neuron (PIN) microcircuits, representing a small minority of neurons, exhibit static chloride dysregulation and should exhibit depolarizing inhibitory post-synaptic potentials (IPSPs). We speculate that chloride ion dysregulation and PIN cluster activation may generate fast ripples and epileptiform spikes as well as initiate the hypersynchronous seizure onset pattern and microseizures. Also, we discuss the genetic, molecular, and cellular players important in chloride dysregulation which regulate epileptogenesis and initiate the low-voltage fast seizure onset pattern. We conclude that chloride dysregulation in neuronal networks appears to be critical for epileptogenesis and seizure genesis, but feed-back and feed-forward inhibitory GABAergic neurotransmission plays an important role in preventing and restraining seizures as well.
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Weiss SA, Fried I, Wu C, Sharan A, Rubinstein D, Engel J, Sperling MR, Staba RJ. Graph theoretical measures of fast ripple networks improve the accuracy of post-operative seizure outcome prediction. Sci Rep 2023; 13:367. [PMID: 36611059 PMCID: PMC9825369 DOI: 10.1038/s41598-022-27248-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
Fast ripples (FR) are a biomarker of epileptogenic brain, but when larger portions of FR generating regions are resected seizure freedom is not always achieved. To evaluate and improve the diagnostic accuracy of FR resection for predicting seizure freedom we compared the FR resection ratio (RR) with FR network graph theoretical measures. In 23 patients FR were semi-automatically detected and quantified in stereo EEG recordings during sleep. MRI normalization and co-registration localized contacts and relation to resection margins. The number of FR, and graph theoretical measures, which were spatial (i.e., FR rate-distance radius) or temporal correlational (i.e., FR mutual information), were compared with the resection margins and with seizure outcome We found that the FR RR did not correlate with seizure-outcome (p > 0.05). In contrast, the FR rate-distance radius resected difference and the FR MI mean characteristic path length RR did correlate with seizure-outcome (p < 0.05). Retesting of positive FR RR patients using either FR rate-distance radius resected difference or the FR MI mean characteristic path length RR reduced seizure-free misclassifications from 44 to 22% and 17%, respectively. These results indicate that graph theoretical measures of FR networks can improve the diagnostic accuracy of the resection of FR events for predicting seizure freedom.
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Affiliation(s)
- Shennan A. Weiss
- grid.262863.b0000 0001 0693 2202Department of Neurology, State University of New York Downstate, Brooklyn, USA ,grid.262863.b0000 0001 0693 2202Department of Physiology and Pharmacology, State University of New York Downstate, 450 Clarkson Avenue, MSC 1213, Brooklyn, NY 11203 USA ,grid.422616.50000 0004 0443 7226Department of Neurology, New York City Health + Hospitals/Kings County, Brooklyn, NY USA
| | - Itzhak Fried
- grid.19006.3e0000 0000 9632 6718Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Chengyuan Wu
- grid.265008.90000 0001 2166 5843Department of Neuroradiology, Thomas Jefferson University, Philadelphia, USA ,grid.265008.90000 0001 2166 5843Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Ashwini Sharan
- grid.265008.90000 0001 2166 5843Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Daniel Rubinstein
- grid.265008.90000 0001 2166 5843Department of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, USA
| | - Jerome Engel
- grid.19006.3e0000 0000 9632 6718Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, USA ,grid.19006.3e0000 0000 9632 6718Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA ,grid.19006.3e0000 0000 9632 6718Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, USA ,grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA ,grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine at UCLA, Brain Research Institute, Los Angeles, CA 90095 USA
| | - Michael R. Sperling
- grid.265008.90000 0001 2166 5843Department of Neurology and Neuroscience, Thomas Jefferson University, Philadelphia, USA
| | - Richard J. Staba
- grid.19006.3e0000 0000 9632 6718Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, USA
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Zhu F, Wang H, Li L, Bragin A, Cao D, Cheng Y. Intracranial electrophysiological recordings on a swine model of mesial temporal lobe epilepsy. Front Neurol 2023; 14:1077702. [PMID: 37139062 PMCID: PMC10150775 DOI: 10.3389/fneur.2023.1077702] [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: 10/27/2022] [Accepted: 03/20/2023] [Indexed: 05/05/2023] Open
Abstract
Objective To test the feasibility and reliability of intracranial electrophysiological recordings in an acute status epilepticus model on laboratory swine. Method Intrahippocampal injection of kainic acid (KA) was performed on 17 male Bama pigs (Sus scrofa domestica) weighing between 25 and 35 kg. Two stereoelectroencephalography (SEEG) electrodes with a total of 16 channels were implanted bilaterally along the sensorimotor cortex to the hippocampus. Brain electrical activity was recorded 2 h daily for 9-28 days. Three KA dosages were tested to evaluate the quantities capable of evoking status epilepticus. Local field potentials (LFPs) were recorded and compared before and after the KA injection. We quantified the epileptic patterns, including the interictal spikes, seizures, and high-frequency oscillations (HFOs), up to 4 weeks after the KA injection. Test-retest reliability using intraclass correlation coefficients (ICCs) were performed on interictal HFO rates to evaluate the recording stability of this model. Results The KA dosage test suggested that a 10 μl (1.0 μg/μl) intrahippocampal injection could successfully evoke status epilepticus lasting from 4 to 12 h. At this dosage, eight pigs (50% of total) had prolonged epileptic events (tonic-chronic seizures + interictal spikes n = 5, interictal spikes alone n = 3) in the later 4 weeks of the video-SEEG recording period. Four pigs (25% of total) had no epileptic activities, and another four (25%) had lost the cap or did not complete the experiments. Animals that showed epileptiform events were grouped as E + (n = 8) and the four animals showing no signs of epileptic events were grouped as E- (n = 4). A total of 46 electrophysiological seizures were captured in the 4-week post-KA period from 4 E + animals, with the earliest onset on day 9. The seizure durations ranged from 12 to 45 s. A significant increase of hippocampal HFOs rate (num/min) was observed in the E+ group during the post-KA period (weeks 1, 2,4, p < 0.05) compared to the baseline. But the E-showed no change or a decrease (in week 2, p = 0.43) compared to their baseline rate. The between-group comparison showed much higher HFO rates in E + vs. E - (F = 35, p < 0.01). The high ICC value [ICC (1, k) = 0.81, p < 0.05] quantified from the HFO rate suggested that this model had a stable measurement of HFOs during the four-week post-KA periods. Significance This study measured intracranial electrophysiological activity in a swine model of KA-induced mesial temporal lobe epilepsy (mTLE). Using the clinical SEEG electrode, we distinguished abnormal EEG patterns in the swine brain. The high test-retest reliability of HFO rates in the post-KA period suggests the utility of this model for studying mechanisms of epileptogenesis. The use of swine may provide satisfactory translational value for clinical epilepsy research.
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Affiliation(s)
- Fengjun Zhu
- Department of Neurosurgery, Shenzhen Children’s Hospital, Shenzhen, Guangdong, China
- Department of Neurosurgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, United States
| | - Hanwen Wang
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, United States
| | - Lin Li
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, United States
- Department of Biomedical Engineering, University of North Texas, Denton, TX, United States
| | - Anatol Bragin
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, United States
| | - Dezhi Cao
- Department of Neurosurgery, Shenzhen Children’s Hospital, Shenzhen, Guangdong, China
- *Correspondence: Dezhi Cao,
| | - Yuan Cheng
- Department of Neurosurgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Yuan Cheng,
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8
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Zhou Y, You J, Kumar U, Weiss SA, Bragin A, Engel J, Papadelis C, Li L. An approach for reliably identifying high-frequency oscillations and reducing false-positive detections. Epilepsia Open 2022; 7:674-686. [PMID: 36053171 PMCID: PMC9712470 DOI: 10.1002/epi4.12647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/31/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Aiming to improve the feasibility and reliability of using high-frequency oscillations (HFOs) for translational studies of epilepsy, we present a pipeline with features specifically designed to reject false positives for HFOs to improve the automatic HFO detector. METHODS We presented an integrated, multi-layered procedure capable of automatically rejecting HFOs from a variety of common false positives, such as motion, background signals, and sharp transients. This method utilizes a time-frequency contour approach that embeds three different layers including peak constraints, power thresholds, and morphological identification to discard false positives. Four experts were involved in rating detected HFO events that were randomly selected from different posttraumatic epilepsy (PTE) animals for a comprehensive evaluation. RESULTS The algorithm was run on 768-h recordings of intracranial electrodes in 48 PTE animals. A total of 453 917 HFOs were identified by initial HFO detection, of which 450 917 were implemented for HFO refinement and 203 531 events were retained. Random sampling was used to evaluate the performance of the detector. The HFO detection yielded an overall accuracy of 0.95 ± 0.03 , with precision, recall, and F1 scores of 0.92 ± 0.05 , 0.99 ± 0.01 , and 0.94 ± 0.03 , respectively. For the HFO classification, our algorithm obtained an accuracy of 0.97 ± 0.02 . For the inter-rater reliability of algorithm evaluation, the agreement among four experts was 0.94 ± 0.03 for HFO detection and 0.85 ± 0.04 for HFO classification. SIGNIFICANCE Our approach shows that a segregated pipeline design with a focus on false-positive rejection can improve the detection efficiency and provide reliable results. This pipeline does not require customization and uses fixed parameters, making it highly feasible and translatable for basic and clinical applications of epilepsy.
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Affiliation(s)
- Yufeng Zhou
- Department of Biomedical EngineeringUniversity of North TexasTexasUSA
| | - Jing You
- Department of Biomedical EngineeringUniversity of North TexasTexasUSA
| | - Udaya Kumar
- Department of NeurologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Shennan A Weiss
- Departments of Neurology, Department of Physiology and PharmacologyState University of New York DownstateBrooklynNew YorkUSA,Department of NeurologyNew York City Health + Hospitals/Kings CountyBrooklynNew YorkUSA
| | - Anatol Bragin
- Department of NeurologyUniversity of California Los AngelesLos AngelesCaliforniaUSA,Brain Research InstituteUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Jerome Engel
- Department of NeurologyUniversity of California Los AngelesLos AngelesCaliforniaUSA,Brain Research InstituteUniversity of CaliforniaLos AngelesCaliforniaUSA,Department of NeurobiologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA,Department of Psychiatry and Biobehavioral SciencesDavid Geffen School of Medicine at UCLACaliforniaUSA
| | - Christos Papadelis
- Jane and John Justin Neurosciences CenterCook Children's Health Care SystemFort WorthTexasUSA,School of MedicineTexas Christian UniversityFort WorthTexasUSA,Department of BioengineeringUniversity of Texas at ArlingtonArlingtonTexasUSA
| | - Lin Li
- Department of Biomedical EngineeringUniversity of North TexasTexasUSA,Department of NeurologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
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9
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Weiss SA, Staba RJ, Sharan A, Wu C, Rubinstein D, Das S, Waldman Z, Orosz I, Worrell G, Engel J, Sperling MR. Accuracy of high-frequency oscillations recorded intraoperatively for classification of epileptogenic regions. Sci Rep 2021; 11:21388. [PMID: 34725412 PMCID: PMC8560764 DOI: 10.1038/s41598-021-00894-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
To see whether acute intraoperative recordings using stereo EEG (SEEG) electrodes can replace prolonged interictal intracranial EEG (iEEG) recording, making the process more efficient and safer, 10 min of iEEG were recorded following electrode implantation in 16 anesthetized patients, and 1-2 days later during non-rapid eye movement (REM) sleep. Ripples on oscillations (RonO, 80-250 Hz), ripples on spikes (RonS), sharp-spikes, fast RonO (fRonO, 250-600 Hz), and fast RonS (fRonS) were semi-automatically detected. HFO power and frequency were compared between the conditions using a generalized linear mixed-effects model. HFO rates were compared using a two-way repeated measures ANOVA with anesthesia type and SOZ as factors. A receiver-operating characteristic (ROC) curve analysis quantified seizure onset zone (SOZ) classification accuracy, and the scalar product was used to assess spatial reliability. Resection of contacts with the highest rate of events was compared with outcome. During sleep, all HFOs, except fRonO, were larger in amplitude compared to intraoperatively (p < 0.01). HFO frequency was also affected (p < 0.01). Anesthesia selection affected HFO and sharp-spike rates. In both conditions combined, sharp-spikes and all HFO subtypes were increased in the SOZ (p < 0.01). However, the increases were larger during the sleep recordings (p < 0.05). The area under the ROC curves for SOZ classification were significantly smaller for intraoperative sharp-spikes, fRonO, and fRonS rates (p < 0.05). HFOs and spikes were only significantly spatially reliable for a subset of the patients (p < 0.05). A failure to resect fRonO areas in the sleep recordings trended the most sensitive and accurate for predicting failure. In summary, HFO morphology is altered by anesthesia. Intraoperative SEEG recordings exhibit increased rates of HFOs in the SOZ, but their spatial distribution can differ from sleep recordings. Recording these biomarkers during non-REM sleep offers a more accurate delineation of the SOZ and possibly the epileptogenic zone.
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Affiliation(s)
- Shennan A Weiss
- Department of Neurology, State University of New York Downstate, Brooklyn, NY, 11203, USA.,Department of Physiology and Pharmacology, State University of New York Downstate, Brooklyn, NY, 11203, USA.,Department of Neurology, New York City Health + Hospitals/Kings County, Brooklyn, NY, USA
| | - Richard J Staba
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Chengyuan Wu
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Daniel Rubinstein
- Department of Neurology and Neuroscience, Thomas Jefferson University, 901 Walnut St. Suite 400, Philadelphia, PA, 19107, USA
| | - Sandhitsu Das
- Penn Image Computing & Science Lab, University of Pennsylvania, Philadelphia, PA, 19143, USA
| | - Zachary Waldman
- Department of Neurology and Neuroscience, Thomas Jefferson University, 901 Walnut St. Suite 400, Philadelphia, PA, 19107, USA
| | - Iren Orosz
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Gregory Worrell
- Department of Neurology, Mayo Systems Electrophysiology Laboratory (MSEL), Rochester, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.,Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Michael R Sperling
- Department of Neurology and Neuroscience, Thomas Jefferson University, 901 Walnut St. Suite 400, Philadelphia, PA, 19107, USA.
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