Suppression of epileptiform activity by a single short-duration electric field in rat hippocampus in vitro

Finding influential nodes in networks using pinning control: Centrality measures confirmed with electrochemical oscillators

The spatiotemporal organization of networks of dynamical units can break down resulting in diseases (e.g., in the brain) or large-scale malfunctions (e.g., power grid blackouts). Re-establishment of function then requires identification of the optimal intervention site from which the network behavior is most efficiently re-stabilized. Here, we consider one such scenario with a network of units with oscillatory dynamics, which can be suppressed by sufficiently strong coupling and stabilizing a single unit, i.e., pinning control. We analyze the stability of the network with hyperbolas in the control gain vs coupling strength state space and identify the most influential node (MIN) as the node that requires the weakest coupling to stabilize the network in the limit of very strong control gain. A computationally efficient method, based on the Moore-Penrose pseudoinverse of the network Laplacian matrix, was found to be efficient in identifying the MIN. In addition, we have found that in some networks, the MIN relocates when the control gain is changed, and thus, different nodes are the most influential ones for weakly and strongly coupled networks. A control theoretic measure is proposed to identify networks with unique or relocating MINs. We have identified real-world networks with relocating MINs, such as social and power grid networks. The results were confirmed in experiments with networks of chemical reactions, where oscillations in the networks were effectively suppressed through the pinning of a single reaction site determined by the computational method.

The history of Danish neuroscience

The history of Danish neuroscience starts with an account of impressive contributions made at the 17th century. Thomas Bartholin was the first Danish neuroscientist, and his disciple Nicolaus Steno became internationally one of the most prominent neuroscientists in this period. From the start, Danish neuroscience was linked to clinical disciplines. This continued in the 19th and first half of the 20th centuries with new initiatives linking basic neuroscience to clinical neurology and psychiatry in the same scientific environment. Subsequently, from the middle of the 20th century, basic neuroscience was developing rapidly within the preclinical university sector. Clinical neuroscience continued and was even reinforced during this period with important translational research and a close co-operation between basic and clinical neuroscience. To distinguish 'history' from 'present time' is not easy, as many historical events continue in present time. Therefore, we decided to consider 'History' as new major scientific developments in Denmark, which were launched before the end of the 20th century. With this aim, scientists mentioned will have been born, with a few exceptions, no later than the early 1960s. However, we often refer to more recent publications in documenting the developments of initiatives launched before the end of the last century. In addition, several scientists have moved to Denmark after the beginning of the present century, and they certainly are contributing to the present status of Danish neuroscience-but, again, this is not the History of Danish neuroscience.

Focal Cortex Stimulation With a Novel Implantable Device and Antiseizure Outcomes in 2 Prospective Multicenter Single-Arm Trials

Importance

For the large population of people with drug-refractory epilepsy, alternative treatment approaches are needed. Clinical trial outcomes of a novel stimulation device, which is newly available in Europe for the treatment of patients with a predominant seizure focus, are reported for the first time.

Objective

To perform a pooled analysis of the results of 2 prospective, multicenter, single-arm trials, A Pilot Study to Assess the Feasibility of Neurostimulation With the EASEE System to Treat Medically Refractory Focal Epilepsy (EASEE II) and A Pilot Study to Assess the Feasibility of Patient-Controlled Neurostimulation With the EASEE System to Treat Medically Refractory Focal Epilepsy (PIMIDES I), assessing the safety and efficacy of epicranial focal cortex stimulation (FCS) with a novel implantable device (EASEE [Precisis]) as adjunctive treatment for adult patients with drug-refractory focal epilepsy.

Design, Setting, and Participants

This study was a pooled analysis of 2 nonrandomized uncontrolled trials, EASEE II and PIMIDES I, which began on January 15, 2019, and January 14, 2020, respectively, and ended on July 28, 2021. EASEE II and PIMIDES I were the first in-human, prospective, single-arm trials with an 8-month evaluation period. Patients were recruited at 7 European epilepsy centers. Consecutive participants with drug-refractory focal epilepsy were enrolled. Study data were analyzed from September 29, 2021, to February 2, 2022.

Interventions

After a 1-month prospective baseline period, patients were implanted with the neurostimulation device. After a 1-month postimplantation recovery period, unblinded FCS was activated using both high-frequency and direct current (DC)-like components performed via electrode arrays placed epicranially above the individual epileptic focus region.

Main Outcomes and Measures

Efficacy was prospectively assessed by the responder rate in the sixth month of stimulation compared with baseline; safety and additional end points were assessed after device implantation and during the stimulation period.

Results

Of the 34 adult patients enrolled at 6 German and 1 Belgian investigational site, 33 (mean [SD] age, 34.6 [13.5] years; 18 male patients [54.5%]) received the neurostimulation device implant. A total of 32 patients underwent combined high-frequency direct current-like stimulation at least until the 8-month postimplant follow-up visit. After 6 months of stimulation, 17 of 32 patients (53.1%) were responders to treatment with at least a 50% reduction in seizure frequency compared with baseline, corresponding to a significant median seizure reduction by 52% (95% CI, 0.37%-0.76%; P < .001). No device- or procedure-related serious adverse events were reported (0; 95% CI, 0%-10.58%). There were no significant alterations in cognition, mood, or overall quality of life.

Conclusions and Relevance

Results of this pooled analysis of 2 nonrandomized uncontrolled trials suggest that FCS with a novel neurostimulation device was associated with an effective reduction in seizure frequency in patients with drug-refractory focal epilepsy and may offer a promising treatment option for patients with a predominant epileptic focus.

Trial Registration

German Clinical Trials Register: DRKS00015918 and DRKS00017833, respectively, and jointly under PROSPERO: CRD42021266440.

Effect of acute mitochondrial dysfunction on hyperexcitable network activity in rat hippocampus in vitro

Metabolic stress imposed by epileptic seizures can result in mitochondrial dysfunction, believed to act as positive feedback on epileptogenesis and seizure susceptibility. As the mechanism behind this positive feedback is unclear, the aim of the present study was to investigate the causal link between acute mitochondrial dysfunction and increased seizure susceptibility in hyperexcitable hippocampal networks. Following the induction of spontaneous interictal-like discharges, acute selective pharmacological blockade of either of the mitochondrial respiratory complexes (MRC) I-IV induced seizure-like events (SLE) in 78-100% of experiments. A similar result was obtained by uncoupling the oxidative phosphorylation (OXPHOS) but not by selective blockade of MRCV (ATP synthase) which did not induce SLE. The reactive oxygen species (ROS) scavenger 4-hydroxy-2,2,6,6-tetramethylpiperidine 1-oxyl (tempol, 2 mM) significantly reduced the proconvulsant effect of blocking MRCI but did not reduce the proconvulsant effect of OXPHOS uncoupling. These findings indicate that acute mitochondrial dysfunction can lead to a convulsive state within a short timeframe, and that increased ROS production makes substantial contribution to such induction in addition to other mitochondrial related factors, which appears to be independent of changes in ROS and ATP production.

Real-time Inference and Detection of Disruptive EEG Networks for Epileptic Seizures

Recent studies in brain science and neurological medicine paid a particular attention to develop machine learning-based techniques for the detection and prediction of epileptic seizures with electroencephalogram (EEG). As a noninvasive monitoring method to record brain electrical activities, EEG has been widely used for capturing the underlying dynamics of disruptive neuronal responses across the brain in real-time to provide clinical guidance in support of epileptic seizure treatments in practice. In this study, we introduce a novel dynamic learning method that first infers a time-varying network constituted by multivariate EEG signals, which represents the overall dynamics of the brain network, and subsequently quantifies its topological property using graph theory. We demonstrate the efficacy of our learning method to detect relatively strong synchronization (characterized by the algebraic connectivity metric) caused by abnormal neuronal firing during a seizure onset. The computational results for a realistic scalp EEG database show a detection rate of 93.6% and a false positive rate of 0.16 per hour (FP/h); furthermore, our method observes potential pre-seizure phenomena in some cases.

Role of GABAB receptors in proepileptic and antiepileptic effects of an applied electric field in rat hippocampus in vitro

The mechanisms underlying antiepileptic effects of deep brain stimulation (DBS) are complex and poorly understood. Studies on the effects of applied electric fields on epileptic nervous tissue could enable future advances in DBS treatments. Applied electric fields are known to inhibit or enhance epileptic activity in vitro through direct effects on local neurons, but it is unclear whether trans-synaptic effects participate in such actions. The present study investigates, in an epileptic brain slice model, the influence of GABA_B receptor activation on excitatory and suppressive effects of a short-duration (10 ms) electric field in rat hippocampus. The results show that perfusion of the GABA_B receptor antagonist, CGP 55845 (2 μM), could abolish applied-field induced suppression of orthodromic-stimulus evoked epileptiform afterdischarge activity in the CA1 region. GABA_B receptor blockade was associated with an enhanced excitatory (proepileptic) effect of the applied field. However, the suppressive effect, observed in isolation using weak field stimuli, was left unchanged. The G-protein-activated inwardly rectifying K⁺ channel (GIRK) antagonist, tertiapin (30-50 nM), mimicked the effects of CGP 55845. The results suggest that the applied field activate (elements of) local interneurons to release GABA onto GABA_B receptors. The resulting activation of postsynaptic GIRK channels inhibits neuronal activity thereby dampening the direct stimulatory effect of the applied field. The study indicates that local-stimulus induced GABA_B receptor activation can serve a protective role under antiepileptic paradigms by preventing electrical stimulation from causing hyperexcitation.

Effects of polarization induced by non-weak electric fields on the excitability of elongated neurons with active dendrites

An externally-applied electric field can polarize a neuron, especially a neuron with elongated dendrites, and thus modify its excitability. Here we use a computational model to examine, predict, and explain these effects. We use a two-compartment Pinsky-Rinzel model neuron polarized by an electric potential difference imposed between its compartments, and we apply an injected ramp current. We vary three model parameters: the magnitude of the applied potential difference, the extracellular potassium concentration, and the rate of current injection. A study of the Time-To-First-Spike (TTFS) as a function of polarization leads to the identification of three regions of polarization strength that have different effects. In the weak region, the TTFS increases linearly with polarization. In the intermediate region, the TTFS increases either sub- or super-linearly, depending on the current injection rate and the extracellular potassium concentration. In the strong region, the TTFS decreases. Our results in the weak and strong region are consistent with experimental observations, and in the intermediate region, we predict novel effects that depend on experimentally-accessible parameters. We find that active channels in the dendrite play a key role in these effects. Our qualitative results were found to be robust over a wide range of inter-compartment conductances and the ratio of somatic to dendritic membrane areas. In addition, we discuss preliminary results where synaptic inputs replace the ramp injection protocol. The insights and conclusions were found to extend from our polarized PR model to a polarized PR model with I h dendritic currents. Finally, we discuss the degree to which our results may be generalized.