Signal characteristics of intraventricular electrodes recordings in human epilepsy: a case report

Ambulatory Local Field Potential Recordings from the Thalamus in Epilepsy: A Feasibility Study

INTRODUCTION

Stimulation of the thalamus is gaining favor in the treatment of medically refractory multifocal and generalized epilepsy. Implanted brain stimulators capable of recording ambulatory local field potentials (LFPs) have recently been introduced, but there is little information to guide their use in thalamic stimulation for epilepsy. This study sought to assess the feasibility of chronically recording ambulatory interictal LFP from the thalamus in patients with epilepsy.

METHODS

In this pilot study, ambulatory LFP was recorded from patients who underwent sensing-enabled deep brain stimulation (DBS, 2 participants) or responsive neurostimulation (RNS, 3 participants) targeting the anterior nucleus of the thalamus (ANT, 2 electrodes), centromedian nucleus (CM, 7 electrodes), or medial pulvinar (PuM, 1 electrode) for multifocal or generalized epilepsy. Time-domain and frequency-domain LFP was investigated for epileptiform discharges, spectral peaks, circadian variation, and peri-ictal patterns.

RESULTS

Thalamic interictal discharges were visible on ambulatory recordings from both DBS and RNS. At-home interictal frequency-domain data could be extracted from both devices. Spectral peaks were noted at 10-15 Hz in CM, 6-11 Hz in ANT, and 19-24 Hz in PuM but varied in prominence and were not visible in all electrodes. In CM, 10-15 Hz power exhibited circadian variation and was attenuated by eye opening.

CONCLUSION

Chronic ambulatory recording of thalamic LFP is feasible. Common spectral peaks can be observed but vary between electrodes and across neural states. DBS and RNS devices provide a wealth of complementary data that have the potential to better inform thalamic stimulation for epilepsy.

Filtering of neurophysiologic signals

Clinical neurophysiologic signals cover a broad range of frequencies. Filters help to emphasize waveforms that are of clinical or research interest and to mold their frequency characteristics to suit the purpose of the investigation. Some frequency content is obvious and well known, such as the alpha rhythm (8-11Hz) or spindles (12-14Hz) in the EEG. Other frequencies are not initially discriminable from background activity and require filtering in order to examine them, such as high-frequency oscillations (80-500Hz) in EEG and brainstem auditory evoked potentials (100-3000Hz). Often used to mitigate the effects of background noise or artifact, filters can be used specifically to attenuate unwanted frequencies, such as mains interference (50 or 60Hz) and electrode offset potential (<0.1Hz). For digital instrumentation, an antialiasing filter (below Nyquist) is always needed prior to sampling by the analog-to-digital converter. Once the signals are in the digital realm, sophisticated filtering operations can be carried out post hoc; but in order not to be misled, the neurophysiologist must always bear in mind the effect of filtering on the physiological waveform.

Intracranially recorded ictal direct current shifts may precede high frequency oscillations in human epilepsy

OBJECTIVE

We assessed the temporal-spatial characteristics of ictal direct current (DC) shifts (or infraslow activity) and high frequency oscillations (HFOs) in 16 patients with intractable focal epilepsy.

METHODS

The underlying etiology consisted of cortical dysplasia, glioma, hippocampal sclerosis, and low-grade neuroepithelial tumor in nine, four, two, and one patients, respectively. The median number of analyzed seizure events was 8.0 per patient (range: 2-10). Chronic electrocorticographic recording was performed with (1) a band-pass filter of 0.016-600Hz (or 0.016-300Hz) and a sampling rate of 2000Hz (or 1000Hz).

RESULTS

Ictal DC shifts and a sustained form of ictal HFOs were observed in 75.0% and 50.0% of the patients, and 71.3% and 46.3% of the analyzed seizures. Visual assessment revealed that the onset of ictal DC shifts preceded that of ictal HFOs with statistical significance in 5/7 patients. The spatial extent of ictal DC shifts or HFOs was smaller than that of the conventionally defined seizure onset zone in 9/12 patients.

CONCLUSION

Both ictal DC shifts and HFOs might represent the core of tissue generating seizures.

SIGNIFICANCE

The early occurrence of ictal DC shifts warrants further studies to determine the role of glia (possibly mediating ictal DC shifts) in seizure generation.

Interictal infraslow activity in patients with epilepsy

OBJECTIVE

To evaluate if interictal infraslow activity (ISA), as obtained from a conventional EEG system, can contribute information about the epileptogenic process.

METHODS

The entire long-term intracranial monitoring sessions of 12 consecutive patients were evaluated on an XLTEK system for ISA. Three additional patients had long-term scalp recordings.

RESULTS

In intracranial as well as scalp recordings, the ISA background was consistently higher in the waking state than during sleep. From this background emerged intermittently focal changes, which could achieve in intracranial recordings millivolt amplitudes, while they remained in the microvolt range in scalp recordings. Although they were mainly contiguous between adjacent channels, this was not necessarily the case and intermittent build-up could be seen distant from the epileptogenic zone or radiographic lesion.

CONCLUSIONS

Interictal ISA can be detected in routine intracranial and scalp recordings, without the need for DC amplifiers, and can provide additional information.

SIGNIFICANCE

Since ISA is a separate element of the electromagnetic spectrum, apparently non-neuronal in origin, its assessment should be included not only in the pre-surgical evaluation of epilepsy patients but also in patients with other neurologic disorders and normal volunteers.