1
|
González-Crespo A, Brugada-Bellsolà F, Candela-Cantó S, Calvo JA, Arboix JR, Bernal JH. Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value. Childs Nerv Syst 2024:10.1007/s00381-024-06571-w. [PMID: 39237764 DOI: 10.1007/s00381-024-06571-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: 07/18/2024] [Accepted: 08/07/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Insular epilepsy is a well-known cause of drug-resistant epilepsy (DRE) in the pediatric population. It can be a source of surgical epilepsy treatment failures when not ruled out pre-operatively. Non-invasive methods often provide limited information about its existence, being the invasive methods necessary to diagnose it in the vast majority of cases. The most used is stereoelectroencephalography (SEEG). We report a series of DRE pediatric patients in which insular SEEG was performed to rule out insular epilepsy. METHOD We performed a retrospective review of pediatric DRE patients operated on SEEG including insular electrodes between April 2016 and September 2022. We described the different trajectories used (orthogonal or oblique) and surgical techniques. After implantation, we assessed electrodes' precision using three measures: entry point location error (EPLE), target point location error (TPLE), and target deviation (TD). We also reported complications that occurred with this technique as well as the diagnostic information provided. RESULTS Overall, 32 DRE patients were operated on SEEG including insular electrodes. Four hundred one electrodes were implanted, 148 (39.91%) of whom were directed to the insula. One hundred twelve followed an orthogonal trajectory, and 36 were oblique. The mean EPLE was 1.45 mm, TPLE was 1.88 mm and TD was 0.71 mm. Three patients suffered from frontal hematoma, two of them diagnosed on post-operative MRI and one who required surgery, with no sequelae. One patient suffered from meningitis treated with antibiotics with no permanent sequelae. Nine patients (28.13%) had the insula included in the epileptogenic zone. CONCLUSIONS Insular epilepsy has to be ruled out in DRE patients when little suspicion is obtained after non-invasive testing. This is especially important in the pediatric population, in which seizure semiology is more difficult to characterize and failures to control epilepsy have devastating consequences in neurocognitive development and scholarship. Given its relative low rate of relevant complications and potential benefits, we should consider widening the inclusion criteria for insular SEEG monitoring.
Collapse
Affiliation(s)
- A González-Crespo
- Department of Neurological Surgery, Germans Trias i Pujol University Hospital Barcelona, Ctra del Canyet sn, Badalona, Barcelona, CP 08916, Spain.
| | - F Brugada-Bellsolà
- Department of Neurological Surgery, Germans Trias i Pujol University Hospital Barcelona, Ctra del Canyet sn, Badalona, Barcelona, CP 08916, Spain
| | - S Candela-Cantó
- Department of Pediatric Neurological Surgery, Hospital Sant Joan de Déu de Barcelona, Barcelona, Spain
| | - J Aparicio Calvo
- Department of Pediatric Neurological Surgery, Hospital Sant Joan de Déu de Barcelona, Barcelona, Spain
| | - J Rumià Arboix
- Department of Neurosurgery, Hospital Clinic I Provincial de Barcelona, Badalona, Barcelona, Spain
| | - J Hinojosa Bernal
- Department of Pediatric Neurological Surgery, Hospital Sant Joan de Déu de Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Wang X, Liu Y, Yang C. Ictal-onset localization through effective connectivity analysis based on RNN-GC with intracranial EEG signals in patients with epilepsy. Brain Inform 2024; 11:22. [PMID: 39179743 PMCID: PMC11343958 DOI: 10.1186/s40708-024-00233-y] [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: 04/25/2024] [Accepted: 07/17/2024] [Indexed: 08/26/2024] Open
Abstract
Epilepsy is one of the most common clinical diseases of the nervous system. The occurrence of epilepsy will bring many serious consequences, and some patients with epilepsy will develop drug-resistant epilepsy. Surgery is an effective means to treat this kind of patients, and lesion localization can provide a basis for surgery. The purpose of this study was to explore the functional types and connectivity evolution patterns of relevant regions of the brain during seizures. We used intracranial EEG signals from patients with epilepsy as the research object, and the method used was GRU-GC. The role of the corresponding area of each channel in the seizure process was determined by the introduction of group analysis. The importance of each area was analysed by introducing the betweenness centrality and PageRank centrality. The experimental results show that the classification method based on effective connectivity has high accuracy, and the role of the different regions of the brain could also change during the seizures. The relevant methods in this study have played an important role in preoperative assessment and revealing the functional evolution patterns of various relevant regions of the brain during seizures.
Collapse
Affiliation(s)
- Xiaojia Wang
- Wuxi Vocational College of Science and Technology, Wuxi, 214028, China
| | - Yanchao Liu
- School of computer science and engineering, Southeast University, Nanjing, 210096, China
| | - Chunfeng Yang
- School of computer science and engineering, Southeast University, Nanjing, 210096, China.
| |
Collapse
|
3
|
Miao Y, Iimura Y, Sugano H, Fukumori K, Tanaka T. Seizure onset zone identification using phase-amplitude coupling and multiple machine learning approaches for interictal electrocorticogram. Cogn Neurodyn 2023; 17:1591-1607. [PMID: 37969944 PMCID: PMC10640557 DOI: 10.1007/s11571-022-09915-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/26/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Automatic seizure onset zone (SOZ) localization using interictal electrocorticogram (ECoG) improves the diagnosis and treatment of patients with medically refractory epilepsy. This study aimed to investigate the characteristics of phase-amplitude coupling (PAC) extracted from interictal ECoG and the feasibility of PAC serving as a promising biomarker for SOZ identification. We employed the mean vector length modulation index approach on the 20-s ECoG window to calculate PAC features between low-frequency rhythms (0.5-24 Hz) and high frequency oscillations (HFOs) (80-560 Hz). We used statistical measures to test the significant difference in PAC between the SOZ and non-seizure onset zone (NSOZ). To overcome the drawback of handcraft feature engineering, we established novel machine learning models to learn automatically the characteristics of the obtained PAC features and classify them to identify the SOZ. Besides, to handle imbalanced dataset classification, we introduced novel feature-wise/class-wise re-weighting strategies in conjunction with classifiers. In addition, we proposed a time-series nest cross-validation to provide more accurate and unbiased evaluations for this model. Seven patients with focal cortical dysplasia were included in this study. The experiment results not only showed that a significant coupling at band pairs of slow waves and HFOs exists in the SOZ when compared with the NSOZ, but also indicated the effectiveness of the PAC features and the proposed models in achieving better classification performance .
Collapse
Affiliation(s)
- Yao Miao
- Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Yasushi Iimura
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hidenori Sugano
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kosuke Fukumori
- Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Toshihisa Tanaka
- Tokyo University of Agriculture and Technology, Tokyo, Japan
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
- RIKEN Center for Brain Science, Saitama, Japan
- RIKEN Center for Advanced Intelligent Project, Tokyo, Japan
| |
Collapse
|
4
|
Arnold TC, Kini LG, Bernabei JM, Revell AY, Das SR, Stein JM, Lucas TH, Englot DJ, Morgan VL, Litt B, Davis KA. Remote effects of temporal lobe epilepsy surgery: Long-term morphological changes after surgical resection. Epilepsia Open 2023; 8:559-570. [PMID: 36944585 PMCID: PMC10235552 DOI: 10.1002/epi4.12733] [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: 07/26/2022] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE Epilepsy surgery is an effective treatment for drug-resistant patients. However, how different surgical approaches affect long-term brain structure remains poorly characterized. Here, we present a semiautomated method for quantifying structural changes after epilepsy surgery and compare the remote structural effects of two approaches, anterior temporal lobectomy (ATL), and selective amygdalohippocampectomy (SAH). METHODS We studied 36 temporal lobe epilepsy patients who underwent resective surgery (ATL = 22, SAH = 14). All patients received same-scanner MR imaging preoperatively and postoperatively (mean 2 years). To analyze postoperative structural changes, we segmented the resection zone and modified the Advanced Normalization Tools (ANTs) longitudinal cortical pipeline to account for resections. We compared global and regional annualized cortical thinning between surgical treatments. RESULTS Across procedures, there was significant cortical thinning in the ipsilateral insula, fusiform, pericalcarine, and several temporal lobe regions outside the resection zone as well as the contralateral hippocampus. Additionally, increased postoperative cortical thickness was seen in the supramarginal gyrus. Patients treated with ATL exhibited greater annualized cortical thinning compared with SAH cases (ATL: -0.08 ± 0.11 mm per year, SAH: -0.01 ± 0.02 mm per year, t = 2.99, P = 0.006). There were focal postoperative differences between the two treatment groups in the ipsilateral insula (P = 0.039, corrected). Annualized cortical thinning rates correlated with preoperative cortical thickness (r = 0.60, P < 0.001) and had weaker associations with age at surgery (r = -0.33, P = 0.051) and disease duration (r = -0.42, P = 0.058). SIGNIFICANCE Our evidence suggests that selective procedures are associated with less cortical thinning and that earlier surgical intervention may reduce long-term impacts on brain structure.
Collapse
Affiliation(s)
- T. Campbell Arnold
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Lohith G. Kini
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - John M. Bernabei
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andrew Y. Revell
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neuroscience, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sandhitsu R. Das
- Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Joel M. Stein
- Department of Radiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Timothy H. Lucas
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neurosurgery, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dario J. Englot
- Department of Neurological SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
- Institute of Imaging ScienceVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Victoria L. Morgan
- Department of Neurological SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
- Institute of Imaging ScienceVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Brian Litt
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kathryn A. Davis
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
5
|
Nejedly P, Kremen V, Lepkova K, Mivalt F, Sladky V, Pridalova T, Plesinger F, Jurak P, Pail M, Brazdil M, Klimes P, Worrell G. Utilization of temporal autoencoder for semi-supervised intracranial EEG clustering and classification. Sci Rep 2023; 13:744. [PMID: 36639549 PMCID: PMC9839708 DOI: 10.1038/s41598-023-27978-6] [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: 11/23/2022] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
Manual visual review, annotation and categorization of electroencephalography (EEG) is a time-consuming task that is often associated with human bias and requires trained electrophysiology experts with specific domain knowledge. This challenge is now compounded by development of measurement technologies and devices allowing large-scale heterogeneous, multi-channel recordings spanning multiple brain regions over days, weeks. Currently, supervised deep-learning techniques were shown to be an effective tool for analyzing big data sets, including EEG. However, the most significant caveat in training the supervised deep-learning models in a clinical research setting is the lack of adequate gold-standard annotations created by electrophysiology experts. Here, we propose a semi-supervised machine learning technique that utilizes deep-learning methods with a minimal amount of gold-standard labels. The method utilizes a temporal autoencoder for dimensionality reduction and a small number of the expert-provided gold-standard labels used for kernel density estimating (KDE) maps. We used data from electrophysiological intracranial EEG (iEEG) recordings acquired in two hospitals with different recording systems across 39 patients to validate the method. The method achieved iEEG classification (Pathologic vs. Normal vs. Artifacts) results with an area under the receiver operating characteristic (AUROC) scores of 0.862 ± 0.037, 0.879 ± 0.042, and area under the precision-recall curve (AUPRC) scores of 0.740 ± 0.740, 0.714 ± 0.042. This demonstrates that semi-supervised methods can provide acceptable results while requiring only 100 gold-standard data samples in each classification category. Subsequently, we deployed the technique to 12 novel patients in a pseudo-prospective framework for detecting Interictal epileptiform discharges (IEDs). We show that the proposed temporal autoencoder was able to generalize to novel patients while achieving AUROC of 0.877 ± 0.067 and AUPRC of 0.705 ± 0.154.
Collapse
Affiliation(s)
- Petr Nejedly
- 1St Department of Neurology, Faculty of Medicine, Masaryk University, Brno, Czech Republic. .,Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic. .,Department of Neurology, Mayo Clinic, Mayo Systems Electrophysiology Laboratory, Rochester, MN, USA.
| | - Vaclav Kremen
- Department of Neurology, Mayo Clinic, Mayo Systems Electrophysiology Laboratory, Rochester, MN, USA. .,Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic.
| | - Kamila Lepkova
- Department of Neurology, Mayo Clinic, Mayo Systems Electrophysiology Laboratory, Rochester, MN, USA.,Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Filip Mivalt
- Department of Neurology, Mayo Clinic, Mayo Systems Electrophysiology Laboratory, Rochester, MN, USA.,Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czech Republic
| | - Vladimir Sladky
- Department of Neurology, Mayo Clinic, Mayo Systems Electrophysiology Laboratory, Rochester, MN, USA
| | - Tereza Pridalova
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic.,Department of Neurology, Mayo Clinic, Mayo Systems Electrophysiology Laboratory, Rochester, MN, USA
| | - Filip Plesinger
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Martin Pail
- 1St Department of Neurology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Milan Brazdil
- 1St Department of Neurology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.,CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Petr Klimes
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Mayo Systems Electrophysiology Laboratory, Rochester, MN, USA.
| |
Collapse
|
6
|
Afif S, Rehan ST, ul Hussain H, Islam MS. Low-intensity focused ultrasound, a novel approach to epilepsy treatment in developing countries. Brain Behav 2023; 13:e2852. [PMID: 36542525 PMCID: PMC9847596 DOI: 10.1002/brb3.2852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/12/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022] Open
Abstract
Approximately 80% of patients with epilepsy reside in poor resource settings. Despite the continued advancements and development of new treatment approaches, epilepsy remains a major health problem in developing countries. Consistent findings of epidemiologic studies reflect that both prevalence and treatment gap are higher in the developing world. The objective of this short review was to evaluate current treatment options and low-intensity, pulsed-focused ultrasound (FUS) as a potential new treatment option for epilepsy. Although some of the patients could be candidates for surgery, many factors, including poor health-care infrastructure, socioeconomic status, risks and complications associated with the surgery, and patients' preferences and attitudes toward the surgical procedure, limit the adherence to get surgical therapies. Low-intensity FUS, a novel and noninvasive therapeutic approach, has the potential to be approved by regulatory bodies and added to the list of standard treatment options for epilepsy. Improved understanding of epilepsy's prevalence and incidence in developing worlds, identification of potential new therapeutic options, and their evaluation through continuous studies and clinical trials are needed to reduce the burden of epilepsy and the treatment gap.
Collapse
Affiliation(s)
- Sadaf Afif
- Touro College of Osteopathic MedicineNew YorkNew YorkUSA
| | | | - Hassan ul Hussain
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Md. Saiful Islam
- Department of Public Health and InformaticsJahangirnagar UniversitySavar DhakaBangladesh
- Centre for Advanced Research Excellence in Public HealthSavar DhakaBangladesh
| |
Collapse
|
7
|
Whitlock JH, Soelter TM, Williams AS, Hardigan AA, Lasseigne BN. Liquid biopsies in epilepsy: biomarkers for etiology, diagnosis, prognosis, and therapeutics. Hum Cell 2022; 35:15-22. [PMID: 34694568 PMCID: PMC8732818 DOI: 10.1007/s13577-021-00624-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/29/2021] [Indexed: 01/19/2023]
Abstract
Epilepsy is one of the most common diseases of the central nervous system, impacting nearly 50 million people around the world. Heterogeneous in nature, epilepsy presents in children and adults alike. Currently, surgery is one treatment approach that can completely cure epilepsy. However, not all individuals are eligible for surgical procedures or have successful outcomes. In addition to surgical approaches, antiepileptic drugs (AEDs) have also allowed individuals with epilepsy to achieve freedom from seizures. Others have found treatment through nonpharmacologic approaches such as vagus nerve stimulation, or responsive neurostimulation. Difficulty in accessing samples of human brain tissue along with advances in sequencing technology have driven researchers to investigate sampling liquid biopsies in blood, serum, plasma, and cerebrospinal fluid within the context of epilepsy. Liquid biopsies provide minimal or non-invasive sample collection approaches and can be assayed relatively easily across multiple time points, unlike tissue-based sampling. Various efforts have investigated circulating nucleic acids from these samples including microRNAs, cell-free DNA, transfer RNAs, and long non-coding RNAs. Here, we review nucleic acid-based liquid biopsies in epilepsy to improve understanding of etiology, diagnosis, prediction, and therapeutic monitoring.
Collapse
Affiliation(s)
- Jordan H Whitlock
- Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tabea M Soelter
- Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Avery S Williams
- Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew A Hardigan
- Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Brittany N Lasseigne
- Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|
8
|
Rincon N, Barr D, Velez-Ruiz N. Neuromodulation in Drug Resistant Epilepsy. Aging Dis 2021; 12:1070-1080. [PMID: 34221550 PMCID: PMC8219496 DOI: 10.14336/ad.2021.0211] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/11/2021] [Indexed: 12/26/2022] Open
Abstract
Epilepsy affects approximately 70 million people worldwide, and it is a significant contributor to the global burden of neurological disorders. Despite the advent of new AEDs, drug resistant-epilepsy continues to affect 30-40% of PWE. Once identified as having drug-resistant epilepsy, these patients should be referred to a comprehensive epilepsy center for evaluation to establish if they are candidates for potential curative surgeries. Unfortunately, a large proportion of patients with drug-resistant epilepsy are poor surgical candidates due to a seizure focus located in eloquent cortex, multifocal epilepsy or inability to identify the zone of ictal onset. An alternative treatment modality for these patients is neuromodulation. Here we present the evidence, indications and safety considerations for the neuromodulation therapies in vagal nerve stimulation (VNS), responsive neurostimulation (RNS), or deep brain stimulation (DBS).
Collapse
Affiliation(s)
- Natalia Rincon
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Donald Barr
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Naymee Velez-Ruiz
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| |
Collapse
|
9
|
Ryan JJ, Kreiner DS, Paolo AM. Handedness of healthy elderly and patients with Alzheimer’s disease. Int J Neurosci 2020; 130:875-883. [DOI: 10.1080/00207454.2019.1707824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Joseph J. Ryan
- Department of Psychology, School of Kinesiology, Nutrition, and Psychological Science, University of Central Missouri, Warrensburg, MO, USA
| | - David S. Kreiner
- Department of Psychology, School of Kinesiology, Nutrition, and Psychological Science, University of Central Missouri, Warrensburg, MO, USA
| | - Anthony M. Paolo
- Office of Medical Education, The University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
10
|
Mettenburg JM, Branstetter BF, Wiley CA, Lee P, Richardson RM. Improved Detection of Subtle Mesial Temporal Sclerosis: Validation of a Commercially Available Software for Automated Segmentation of Hippocampal Volume. AJNR Am J Neuroradiol 2019; 40:440-445. [PMID: 30733255 DOI: 10.3174/ajnr.a5966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/23/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Identification of mesial temporal sclerosis is critical in the evaluation of individuals with temporal lobe epilepsy. Our aim was to assess the performance of FDA-approved software measures of hippocampal volume to identify mesial temporal sclerosis in patients with medically refractory temporal lobe epilepsy compared with the initial clinical interpretation of a neuroradiologist. MATERIALS AND METHODS Preoperative MRIs of 75 consecutive patients who underwent a temporal resection for temporal lobe epilepsy from 2011 to 2016 were retrospectively reviewed, and 71 were analyzed using Neuroreader, a commercially available automated segmentation and volumetric analysis package. Volume measures, including hippocampal volume as a percentage of total intracranial volume and the Neuroreader Index, were calculated. Radiologic interpretations of the MR imaging and pathology from subsequent resections were classified as either mesial temporal sclerosis or other, including normal findings. These measures of hippocampal volume were evaluated by receiver operating characteristic curves on the basis of pathologic confirmation of mesial temporal sclerosis in the resected temporal lobe. Sensitivity and specificity were calculated for each method and compared by means of the McNemar test using the optimal threshold as determined by the Youden J point. RESULTS Optimized thresholds of hippocampal percentage of a structural volume relative to total intracranial volume (<0.19%) and the Neuroreader Index (≤-3.8) were selected to optimize sensitivity and specificity (89%/71% and 89%/78%, respectively) for the identification of mesial temporal sclerosis in temporal lobe epilepsy compared with the initial clinical interpretation of the neuroradiologist (50% and 87%). Automated measures of hippocampal volume predicted mesial temporal sclerosis more accurately than radiologic interpretation (McNemar test, P < .0001). CONCLUSIONS Commercially available automated segmentation and volume analysis of the hippocampus accurately identifies mesial temporal sclerosis and performs significantly better than the interpretation of the radiologist.
Collapse
Affiliation(s)
| | - B F Branstetter
- From the Departments of Radiology (J.M.M., B.F.B.,)
- Biomedical Informatics (B.F.B.)
| | | | - P Lee
- Neurosurgery (P.L., R.M.R.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - R M Richardson
- Neurosurgery (P.L., R.M.R.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
11
|
Pichette J, Laurence A, Angulo L, Lesage F, Bouthillier A, Nguyen DK, Leblond F. Intraoperative video-rate hemodynamic response assessment in human cortex using snapshot hyperspectral optical imaging. NEUROPHOTONICS 2016; 3:045003. [PMID: 27752519 PMCID: PMC5061108 DOI: 10.1117/1.nph.3.4.045003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/19/2016] [Indexed: 05/21/2023]
Abstract
Using light, we are able to visualize the hemodynamic behavior of the brain to better understand neurovascular coupling and cerebral metabolism. In vivo optical imaging of tissue using endogenous chromophores necessitates spectroscopic detection to ensure molecular specificity as well as sufficiently high imaging speed and signal-to-noise ratio, to allow dynamic physiological changes to be captured, isolated, and used as surrogate of pathophysiological processes. An optical imaging system is introduced using a 16-bands on-chip hyperspectral camera. Using this system, we show that up to three dyes can be imaged and quantified in a tissue phantom at video-rate through the optics of a surgical microscope. In vivo human patient data are presented demonstrating brain hemodynamic response can be measured intraoperatively with molecular specificity at high speed.
Collapse
Affiliation(s)
- Julien Pichette
- Polytechnique Montreal, Department of Engineering Physics, C.P. 6079, Succ. Centre-Ville, Montréal H3C3A7, Canada
| | - Audrey Laurence
- Polytechnique Montreal, Department of Engineering Physics, C.P. 6079, Succ. Centre-Ville, Montréal H3C3A7, Canada
| | - Leticia Angulo
- Polytechnique Montreal, Department of Engineering Physics, C.P. 6079, Succ. Centre-Ville, Montréal H3C3A7, Canada
| | - Frederic Lesage
- Polytechnique Montreal, Department of Electrical Engineering, C.P. 6079, Succ. Centre-Ville, Montréal H3C3A7, Canada
| | - Alain Bouthillier
- Centre Hospitalier de l’Université de Montréal, Notre-Dame Hospital, Division of Neurosurgery, 1560 Sherbrooke Street East, Montréal H2L4M1, Canada
| | - Dang Khoa Nguyen
- Centre Hospitalier de l’Université de Montréal, Notre-Dame Hospital, Division of Neurology, 1560 Sherbrooke Street East, Montréal H2L4M1, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, 900 Saint-Denis, Montréal H2X0A9, Canada
| | - Frederic Leblond
- Polytechnique Montreal, Department of Engineering Physics, C.P. 6079, Succ. Centre-Ville, Montréal H3C3A7, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, 900 Saint-Denis, Montréal H2X0A9, Canada
| |
Collapse
|