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Qiu Z, Nguyen AT, Su K, Yang Z, Xu J. A High Precision, Wide Dynamic Range Closed-Loop Neuromodulation IC With Rapid Stimulation Artifact Recovery. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2024; 18:274-287. [PMID: 37782620 DOI: 10.1109/tbcas.2023.3321295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
This article presents a high precision, wide dynamic range (DR) closed-loop neuromodulation (CLNM) system that can completely reject stimulation artifacts (SA) and achieve rapid SA recovery. In the recorder, a novel SA quick-blanking scheme is proposed for rail-to-rail SA rejection while minimizing SA recovery time. Besides, a new analog front-end (AFE) architecture based on a frequency-shaping (FS) technique is developed to extend DR intrinsically. In the stimulator, a stimulation driver implemented with a proposed redundant crossfire (RXF) technique is incorporated to improve the effective resolution of the stimulation current. The designed CLNM system is implemented in a 180 nm Bipolar-CMOS-DMOS (BCD) process. Measurement results show that the system is capable of tolerating rail-to-rail (5 V) SA and reducing the SA recovery time from 12 ms to 0.15 ms. The FS recorder extends the DR at low frequencies (LF) to 17.5 bits to enhance tolerance to LF interferences. The proposed stimulator adopting the 4-way RXF topology improves the effective resolution to 12.75 bits without consuming much extra area and power. Animal experiments demonstrate that the designed system can acquire high-fidelity neural signals immediately after stimulation onsets, thus supporting concurrent recording and stimulation.
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Hamani C, Davidson B, Lipsman N, Abrahao A, Nestor SM, Rabin JS, Giacobbe P, Pagano RL, Campos ACP. Insertional effect following electrode implantation: an underreported but important phenomenon. Brain Commun 2024; 6:fcae093. [PMID: 38707711 PMCID: PMC11069120 DOI: 10.1093/braincomms/fcae093] [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: 09/11/2023] [Revised: 12/08/2023] [Accepted: 03/26/2024] [Indexed: 05/07/2024] Open
Abstract
Deep brain stimulation has revolutionized the treatment of movement disorders and is gaining momentum in the treatment of several other neuropsychiatric disorders. In almost all applications of this therapy, the insertion of electrodes into the target has been shown to induce some degree of clinical improvement prior to stimulation onset. Disregarding this phenomenon, commonly referred to as 'insertional effect', can lead to biased results in clinical trials, as patients receiving sham stimulation may still experience some degree of symptom amelioration. Similar to the clinical scenario, an improvement in behavioural performance following electrode implantation has also been reported in preclinical models. From a neurohistopathologic perspective, the insertion of electrodes into the brain causes an initial trauma and inflammatory response, the activation of astrocytes, a focal release of gliotransmitters, the hyperexcitability of neurons in the vicinity of the implants, as well as neuroplastic and circuitry changes at a distance from the target. Taken together, it would appear that electrode insertion is not an inert process, but rather triggers a cascade of biological processes, and, as such, should be considered alongside the active delivery of stimulation as an active part of the deep brain stimulation therapy.
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Affiliation(s)
- Clement Hamani
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Benjamin Davidson
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Agessandro Abrahao
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Sean M Nestor
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Jennifer S Rabin
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto M5G 1V7, Canada
| | - Peter Giacobbe
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Rosana L Pagano
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, SP CEP 01308-060, Brazil
| | - Ana Carolina P Campos
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, SP CEP 01308-060, Brazil
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Gravitis AC, Tufa U, Zukotynski K, Streiner DL, Friedman D, Laze J, Chinvarun Y, Devinsky O, Wennberg R, Carlen PL, Bardakjian BL. Ictal ECG-based assessment of sudden unexpected death in epilepsy. Front Neurol 2023; 14:1147576. [PMID: 36994379 PMCID: PMC10040863 DOI: 10.3389/fneur.2023.1147576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
IntroductionPrevious case-control studies of sudden unexpected death in epilepsy (SUDEP) patients failed to identify ECG features (peri-ictal heart rate, heart rate variability, corrected QT interval, postictal heart rate recovery, and cardiac rhythm) predictive of SUDEP risk. This implied a need to derive novel metrics to assess SUDEP risk from ECG.MethodsWe applied Single Spectrum Analysis and Independent Component Analysis (SSA-ICA) to remove artifact from ECG recordings. Then cross-frequency phase-phase coupling (PPC) was applied to a 20-s mid-seizure window and a contour of −3 dB coupling strength was determined. The contour centroid polar coordinates, amplitude (alpha) and angle (theta), were calculated. Association of alpha and theta with SUDEP was assessed and a logistic classifier for alpha was constructed.ResultsAlpha was higher in SUDEP patients, compared to non-SUDEP patients (p < 0.001). Theta showed no significant difference between patient populations. The receiver operating characteristic (ROC) of a logistic classifier for alpha resulted in an area under the ROC curve (AUC) of 94% and correctly classified two test SUDEP patients.DiscussionThis study develops a novel metric alpha, which highlights non-linear interactions between two rhythms in the ECG, and is predictive of SUDEP risk.
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Affiliation(s)
- Adam C. Gravitis
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Uilki Tufa
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Katherine Zukotynski
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - David L. Streiner
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Daniel Friedman
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Juliana Laze
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Yotin Chinvarun
- Department of Medicine, Phramongkutklao Royal Army Hospital, Bangkok, Thailand
| | - Orrin Devinsky
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Richard Wennberg
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Peter L. Carlen
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Berj L. Bardakjian
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
- *Correspondence: Berj L. Bardakjian
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Tiefenbach J, Chan HH, Machado AG, Baker KB. Neurostimulation for Functional Recovery After Traumatic Brain Injury: Current Evidence and Future Directions for Invasive Surgical Approaches. Neurosurgery 2022; 91:823-830. [PMID: 36069568 PMCID: PMC10552985 DOI: 10.1227/neu.0000000000002134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022] Open
Abstract
We aim to provide a comprehensive review of the current scientific evidence supporting the use of invasive neurostimulation in the treatment of deficits associated with traumatic brain injury (TBI), as well as to identify future directions for research and highlight important questions that remain unaddressed. Neurostimulation is a treatment modality with expanding applications in modern medical practice. Targeted electrical stimulation of specific brain regions has been shown to increase synaptogenesis and enhance structural reorganization of neuronal networks. This underlying therapeutic effect might be of high value for patients suffering from TBI because it could modulate neuronal connectivity and function of areas that are partially or completely spared after injury. The current published literature exploring the application of invasive neurostimulation for the treatment of functional deficits associated with TBI is scarce but promising. Rodent models have shown that targeted stimulation of the hippocampus or connecting structures can result in significant cognitive recovery, while stimulation of the motor cortex and deep cerebellar nuclei is associated with motor improvements. Data from clinical studies are extremely limited; single-patient reports and case series found neurostimulation to be effective in relieving motor symptoms, improving visuospatial memory, and supporting emotional adjustment. Looking forward, it will be important to identify stimulation targets and paradigms that can maximize improvement over multiple functional domains. It will also be important to corroborate the observed behavioral improvements with histological, electrophysiological, and radiological evidence. Finally, the impact of biological variables such as sex and age on the treatment outcomes needs to be explored.
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Affiliation(s)
- Jakov Tiefenbach
- Department of Neurosciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio USA
| | - Hugh H. Chan
- Department of Neurosciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio USA
| | - Andre G. Machado
- Department of Neurosciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio USA
| | - Kenneth B. Baker
- Department of Neurosciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio USA
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Caron D, Canal-Alonso Á, Panuccio G. Mimicking CA3 Temporal Dynamics Controls Limbic Ictogenesis. BIOLOGY 2022; 11:371. [PMID: 35336745 PMCID: PMC8944954 DOI: 10.3390/biology11030371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
Mesial temporal lobe epilepsy (MTLE) is the most common partial complex epilepsy in adults and the most unresponsive to medications. Electrical deep brain stimulation (DBS) of the hippocampus has proved effective in controlling seizures in epileptic rodents and in drug-refractory MTLE patients. However, current DBS paradigms implement arbitrary fixed-frequency or patterned stimuli, disregarding the temporal profile of brain electrical activity. The latter, herein included hippocampal spontaneous firing, has been shown to follow lognormal temporal dynamics. Here, we present a novel paradigm to devise DBS protocols based on stimulation patterns fashioned as a surrogate brain signal. We focus on the interictal activity originating in the hippocampal subfield CA3, which has been shown to be anti-ictogenic. Using 4-aminopyridine-treated hippocampus-cortex slices coupled to microelectrode array, we pursue three specific aims: (1) address whether lognormal temporal dynamics can describe the CA3-driven interictal pattern, (2) explore the possibility of restoring the non-seizing state by mimicking the temporal dynamics of this anti-ictogenic pattern with electrical stimulation, and (3) compare the performance of the CA3-surrogate against periodic stimulation. We show that the CA3-driven interictal activity follows lognormal temporal dynamics. Further, electrical stimulation fashioned as a surrogate interictal pattern exhibits similar efficacy but uses less pulses than periodic stimulation. Our results support the possibility of mimicking the temporal dynamics of relevant brain signals as a straightforward DBS strategy to ameliorate drug-refractory epilepsy. Further, they herald a paradigm shift in neuromodulation, wherein a compromised brain signal can be recreated by the appropriate stimuli distribution to bypass trial-and-error studies and attain physiologically meaningful DBS operating modes.
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Affiliation(s)
- Davide Caron
- Enhanced Regenerative Medicine, Istituto Italiano di Tecnologia, 16163 Genova, Italy;
| | - Ángel Canal-Alonso
- BISITE Research Group, University of Salamanca, 37008 Salamanca, Spain;
- Institute for Biomedical Research of Salamanca, University of Salamanca, 37008 Salamanca, Spain
| | - Gabriella Panuccio
- Enhanced Regenerative Medicine, Istituto Italiano di Tecnologia, 16163 Genova, Italy;
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Shlobin NA, Campbell JM, Rosenow JM, Rolston JD. Ethical considerations in the surgical and neuromodulatory treatment of epilepsy. Epilepsy Behav 2022; 127:108524. [PMID: 34998267 PMCID: PMC10184316 DOI: 10.1016/j.yebeh.2021.108524] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 02/08/2023]
Abstract
Surgical resection and neuromodulation are well-established treatments for those with medically refractory epilepsy. These treatments entail important ethical considerations beyond those which extend to the treatment of epilepsy generally. In this paper, the authors explore these unique considerations through a framework that relates foundational principles of bioethics to features of resective epilepsy surgery and neuromodulation. The authors conducted a literature review to identify ethical considerations for a variety of epilepsy surgery procedures and to examine how foundational principles in bioethics may inform treatment decisions. Healthcare providers should be cognizant of how an increased prevalence of somatic and psychiatric comorbidities, the dynamic nature of symptom burden over time, the individual and systemic barriers to treatment, and variable sociocultural contexts constitute important ethical considerations regarding the use of surgery or neuromodulation for the treatment of epilepsy. Moreover, careful attention should be paid to how resective epilepsy surgery and neuromodulation relate to notions of patient autonomy, safety and privacy, and the shared responsibility for device management and maintenance. A three-tiered approach-(1) gathering information and assessing the risks and benefits of different treatment options, (2) clear communication with patient or proxy with awareness of patient values and barriers to treatment, and (3) long-term decision maintenance through continued identification of gaps in understanding and provision of information-allows for optimal treatment of the individual person with epilepsy while minimizing disparities in epilepsy care.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Justin M Campbell
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA; Department of Neuroscience, University of Utah, Salt Lake City, UT, USA
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
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Lee CC, Chou CC, Hsiao FJ, Chen YH, Lin CF, Chen CJ, Peng SJ, Liu HL, Yu HY. Pilot study of focused ultrasound for drug-resistant epilepsy. Epilepsia 2021; 63:162-175. [PMID: 34729772 PMCID: PMC9297900 DOI: 10.1111/epi.17105] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 02/04/2023]
Abstract
Objective The neuromodulatory effects of focused ultrasound (FUS) have been demonstrated in animal epilepsy models; however, the safety and efficacy of FUS in humans with epilepsy have not been well established. Patients with drug‐resistant epilepsy (DRE) undergoing stereo‐electroencephalography (SEEG) provide an opportunity to investigate the neuromodulatory effects of FUS in humans. Methods Patients with DRE undergoing SEEG for localization of the seizure onset zone (SOZ) were prospectively enrolled. FUS was delivered to the SOZ using a neuronavigation‐guided FUS system (ceiling spatial‐peak temporal‐average intensity level = 2.8 W/cm2, duty cycle = 30%, modulating duration = 10 min). Simultaneous SEEG recordings were obtained during sonication and for 3 days after treatment. Seizures, interictal epileptiform discharges, and adverse events after FUS were monitored. Results Six patients met the eligibility criteria and completed FUS treatment. A decrease in seizure frequency was observed in two patients within the 3‐day follow‐up; however, one patient presented an increase in the frequency of subclinical seizures. Posttreatment magnetic resonance imaging revealed neither lesion nor brain edema. Significant changes in spectral power of SEEG were noted at the targeted electrodes during FUS treatment. One patient reported subjective scalp heating during FUS, and one patient developed transient naming and memory impairment that resolved within 3 weeks after FUS. Significance FUS can be safely delivered to the SOZ of patients with DRE, resulting in significant changes in spectral power of SEEG. A larger sample cohort and pursuing optimal sonication parameters will be required to elucidate the neuromodulatory effects of FUS when used for seizure control.
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Affiliation(s)
- Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Chen Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Jung Hsiao
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hsiu Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hao-Li Liu
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Yu Yu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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Alqadi K, Aldhalaan H, Alghamdi A, Bamgadam F, Abu-Jabber A, Baeesa S, Althubaiti I, Baz S. Saudi Arabian Consensus Statement on Vagus Nerve Stimulation for Refractory Epilepsy. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 9:75-81. [PMID: 33519349 PMCID: PMC7839567 DOI: 10.4103/sjmms.sjmms_578_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/09/2020] [Accepted: 11/23/2020] [Indexed: 11/04/2022]
Abstract
Vagus nerve stimulation (VNS) is an approved adjunctive therapy for refractory epilepsy and used in patients who are not candidates for resective epilepsy surgery. In Saudi Arabia, VNS device implantation is being performed since 2008 by several comprehensive epilepsy programs, but with variable protocols. Therefore, to standardize the use of VNS, a task force was established to create a national consensus. This group consisted of epileptologists, epilepsy surgeons and a VNS nurse coordinator working in comprehensive epilepsy centers and dealing with refractory epilepsy cases. The group intensively reviewed the literature using Medline, EMBASE, Web of Science and Cochrane Library, in addition to physician's manual. Evidence is reported as three stages: preimplantation and patient selection, a perioperative phase involving all stakeholders and post-operative care with specific programming pathways.
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Affiliation(s)
- Khalid Alqadi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hesham Aldhalaan
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulaziz Alghamdi
- Department of Neurosciences, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fawzia Bamgadam
- Department of Neurosciences, King Fahad Medical Centre, Riyadh, Saudi Arabia
| | - Amal Abu-Jabber
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Saleh Baeesa
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ibrahim Althubaiti
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Salah Baz
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Bröer S. Not Part of the Temporal Lobe, but Still of Importance? Substantia Nigra and Subthalamic Nucleus in Epilepsy. Front Syst Neurosci 2020; 14:581826. [PMID: 33381016 PMCID: PMC7768985 DOI: 10.3389/fnsys.2020.581826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/09/2020] [Indexed: 01/15/2023] Open
Abstract
The most researched brain region in epilepsy research is the temporal lobe, and more specifically, the hippocampus. However, numerous other brain regions play a pivotal role in seizure circuitry and secondary generalization of epileptic activity: The substantia nigra pars reticulata (SNr) and its direct input structure, the subthalamic nucleus (STN), are considered seizure gating nuclei. There is ample evidence that direct inhibition of the SNr is capable of suppressing various seizure types in experimental models. Similarly, inhibition via its monosynaptic glutamatergic input, the STN, can decrease seizure susceptibility as well. This review will focus on therapeutic interventions such as electrical stimulation and targeted drug delivery to SNr and STN in human patients and experimental animal models of epilepsy, highlighting the opportunities for overcoming pharmacoresistance in epilepsy by investigating these promising target structures.
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Affiliation(s)
- Sonja Bröer
- Faculty of Veterinary Medicine, Institute of Pharmacology and Toxicology, Freie Universität Berlin, Berlin, Germany
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Ultrasonic Neuromodulation via Astrocytic TRPA1. Curr Biol 2019; 29:3386-3401.e8. [PMID: 31588000 DOI: 10.1016/j.cub.2019.08.021] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/26/2019] [Accepted: 08/08/2019] [Indexed: 01/07/2023]
Abstract
Low-intensity, low-frequency ultrasound (LILFU) is the next-generation, non-invasive brain stimulation technology for treating various neurological and psychiatric disorders. However, the underlying cellular and molecular mechanism of LILFU-induced neuromodulation has remained unknown. Here, we report that LILFU-induced neuromodulation is initiated by opening of TRPA1 channels in astrocytes. The Ca2+ entry through TRPA1 causes a release of gliotransmitters including glutamate through Best1 channels in astrocytes. The released glutamate activates NMDA receptors in neighboring neurons to elicit action potential firing. Our results reveal an unprecedented mechanism of LILFU-induced neuromodulation, involving TRPA1 as a unique sensor for LILFU and glutamate-releasing Best1 as a mediator of glia-neuron interaction. These discoveries should prove to be useful for optimization of human brain stimulation and ultrasonogenetic manipulations of TRPA1.
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Baeesa SS, Maghrabi YE, Baeesa MS, Jan FM, Jan MM. Publications pattern of clinical epilepsy research in Saudi Arabia. ACTA ACUST UNITED AC 2019; 22:255-260. [PMID: 29057863 PMCID: PMC5946373 DOI: 10.17712/nsj.2017.4.20170231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective: To assess the progress in the field clinical epilepsy in Saudi Arabia, by analyzing in depth the research output productivity and publication pattern, and to identify the current situation of epilepsy research and offer solutions. Method: Literature search strategy was designed to retrieve accessible articles that are related to epilepsy utilizing PubMed, Google Scholar, and Embase. The retrieved articles were analyzed with several parameters, then evaluated using Oxford Center of Evidence Based Medicine level of evidence scale. Results: Of all identified articles, 90 were conducted in Kingdom of Saudi Arabia and therefore were included. The included articles had a frequency of only 3.5 publications per year, and growth of 24.4% between the periods of 1990-2003 and 2004-2016. Only 13.3% of the articles were related to surgical epilepsy but the majority (86.7%) were related to medical epilepsy. Many articles (53.3%) were level III studies. The most common study design was retrospective studies in 35.6%, and the citations number ranged from 1–289 (Mean=7). Conclusion: Pattern of publications in clinical epilepsy researches revealed a slow growth rate in the frequency and a lower significance in the quality throughout the past 26 years. Active institutional and national promotion of clinical research is needed to help assess and therefore improve the quality of the provided epilepsy services.
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Affiliation(s)
- Saleh S Baeesa
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail:
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12
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Carvallo A, Modolo J, Benquet P, Lagarde S, Bartolomei F, Wendling F. Biophysical Modeling for Brain Tissue Conductivity Estimation Using SEEG Electrodes. IEEE Trans Biomed Eng 2019; 66:1695-1704. [DOI: 10.1109/tbme.2018.2877931] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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San-Juan D, Dávila-Rodríguez DO, Jiménez CR, González MS, Carranza SM, Hernández Mendoza JR, Anschel DJ. Neuromodulation techniques for status epilepticus: A review. Brain Stimul 2019; 12:835-844. [PMID: 31053521 DOI: 10.1016/j.brs.2019.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 04/05/2019] [Accepted: 04/14/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT), Vagal Nerve Stimulation (VNS), Transcranial Magnetic Stimulation (TMS) and Deep Brain Stimulation (DBS) are neuromodulation therapies that have been used to treat Status Epilepticus (SE). OBJECTIVE Review the literature about the efficacy and safety of neuromodulation therapies in SE in humans. METHODS We searched studies in PubMed, Scopus, Google Scholar and Science Direct (inception to June 2018). Four review authors independently selected the studies, extracted data and assessed the methodological quality of the studies using the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, PRISMA guidelines, Oxford and GRADE scales, and Murad et al., 2018 methodological quality and synthesis of case series and case reports. RESULTS We analyzed 27 articles (45 patients) with 4 different neuromodulation therapies. In ECT we found 80% rate of disruption of SE and 5% of adverse events was reported. Using iVNS 15/16 (93.7%) patients resolved the SE. All patients who underwent TMS and DBS aborted SE, however, 50% of patients with DBS had severe adverse events. CONCLUSIONS Case series and case reports suggest that neuromodulation therapies can abort SE in 80-100% of patients (Oxford scale and GRADE were level 4 and D) with a wide range of adverse effects, which claims for prospective studies on the relationship be-tween efficacy and safety.
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Affiliation(s)
- Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.
| | | | - Christian Ramos Jiménez
- Faculty of Medicine, Autonomous University of State of Mexico, Toluca de Lerdo, State of Mexico, Mexico
| | | | | | - Jesús Ricardo Hernández Mendoza
- Faculty of Medicine Mexicali, Autonomous University of Baja California, Dr. Humberto Torres Sangines, Mexicali, Baja California, Mexico
| | - David J Anschel
- Comprehensive Epilepsy Center of Long Island, Port Jefferson, NY, USA
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14
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Flexible, Scalable and Energy Efficient Bio-Signals Processing on the PULP Platform: A Case Study on Seizure Detection. JOURNAL OF LOW POWER ELECTRONICS AND APPLICATIONS 2017. [DOI: 10.3390/jlpea7020016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Kundishora AJ, Gummadavelli A, Ma C, Liu M, McCafferty C, Schiff ND, Willie JT, Gross RE, Gerrard J, Blumenfeld H. Restoring Conscious Arousal During Focal Limbic Seizures with Deep Brain Stimulation. Cereb Cortex 2017; 27:1964-1975. [PMID: 26941379 PMCID: PMC5964488 DOI: 10.1093/cercor/bhw035] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Impaired consciousness occurs suddenly and unpredictably in people with epilepsy, markedly worsening quality of life and increasing risk of mortality. Focal seizures with impaired consciousness are the most common form of epilepsy and are refractory to all current medical and surgical therapies in about one-sixth of cases. Restoring consciousness during and following seizures would be potentially transformative for these individuals. Here, we investigate deep brain stimulation to improve level of conscious arousal in a rat model of focal limbic seizures. We found that dual-site stimulation of the central lateral nucleus of the intralaminar thalamus (CL) and the pontine nucleus oralis (PnO) bilaterally during focal limbic seizures restored normal-appearing cortical electrophysiology and markedly improved behavioral arousal. In contrast, single-site bilateral stimulation of CL or PnO alone was insufficient to achieve the same result. These findings support the "network inhibition hypothesis" that focal limbic seizures impair consciousness through widespread inhibition of subcortical arousal. Driving subcortical arousal function would be a novel therapeutic approach to some forms of refractory epilepsy and may be compatible with devices already in use for responsive neurostimulation. Multisite deep brain stimulation of subcortical arousal structures may benefit not only patients with epilepsy but also those with other disorders of consciousness.
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Affiliation(s)
| | - Abhijeet Gummadavelli
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA
| | | | | | | | - Nicholas D. Schiff
- Department of Neurology, Weill-Cornell Medical College, New York, NY 10021, USA
| | | | - Robert E. Gross
- Department of Neurological Surgery
- Department of Neurology, Emory School of Medicine, Atlanta, GA 30322, USA
| | - Jason Gerrard
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Hal Blumenfeld
- Department of Neurology
- Department of Neuroscience
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA
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16
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Afra P, Hanrahan SJ, Kellis SS, House P. Non ictal onset zone: A window to ictal dynamics. EPILEPSY & BEHAVIOR CASE REPORTS 2017; 8:123-127. [PMID: 29204348 PMCID: PMC5707213 DOI: 10.1016/j.ebcr.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/03/2017] [Accepted: 10/11/2017] [Indexed: 11/24/2022]
Abstract
The focal and network concepts of epilepsy present different aspects of electroclinical phenomenon of seizures. Here, we present a 23-year-old man undergoing surgical evaluation with left fronto-temporal electrocorticography (ECoG) and microelectrode-array (MEA) in the middle temporal gyrus (MTG). We compare action-potential (AP) and local field potentials (LFP) recorded from MEA with ECoG. Seizure onset in the mesial-temporal lobe was characterized by changes in the pattern of AP-firing without clear changes in LFP or ECoG in MTG. This suggests simultaneous analysis of neuronal activity in differing spatial scales and frequency ranges provide complementary insights into how focal and network neurophysiological activity contribute to ictal activity.
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17
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Stimulus-induced Epileptic Spike-Wave Discharges in Thalamocortical Model with Disinhibition. Sci Rep 2016; 6:37703. [PMID: 27876879 PMCID: PMC5120301 DOI: 10.1038/srep37703] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/03/2016] [Indexed: 12/17/2022] Open
Abstract
Epileptic absence seizure characterized by the typical 2–4 Hz spike-wave discharges (SWD) are known to arise due to the physiologically abnormal interactions within the thalamocortical network. By introducing a second inhibitory neuronal population in the cortical system, here we propose a modified thalamocortical field model to mathematically describe the occurrences and transitions of SWD under the mutual functions between cortex and thalamus, as well as the disinhibitory modulations of SWD mediated by the two different inhibitory interneuronal populations. We first show that stimulation can induce the recurrent seizures of SWD in the modified model. Also, we demonstrate the existence of various types of firing states including the SWD. Moreover, we can identify the bistable parametric regions where the SWD can be both induced and terminated by stimulation perturbations applied in the background resting state. Interestingly, in the absence of stimulation disinhibitory functions between the two different interneuronal populations can also both initiate and abate the SWD, which suggests that the mechanism of disinhibition is comparable to the effect of stimulation in initiating and terminating the epileptic SWD. Hopefully, the obtained results can provide theoretical evidences in exploring dynamical mechanism of epileptic seizures.
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18
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Hernández-Cerón M, Martínez-Lazcano JC, Rubio C, Custodio V, González-Guevara E, Castillo-Pérez C, Paz C. Participation of the dentate-rubral pathway in the kindling model of epilepsy. J Neurosci Res 2016; 95:1495-1502. [DOI: 10.1002/jnr.23974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/28/2016] [Accepted: 09/28/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Miguel Hernández-Cerón
- Departamento de Neurofisiología; Instituto Nacional de Neurología y Neurocirugía M.V.S; Insurgentes Sur 3877 C.P 14269 México
| | - Juan Carlos Martínez-Lazcano
- Departamento de Neurofisiología; Instituto Nacional de Neurología y Neurocirugía M.V.S; Insurgentes Sur 3877 C.P 14269 México
| | - Carmen Rubio
- Departamento de Neurofisiología; Instituto Nacional de Neurología y Neurocirugía M.V.S; Insurgentes Sur 3877 C.P 14269 México
| | - Verónica Custodio
- Departamento de Neurofisiología; Instituto Nacional de Neurología y Neurocirugía M.V.S; Insurgentes Sur 3877 C.P 14269 México
| | - Edith González-Guevara
- Departamento de Neurofisiología; Instituto Nacional de Neurología y Neurocirugía M.V.S; Insurgentes Sur 3877 C.P 14269 México
| | - Carlos Castillo-Pérez
- Departamento de Neurofisiología; Instituto Nacional de Neurología y Neurocirugía M.V.S; Insurgentes Sur 3877 C.P 14269 México
| | - Carlos Paz
- Departamento de Neurofisiología; Instituto Nacional de Neurología y Neurocirugía M.V.S; Insurgentes Sur 3877 C.P 14269 México
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19
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Langer TM, Neumueller SE, Crumley E, Burgraff NJ, Talwar S, Hodges MR, Pan L, Forster HV. State-dependent and -independent effects of dialyzing excitatory neuromodulator receptor antagonists into the ventral respiratory column. J Appl Physiol (1985) 2016; 122:327-338. [PMID: 27687562 DOI: 10.1152/japplphysiol.00619.2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/12/2016] [Accepted: 09/25/2016] [Indexed: 12/30/2022] Open
Abstract
Unilateral dialysis of the broad-spectrum muscarinic receptor antagonist atropine (50 mM) into the ventral respiratory column [(VRC) including the pre-Bötzinger complex region] of awake goats increased pulmonary ventilation (V̇i) and breathing frequency (f), conceivably due to local compensatory increases in serotonin (5-HT) and substance P (SP) measured in effluent mock cerebral spinal fluid (mCSF). In contrast, unilateral dialysis of a triple cocktail of antagonists to muscarinic (atropine; 5 mM), neurokinin-1, and 5-HT receptors does not alter V̇i or f, but increases local SP. Herein, we tested hypotheses that 1) local compensatory 5-HT and SP responses to 50 mM atropine dialyzed into the VRC of goats will not differ between anesthetized and awake states; and 2) bilateral dialysis of the triple cocktail of antagonists into the VRC of awake goats will not alter V̇i or f, but will increase local excitatory neuromodulators. Through microtubules implanted into the VRC of goats, probes were inserted to dialyze mCSF alone (time control), 50 mM atropine, or the triple cocktail of antagonists. We found 1) equivalent increases in local 5-HT and SP with 50 mM atropine dialysis during wakefulness compared with isoflurane anesthesia, but V̇i and f only increased while awake; and 2) dialyses of the triple cocktail of antagonists increased V̇i, f, 5-HT, and SP (<0.05) during both day and night studies. We conclude that the mechanisms governing local neuromodulator levels are state independent, and that bilateral excitatory receptor blockade elicits an increase in breathing, presumably due to a local, (over)compensatory neuromodulator response.NEW & NOTEWORTHY The two major findings are as follows: 1) during unilateral dialysis of 50 mM atropine into the ventral respiratory column to block excitatory muscarinic receptor activity, a compensatory increase in other neuromodulators was state independent, but the ventilatory response appears to be state dependent; and 2) the hypothesis that absence of decreased V̇i and f during unilateral dialysis of excitatory receptor antagonists was due to compensation by the contralateral VRC was not supported by findings herein.
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Affiliation(s)
- Thomas M Langer
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Emma Crumley
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicholas J Burgraff
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sawan Talwar
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew R Hodges
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Lawrence Pan
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
| | - Hubert V Forster
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin; .,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin; and.,Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
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20
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Han Y, Ma F, Li H, Wang Y, Xu K. Optogenetic control of thalamus as a tool for interrupting penicillin induced seizures. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6606-9. [PMID: 26737807 DOI: 10.1109/embc.2015.7319907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Penicillin epilepsy model, whose discharge resembles that of human absence epilepsy, is one of the most useful acute experimental epilepsy models. Though closed-loop optogenetic strategy of interrupting seizures was proved sufficient to switch off epilepsy by controlling thalamus in the post-lesion partial chronic epilepsy model, doubts still exist in absence epilepsy attenuation through silencing thalamus. Here we directly arrested the thalamus to modulate penicillin-induced absence seizures through pseudorandom responsive stimulation on eNpHR-transfected rats. Our data suggested that the duration of epileptiform bursts under light conditions, compared with no light conditions, did not increase or decrease when modulated specific eNpHR-expressing neurons in thalamus.
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21
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Wostyn S, Staljanssens W, De Taeye L, Strobbe G, Gadeyne S, Van Roost D, Raedt R, Vonck K, van Mierlo P. EEG Derived Brain Activity Reflects Treatment Response from Vagus Nerve Stimulation in Patients with Epilepsy. Int J Neural Syst 2016; 27:1650048. [PMID: 27712133 DOI: 10.1142/s0129065716500489] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The mechanism of action of vagus nerve stimulation (VNS) is yet to be elucidated. To that end, the effects of VNS on the brain of epileptic patients were studied. Both when VNS was switched "On" and "Off", the brain activity of responders (R, seizure frequency reduction of over 50%) was compared to the brain activity of nonresponders (NR, seizure frequency reduction of less than 50%). Using EEG recordings, a significant increase in P300 amplitude for R and a significant decrease in P300 amplitude for NR were found. We found biomarkers for checking the efficacy of VNS with accuracy up to 94%. The results show that P300 features recorded in nonmidline electrodes are better P300 biomarkers for VNS efficacy than P300 features recorded in midline electrodes. Using source localization and connectivity analyses, the activity of the limbic system, insula and orbitofrontal cortex was found to be dependent on VNS switched "On" versus "Off" or patient group (R versus NR). The results suggest an important role for these areas in the mechanism of action of VNS, although a larger patient study should be done to confirm the findings.
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Affiliation(s)
- Simon Wostyn
- * MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.,† iMinds Medical IT Department, Ghent University, Ghent, Belgium
| | - Willeke Staljanssens
- * MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.,† iMinds Medical IT Department, Ghent University, Ghent, Belgium
| | - Leen De Taeye
- ‡ LCEN3, Department of Neurology, Ghent University, Ghent, Belgium
| | - Gregor Strobbe
- * MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Stefanie Gadeyne
- ‡ LCEN3, Department of Neurology, Ghent University, Ghent, Belgium
| | - Dirk Van Roost
- § Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| | - Robrecht Raedt
- ‡ LCEN3, Department of Neurology, Ghent University, Ghent, Belgium
| | - Kristl Vonck
- ‡ LCEN3, Department of Neurology, Ghent University, Ghent, Belgium
| | - Pieter van Mierlo
- * MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.,† iMinds Medical IT Department, Ghent University, Ghent, Belgium.,¶ Functional Brain Mapping lab, University of Geneva, Geneva, Switzerland
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22
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Hendriksen RGF, Schipper S, Hoogland G, Schijns OEMG, Dings JTA, Aalbers MW, Vles JSH. Dystrophin Distribution and Expression in Human and Experimental Temporal Lobe Epilepsy. Front Cell Neurosci 2016; 10:174. [PMID: 27458343 PMCID: PMC4937016 DOI: 10.3389/fncel.2016.00174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/21/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Dystrophin is part of a protein complex that connects the cytoskeleton to the extracellular matrix. In addition to its role in muscle tissue, it functions as an anchoring protein within the central nervous system such as in hippocampus and cerebellum. Its presence in the latter regions is illustrated by the cognitive problems seen in Duchenne Muscular Dystrophy (DMD). Since epilepsy is also supposed to constitute a comorbidity of DMD, it is hypothesized that dystrophin plays a role in neuronal excitability. Here, we aimed to study brain dystrophin distribution and expression in both, human and experimental temporal lobe epilepsy (TLE). METHOD Regional and cellular dystrophin distribution was evaluated in both human and rat hippocampi and in rat cerebellar tissue by immunofluorescent colocalization with neuronal (NeuN and calbindin) and glial (GFAP) markers. In addition, hippocampal dystrophin levels were estimated by Western blot analysis in biopsies from TLE patients, post-mortem controls, amygdala kindled (AK)-, and control rats. RESULTS Dystrophin was expressed in all hippocampal pyramidal subfields and in the molecular-, Purkinje-, and granular cell layer of the cerebellum. In these regions it colocalized with GFAP, suggesting expression in astrocytes such as Bergmann glia (BG) and velate protoplasmic astrocytes. In rat hippocampus and cerebellum there were neither differences in dystrophin positive cell types, nor in the regional dystrophin distribution between AK and control animals. Quantitatively, hippocampal full-length dystrophin (Dp427) levels were about 60% higher in human TLE patients than in post-mortem controls (p < 0.05), whereas the level of the shorter Dp71 isoform did not differ. In contrast, AK animals showed similar dystrophin levels as controls. CONCLUSION Dystrophin is ubiquitously expressed by astrocytes in the human and rat hippocampus and in the rat cerebellum. Hippocampal full-length dystrophin (Dp427) levels are upregulated in human TLE, but not in AK rats, possibly indicating a compensatory mechanism in the chronic epileptic human brain.
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Affiliation(s)
- Ruben G F Hendriksen
- Department of Neurology, Maastricht University Medical Centre Maastricht, Netherlands
| | - Sandra Schipper
- Department of Neurology, Maastricht University Medical CentreMaastricht, Netherlands; School for Mental Health and Neuroscience, Maastricht UniversityMaastricht, Netherlands
| | - Govert Hoogland
- School for Mental Health and Neuroscience, Maastricht UniversityMaastricht, Netherlands; Department of Neurosurgery, Maastricht University Medical CentreMaastricht, Netherlands
| | - Olaf E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Centre Maastricht, Netherlands
| | - Jim T A Dings
- Department of Neurosurgery, Maastricht University Medical Centre Maastricht, Netherlands
| | - Marlien W Aalbers
- Department of Neurosurgery, Groningen University Medical Centre Groningen, Netherlands
| | - Johan S H Vles
- Department of Neurology, Maastricht University Medical Centre Maastricht, Netherlands
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23
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Continuous bilateral infusion of vigabatrin into the subthalamic nucleus: Effects on seizure threshold and GABA metabolism in two rat models. Neurobiol Dis 2016; 91:194-208. [DOI: 10.1016/j.nbd.2016.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/07/2016] [Accepted: 03/10/2016] [Indexed: 01/26/2023] Open
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24
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Predictability of uncontrollable multifocal seizures - towards new treatment options. Sci Rep 2016; 6:24584. [PMID: 27091239 PMCID: PMC4835791 DOI: 10.1038/srep24584] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/30/2016] [Indexed: 01/03/2023] Open
Abstract
Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage. An approach to control previously uncontrollable seizures in epilepsy patients would consist of identifying seizure precursors in critical brain areas combined with delivering a counteracting influence to prevent seizure generation. Predictability of seizures with acceptable levels of sensitivity and specificity, even in an ambulatory setting, has been repeatedly shown, however, in patients with a single seizure focus only. We did a study to assess feasibility of state-of-the-art, electroencephalogram-based seizure-prediction techniques in patients with uncontrollable multifocal seizures. We obtained significant predictive information about upcoming seizures in more than two thirds of patients. Unexpectedly, the emergence of seizure precursors was confined to non-affected brain areas. Our findings clearly indicate that epileptic networks, spanning lobes and hemispheres, underlie generation of seizures. Our proof-of-concept study is an important milestone towards new therapeutic strategies based on seizure-prediction techniques for clinical practice.
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25
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Lim SN, Lee CY, Lee ST, Tu PH, Chang BL, Lee CH, Cheng MY, Chang CW, Tseng WEJ, Hsieh HY, Chiang HI, Wu T. Low and High Frequency Hippocampal Stimulation for Drug-Resistant Mesial Temporal Lobe Epilepsy. Neuromodulation 2016; 19:365-72. [PMID: 27072376 PMCID: PMC5074270 DOI: 10.1111/ner.12435] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/23/2015] [Accepted: 02/28/2016] [Indexed: 11/26/2022]
Abstract
Objective Electrical stimulation of the hippocampus offers the possibility to treat patients with mesial temporal lobe epilepsy (MTLE) who are not surgical candidates. We report long‐term follow‐up results in five patients receiving low or high frequency hippocampal stimulation for drug‐resistant MTLE. Materials and Methods The patients underwent stereotactic implantation of quadripolar stimulating electrodes in the hippocampus. Two of the patients received unilateral electrode implantation, while the other three received bilateral implantation. Stimulation of the hippocampal electrodes was turned ON immediately after the implantation of an implantable pulse generator, with initial stimulation parameters: 1 V, 90–150 μs, 5 or 145 Hz. The frequency of seizures was monitored and compared with preimplantation baseline data. Results Two men and three women, aged 27–61 years were studied, with a mean follow‐up period of 38.4 months (range, 30–42 months). The baseline seizure frequency was 2.0–15.3/month. The five patients had an average 45% (range 22–72%) reduction in the frequency of seizures after hippocampal stimulation over the study period. Low frequency hippocampal stimulation decreased the frequency of seizures in two patients (by 54% and 72%, respectively). No implantation‐ or stimulation‐related side effects were reported. Conclusions Electrical stimulation of the hippocampus is a minimally invasive and reversible method that can improve seizure outcomes in patients with drug‐resistant MTLE. The optimal frequency of stimulation varied from patient to patient and therefore required individual setting. These experimental results warrant further controlled studies with a large patient population to evaluate the long‐term effect of hippocampal stimulation with different stimulation parameters.
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Affiliation(s)
- Siew-Na Lim
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Bao-Luen Chang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Hong Lee
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-En Johnny Tseng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiang-Yao Hsieh
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsing-I Chiang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
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26
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Klooster DCW, de Louw AJA, Aldenkamp AP, Besseling RMH, Mestrom RMC, Carrette S, Zinger S, Bergmans JWM, Mess WH, Vonck K, Carrette E, Breuer LEM, Bernas A, Tijhuis AG, Boon P. Technical aspects of neurostimulation: Focus on equipment, electric field modeling, and stimulation protocols. Neurosci Biobehav Rev 2016; 65:113-41. [PMID: 27021215 DOI: 10.1016/j.neubiorev.2016.02.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/05/2016] [Accepted: 02/17/2016] [Indexed: 12/31/2022]
Abstract
Neuromodulation is a field of science, medicine, and bioengineering that encompasses implantable and non-implantable technologies for the purpose of improving quality of life and functioning of humans. Brain neuromodulation involves different neurostimulation techniques: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), which are being used both to study their effects on cognitive brain functions and to treat neuropsychiatric disorders. The mechanisms of action of neurostimulation remain incompletely understood. Insight into the technical basis of neurostimulation might be a first step towards a more profound understanding of these mechanisms, which might lead to improved clinical outcome and therapeutic potential. This review provides an overview of the technical basis of neurostimulation focusing on the equipment, the present understanding of induced electric fields, and the stimulation protocols. The review is written from a technical perspective aimed at supporting the use of neurostimulation in clinical practice.
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Affiliation(s)
- D C W Klooster
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - A J A de Louw
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - A P Aldenkamp
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - R M H Besseling
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - R M C Mestrom
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - S Carrette
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - S Zinger
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - J W M Bergmans
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - W H Mess
- Departments of Clinical Neurophysiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - K Vonck
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - E Carrette
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - L E M Breuer
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands.
| | - A Bernas
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - A G Tijhuis
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - P Boon
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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27
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Taylor PN, Wang Y, Goodfellow M, Dauwels J, Moeller F, Stephani U, Baier G. A computational study of stimulus driven epileptic seizure abatement. PLoS One 2014; 9:e114316. [PMID: 25531883 PMCID: PMC4273970 DOI: 10.1371/journal.pone.0114316] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/05/2014] [Indexed: 01/24/2023] Open
Abstract
Active brain stimulation to abate epileptic seizures has shown mixed success. In spike-wave (SW) seizures, where the seizure and background state were proposed to coexist, single-pulse stimulations have been suggested to be able to terminate the seizure prematurely. However, several factors can impact success in such a bistable setting. The factors contributing to this have not been fully investigated on a theoretical and mechanistic basis. Our aim is to elucidate mechanisms that influence the success of single-pulse stimulation in noise-induced SW seizures. In this work, we study a neural population model of SW seizures that allows the reconstruction of the basin of attraction of the background activity as a four dimensional geometric object. For the deterministic (noise-free) case, we show how the success of response to stimuli depends on the amplitude and phase of the SW cycle, in addition to the direction of the stimulus in state space. In the case of spontaneous noise-induced seizures, the basin becomes probabilistic introducing some degree of uncertainty to the stimulation outcome while maintaining qualitative features of the noise-free case. Additionally, due to the different time scales involved in SW generation, there is substantial variation between SW cycles, implying that there may not be a fixed set of optimal stimulation parameters for SW seizures. In contrast, the model suggests an adaptive approach to find optimal stimulation parameters patient-specifically, based on real-time estimation of the position in state space. We discuss how the modelling work can be exploited to rationally design a successful stimulation protocol for the abatement of SW seizures using real-time SW detection.
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Affiliation(s)
- Peter Neal Taylor
- School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yujiang Wang
- School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marc Goodfellow
- College of Engineering, University of Exeter, Exeter, United Kingdom
| | - Justin Dauwels
- School of Electrical & Electronic Engineering, Nanyang Technological University, Singapore, Singapore
| | - Friederike Moeller
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ulrich Stephani
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gerold Baier
- Cell and Developmental Biology, University College London, London, United Kingdom
- * E-mail:
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28
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Laxpati NG, Kasoff WS, Gross RE. Deep brain stimulation for the treatment of epilepsy: circuits, targets, and trials. Neurotherapeutics 2014; 11:508-26. [PMID: 24957200 PMCID: PMC4121455 DOI: 10.1007/s13311-014-0279-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Deep brain stimulation (DBS) has proven remarkably safe and effective in the treatment of movement disorders. As a result, it is being increasingly applied to a range of neurologic and psychiatric disorders, including medically refractory epilepsy. This review will examine the use of DBS in epilepsy, including known targets, mechanisms of neuromodulation and seizure control, published clinical evidence, and novel technologies. Cortical and deep neuromodulation for epilepsy has a long experimental history, but only recently have better understanding of epileptogenic networks, precise stereotactic techniques, and rigorous trial design combined to improve the quality of available evidence and make DBS a viable treatment option. Nonetheless, underlying mechanisms, anatomical targets, and stimulation parameters remain areas of active investigation.
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Affiliation(s)
- Nealen G. Laxpati
- />Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road NE, Atlanta, GA 30322 USA
- />Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA USA
| | - Willard S. Kasoff
- />Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, AZ USA
| | - Robert E. Gross
- />Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road NE, Atlanta, GA 30322 USA
- />Department of Neurology, Emory University School of Medicine, Atlanta, GA USA
- />Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA USA
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29
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Terra VC, Amorim R, Silvado C, Oliveira AJD, Jorge CL, Faveret E, Ragazzo P, De Paola L. Vagus nerve stimulator in patients with epilepsy: indications and recommendations for use. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:902-6. [PMID: 24394879 DOI: 10.1590/0004-282x20130116] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 04/30/2013] [Accepted: 05/05/2013] [Indexed: 11/21/2022]
Abstract
Epilepsy comprises a set of neurologic and systemic disorders characterized by recurrent spontaneous seizures, and is the most frequent chronic neurologic disorder. In patients with medically refractory epilepsy, therapeutic options are limited to ablative brain surgery, trials of experimental antiepileptic drugs, or palliative surgery. Vagal nerve stimulation is an available palliative procedure of which the mechanism of action is not understood, but with established efficacy for medically refractory epilepsy and low incidence of side-effects. In this paper we discuss the recommendations for VNS use as suggested by the Brazilian League of Epilepsy and the Scientific Department of Epilepsy of the Brazilian Academy of Neurology Committee of Neuromodulation.
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Affiliation(s)
- Vera C Terra
- Comissão de Neuromodulação, Liga Brasileira de Epilepsia, Brasil, São PauloSP
| | - Ricardo Amorim
- Comissão de Neuromodulação, Liga Brasileira de Epilepsia, Brasil, São PauloSP
| | - Carlos Silvado
- Comissão de Neuromodulação, Liga Brasileira de Epilepsia, Brasil, São PauloSP
| | | | - Carmen Lisa Jorge
- Comissão de Neuromodulação, Liga Brasileira de Epilepsia, Brasil, São PauloSP
| | - Eduardo Faveret
- Comissão de Neuromodulação, Liga Brasileira de Epilepsia, Brasil, São PauloSP
| | - Paulo Ragazzo
- Comissão de Neuromodulação, Liga Brasileira de Epilepsia, Brasil, São PauloSP
| | - Luciano De Paola
- Comissão de Neuromodulação, Liga Brasileira de Epilepsia, Brasil, São PauloSP
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30
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Covolan L, de Almeida ACG, Amorim B, Cavarsan C, Miranda MF, Aarão MC, Madureira AP, Rodrigues AM, Nobrega JN, Mello LE, Hamani C. Effects of anterior thalamic nucleus deep brain stimulation in chronic epileptic rats. PLoS One 2014; 9:e97618. [PMID: 24892420 PMCID: PMC4043725 DOI: 10.1371/journal.pone.0097618] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/22/2014] [Indexed: 11/19/2022] Open
Abstract
Deep brain stimulation (DBS) has been investigated for the treatment of epilepsy. In rodents, an increase in the latency for the development of seizures and status epilepticus (SE) has been reported in different animal models but the consequences of delivering stimulation to chronic epileptic animals have not been extensively addressed. We study the effects of anterior thalamic nucleus (AN) stimulation at different current intensities in rats rendered epileptic following pilocarpine (Pilo) administration. Four months after Pilo-induced SE, chronic epileptic rats were bilaterally implanted with AN electrodes or had sham-surgery. Stimulation was delivered for 6 h/day, 5 days/week at 130 Hz, 90 µsec. and either 100 µA or 500 µA. The frequency of spontaneous recurrent seizures in animals receiving stimulation was compared to that recorded in the preoperative period and in rats given sham treatment. To investigate the effects of DBS on hippocampal excitability, brain slices from animals receiving AN DBS or sham surgery were studied with electrophysiology. We found that rats treated with AN DBS at 100 µA had a 52% non-significant reduction in the frequency of seizures as compared to sham-treated controls and 61% less seizures than at baseline. Animals given DBS at 500 µA had 5.1 times more seizures than controls and a 2.8 fold increase in seizure rate as compared to preoperative values. In non-stimulated controls, the average frequency of seizures before and after surgery remained unaltered. In vitro recordings have shown that slices from animals previously given DBS at 100 µA had a longer latency for the development of epileptiform activity, shorter and smaller DC shifts, and a smaller spike amplitude compared to non-stimulated controls. In contrast, a higher spike amplitude was recorded in slices from animals given AN DBS at 500 µA.
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Affiliation(s)
- Luciene Covolan
- Disciplina de Neurofisiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Antônio-Carlos G. de Almeida
- Laboratório de Neurociência Experimental e Computacional, Universidade Federal de São João del-Rei, São João del-Rei, Brazil
| | - Beatriz Amorim
- Disciplina de Neurofisiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Clarissa Cavarsan
- Disciplina de Neurofisiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maisa Ferreira Miranda
- Laboratório de Neurociência Experimental e Computacional, Universidade Federal de São João del-Rei, São João del-Rei, Brazil
| | - Mayra C. Aarão
- Laboratório de Neurociência Experimental e Computacional, Universidade Federal de São João del-Rei, São João del-Rei, Brazil
| | - Ana Paula Madureira
- Laboratório de Neurociência Experimental e Computacional, Universidade Federal de São João del-Rei, São João del-Rei, Brazil
| | - Antônio M. Rodrigues
- Laboratório de Neurociência Experimental e Computacional, Universidade Federal de São João del-Rei, São João del-Rei, Brazil
| | - José N. Nobrega
- Behavioural Neurobiology Laboratory, Centre for Addiction and Mental Health, Toronto, Canada
| | - Luiz E. Mello
- Disciplina de Neurofisiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Clement Hamani
- Disciplina de Neurofisiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Behavioural Neurobiology Laboratory, Centre for Addiction and Mental Health, Toronto, Canada
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
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31
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Krishna V, Lozano AM. Brain stimulation for intractable epilepsy: Anterior thalamus and responsive stimulation. Ann Indian Acad Neurol 2014; 17:S95-8. [PMID: 24791096 PMCID: PMC4001217 DOI: 10.4103/0972-2327.128671] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 11/18/2022] Open
Abstract
Despite medications, resective surgery, and vagal nerve stimulation, some patients with epilepsy continue to have seizures. In these patients, other approaches are urgently needed. The biological basis of stimulation of anterior thalamic nucleus and epileptogenic focus is presented. Results from two large randomized controlled trials Stimulation of Anterior Nucleus of Thalamus for Epilepsy (SANTE) and Neuropace pivotal trial are discussed. Neuromodulation provides effective treatment for a select group of refractory epilepsy patients. Future investigations into the mechanism underlying ‘response’ to brain stimulation are desired.
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Affiliation(s)
- Vibhor Krishna
- Department of Surgery, Division of Neurosurgery, Krembil Neuroscience Center, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Department of Surgery, Division of Neurosurgery, Krembil Neuroscience Center, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Handreck A, Backofen-Wehrhahn B, Bröer S, Löscher W, Gernert M. Anticonvulsant Effects by Bilateral and Unilateral Transplantation of GABA-Producing Cells into the Subthalamic Nucleus in an Acute Seizure Model. Cell Transplant 2014. [DOI: 10.3727/096368912x658944] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Neural transplantation of GABA-producing cells into key structures within seizure-suppressing circuits holds promise for medication-resistant epilepsy patients not eligible for resection of the epileptic focus. The substantia nigra pars reticulata (SNr), a basal ganglia output structure, is well known to modulate different seizure types. A recent microinjection study by our group indicated that the subthalamic nucleus (STN), which critically regulates nigral activity, might be a more promising target for focal therapy in epilepsies than the SNr. As a proof of principle, we therefore assessed the anticonvulsant efficacy of bilateral and unilateral allografting of GABA-producing cell lines into the STN using the timed intravenous pentylenetetrazole seizure threshold test, which allows repeated seizure threshold determinations in individual rats. We observed (a) that grafted cells survived up to the end of the experiments, (b) that anticonvulsant effects can be induced by bilateral transplantation into the STN using immortalized GABAergic cells derived from the rat embryonic striatum and cells additionally transfected to obtain higher GABA synthesis than the parent cell line, and (c) that anticonvulsant effects were observed even after unilateral transplantation into the STN. Neither grafting of control cells nor transplantation outside the STN induced anticonvulsant effects, emphasizing the site and cell specificity of the observed anticonvulsant effects. To our knowledge, the present study is the first showing anticonvulsant effects by grafting of GABA-producing cells into the STN. The STN can be considered a highly promising target region for modulation of seizure circuits and, moreover, has the advantage of being clinically established for functional neurosurgery.
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Affiliation(s)
- Annelie Handreck
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
| | - Bianca Backofen-Wehrhahn
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany
| | - Sonja Bröer
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
| | - Manuela Gernert
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
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33
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La Corte G, Wei Y, Chernyy N, Gluckman BJ, Schiff SJ. Frequency dependence of behavioral modulation by hippocampal electrical stimulation. J Neurophysiol 2013; 111:470-80. [PMID: 24198322 DOI: 10.1152/jn.00523.2013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Electrical stimulation offers the potential to develop novel strategies for the treatment of refractory medial temporal lobe epilepsy. In particular, direct electrical stimulation of the hippocampus presents the opportunity to modulate pathological dynamics at the ictal focus, although the neuroanatomical substrate of this region renders it susceptible to altering cognition and affective processing as a side effect. We investigated the effects of three electrical stimulation paradigms on separate groups of freely moving rats (sham, 8-Hz and 40-Hz sine-wave stimulation of the ventral/intermediate hippocampus, where 8- and 40-Hz stimulation were chosen to mimic naturally occurring hippocampal oscillations). Animals exhibited attenuated locomotor and exploratory activity upon stimulation at 40 Hz, but not at sham or 8-Hz stimulation. Such behavioral modifications were characterized by a significant reduction in rearing frequency, together with increased freezing behavior. Logistic regression analysis linked the observed changes in animal locomotion to 40-Hz electrical stimulation independently of time-related variables occurring during testing. Spectral analysis, conducted to monitor the electrophysiological profile in the CA1 area of the dorsal hippocampus, showed a significant reduction in peak theta frequency, together with reduced theta power in the 40-Hz vs. the sham stimulation animal group, independent of locomotion speed (theta range: 4-12 Hz). These findings contribute to the development of novel and safe medical protocols by indicating a strategy to constrain or optimize parameters in direct hippocampal electrical stimulation.
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Affiliation(s)
- Giorgio La Corte
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, State College, Pennsylvania
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34
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Stefan H, Lopes da Silva FH. Epileptic neuronal networks: methods of identification and clinical relevance. Front Neurol 2013; 4:8. [PMID: 23532203 PMCID: PMC3607195 DOI: 10.3389/fneur.2013.00008] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/24/2013] [Indexed: 11/13/2022] Open
Abstract
The main objective of this paper is to examine evidence for the concept that epileptic activity should be envisaged in terms of functional connectivity and dynamics of neuronal networks. Basic concepts regarding structure and dynamics of neuronal networks are briefly described. Particular attention is given to approaches that are derived, or related, to the concept of causality, as formulated by Granger. Linear and non-linear methodologies aiming at characterizing the dynamics of neuronal networks applied to EEG/MEG and combined EEG/fMRI signals in epilepsy are critically reviewed. The relevance of functional dynamical analysis of neuronal networks with respect to clinical queries in focal cortical dysplasias, temporal lobe epilepsies, and "generalized" epilepsies is emphasized. In the light of the concepts of epileptic neuronal networks, and recent experimental findings, the dichotomic classification in focal and generalized epilepsy is re-evaluated. It is proposed that so-called "generalized epilepsies," such as absence seizures, are actually fast spreading epilepsies, the onset of which can be tracked down to particular neuronal networks using appropriate network analysis. Finally new approaches to delineate epileptogenic networks are discussed.
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Affiliation(s)
- Hermann Stefan
- Department of Neurology, University Hospital ErlangenErlangen, Bavaria, Germany
| | - Fernando H. Lopes da Silva
- Centre of Neuroscience, Swammerdam Institute for Life Sciences, University of AmsterdamAmsterdam, Netherlands
- Department of Bioengineering, Instituto Superior Técnico, Lisbon Technical UniversityLisbon, Portugal
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35
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Wu C, Sharan AD. Neurostimulation for the Treatment of Epilepsy: A Review of Current Surgical Interventions. Neuromodulation 2012; 16:10-24; discussion 24. [DOI: 10.1111/j.1525-1403.2012.00501.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Stamoulis C, Chang BS. Modeling noninvasive neurostimulation in epilepsy as stochastic interference in brain networks. IEEE Trans Neural Syst Rehabil Eng 2012; 21:354-63. [PMID: 22692940 DOI: 10.1109/tnsre.2012.2201173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Noninvasive brain stimulation is one of very few potential therapies for medically refractory epilepsy. However, its efficacy remains suboptimal and its therapeutic value has not been consistently assessed. This is in part due to the nonoptimized spatio-temporal application of stimulation protocols for seizure prevention or arrest, and incomplete knowledge of the neurodynamics of seizure evolution. Through simulations, this study investigated electroencephalography (EEG)-guided, stochastic interference with aberrantly coordinated neuronal networks, to prevent seizure onset or interrupt a propagating partial seizure, and prevent it from spreading to large areas of the brain. Brain stimulation was modeled as additive white or band-limited noise, and simulations using real EEGs and data generated from a network of integrate-and-fire neuronal ensembles were used to quantify spatio-temporal noise effects. It was shown that additive stochastic signals (noise) may destructively interfere with network dynamics and decrease or abolish synchronization associated with progressively coupled networks. Furthermore, stimulation parameters, particularly amplitude and spatio-temporal application, may be optimized based on patient-specific neurodynamics estimated directly from noninvasive EEGs.
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Affiliation(s)
- Catherine Stamoulis
- Department of Radiology and Clinical Research Center, Children’s Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
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37
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Bröer S, Backofen-Wehrhahn B, Bankstahl M, Gey L, Gernert M, Löscher W. Vigabatrin for focal drug delivery in epilepsy: Bilateral microinfusion into the subthalamic nucleus is more effective than intranigral or systemic administration in a rat seizure model. Neurobiol Dis 2012; 46:362-76. [DOI: 10.1016/j.nbd.2012.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/23/2011] [Accepted: 01/31/2012] [Indexed: 01/04/2023] Open
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38
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Sankar T, Tierney TS, Hamani C. Novel applications of deep brain stimulation. Surg Neurol Int 2012; 3:S26-33. [PMID: 22826807 PMCID: PMC3400483 DOI: 10.4103/2152-7806.91607] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 12/20/2011] [Indexed: 11/11/2022] Open
Abstract
The success of deep brain stimulation (DBS) surgery in treating medically refractory symptoms of some movement disorders has inspired further investigation into a wide variety of other treatment-resistant conditions. These range from disorders of gait, mood, and memory to problems as diverse as obesity, consciousness, and addiction. We review the emerging indications, rationale, and outcomes for some of the most promising new applications of DBS in the treatment of postural instability associated with Parkinson's disease, depression, obsessive–compulsive disorder, obesity, substance abuse, epilepsy, Alzheimer′s-type dementia, and traumatic brain injury. These studies reveal some of the excitement in a field at the edge of a rapidly expanding frontier. Much work still remains to be done on basic mechanism of DBS, optimal target and patient selection, and long-term durability of this technology in treating new indications.
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Affiliation(s)
- Tejas Sankar
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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39
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Thompson A, Morishita T, Okun MS. DBS and electrical neuro-network modulation to treat neurological disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2012. [PMID: 23206686 DOI: 10.1016/b978-0-12-404706-8.00014-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The use of neuromodulatory techniques in the treatment of neurological disorders is expanding and now includes devices targeting the motor cortex, basal ganglia, spinal cord, peripheral nervous system, and autonomic nervous system. In this chapter, we review and discuss the current and past literature as well as review indications for each of these devices in the ongoing management of many common neurological diseases including chronic pain, Parkinson's disease, tremor, dystonia, and epilepsy. We also discuss and update mechanisms of deep brain stimulation and electrical neuro-network modulation.
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Affiliation(s)
- Amanda Thompson
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, USA
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