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Jahromi S, Matarrese MA, Fabbri L, Tamilia E, Perry MS, Madsen JR, Bolton J, Stone SS, Pearl PL, Papadelis C. Overlap of spike and ripple propagation onset predicts surgical outcome in epilepsy. Ann Clin Transl Neurol 2024; 11:2530-2547. [PMID: 39374135 PMCID: PMC11514932 DOI: 10.1002/acn3.52156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/19/2024] [Accepted: 07/09/2024] [Indexed: 10/09/2024] Open
Abstract
OBJECTIVE Interictal biomarkers are critical for identifying the epileptogenic focus. However, spikes and ripples lack specificity while fast ripples lack sensitivity. These biomarkers propagate from more epileptogenic onset to areas of spread. The pathophysiological mechanism of these propagations is elusive. Here, we examine zones where spikes and high frequency oscillations co-occur (SHFO), the spatiotemporal propagations of spikes, ripples, and fast ripples, and evaluate the spike-ripple onset overlap (SRO) as an epilepsy biomarker. METHODS We retrospectively analyzed intracranial EEG data from 41 patients with drug-resistant epilepsy. We mapped propagations of spikes, ripples, and fast ripples, and identified their onset and spread zones, as well as SHFO and SRO. We then estimated the SRO prognostic value in predicting surgical outcome and compared it to onset and spread zones of spike, ripple, and fast ripple propagations, and SHFO. RESULTS We detected spikes and ripples in all patients and fast ripples in 12 patients (29%). We observed spike and ripple propagations in 40 (98%) patients. Spike and ripple onsets overlapped in 35 (85%) patients. In good outcome patients, SRO showed higher specificity and precision (p < 0.05) in predicting resection compared to onset and zones of spikes, ripples, and SHFO. Only SRO resection predicted outcome (p = 0.01) with positive and negative predictive values of 82% and 57%, respectively. INTERPRETATION SRO is a specific and precise biomarker of the epileptogenic zone whose removal predicts outcome. SRO is present in most patients with drug-resistant epilepsy. Such a biomarker may reduce prolonged intracranial monitoring and improve outcome.
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Affiliation(s)
- Saeed Jahromi
- Neuroscience Research CenterJane and John Justin Institute for Mind Health, Cook Children's Health Care SystemFort WorthTexasUSA
- Department of BioengineeringThe University of Texas at ArlingtonArlingtonTexasUSA
| | - Margherita A.G. Matarrese
- Neuroscience Research CenterJane and John Justin Institute for Mind Health, Cook Children's Health Care SystemFort WorthTexasUSA
- Department of BioengineeringThe University of Texas at ArlingtonArlingtonTexasUSA
- Research Unit of Intelligent Health Technology for Health and Wellbeing, Department of EngineeringUniversità Campus Bio‐Medico di RomaRomeItaly
| | - Lorenzo Fabbri
- Neuroscience Research CenterJane and John Justin Institute for Mind Health, Cook Children's Health Care SystemFort WorthTexasUSA
- Department of BioengineeringThe University of Texas at ArlingtonArlingtonTexasUSA
| | - Eleonora Tamilia
- Fetal‐Neonatal Neuroimaging and Developmental Science CenterBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Division of Epilepsy and Clinical Neurophysiology, Department of NeurologyBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - M. Scott Perry
- Neuroscience Research CenterJane and John Justin Institute for Mind Health, Cook Children's Health Care SystemFort WorthTexasUSA
| | - Joseph R. Madsen
- Division of Epilepsy Surgery, Department of NeurosurgeryBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Jeffrey Bolton
- Division of Epilepsy and Clinical Neurophysiology, Department of NeurologyBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Scellig S.D. Stone
- Division of Epilepsy Surgery, Department of NeurosurgeryBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Phillip L. Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of NeurologyBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Christos Papadelis
- Neuroscience Research CenterJane and John Justin Institute for Mind Health, Cook Children's Health Care SystemFort WorthTexasUSA
- Department of BioengineeringThe University of Texas at ArlingtonArlingtonTexasUSA
- Burnett School of MedicineTexas Christian UniversityFort WorthTexasUSA
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Diamond JM, Chapeton JI, Xie W, Jackson SN, Inati SK, Zaghloul KA. Focal seizures induce spatiotemporally organized spiking activity in the human cortex. Nat Commun 2024; 15:7075. [PMID: 39152115 PMCID: PMC11329741 DOI: 10.1038/s41467-024-51338-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 08/05/2024] [Indexed: 08/19/2024] Open
Abstract
Epileptic seizures are debilitating because of the clinical symptoms they produce. These symptoms, in turn, may stem directly from disruptions in neural coding. Recent evidence has suggested that the specific temporal order, or sequence, of spiking across a population of cortical neurons may encode information. Here, we investigate how seizures disrupt neuronal spiking sequences in the human brain by recording multi-unit activity from the cerebral cortex in five male participants undergoing monitoring for seizures. We find that pathological discharges during seizures are associated with bursts of spiking activity across a population of cortical neurons. These bursts are organized into highly consistent and stereotyped temporal sequences. As the seizure evolves, spiking sequences diverge from the sequences observed at baseline and become more spatially organized. The direction of this spatial organization matches the direction of the ictal discharges, which spread over the cortex as traveling waves. Our data therefore suggest that seizures can entrain cortical spiking sequences by changing the spatial organization of neuronal firing, providing a possible mechanism by which seizures create symptoms.
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Affiliation(s)
- Joshua M Diamond
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Julio I Chapeton
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Weizhen Xie
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
| | - Samantha N Jackson
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sara K Inati
- Clinical Epilepsy Section, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, 20892, USA.
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Sims SK, Saddow M, McGonegal L, Sims-Robinson C. Intranasal Administration of BDNF Improves Recovery and Promotes Neural Plasticity in a Neonatal Mouse Model of Hypoxic Ischemia. Exp Neurobiol 2024; 33:25-35. [PMID: 38471802 PMCID: PMC10938072 DOI: 10.5607/en23030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/18/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
The benefit of intranasal brain derived neurotrophic factor (BDNF) treatment on cognitive function in a neonatal postnatal day 7 (P7) mouse model of hypoxic ischemia (HI) was explored. Intranasal delivery is attractive in that it can promote widespread distribution of BDNF within both the brain and spinal cord. In this study we evaluated the effectiveness of intranasal BDNF to improve cognitive recovery following HI. HI is induced via ligation of the right carotid artery followed by a 45-minute exposure to an 8% oxygen/ 92% nitrogen mixture in an enclosed chamber. Male and female pups were subjected to a 2-hour hypothermia in a temperature-controlled chamber as a standard of care. A solution of saline (control) or recombinant human BDNF (Harlan Laboratories) was administered with a Gilson pipette at the same time each day for 7 days into each nasal cavity in awake mice beginning 24 hours after HI. We evaluated cognitive recovery using the novel object recognition (NOR) and western analysis to analyze neuro-markers and brain health such as synaptophysin and microtubule associated protein -2 (MAP2). The objective of this study was to evaluate the role and therapeutic potential of BDNF in neonatal HI recovery. Our results indicate that intranasal BDNF delivered within 24 hours after HI improved object discrimination at both 28 and 42 days after HI. Our results also demonstrate increased synaptophysin and MAP2 at day 42 in HI animals that received intranasal BDNF treatment compared to HI animals that were administered saline.
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Affiliation(s)
- Serena-Kaye Sims
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
- Department of Biology, College of Charleston, Charleston, SC 29424, USA
| | - Madelynne Saddow
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
- Department of Biology, College of Charleston, Charleston, SC 29424, USA
| | - Lilly McGonegal
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
- Department of Biology, College of Charleston, Charleston, SC 29424, USA
| | - Catrina Sims-Robinson
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
- Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC 29401, USA
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Kokkinos V, Hussein H, Sakelliadou DG, Mark Richardson R, Bagić AΙ, Urban A. Hippocampal barques and their manifestation as 14&6 Hz positive spikes during sleep. Clin Neurophysiol 2024; 157:37-43. [PMID: 38042011 DOI: 10.1016/j.clinph.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/22/2023] [Accepted: 11/10/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE This study investigates variations in hippocampal barque occurrence during sleep and compares findings to respective variations of their scalp manifestation as 14&6/sec positive spikes. METHODS From 11 epilepsy patients, 12 non-epileptogenic hippocampi with barques were identified for this study. Using the first seizure-free whole-night sleep stereo-encephalography (sEEG) recording, we performed sleep staging and measured the occurrence of barques and 14&6/sec positive spikes variants. RESULTS Hippocampal barques (total count: 9,183; mean count per record: 765.2 ± 251.2) occurred predominantly during non-rapid eye movement (NREM) II sleep (total: 5,744; mean: 478.6 ± 176.1; 62.2 ± 6.0%) and slow-wave sleep (SWS) (total: 2,950; mean: 245.83 ± 92.9; 32.0 ± 6.2%), with rare to occasional occurrence in NREM I (total: 85; mean: 7.0 ± 2.8; 0.9 ± 0.4%), rapid eye movement (REM) (total: 153; mean: 12.75 ± 4.0; 1.7 ± 0.6) and wakefulness (total: 251; mean: 20.9 ± 6.3; 2.9 ± 0.9%). Barque rate increased during SWS (mean: 2.7 ± 1.0 per min) compared to NREM II (2.2 ± 1.0 per min) and other states (wakefulness: 0.1 ± 0.0 per min; NREM I: 0.3 ± 0.1 per min; REM: 0.1 ± 0.0 per min). The 14&6/sec positive spikes variant (total count: 2,406; mean: 343.7 ± 106.7) was present in NREM II (total: 2,059; mean: 249.1 ± 100.2, 84.9 ± 3.6%) and SWS (total: 347; mean: 49.5 ± 12.8, 15.0 ± 3.6%) stages, and absent from the rest of sleep and wakefulness. While all 14&6/sec positive spikes correlated with barques, only 44.7 ± 6.1% of barques manifested as 14&6/sec positive spikes. CONCLUSIONS Hippocampal barques are predominant in NREM II and SWS, and tend to increase their presence during SWS. Their scalp manifestation as 14&6/sec positive spikes is confounded by wakefulness, REM and NREM I stages, and "masked" by the co-occurrence of NREM II and SWS slow waves, and overlapping reactive micro-arousal elements. SIGNIFICANCE Our study highlighted the overnight profile of hippocampal barques, in relation to the respective profile of their scalp manifestation, the 14&6/sec positive spikes variant.
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Affiliation(s)
- Vasileios Kokkinos
- Department of Neurology, Feinberg School of Medicine, Northwestern University, IL, USA; Comprehensive Epilepsy Center, Northwestern Memorial Hospital, Chicago, IL, USA.
| | - Helweh Hussein
- Department of General Surgery, Trident Medical Center, North Charleston, SC, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Anto Ι Bagić
- Department of Neurology, School of Medicine, University of Pittsburgh, PA, USA; University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - Alexandra Urban
- Department of Neurology, School of Medicine, University of Pittsburgh, PA, USA; University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
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Wu D, Schaper FLWVJ, Jin G, Qi L, Du J, Wang X, Wang Y, Xu C, Wang X, Yu T, Fox MD, Ren L. Human anterior thalamic stimulation evoked cortical potentials align with intrinsic functional connectivity. Neuroimage 2023:120243. [PMID: 37353098 DOI: 10.1016/j.neuroimage.2023.120243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/05/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023] Open
Abstract
Characterizing human thalamocortical network is fundamental for understanding a vast array of human behaviors since the thalamus plays a central role in cortico-subcortical communication. Over the past few decades, advances in functional magnetic resonance imaging have allowed for spatial mapping of intrinsic resting-state functional connectivity (RSFC) between both cortical regions and in cortico-subcortical networks. Despite these advances, identifying the electrophysiological basis of human thalamocortical network architecture remains challenging. By leveraging stereoelectroencephalography electrodes temporarily implanted into distributed cortical regions and the anterior nucleus of the thalamus (ANT) of 10 patients with refractory focal epilepsy, we tested whether ANT stimulation evoked cortical potentials align with RSFC from the stimulation site, derived from a normative functional connectome (n=1000). Our study identifies spatial convergence of ANT stimulation evoked cortical potentials and normative RSFC. Other than connections to the Papez circuit, the ANT was found to be closely connected to several distinct higher-order association cortices, including the precuneus, angular gyrus, dorsal lateral prefrontal cortex, and anterior insula. Remarkably, we found that the spatial distribution and magnitude of cortical-evoked responses to single-pulse electrical stimulation of the ANT aligned with the spatial pattern and strength of normative RSFC of the stimulation site. The present study provides electrophysiological evidence that stimulation evoked electrical activity flows along intrinsic brain networks connected on a thalamocortical level.
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Affiliation(s)
- Di Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Clinical Research Center of Epilepsy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; National Center for Neurological Disorders, Beijing 100053, China
| | - Frederic L W V J Schaper
- Center of Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Guangyuan Jin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Clinical Research Center of Epilepsy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; National Center for Neurological Disorders, Beijing 100053, China
| | - Lei Qi
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Clinical Research Center of Epilepsy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; National Center for Neurological Disorders, Beijing 100053, China
| | - Jialin Du
- Department of Pharmacy Phase I Clinical Trial Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiaopeng Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Clinical Research Center of Epilepsy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; National Center for Neurological Disorders, Beijing 100053, China
| | - Yuke Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Cuiping Xu
- National Center for Neurological Disorders, Beijing 100053, China; Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xueyuan Wang
- National Center for Neurological Disorders, Beijing 100053, China; Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Tao Yu
- National Center for Neurological Disorders, Beijing 100053, China; Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Michael D Fox
- Center of Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States; Berenson-Allen Center for Non-invasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA 02115, United States; Martinos Center for Biomedical Imaging, Departments of Neurology and Radiology, Harvard Medical School and Massachusetts General Hospital, Boston, MA 02115, United States; Havard Medical School, Boston, MA 02115, USA
| | - Liankun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Clinical Research Center of Epilepsy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; National Center for Neurological Disorders, Beijing 100053, China; Chinese Institute for Brain Research, Beijing 102206, China.
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Alorfi NM, Ashour AM, Bafhaid HS, Alshehri FS. Evaluation of Pharmacology and Pathophysiology Knowledge of Epilepsy among Senior Pharmacy Students: A Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050848. [PMID: 37241080 DOI: 10.3390/medicina59050848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Epilepsy is a chronic disease that causes substantial morbidity and mortality. Pharmacists represent an integral role in managing patients with epilepsy. The aim of this study was to evaluate the level of knowledge about the pharmacology and pathophysiology of epilepsy among senior pharmacy students. Materials and Methods: Cross-sectional study using a designed questionnaire to measure the pharmacological and physiological knowledge of senior pharmacy students regarding epilepsy who are studying at Umm Al-Qura University, Makkah, Saudi Arabia, from August to October 2022. Results: A total of 211 senior clinical pharmacy students responded to the questionnaire. The majority of the respondents were 4th year pharmacy students. The numbers of female and male participants were equal (106 and 105 students, respectively). The participants represented an acceptable level of knowledge about the pathophysiology aspects of epilepsy, with a mean total score of 6.22 ± 1.9 out of a maximum score of 10. The respondents reported that epilepsy could be due to genetic predisposition combined with environmental conditions (80.1%) or brain stroke (17.1%). Regarding the respondent knowledge about the pharmacology of epilepsy, the total score was 4.6 ± 2.1 (maximum attainable score: 9). Conclusions: The majority of pharmacy students had knowledge about the pathophysiology concept of the disease; however, low knowledge was shown by the respondents regarding the pharmacology of epilepsy. Thus, there is a need to identify better strategies to improve students' education.
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Affiliation(s)
- Nasser M Alorfi
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Ahmed M Ashour
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Hanouf S Bafhaid
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Fahad S Alshehri
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
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Goldenberg AM, Schmidt S, Mitelman R, Levy DR, Prigge M, Katz Y, Yizhar O, Beck H, Lampl I. Localized chemogenetic silencing of inhibitory neurons: a novel mouse model of focal cortical epileptic activity. Cereb Cortex 2023; 33:2838-2856. [PMID: 35788286 DOI: 10.1093/cercor/bhac245] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Focal cortical epilepsies are frequently refractory to available anticonvulsant drug therapies. One key factor contributing to this state is the limited availability of animal models that allow to reliably study focal cortical seizures and how they recruit surrounding brain areas in vivo. In this study, we selectively expressed the inhibitory chemogenetic receptor, hM4D, in GABAergic neurons in focal cortical areas using viral gene transfer. GABAergic silencing using Clozapine-N-Oxide (CNO) demonstrated reliable induction of local epileptiform events in the electroencephalogram signal of awake freely moving mice. Anesthetized mice experiments showed consistent induction of focal epileptiform-events in both the barrel cortex (BC) and the medial prefrontal cortex (mPFC), accompanied by high-frequency oscillations, a known characteristic of human seizures. Epileptiform-events showed propagation indication with favored propagation pathways: from the BC on 1 hemisphere to its counterpart and from the BC to the mPFC, but not vice-versa. Lastly, sensory whisker-pad stimulation evoked BC epileptiform events post-CNO, highlighting the potential use of this model in studying sensory-evoked seizures. Combined, our results show that targeted chemogenetic inhibition of GABAergic neurons using hM4D can serve as a novel, versatile, and reliable model of focal cortical epileptic activity suitable for systematically studying cortical ictogenesis in different cortical areas.
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Affiliation(s)
- Adi Miriam Goldenberg
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Sarah Schmidt
- Institute for Experimental Epileptology and Cognition Research, Life and Brain Center, University of Bonn, Bonn 53105, Germany
| | - Rea Mitelman
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Dana Rubi Levy
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Matthias Prigge
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Yonatan Katz
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Ofer Yizhar
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Heinz Beck
- Institute for Experimental Epileptology and Cognition Research, Life and Brain Center, University of Bonn, Bonn 53105, Germany
| | - Ilan Lampl
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
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Schroeder GM, Chowdhury FA, Cook MJ, Diehl B, Duncan JS, Karoly PJ, Taylor PN, Wang Y. Multiple mechanisms shape the relationship between pathway and duration of focal seizures. Brain Commun 2022; 4:fcac173. [PMID: 35855481 PMCID: PMC9280328 DOI: 10.1093/braincomms/fcac173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/18/2022] [Accepted: 06/30/2022] [Indexed: 12/22/2022] Open
Abstract
A seizure's electrographic dynamics are characterized by its spatiotemporal evolution, also termed dynamical 'pathway', and the time it takes to complete that pathway, which results in the seizure's duration. Both seizure pathways and durations have been shown to vary within the same patient. However, it is unclear whether seizures following the same pathway will have the same duration or if these features can vary independently. We compared within-subject variability in these seizure features using (i) epilepsy monitoring unit intracranial EEG (iEEG) recordings of 31 patients (mean: 6.7 days, 16.5 seizures/subject), (ii) NeuroVista chronic iEEG recordings of 10 patients (mean: 521.2 days, 252.6 seizures/subject) and (iii) chronic iEEG recordings of three dogs with focal-onset seizures (mean: 324.4 days, 62.3 seizures/subject). While the strength of the relationship between seizure pathways and durations was highly subject-specific, in most subjects, changes in seizure pathways were only weakly to moderately associated with differences in seizure durations. The relationship between seizure pathways and durations was strengthened by seizures that were 'truncated' versions, both in pathway and duration, of other seizures. However, the relationship was weakened by seizures that had a common pathway, but different durations ('elasticity'), or had similar durations, but followed different pathways ('semblance'). Even in subjects with distinct populations of short and long seizures, seizure durations were not a reliable indicator of different seizure pathways. These findings suggest that seizure pathways and durations are modulated by multiple different mechanisms. Uncovering such mechanisms may reveal novel therapeutic targets for reducing seizure duration and severity.
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Affiliation(s)
- Gabrielle M Schroeder
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fahmida A Chowdhury
- UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| | - Mark J Cook
- Graeme Clark Institute and St Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
| | - Beate Diehl
- UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| | - John S Duncan
- UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| | - Philippa J Karoly
- Graeme Clark Institute and St Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
- Seer Medical Pty Ltd, Melbourne, VIC, Australia
| | - Peter N Taylor
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| | - Yujiang Wang
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom
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Smith EH, Liou JY, Merricks EM, Davis T, Thomson K, Greger B, House P, Emerson RG, Goodman R, McKhann GM, Sheth S, Schevon C, Rolston JD. Human interictal epileptiform discharges are bidirectional traveling waves echoing ictal discharges. eLife 2022; 11:e73541. [PMID: 35050851 PMCID: PMC8813051 DOI: 10.7554/elife.73541] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
Interictal epileptiform discharges (IEDs), also known as interictal spikes, are large intermittent electrophysiological events observed between seizures in patients with epilepsy. Although they occur far more often than seizures, IEDs are less studied, and their relationship to seizures remains unclear. To better understand this relationship, we examined multi-day recordings of microelectrode arrays implanted in human epilepsy patients, allowing us to precisely observe the spatiotemporal propagation of IEDs, spontaneous seizures, and how they relate. These recordings showed that the majority of IEDs are traveling waves, traversing the same path as ictal discharges during seizures, and with a fixed direction relative to seizure propagation. Moreover, the majority of IEDs, like ictal discharges, were bidirectional, with one predominant and a second, less frequent antipodal direction. These results reveal a fundamental spatiotemporal similarity between IEDs and ictal discharges. These results also imply that most IEDs arise in brain tissue outside the site of seizure onset and propagate toward it, indicating that the propagation of IEDs provides useful information for localizing the seizure focus.
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Affiliation(s)
- Elliot H Smith
- Departments of Neurosurgery and Biomedical Engineering, University of UtahSalt Lake CityUnited States
- Department of Neurology, Columbia UniversityNew YorkUnited States
| | - Jyun-you Liou
- Department of Anesthesiology, Weill Cornell MedicineNew York CItyUnited States
| | | | - Tyler Davis
- Departments of Neurosurgery and Biomedical Engineering, University of UtahSalt Lake CityUnited States
| | - Kyle Thomson
- Department of Pharmacology & Toxicology, University of UtahSalt Lake CityUnited States
| | - Bradley Greger
- Department of Bioengineering, Arizona State UniversityTempeUnited States
| | - Paul House
- Neurosurgical Associates, LLCMurrayUnited States
| | | | | | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical CenterNew YorkUnited States
| | - Sameer Sheth
- Department of Neurological Surgery, Baylor College of MedicineHoustonUnited States
| | | | - John D Rolston
- Departments of Neurosurgery and Biomedical Engineering, University of UtahSalt Lake CityUnited States
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Chizhov AV, Amakhin DV, Smirnova EY, Zaitsev AV. Ictal wavefront propagation in slices and simulations with conductance-based refractory density model. PLoS Comput Biol 2022; 18:e1009782. [PMID: 35041661 PMCID: PMC8797236 DOI: 10.1371/journal.pcbi.1009782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 01/28/2022] [Accepted: 12/21/2021] [Indexed: 12/04/2022] Open
Abstract
The mechanisms determining ictal discharge (ID) propagation are still not clear. In the present study, we aimed to examine these mechanisms in animal and mathematical models of epileptiform activity. Using double-patch and extracellular potassium ion concentration recordings in rat hippocampal-cortical slices, we observed that IDs moved at a speed of about 1 mm/s or less. The mechanisms of such slow propagation have been studied with a mathematical, conductance-based refractory density (CBRD) model that describes the GABA- and glutamatergic neuronal populations’ interactions and ion dynamics in brain tissue. The modeling study reveals two main factors triggerring IDs: (i) increased interneuronal activity leading to chloride ion accumulation and a consequent depolarizing GABAergic effect and (ii) the elevation of extracellular potassium ion concentration. The local synaptic transmission followed by local potassium ion extrusion and GABA receptor-mediated chloride ion accumulation underlies the ID wavefront’s propagation. In contrast, potassium ion diffusion in the extracellular space is slower and does not affect ID’s speed. The short discharges, constituting the ID, propagate much faster than the ID front. The accumulation of sodium ions inside neurons due to their hyperactivity and glutamatergic currents boosts the Na+/K+ pump, which terminates the ID. Knowledge of the mechanism of ID generation and propagation contributes to the development of new treatments against epilepsy. During an epileptic seizure, neuronal excitation spreads across the brain tissue and is accompanied by significant changes in ionic concentrations. Ictal discharge front spreads at low speeds, less than 1 mm/s. Mechanisms underlying this phenomenon are not yet well understood. We study these mechanisms using electrophysiological recordings in brain slices and computer simulations. Our detailed biophysical model describing neuronal populations’ interaction, spatial propagation, and ionic dynamics reproduces the generation and propagation of spontaneously repeating ictal discharges. The simulations are consistent with our recordings of the electrical activity and the extracellular potassium ion concentration. We distinguished between the two alternative mechanisms of the ictal wavefront propagation: (i) the diffusion of potassium ions released from excited neurons, which depolarizes distant neurons and thus supports excitation, and (ii) the axonal spread of excitation followed by the local extracellular potassium ion accumulation that supports the excitation. Our simulations provide evidence in favor of the latter mechanism. Our experiment-based modeling contributes to a mathematical description of brain tissue functioning and potentially contributes to developing new treatments against epilepsy.
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Affiliation(s)
- Anton V. Chizhov
- Laboratory of Molecular Mechanisms of Neural Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Saint Petersburg, Russia
- Computational Physics Laboratory, Ioffe Institute, Saint Petersburg, Russia
- * E-mail:
| | - Dmitry V. Amakhin
- Laboratory of Molecular Mechanisms of Neural Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Saint Petersburg, Russia
| | - Elena Yu. Smirnova
- Laboratory of Molecular Mechanisms of Neural Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Saint Petersburg, Russia
- Computational Physics Laboratory, Ioffe Institute, Saint Petersburg, Russia
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Aleksey V. Zaitsev
- Laboratory of Molecular Mechanisms of Neural Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Saint Petersburg, Russia
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11
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Bando Y, Wenzel M, Yuste R. Simultaneous two-photon imaging of action potentials and subthreshold inputs in vivo. Nat Commun 2021; 12:7229. [PMID: 34893595 PMCID: PMC8664861 DOI: 10.1038/s41467-021-27444-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022] Open
Abstract
To better understand the input-output computations of neuronal populations, we developed ArcLight-ST, a genetically-encoded voltage indicator, to specifically measure subthreshold membrane potentials. We combined two-photon imaging of voltage and calcium, and successfully discriminated subthreshold inputs and spikes with cellular resolution in vivo. We demonstrate the utility of the method by mapping epileptic seizures progression through cortical circuits, revealing divergent sub- and suprathreshold dynamics within compartmentalized epileptic micronetworks. Two-photon, two-color imaging of calcium and voltage enables mapping of inputs and outputs in neuronal populations in living animals.
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Affiliation(s)
- Yuki Bando
- NeuroTechnology Center, Department of Biological Sciences, Columbia University, New York, NY, 10027, USA. .,Department of Organ and Tissue Anatomy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan.
| | - Michael Wenzel
- NeuroTechnology Center, Department of Biological Sciences, Columbia University, New York, NY, 10027, USA.,Department of Epileptology, University of Bonn, 53127, Bonn, Germany
| | - Rafael Yuste
- NeuroTechnology Center, Department of Biological Sciences, Columbia University, New York, NY, 10027, USA
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12
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Rapidly spreading seizures arise from large-scale functional brain networks in focal epilepsy. Neuroimage 2021; 237:118104. [PMID: 33933597 DOI: 10.1016/j.neuroimage.2021.118104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 11/21/2022] Open
Abstract
It remains unclear whether epileptogenic networks in focal epilepsy develop on physiological networks. This work aimed to explore the association between the rapid spread of ictal fast activity (IFA), a proposed biomarker for epileptogenic networks, and the functional connectivity or networks of healthy subjects. We reviewed 45 patients with focal epilepsy who underwent electrocorticographic (ECoG) recordings to identify the patients showing the rapid spread of IFA. IFA power was quantified as normalized beta-gamma band power. Using published resting-state functional magnetic resonance imaging databases, we estimated resting-state functional connectivity of healthy subjects (RSFC-HS) and resting-state networks of healthy subjects (RSNs-HS) at the locations corresponding to the patients' electrodes. We predicted the IFA power of each electrode based on RSFC-HS between electrode locations (RSFC-HS-based prediction) using a recently developed method, termed activity flow mapping. RSNs-HS were identified using seed-based and atlas-based methods. We compared IFA power with RSFC-HS-based prediction or RSNs-HS using non-parametric correlation coefficients. RSFC and seed-based RSNs of each patient (RSFC-PT and seed-based RSNs-PT) were also estimated using interictal ECoG data and compared with IFA power in the same way as RSFC-HS and seed-based RSNs-HS. Spatial autocorrelation-preserving randomization tests were performed for significance testing. Nine patients met the inclusion criteria. None of the patients had reflex seizures. Six patients showed pathological evidence of a structural etiology. In total, we analyzed 49 seizures (2-13 seizures per patient). We observed significant correlations between IFA power and RSFC-HS-based prediction, seed-based RSNs-HS, or atlas-based RSNs-HS in 28 (57.1%), 21 (42.9%), and 28 (57.1%) seizures, respectively. Thirty-two (65.3%) seizures showed a significant correlation with either seed-based or atlas-based RSNs-HS, but this ratio varied across patients: 27 (93.1%) of 29 seizures in six patients correlated with either of them. Among atlas-based RSNs-HS, correlated RSNs-HS with IFA power included the default mode, control, dorsal attention, somatomotor, and temporal-parietal networks. We could not obtain RSFC-PT and RSNs-PT in one patient due to frequent interictal epileptiform discharges. In the remaining eight patients, most of the seizures showed significant correlations between IFA power and RSFC-PT-based prediction or seed-based RSNs-PT. Our study provides evidence that the rapid spread of IFA in focal epilepsy can arise from physiological RSNs. This finding suggests an overlap between epileptogenic and functional networks, which may explain why functional networks in patients with focal epilepsy frequently disrupt.
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13
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Diamond JM, Diamond BE, Trotta MS, Dembny K, Inati SK, Zaghloul KA. Travelling waves reveal a dynamic seizure source in human focal epilepsy. Brain 2021; 144:1751-1763. [PMID: 33693588 DOI: 10.1093/brain/awab089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/08/2020] [Accepted: 12/23/2020] [Indexed: 11/14/2022] Open
Abstract
Treatment of patients with drug-resistant focal epilepsy relies upon accurate seizure localization. Ictal activity captured by intracranial EEG has traditionally been interpreted to suggest that the underlying cortex is actively involved in seizures. Here, we hypothesize that such activity instead reflects propagated activity from a relatively focal seizure source, even during later time points when ictal activity is more widespread. We used the time differences observed between ictal discharges in adjacent electrodes to estimate the location of the hypothesized focal source and demonstrated that the seizure source, localized in this manner, closely matches the clinically and neurophysiologically determined brain region giving rise to seizures. Moreover, we determined this focal source to be a dynamic entity that moves and evolves over the time course of a seizure. Our results offer an interpretation of ictal activity observed by intracranial EEG that challenges the traditional conceptualization of the seizure source.
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Affiliation(s)
- Joshua M Diamond
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Benjamin E Diamond
- J.P. Morgan AI Research, Corporate and Investment Bank, JP Morgan Chase & Co., New York, NY 10017, USA
| | - Michael S Trotta
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kate Dembny
- Clinical Epilepsy Section, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sara K Inati
- Clinical Epilepsy Section, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
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14
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Sip V, Scholly J, Guye M, Bartolomei F, Jirsa V. Evidence for spreading seizure as a cause of theta-alpha activity electrographic pattern in stereo-EEG seizure recordings. PLoS Comput Biol 2021; 17:e1008731. [PMID: 33635864 PMCID: PMC7946361 DOI: 10.1371/journal.pcbi.1008731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/10/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
Intracranial electroencephalography is a standard tool in clinical evaluation of patients with focal epilepsy. Various early electrographic seizure patterns differing in frequency, amplitude, and waveform of the oscillations are observed. The pattern most common in the areas of seizure propagation is the so-called theta-alpha activity (TAA), whose defining features are oscillations in the θ - α range and gradually increasing amplitude. A deeper understanding of the mechanism underlying the generation of the TAA pattern is however lacking. In this work we evaluate the hypothesis that the TAA patterns are caused by seizures spreading across the cortex. To do so, we perform simulations of seizure dynamics on detailed patient-derived cortical surfaces using the spreading seizure model as well as reference models with one or two homogeneous sources. We then detect the occurrences of the TAA patterns both in the simulated stereo-electroencephalographic signals and in the signals of recorded epileptic seizures from a cohort of fifty patients, and we compare the features of the groups of detected TAA patterns to assess the plausibility of the different models. Our results show that spreading seizure hypothesis is qualitatively consistent with the evidence available in the seizure recordings, and it can explain the features of the detected TAA groups best among the examined models.
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Affiliation(s)
- Viktor Sip
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Julia Scholly
- Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, CEMEREM, Pôle d’Imagerie Médicale, CHU, Marseille, France
- Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, Service de Neurophysiologie Clinique, CHU, Marseille, France
| | - Maxime Guye
- Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, CEMEREM, Pôle d’Imagerie Médicale, CHU, Marseille, France
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Fabrice Bartolomei
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, Service de Neurophysiologie Clinique, CHU, Marseille, France
| | - Viktor Jirsa
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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15
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Driscoll N, Rosch RE, Murphy BB, Ashourvan A, Vishnubhotla R, Dickens OO, Johnson ATC, Davis KA, Litt B, Bassett DS, Takano H, Vitale F. Multimodal in vivo recording using transparent graphene microelectrodes illuminates spatiotemporal seizure dynamics at the microscale. Commun Biol 2021; 4:136. [PMID: 33514839 PMCID: PMC7846732 DOI: 10.1038/s42003-021-01670-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/24/2020] [Indexed: 01/21/2023] Open
Abstract
Neurological disorders such as epilepsy arise from disrupted brain networks. Our capacity to treat these disorders is limited by our inability to map these networks at sufficient temporal and spatial scales to target interventions. Current best techniques either sample broad areas at low temporal resolution (e.g. calcium imaging) or record from discrete regions at high temporal resolution (e.g. electrophysiology). This limitation hampers our ability to understand and intervene in aberrations of network dynamics. Here we present a technique to map the onset and spatiotemporal spread of acute epileptic seizures in vivo by simultaneously recording high bandwidth microelectrocorticography and calcium fluorescence using transparent graphene microelectrode arrays. We integrate dynamic data features from both modalities using non-negative matrix factorization to identify sequential spatiotemporal patterns of seizure onset and evolution, revealing how the temporal progression of ictal electrophysiology is linked to the spatial evolution of the recruited seizure core. This integrated analysis of multimodal data reveals otherwise hidden state transitions in the spatial and temporal progression of acute seizures. The techniques demonstrated here may enable future targeted therapeutic interventions and novel spatially embedded models of local circuit dynamics during seizure onset and evolution.
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Affiliation(s)
- Nicolette Driscoll
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Richard E Rosch
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Brendan B Murphy
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Arian Ashourvan
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ramya Vishnubhotla
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA
| | - Olivia O Dickens
- Graduate Group in Biochemistry and Molecular Biophysics, University of Pennsylvania, Philadelphia, PA, USA
| | - A T Charlie Johnson
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn A Davis
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Litt
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Electrical & Systems Engineering, University of Pennsylvania, Philadelphia, PA, USA
- Santa Fe Institute, Santa Fe, NM, USA
| | - Hajime Takano
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Flavia Vitale
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA.
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16
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Andrews JP, Ammanuel S, Kleen J, Khambhati AN, Knowlton R, Chang EF. Early seizure spread and epilepsy surgery: A systematic review. Epilepsia 2020; 61:2163-2172. [PMID: 32944952 DOI: 10.1111/epi.16668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE A fundamental question in epilepsy surgery is how to delineate the margins of cortex that must be resected to result in seizure freedom. Whether and which areas showing seizure activity early in ictus must be removed to avoid postoperative recurrence of seizures is an area of ongoing research. Seizure spread dynamics in the initial seconds of ictus are often correlated with postoperative outcome; there is neither a consensus definition of early spread nor a concise summary of the existing literature linking seizure spread to postsurgical seizure outcomes. The present study is intended to summarize the literature that links seizure spread to postoperative seizure outcome and to provide a framework for quantitative assessment of early seizure spread. METHODS A systematic review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A Medline search identified clinical studies reporting data on seizure spread measured by intracranial electrodes, having at least 10 subjects and reporting at least 1-year postoperative outcome in the English literature from 1990 to 2019. Studies were evaluated regarding support for a primary hypothesis: Areas of early seizure spread represent cortex with seizure-generating potential. RESULTS The search yielded 4562 studies: 15 studies met inclusion criteria and 7 studies supported the primary hypothesis. The methods and metrics used to describe seizure spread were heterogenous. The timeframe of seizure spread associated with seizure outcome ranged from 1-14 seconds, with large, well-designed, retrospective studies pointing to 3-10 seconds as most likely to provide meaningful correlates of postoperative seizure freedom. SIGNIFICANCE The complex correlation between electrophysiologic seizure spread and the potential for seizure generation needs further elucidation. Prospective cohort studies or trials are needed to evaluate epilepsy surgery targeting cortex involved in the first 3-10 seconds of ictus.
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Affiliation(s)
- John P Andrews
- Department of Neurological Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Simon Ammanuel
- Department of Neurological Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Jonathan Kleen
- Department of Neurology, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Ankit N Khambhati
- Department of Neurological Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Robert Knowlton
- Department of Neurology, School of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Edward F Chang
- Department of Neurological Surgery, School of Medicine, University of California-San Francisco, San Francisco, California, USA
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17
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Creaser J, Lin C, Ridler T, Brown JT, D’Souza W, Seneviratne U, Cook M, Terry JR, Tsaneva-Atanasova K. Domino-like transient dynamics at seizure onset in epilepsy. PLoS Comput Biol 2020; 16:e1008206. [PMID: 32986695 PMCID: PMC7544071 DOI: 10.1371/journal.pcbi.1008206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 10/08/2020] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
Abstract
The International League Against Epilepsy (ILAE) groups seizures into "focal", "generalized" and "unknown" based on whether the seizure onset is confined to a brain region in one hemisphere, arises in several brain region simultaneously, or is not known, respectively. This separation fails to account for the rich diversity of clinically and experimentally observed spatiotemporal patterns of seizure onset and even less so for the properties of the brain networks generating them. We consider three different patterns of domino-like seizure onset in Idiopathic Generalized Epilepsy (IGE) and present a novel approach to classification of seizures. To understand how these patterns are generated on networks requires understanding of the relationship between intrinsic node dynamics and coupling between nodes in the presence of noise, which currently is unknown. We investigate this interplay here in the framework of domino-like recruitment across a network. In particular, we use a phenomenological model of seizure onset with heterogeneous coupling and node properties, and show that in combination they generate a range of domino-like onset patterns observed in the IGE seizures. We further explore the individual contribution of heterogeneous node dynamics and coupling by interpreting in-vitro experimental data in which the speed of onset can be chemically modulated. This work contributes to a better understanding of possible drivers for the spatiotemporal patterns observed at seizure onset and may ultimately contribute to a more personalized approach to classification of seizure types in clinical practice.
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Affiliation(s)
- Jennifer Creaser
- Department of Mathematics, University of Exeter, Exeter, EX4 4QF, UK
- EPSRC Centre for Predictive modeling in Healthcare, University of Exeter, Exeter, EX4 4QJ, UK
| | - Congping Lin
- Center for Mathematical Sciences, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China
- Hubei Key Lab of Engineering Modeling and Scientific Computing, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China
| | - Thomas Ridler
- Institute of Biomedical and Clinical Sciences, College of Medicine and Health, University of Exeter, EX4 4PS, UK
| | - Jonathan T. Brown
- Institute of Biomedical and Clinical Sciences, College of Medicine and Health, University of Exeter, EX4 4PS, UK
| | - Wendyl D’Souza
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Melbourne, VIC 3065, Australia
| | - Udaya Seneviratne
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Melbourne, VIC 3065, Australia
- Department of Neuroscience, Monash Medical Centre, Melbourne, VIC 3168, Australia
| | - Mark Cook
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Melbourne, VIC 3065, Australia
- Graeme Clark Institute, University of Melbourne, Parkville, VIC 3010, Australia
| | - John R. Terry
- EPSRC Centre for Predictive modeling in Healthcare, University of Exeter, Exeter, EX4 4QJ, UK
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, B15 2TT, UK
| | - Krasimira Tsaneva-Atanasova
- Department of Mathematics, University of Exeter, Exeter, EX4 4QF, UK
- EPSRC Centre for Predictive modeling in Healthcare, University of Exeter, Exeter, EX4 4QJ, UK
- Living System Institute, University of Exeter, Exeter, EX4 4QJ, UK
- Institute for Advanced Study, Technical University of Munich, Lichtenbergstrasse 2a, D-85748 Garching, Germany
- Department of Bioinformatics and Mathematical Modelling, Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, 105 Acad. G. Bonchev Str, 1113 Sofia, Bulgaria
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18
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Soriano J, Kubo T, Ikeda K. Feasibility of focal brain cooling for partial epilepsy with secondary generalization: A computational study . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020;2020:2532-2535. [PMID: 33018522 DOI: 10.1109/embc44109.2020.9175157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Experiments with animal models of epilepsy have consistently shown that focal cooling of epilepsy-induced brain region reversibly suppresses or terminates epileptic discharge activity. Recently, we formulated a physiologically plausible temperature dependence in a neural mass model that can reproduce the effect of focal cooling on epileptic discharge activity. This can be used to implement a temperature control in an implantable cooling device for thermal neuromodulation of the epileptogenic zone in patients with partial epilepsy when seizure activity is detected. However, there have been no experiments that looked into the effect of focal cooling in animal models of epilepsy with secondary generalization in which the seizure activity spreads from the pathologic region to other regions of the brain. Using the temperature-dependent neural mass model and a physiological coupling model, we show that focal cooling stops the propagation of low-frequency discharge activity; on the other hand, it increases the amount of coupling required to propagate high-frequency discharge activity. Moreover, discharge activities that are propagated with cooling are lower in both magnitude and frequency compared to those propagated without cooling. These results suggest the feasibility of focal cooling as an effective alternative therapeutic treatment for medically intractable partial epilepsy even with secondary generalization.Clinical Relevance- The computational study establishes focal cooling of the brain region with partial epilepsy not only suppresses epileptic discharges but can also prevent its generalization to other brain regions.
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19
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Robust dynamic community detection with applications to human brain functional networks. Nat Commun 2020; 11:2785. [PMID: 32503997 PMCID: PMC7275079 DOI: 10.1038/s41467-020-16285-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
While current technology permits inference of dynamic brain networks over long time periods at high temporal resolution, the detailed structure of dynamic network communities during human seizures remains poorly understood. We introduce a new methodology that addresses critical aspects unique to the analysis of dynamic functional networks inferred from noisy data. We propose a dynamic plex percolation method (DPPM) that is robust to edge noise, and yields well-defined spatiotemporal communities that span forward and backwards in time. We show in simulation that DPPM outperforms existing methods in accurately capturing certain stereotypical dynamic community behaviors in noisy situations. We then illustrate the ability of this method to track dynamic community organization during human seizures, using invasive brain voltage recordings at seizure onset. We conjecture that application of this method will yield new targets for surgical treatment of epilepsy, and more generally could provide new insights in other network neuroscience applications. Understanding how brain networks evolve in time remains a challenge, with the potential for significant impact to human health and disease. Here, the authors introduce a new methodology to track dynamic functional networks that is robust to edge noise, and yields well-defined spatiotemporal communities that span forward and backwards in time.
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20
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Schroeder GM, Diehl B, Chowdhury FA, Duncan JS, de Tisi J, Trevelyan AJ, Forsyth R, Jackson A, Taylor PN, Wang Y. Seizure pathways change on circadian and slower timescales in individual patients with focal epilepsy. Proc Natl Acad Sci U S A 2020; 117:11048-11058. [PMID: 32366665 PMCID: PMC7245106 DOI: 10.1073/pnas.1922084117] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Personalized medicine requires that treatments adapt to not only the patient but also changing factors within each individual. Although epilepsy is a dynamic disorder characterized by pathological fluctuations in brain state, surprisingly little is known about whether and how seizures vary in the same patient. We quantitatively compared within-patient seizure network evolutions using intracranial electroencephalographic (iEEG) recordings of over 500 seizures from 31 patients with focal epilepsy (mean 16.5 seizures per patient). In all patients, we found variability in seizure paths through the space of possible network dynamics. Seizures with similar pathways tended to occur closer together in time, and a simple model suggested that seizure pathways change on circadian and/or slower timescales in the majority of patients. These temporal relationships occurred independent of whether the patient underwent antiepileptic medication reduction. Our results suggest that various modulatory processes, operating at different timescales, shape within-patient seizure evolutions, leading to variable seizure pathways that may require tailored treatment approaches.
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Affiliation(s)
- Gabrielle M Schroeder
- Interdisciplinary Computing and Complex BioSystems Group, School of Computing Science, Newcastle University, Newcastle upon Tyne, NE4 5TG, United Kingdom
| | - Beate Diehl
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Fahmida A Chowdhury
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - John S Duncan
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Jane de Tisi
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Andrew J Trevelyan
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Rob Forsyth
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Andrew Jackson
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Peter N Taylor
- Interdisciplinary Computing and Complex BioSystems Group, School of Computing Science, Newcastle University, Newcastle upon Tyne, NE4 5TG, United Kingdom
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Yujiang Wang
- Interdisciplinary Computing and Complex BioSystems Group, School of Computing Science, Newcastle University, Newcastle upon Tyne, NE4 5TG, United Kingdom;
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
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21
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Andrews JP, Gummadavelli A, Farooque P, Bonito J, Arencibia C, Blumenfeld H, Spencer DD. Association of Seizure Spread With Surgical Failure in Epilepsy. JAMA Neurol 2020; 76:462-469. [PMID: 30508033 DOI: 10.1001/jamaneurol.2018.4316] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Seizures recur in as many as half of patients who undergo surgery for drug-resistant temporal lobe epilepsy (TLE). Understanding why TLE is resistant to surgery in some patients may reveal insights into epileptogenic networks and direct new therapies to improve outcomes. Objective To characterize features of surgically refractory TLE. Design, Setting, and Participants Medical records from a comprehensive epilepsy center were retrospectively reviewed for 131 patients who received a standard anteromedial temporal resection by a single surgeon from January 1, 2000, to December 31, 2015. Thirteen patients were excluded for having less than 1 year of follow-up. Patients at the highest risk for seizure recurrence were identified. Intracranial electroencephalogram (iEEG) analyses generated 3-dimensional seizure spread representations and quantified rapid seizure spread. The final analyses of seizure outcome and follow-up data were performed in June 2017. Main Outcomes and Measures The Engel class seizure outcome following surgery was evaluated for all patients, defining seizure recurrence as Engel class II or greater. Intracranial recordings of neocortical grids/strips and depth electrodes were analyzed visually for seizure spread. Fast β power was projected onto reconstructions of patients' brain magnetic resonance imaging scans to visualize spread patterns and was quantified to compare power within vs outside resective margins. Results Of 118 patients with 1 year of follow-up or more (mean [SD], 6.5 [4.6] years), 66 (55.9%) were women and 52 (44.1%) were men (median age, 39 years [range, 4-66 years]). The cumulative probability of continuous Engel class I seizure freedom since surgery at postoperative year 10 and afterward was 65.6%, with 92% of recurrences in years 1 to 3. Multivariable statistical analyses found that the selection for iEEG study was the most reliable predictor of seizure recurrence, with a mixed-effects model estimating that the Engel score in the iEEG cohort was higher by a mean (SD) of 1.1 (0.33) (P = .001). In patients with iEEG results, rapid seizure spread in less than 10 seconds was associated with recurrence (hazard ratio, 5.99; 95% CI, 1.7-21.1; P < .01). In the first 10 seconds of seizures, fast β power activity outside the resective margins in the lateral temporal cortex was significantly greater in patients whose seizures recurred compared with patients who were seizure-free (mean [SEM], 137.5% [16.8%] vs 93.4% [4.6%]; P < .05). Conclusions and significance Rapid seizure spread outside anteromedial temporal resection resective margins plays a significant role in the surgical failure of drug-resistant TLE. Seizure control after epilepsy surgery might be improved by investigating areas of early spread as candidates for resection or neuromodulation.
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Affiliation(s)
- John P Andrews
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Abhijeet Gummadavelli
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Pue Farooque
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer Bonito
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | | | - Hal Blumenfeld
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.,Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis D Spencer
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
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22
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Yang DP, Robinson PA. Unified analysis of global and focal aspects of absence epilepsy via neural field theory of the corticothalamic system. Phys Rev E 2019; 100:032405. [PMID: 31639915 DOI: 10.1103/physreve.100.032405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 06/10/2023]
Abstract
Absence epilepsy is characterized by a sudden paroxysmal loss of consciousness accompanied by oscillatory activity propagating over many brain areas. Although primary generalized absence seizures are supported by the global corticothalamic system, converging experimental evidence supports a focal theory of absence epilepsy. Here a physiology-based corticothalamic model is investigated with spatial heterogeneity due to focal epilepsy to unify global and focal aspects of absence epilepsy. Numeric and analytic calculations are employed to investigate the emergent spatiotemporal dynamics as well as their underlying dynamical mechanisms. They can be categorized into three scenarios: suppressed epilepsy, focal seizures, or generalized seizures, as summarized from a phase diagram vs focal width and characteristic axon range. The corresponding temporal frequencies and spatial extents of cortical waves in generalized seizures and focal seizures agree well with experimental observations of global and focal aspects of absence epilepsy, respectively. The emergence of the spatiotemporal dynamics corresponding to focal seizures provides a biophysical explanation of the temporally higher frequency but spatially more localized cortical waves observed in genetic rat models that display characteristics of human absence epilepsy. Predictions are also presented for further experimental test.
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Affiliation(s)
- Dong-Ping Yang
- School of Physics, University of Sydney, New South Wales 2006, Australia and Center for Integrative Brain Function, University of Sydney, New South Wales 2006, Australia
| | - P A Robinson
- School of Physics, University of Sydney, New South Wales 2006, Australia and Center for Integrative Brain Function, University of Sydney, New South Wales 2006, Australia
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23
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Wenzel M, Hamm JP, Peterka DS, Yuste R. Reliable and Elastic Propagation of Cortical Seizures In Vivo. Cell Rep 2018; 19:2681-2693. [PMID: 28658617 DOI: 10.1016/j.celrep.2017.05.090] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 05/15/2017] [Accepted: 05/28/2017] [Indexed: 12/27/2022] Open
Abstract
Mapping the fine-scale neural activity that underlies epilepsy is key to identifying potential control targets of this frequently intractable disease. Yet, the detailed in vivo dynamics of seizure progression in cortical microcircuits remain poorly understood. We combine fast (30-Hz) two-photon calcium imaging with local field potential (LFP) recordings to map, cell by cell, the spread of locally induced (4-AP or picrotoxin) seizures in anesthetized and awake mice. Using single-layer and microprism-assisted multilayer imaging in different cortical areas, we uncover reliable recruitment of local neural populations within and across cortical layers, and we find layer-specific temporal delays, suggesting an initial supra-granular invasion followed by deep-layer recruitment during lateral seizure spread. Intriguingly, despite consistent progression pathways, successive seizures show pronounced temporal variability that critically depends on GABAergic inhibition. We propose an epilepsy circuit model resembling an elastic meshwork, wherein ictal progression faithfully follows preexistent pathways but varies flexibly in time, depending on the local inhibitory restraint.
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Affiliation(s)
- Michael Wenzel
- Neurotechnology Center, Department of Biological Sciences, Columbia University, New York, NY 10027, USA.
| | - Jordan P Hamm
- Neurotechnology Center, Department of Biological Sciences, Columbia University, New York, NY 10027, USA
| | - Darcy S Peterka
- Neurotechnology Center, Department of Biological Sciences, Columbia University, New York, NY 10027, USA
| | - Rafael Yuste
- Neurotechnology Center, Department of Biological Sciences, Columbia University, New York, NY 10027, USA
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24
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Proix T, Jirsa VK, Bartolomei F, Guye M, Truccolo W. Predicting the spatiotemporal diversity of seizure propagation and termination in human focal epilepsy. Nat Commun 2018. [PMID: 29540685 PMCID: PMC5852068 DOI: 10.1038/s41467-018-02973-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Recent studies have shown that seizures can spread and terminate across brain areas via a rich diversity of spatiotemporal patterns. In particular, while the location of the seizure onset area is usually invariant across seizures in an individual patient, the source of traveling (2–3 Hz) spike-and-wave discharges during seizures can either move with the slower propagating ictal wavefront or remain stationary at the seizure onset area. Furthermore, although many focal seizures terminate synchronously across brain areas, some evolve into distinct ictal clusters and terminate asynchronously. Here, we introduce a unifying perspective based on a new neural field model of epileptic seizure dynamics. Two main mechanisms, the co-existence of wave propagation in excitable media and coupled-oscillator dynamics, together with the interaction of multiple time scales, account for the reported diversity. We confirm our predictions in seizures and tractography data obtained from patients with pharmacologically resistant epilepsy. Our results contribute toward patient-specific seizure modeling. A major goal of epilepsy research is understanding the spatiotemporal dynamics of seizure. Here, the authors extend the Epileptor neural mass model into a neural field model, in order to provide a unified and patient-specific model of seizure initiation, propagation, and termination.
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Affiliation(s)
- Timothée Proix
- Department of Neuroscience, Brown University, Providence, RI, 02912, USA.,Institute for Brain Science, Brown University, Providence, RI, 02912, USA.,Center for Neurorestoration & Neurotechnology, U.S. Department of Veterans Affairs, Providence, RI, 02912, USA
| | - Viktor K Jirsa
- Institut de Neurosciences des Systèmes (INS), Inserm, Aix Marseille Univ, Marseille, 13005, France
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes (INS), Inserm, Aix Marseille Univ, Marseille, 13005, France
| | - Maxime Guye
- CNRS, CRMBM UMR 7339, Aix Marseille Univ, Marseille, 13005, France
| | - Wilson Truccolo
- Department of Neuroscience, Brown University, Providence, RI, 02912, USA. .,Institute for Brain Science, Brown University, Providence, RI, 02912, USA. .,Center for Neurorestoration & Neurotechnology, U.S. Department of Veterans Affairs, Providence, RI, 02912, USA.
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25
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Chiang CC, Wei X, Ananthakrishnan AK, Shivacharan RS, Gonzalez-Reyes LE, Zhang M, Durand DM. Slow moving neural source in the epileptic hippocampus can mimic progression of human seizures. Sci Rep 2018; 8:1564. [PMID: 29367722 PMCID: PMC5784157 DOI: 10.1038/s41598-018-19925-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/10/2018] [Indexed: 11/23/2022] Open
Abstract
Fast and slow neural waves have been observed to propagate in the human brain during seizures. Yet the nature of these waves is difficult to study in a surgical setting. Here, we report an observation of two different traveling waves propagating in the in-vitro epileptic hippocampus at speeds similar to those in the human brain. A fast traveling spike and a slow moving wave were recorded simultaneously with a genetically encoded voltage sensitive fluorescent protein (VSFP Butterfly 1.2) and a high speed camera. The results of this study indicate that the fast traveling spike is NMDA-sensitive but the slow moving wave is not. Image analysis and model simulation demonstrate that the slow moving wave is moving slowly, generating the fast traveling spike and is, therefore, a moving source of the epileptiform activity. This slow moving wave is associated with a propagating neural calcium wave detected with calcium dye (OGB-1) but is independent of NMDA receptors, not related to ATP release, and much faster than those previously recorded potassium waves. Computer modeling suggests that the slow moving wave can propagate by the ephaptic effect like epileptiform activity. These findings provide an alternative explanation for slow propagation seizure wavefronts associated with fast propagating spikes.
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Affiliation(s)
- Chia-Chu Chiang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Xile Wei
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA
- School of Electrical and Information Engineering, Tianjin University, Tianjin, 300072, China
| | | | - Rajat S Shivacharan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Luis E Gonzalez-Reyes
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Mingming Zhang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Dominique M Durand
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, 44106, USA.
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26
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Proix T, Bartolomei F, Guye M, Jirsa VK. Individual brain structure and modelling predict seizure propagation. Brain 2017; 140:641-654. [PMID: 28364550 PMCID: PMC5837328 DOI: 10.1093/brain/awx004] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/03/2016] [Indexed: 01/03/2023] Open
Abstract
See Lytton (doi:10.1093/awx018) for a scientific commentary on this article.Neural network oscillations are a fundamental mechanism for cognition, perception and consciousness. Consequently, perturbations of network activity play an important role in the pathophysiology of brain disorders. When structural information from non-invasive brain imaging is merged with mathematical modelling, then generative brain network models constitute personalized in silico platforms for the exploration of causal mechanisms of brain function and clinical hypothesis testing. We here demonstrate with the example of drug-resistant epilepsy that patient-specific virtual brain models derived from diffusion magnetic resonance imaging have sufficient predictive power to improve diagnosis and surgery outcome. In partial epilepsy, seizures originate in a local network, the so-called epileptogenic zone, before recruiting other close or distant brain regions. We create personalized large-scale brain networks for 15 patients and simulate the individual seizure propagation patterns. Model validation is performed against the presurgical stereotactic electroencephalography data and the standard-of-care clinical evaluation. We demonstrate that the individual brain models account for the patient seizure propagation patterns, explain the variability in postsurgical success, but do not reliably augment with the use of patient-specific connectivity. Our results show that connectome-based brain network models have the capacity to explain changes in the organization of brain activity as observed in some brain disorders, thus opening up avenues towards discovery of novel clinical interventions.
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Affiliation(s)
- Timothée Proix
- Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Fabrice Bartolomei
- Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.,Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, Service de Neurophysiologie Clinique, CHU, 13005 Marseille, France
| | - Maxime Guye
- Aix-Marseille Université, Centre de Résonance Magnétique et Biologique et Médicale (CRMBM, UMR CNRS-AMU 7339), Medical School of Marseille, 13005, Marseille, France.,Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, CEMEREM, Pôle d'Imagerie Médicale, CHU, 13005, Marseille, France
| | - Viktor K Jirsa
- Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
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27
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Abstract
Diffuse WHO grade II gliomas are histologically and genetically heterogeneous. The 2016 WHO classification redefines grade II gliomas with respect to morphological and molecular tumour alterations: grade II oligodendrogliomas are defined by the presence of whole-arm codeletion in chromosomal arms 1p/19q, whereas isocitrate dehydrogenase (IDH) mutations define subclasses of astrocytoma. Although histological grade remains useful, the prognoses of patients with glioma are more tightly associated with molecular alterations than with grade, and chromosomal and gene array technologies are becoming increasingly beneficial in understanding tumour genetic heterogeneity. The indolent nature of the disease often creates subtle neurological symptoms that can be overlooked or misunderstood, resulting in delayed diagnosis. Seizures often herald the diagnosis, especially in patients who have IDH mutations, which are associated with an increased production of 2-hydroxyglutarate. Treatment paradigms have shifted, owing to new diagnostic criteria and new clinical trial evidence. Patients benefit more from chemoradiation than radiation alone, especially those with tumour IDH1 Arg132His mutations; gross total resection of the tumour, including tumours with IDH mutations, is associated with prolonged survival. Initial observation remains appropriate in patients whose rate of disease growth is not yet completely defined; such patients could include those with completely resected disease and those with 1p/19q codeleted tumours.
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28
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Wang Y, Trevelyan AJ, Valentin A, Alarcon G, Taylor PN, Kaiser M. Mechanisms underlying different onset patterns of focal seizures. PLoS Comput Biol 2017; 13:e1005475. [PMID: 28472032 PMCID: PMC5417416 DOI: 10.1371/journal.pcbi.1005475] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/23/2017] [Indexed: 02/07/2023] Open
Abstract
Focal seizures are episodes of pathological brain activity that appear to arise from a localised area of the brain. The onset patterns of focal seizure activity have been studied intensively, and they have largely been distinguished into two types-low amplitude fast oscillations (LAF), or high amplitude spikes (HAS). Here we explore whether these two patterns arise from fundamentally different mechanisms. Here, we use a previously established computational model of neocortical tissue, and validate it as an adequate model using clinical recordings of focal seizures. We then reproduce the two onset patterns in their most defining properties and investigate the possible mechanisms underlying the different focal seizure onset patterns in the model. We show that the two patterns are associated with different mechanisms at the spatial scale of a single ECoG electrode. The LAF onset is initiated by independent patches of localised activity, which slowly invade the surrounding tissue and coalesce over time. In contrast, the HAS onset is a global, systemic transition to a coexisting seizure state triggered by a local event. We find that such a global transition is enabled by an increase in the excitability of the "healthy" surrounding tissue, which by itself does not generate seizures, but can support seizure activity when incited. In our simulations, the difference in surrounding tissue excitability also offers a simple explanation of the clinically reported difference in surgical outcomes. Finally, we demonstrate in the model how changes in tissue excitability could be elucidated, in principle, using active stimulation. Taken together, our modelling results suggest that the excitability of the tissue surrounding the seizure core may play a determining role in the seizure onset pattern, as well as in the surgical outcome.
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Affiliation(s)
- Yujiang Wang
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
| | - Andrew J Trevelyan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Antonio Valentin
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Gonzalo Alarcon
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Comprehensive Epilepsy Center, Neuroscience Institute, Academic Health Systems, Hamad Medical Corporation, Doha, Qatar
| | - Peter N Taylor
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing Science, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
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29
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Human seizures couple across spatial scales through travelling wave dynamics. Nat Commun 2017; 8:14896. [PMID: 28374740 PMCID: PMC5382286 DOI: 10.1038/ncomms14896] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/08/2017] [Indexed: 11/21/2022] Open
Abstract
Epilepsy—the propensity toward recurrent, unprovoked seizures—is a devastating disease affecting 65 million people worldwide. Understanding and treating this disease remains a challenge, as seizures manifest through mechanisms and features that span spatial and temporal scales. Here we address this challenge through the analysis and modelling of human brain voltage activity recorded simultaneously across microscopic and macroscopic spatial scales. We show that during seizure large-scale neural populations spanning centimetres of cortex coordinate with small neural groups spanning cortical columns, and provide evidence that rapidly propagating waves of activity underlie this increased inter-scale coupling. We develop a corresponding computational model to propose specific mechanisms—namely, the effects of an increased extracellular potassium concentration diffusing in space—that support the observed spatiotemporal dynamics. Understanding the multi-scale, spatiotemporal dynamics of human seizures—and connecting these dynamics to specific biological mechanisms—promises new insights to treat this devastating disease. The authors record both local and long-range neural activity during human epileptic seizures to study the underlying multi-scale dynamics. They find that coupling of activity across spatial scales increases during seizures through propagating waves that are fit by a model that combines neural activity and potassium concentration dynamics.
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30
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Tomlinson SB, Bermudez C, Conley C, Brown MW, Porter BE, Marsh ED. Spatiotemporal Mapping of Interictal Spike Propagation: A Novel Methodology Applied to Pediatric Intracranial EEG Recordings. Front Neurol 2016; 7:229. [PMID: 28066315 PMCID: PMC5165024 DOI: 10.3389/fneur.2016.00229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/30/2016] [Indexed: 12/19/2022] Open
Abstract
Synchronized cortical activity is implicated in both normative cognitive functioning and many neurologic disorders. For epilepsy patients with intractable seizures, irregular synchronization within the epileptogenic zone (EZ) is believed to provide the network substrate through which seizures initiate and propagate. Mapping the EZ prior to epilepsy surgery is critical for detecting seizure networks in order to achieve postsurgical seizure control. However, automated techniques for characterizing epileptic networks have yet to gain traction in the clinical setting. Recent advances in signal processing and spike detection have made it possible to examine the spatiotemporal propagation of interictal spike discharges across the epileptic cortex. In this study, we present a novel methodology for detecting, extracting, and visualizing spike propagation and demonstrate its potential utility as a biomarker for the EZ. Eighteen presurgical intracranial EEG recordings were obtained from pediatric patients ultimately experiencing favorable (i.e., seizure-free, n = 9) or unfavorable (i.e., seizure-persistent, n = 9) surgical outcomes. Novel algorithms were applied to extract multichannel spike discharges and visualize their spatiotemporal propagation. Quantitative analysis of spike propagation was performed using trajectory clustering and spatial autocorrelation techniques. Comparison of interictal propagation patterns revealed an increase in trajectory organization (i.e., spatial autocorrelation) among Sz-Free patients compared with Sz-Persist patients. The pathophysiological basis and clinical implications of these findings are considered.
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Affiliation(s)
- Samuel B Tomlinson
- Department of Pediatrics, Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Camilo Bermudez
- Department of Pediatrics, Division of Child Neurology, Children's Hospital of Philadelphia , Philadelphia, PA , USA
| | - Chiara Conley
- Department of Pediatrics, Division of Child Neurology, Children's Hospital of Philadelphia , Philadelphia, PA , USA
| | - Merritt W Brown
- Department of Pediatrics, Division of Child Neurology, Children's Hospital of Philadelphia , Philadelphia, PA , USA
| | - Brenda E Porter
- Department of Neurology and Neurological Science, Stanford School of Medicine , Palo Alto, CA , USA
| | - Eric D Marsh
- Department of Pediatrics, Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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31
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Tomlinson SB, Venkataraman A. Secondary generalization of focal-onset seizures: examining the relationship between seizure propagation and epilepsy surgery outcome. J Neurophysiol 2016; 117:1426-1430. [PMID: 27707815 DOI: 10.1152/jn.00739.2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/03/2016] [Indexed: 11/22/2022] Open
Abstract
Surgical intervention often fails to achieve seizure-free results in patients with intractable epilepsy. Identifying features of the epileptic brain that dispose certain patients to unfavorable outcomes is critical for improving surgical candidacy assessments. Recent research by Martinet, Ahmad, Lepage, Cash, and Kramer (J Neurosci 35: 9477-9490, 2015) suggests that pathways of secondary seizure generalization distinguish patients with favorable (i.e., seizure free) vs. unfavorable (i.e., seizure persistent) surgical outcomes, lending insights into the network mechanisms of epilepsy surgery failure.
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Affiliation(s)
- Samuel B Tomlinson
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Arun Venkataraman
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
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32
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Kannan L, Vogrin S, Bailey C, Maixner W, Harvey AS. Centre of epileptogenic tubers generate and propagate seizures in tuberous sclerosis. Brain 2016; 139:2653-2667. [DOI: 10.1093/brain/aww192] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2025] Open
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33
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Dlugos D, Worrell G, Davis K, Stacey W, Szaflarski J, Kanner A, Sunderam S, Rogawski M, Jackson-Ayotunde P, Loddenkemper T, Diehl B, Fureman B, Dingledine R. 2014 Epilepsy Benchmarks Area III: Improve Treatment Options for Controlling Seizures and Epilepsy-Related Conditions Without Side Effects. Epilepsy Curr 2016; 16:192-7. [PMID: 27330452 PMCID: PMC4913858 DOI: 10.5698/1535-7511-16.3.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Dennis Dlugos
- Professor of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Greg Worrell
- Associate Professor of Neurology, Mayo Systems Electrophysiology Laboratory, Departments of Neurology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Kathryn Davis
- Assistant Professor, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - William Stacey
- Assistant Professor of Neurology, Department of Neurology, Department of Biomedical Engineering, University of Michigan
| | - Jerzy Szaflarski
- Professor, Department of Neurology, University of Alabama at Birmingham Department of Neurology and UAB Epilepsy Center, Birmingham, AL
| | - Andres Kanner
- Profressor of Clinical Neurology, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
| | - Sridhar Sunderam
- Assistant Professor, Department of Biomedical Engineering, University of Kentucky, Lexington, KY
| | - Mike Rogawski
- Professor, Center for Neurotherapeutics Discovery and Development and Department of Neurology, UC Davis School of Medicine, Sacramento, CA
| | - Patrice Jackson-Ayotunde
- Associate Professor, Department of Pharmaceutical Sciences, University of Maryland Eastern Shore, Princess Anne, MD
| | - Tobias Loddenkemper
- Associate Professor, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Beate Diehl
- Clinical Neurophysiologist and Neurologist, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - Brandy Fureman
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Ray Dingledine
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta, GA
| | - for the Epilepsy Benchmark Stewards
- Professor of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Associate Professor of Neurology, Mayo Systems Electrophysiology Laboratory, Departments of Neurology and Biomedical Engineering, Mayo Clinic, Rochester, MN
- Assistant Professor, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Assistant Professor of Neurology, Department of Neurology, Department of Biomedical Engineering, University of Michigan
- Professor, Department of Neurology, University of Alabama at Birmingham Department of Neurology and UAB Epilepsy Center, Birmingham, AL
- Profressor of Clinical Neurology, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
- Assistant Professor, Department of Biomedical Engineering, University of Kentucky, Lexington, KY
- Professor, Center for Neurotherapeutics Discovery and Development and Department of Neurology, UC Davis School of Medicine, Sacramento, CA
- Associate Professor, Department of Pharmaceutical Sciences, University of Maryland Eastern Shore, Princess Anne, MD
- Associate Professor, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA
- Clinical Neurophysiologist and Neurologist, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta, GA
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