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Andrade Machado R, Meylor J. Cortico-cortical evoked potential and language mapping: A meta-analysis. Epilepsy Behav 2024; 157:109851. [PMID: 38823074 DOI: 10.1016/j.yebeh.2024.109851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/21/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE The purpose of this meta-analysis was to determine the best available evidence for the use of cortico-cortical evoked potential (CCEP) for language mapping. METHODS PubMed/Medline/Google Scholar/Cochrane and Scopus electronic databases were searched for articles using CCEP for language mapping. CCEP data was obtained including the area of the cortex generating CCEP, resection data, and post-resection language outcomes. Inclusion criteria were clinical articles reporting the use of CCEP in language regions of the brain, reporting language outcomes and whether there was final resection of the cortex, studies with more than five patients, and studies in either English or Spanish. Review articles, systematic reviews, meta-analyses, or case series with less than five patients were excluded. RESULTS Seven studies with a total of 59 patients were included in this meta-analysis. The presence of CCEPs from stimulation of Broca's area or posterior perisylvian region in the resection predicts language deficits after surgery. The diagnostic odds ratio shows values greater than 0 perioperatively (0.69-5.82) and after six months (1.38-11), supporting a high likelihood of a language deficit if the presence of CCEPs from stimulation of Broca's area or posterior perisylvian region are included in the resection and vice versa. The True Positive rate varied between 0.38 and 0.87. This effect decreases after six months to 0.61 (0.30-0.86). However, the True Negative rate increased from 0.53 (0.32-0.79) to 0.71 (0.55-0.88). CONCLUSION This meta-analysis supports the utility of CCEP to predict the probability of having long-term language deficits after surgery. .
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Affiliation(s)
| | - Jennifer Meylor
- Medical College of Wisconsin, Department of Neurology, Milwaukee, WI, USA.
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Nix KC, Oh A, Goad BS, Wu W, Lucas MV, Baumer FM. Detection of Language Lateralization Using Spectral Analysis of EEG. J Clin Neurophysiol 2024; 41:334-343. [PMID: 38710040 PMCID: PMC11076005 DOI: 10.1097/wnp.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
PURPOSE Language lateralization relies on expensive equipment and can be difficult to tolerate. We assessed if lateralized brain responses to a language task can be detected with spectral analysis of electroencephalography (EEG). METHODS Twenty right-handed, neurotypical adults (28 ± 10 years; five males) performed a verb generation task and two control tasks (word listening and repetition). We measured changes in EEG activity elicited by tasks (the event-related spectral perturbation [ERSP]) in the theta, alpha, beta, and gamma frequency bands in two language (superior temporal and inferior frontal [ST and IF]) and one control (occipital [Occ]) region bilaterally. We tested whether language tasks elicited (1) changes in spectral power from baseline (significant ERSP) at any region or (2) asymmetric ERSPs between matched left and right regions. RESULTS Left IF beta power (-0.37±0.53, t = -3.12, P = 0.006) and gamma power in all regions decreased during verb generation. Asymmetric ERSPs (right > left) occurred between the (1) IF regions in the beta band (right vs. left difference of 0.23±0.37, t(19) = -2.80, P = 0.0114) and (2) ST regions in the alpha band (right vs. left difference of 0.48±0.63, t(19) = -3.36, P = 0.003). No changes from baseline or hemispheric asymmetries were noted in language regions during control tasks. On the individual level, 16 (80%) participants showed decreased left IF beta power from baseline, and 16 showed ST alpha asymmetry. Eighteen participants (90%) showed one of these two findings. CONCLUSIONS Spectral EEG analysis detects lateralized responses during language tasks in frontal and temporal regions. Spectral EEG analysis could be developed into a readily available language lateralization modality.
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Affiliation(s)
- Kerry C Nix
- Department of Neurology, Stanford University School of Medicine, Palo Alto, California, U.S.A
- Wu Tsai Neurosciences Institute, Stanford, California, U.S.A.; and
| | - Ahyuda Oh
- Department of Neurology, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Beattie S Goad
- Department of Neurology, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Wei Wu
- Wu Tsai Neurosciences Institute, Stanford, California, U.S.A.; and
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Molly V Lucas
- Wu Tsai Neurosciences Institute, Stanford, California, U.S.A.; and
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Fiona M Baumer
- Department of Neurology, Stanford University School of Medicine, Palo Alto, California, U.S.A
- Wu Tsai Neurosciences Institute, Stanford, California, U.S.A.; and
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Seidel K, Wermelinger J, Alvarez-Abut P, Deletis V, Raabe A, Zhang D, Schucht P. Cortico-cortical evoked potentials of language tracts in minimally invasive glioma surgery guided by Penfield stimulation. Clin Neurophysiol 2024; 161:256-267. [PMID: 38521679 DOI: 10.1016/j.clinph.2023.12.136] [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: 08/10/2023] [Revised: 11/19/2023] [Accepted: 12/23/2023] [Indexed: 03/25/2024]
Abstract
OBJECTIVE We investigated the feasibility of recording cortico-cortical evoked potentials (CCEPs) in patients with low- and high-grade glioma. We compared CCEPs during awake and asleep surgery, as well as those stimulated from the functional Broca area and recorded from the functional Wernicke area (BtW), and vice versa (WtB). We also analyzed CCEP properties according to tumor location, histopathology, and aphasia. METHODS We included 20 patients who underwent minimally invasive surgery in an asleep-awake-asleep setting. Strip electrode placement was guided by classical Penfield stimulation of positive language sites and fiber tracking of the arcuate fascicle. CCEPs were elicited with alternating monophasic single pulses of 1.1 Hz frequency and recorded as averaged signals. Intraoperatively, there was no post-processing of the signal. RESULTS Ninety-seven CCEPs from 19 patients were analyzed. There was no significant difference in CCEP properties when comparing awake versus asleep, nor BtW versus WtB. CCEP amplitude and latency were affected by tumor location and histopathology. CCEP features after tumor resection correlated with short- and long-term postoperative aphasia. CONCLUSION CCEP recordings are feasible during minimally invasive surgery. CCEPs might be surrogate markers for altered connectivity of the language tracts. SIGNIFICANCE This study may guide the incorporation of CCEPs into intraoperative neurophysiological monitoring.
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Affiliation(s)
- Kathleen Seidel
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Jonathan Wermelinger
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pablo Alvarez-Abut
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vedran Deletis
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia; Albert Einstein College of Medicine, New York, NY, USA
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Zhang
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philippe Schucht
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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van den Boom MA, Gregg NM, Valencia GO, Lundstrom BN, Miller KJ, van Blooijs D, Huiskamp GJ, Leijten FS, Worrell GA, Hermes D. ER-detect: a pipeline for robust detection of early evoked responses in BIDS-iEEG electrical stimulation data. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.09.574915. [PMID: 38260687 PMCID: PMC10802406 DOI: 10.1101/2024.01.09.574915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Human brain connectivity can be measured in different ways. Intracranial EEG (iEEG) measurements during single pulse electrical stimulation provide a unique way to assess the spread of electrical information with millisecond precision. To provide a robust workflow to process these cortico-cortical evoked potential (CCEP) data and detect early evoked responses in a fully automated and reproducible fashion, we developed Early Response (ER)-detect. ER-detect is an open-source Python package and Docker application to preprocess BIDS structured iEEG data and detect early evoked CCEP responses. ER-detect can use three response detection methods, which were validated against 14-manually annotated CCEP datasets from two different sites by four independent raters. Results showed that ER-detect's automated detection performed on par with the inter-rater reliability (Cohen's Kappa of ~0.6). Moreover, ER-detect was optimized for processing large CCEP datasets, to be used in conjunction with other connectomic investigations. ER-detect provides a highly efficient standardized workflow such that iEEG-BIDS data can be processed in a consistent manner and enhance the reproducibility of CCEP based connectivity results.
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Affiliation(s)
- Max A. van den Boom
- Department of Physiology and Biomedical Engineering, Mayo Clinic; Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic; Rochester, MN, USA
| | | | | | | | - Kai J. Miller
- Department of Neurosurgery, Mayo Clinic; Rochester, MN, USA
| | - Dorien van Blooijs
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht; Utrecht, NL
- Stichting Epilepsie Instellingen Nederland (SEIN); Zwolle, The Netherlands
| | - Geertjan J.M. Huiskamp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht; Utrecht, NL
| | - Frans S.S. Leijten
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht; Utrecht, NL
| | - Gregory A. Worrell
- Department of Physiology and Biomedical Engineering, Mayo Clinic; Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN; USA
| | - Dora Hermes
- Department of Physiology and Biomedical Engineering, Mayo Clinic; Rochester, MN, USA
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Gruenwald J, Sieghartsleitner S, Kapeller C, Scharinger J, Kamada K, Brunner P, Guger C. Characterization of High-Gamma Activity in Electrocorticographic Signals. Front Neurosci 2023; 17:1206120. [PMID: 37609450 PMCID: PMC10440607 DOI: 10.3389/fnins.2023.1206120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction Electrocorticographic (ECoG) high-gamma activity (HGA) is a widely recognized and robust neural correlate of cognition and behavior. However, fundamental signal properties of HGA, such as the high-gamma frequency band or temporal dynamics of HGA, have never been systematically characterized. As a result, HGA estimators are often poorly adjusted, such that they miss valuable physiological information. Methods To address these issues, we conducted a thorough qualitative and quantitative characterization of HGA in ECoG signals. Our study is based on ECoG signals recorded from 18 epilepsy patients while performing motor control, listening, and visual perception tasks. In this study, we first categorize HGA into HGA types based on the cognitive/behavioral task. For each HGA type, we then systematically quantify three fundamental signal properties of HGA: the high-gamma frequency band, the HGA bandwidth, and the temporal dynamics of HGA. Results The high-gamma frequency band strongly varies across subjects and across cognitive/behavioral tasks. In addition, HGA time courses have lowpass character, with transients limited to 10 Hz. The task-related rise time and duration of these HGA time courses depend on the individual subject and cognitive/behavioral task. Task-related HGA amplitudes are comparable across the investigated tasks. Discussion This study is of high practical relevance because it provides a systematic basis for optimizing experiment design, ECoG acquisition and processing, and HGA estimation. Our results reveal previously unknown characteristics of HGA, the physiological principles of which need to be investigated in further studies.
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Affiliation(s)
- Johannes Gruenwald
- g.tec medical engineering GmbH, Schiedlberg, Austria
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | - Sebastian Sieghartsleitner
- g.tec medical engineering GmbH, Schiedlberg, Austria
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | | | - Josef Scharinger
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | - Kyousuke Kamada
- Department for Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
- Hokashin Group Megumino Hospital, Sapporo, Japan
| | - Peter Brunner
- National Center for Adaptive Neurotechnologies, Albany, NY, United States
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States
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Collée E, Vincent A, Dirven C, Satoer D. Speech and Language Errors during Awake Brain Surgery and Postoperative Language Outcome in Glioma Patients: A Systematic Review. Cancers (Basel) 2022; 14:cancers14215466. [PMID: 36358884 PMCID: PMC9658495 DOI: 10.3390/cancers14215466] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
Awake craniotomy with direct electrical stimulation (DES) is the standard treatment for patients with gliomas in eloquent areas. Even though language is monitored carefully during surgery, many patients suffer from postoperative aphasia, with negative effects on their quality of life. Some perioperative factors are reported to influence postoperative language outcome. However, the influence of different intraoperative speech and language errors on language outcome is not clear. Therefore, we investigate this relation. A systematic search was performed in which 81 studies were included, reporting speech and language errors during awake craniotomy with DES and postoperative language outcomes in adult glioma patients up until 6 July 2020. The frequencies of intraoperative errors and language status were calculated. Binary logistic regressions were performed. Preoperative language deficits were a significant predictor for postoperative acute (OR = 3.42, p < 0.001) and short-term (OR = 1.95, p = 0.007) language deficits. Intraoperative anomia (OR = 2.09, p = 0.015) and intraoperative production errors (e.g., dysarthria or stuttering; OR = 2.06, p = 0.016) were significant predictors for postoperative acute language deficits. Postoperatively, the language deficits that occurred most often were production deficits and spontaneous speech deficits. To conclude, during surgery, intraoperative anomia and production errors should carry particular weight during decision-making concerning the optimal onco-functional balance for a given patient, and spontaneous speech should be monitored. Further prognostic research could facilitate intraoperative decision-making, leading to fewer or less severe postoperative language deficits and improvement of quality of life.
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Herta J, Winter F, Pataraia E, Feucht M, Czech T, Porsche B, Leiss U, Slavc I, Peyrl A, Kasprian G, Rössler K, Dorfer C. Awake brain surgery for language mapping in pediatric patients: a single-center experience. J Neurosurg Pediatr 2022:1-11. [PMID: 35276657 DOI: 10.3171/2022.1.peds21569] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the feasibility, benefit, and safety of awake brain surgery (ABS) and intraoperative language mapping in children and adolescents with structural epilepsies. Whereas ABS is an established method to monitor language function in adults intraoperatively, reports of ABS in children are scarce. METHODS A retrospective chart review of pediatric patients ≤ 18 years of age who underwent ABS and cortical language mapping for supratentorial tumors and nontumoral epileptogenic lesions between 2008 and 2019 was conducted. The authors evaluated the global intellectual and specific language performance by using detailed neuropsychological testing, the patient's intraoperative compliance, results of intraoperative language mapping assisted by electrocorticography (ECoG), and postsurgical language development and seizure outcomes. Descriptive statistics were used for this study, with a statistical significance of p < 0.05. RESULTS Eleven children (7 boys) with a median age of 13 years (range 10-18 years) underwent ABS for a lesion in close vicinity to cortical language areas as defined by structural and functional MRI (left hemisphere in 9 children, right hemisphere in 2). Patients were neurologically intact but experiencing seizures; these were refractory to therapy in 9 patients. Compliance during the awake phase was high in 10 patients and low in 1 patient. Cortical mapping identified eloquent language areas in 6/10 (60%) patients and was concordant in 3/8 (37.5%), discordant in 3/8 (37.5%), and unclear in 2/8 (25%) patients compared to preoperative functional MRI. Stimulation-induced seizures occurred in 2 patients and could be interrupted easily. ECoG revealed that afterdischarge potentials (ADP) were involved in 5/9 (56%) patients with speech disturbances during stimulation. None of these patients harbored postoperative language dysfunction. Gross-total resection was achieved in 10/11 (91%) patients, and all were seizure free after a median follow-up of 4.3 years. Neuropsychological testing using the Wechsler Intelligence Scale for Children and the verbal learning and memory test showed an overall nonsignificant trend toward an immediate postoperative deterioration followed by an improvement to above preoperative levels after 1 year. CONCLUSIONS ABS is a valuable technique in selected pediatric patients with lesions in language areas. An interdisciplinary approach, careful patient selection, extensive preoperative training of patients, and interpretation of intraoperative ADP are pivotal to a successful surgery.
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Titov O, Bykanov A, Pitskhelauri D, Danilov G. Neuromonitoring of the language pathways using cortico-cortical evoked potentials: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:1883-1894. [PMID: 35031897 DOI: 10.1007/s10143-021-01718-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
Cortico-cortical evoked potentials (CCEPs) are a surge in activity of one cortical zone caused by stimulation of another cortical zone. Recording of CCEP may be a useful method of intraoperative monitoring of the brain pathways, particularly of the language-related tracts. We aimed to conduct a systematic review and meta-analysis, dedicated to the clinical question: Does the CCEP recording effectively predict the postoperative speech deficits in neurosurgical patients? We conducted language-restricted PubMed, Google Scholar, Scopus, and Cochrane database search for eligible studies of CCEP published until March 2021. There were 4 articles (3 case series and 1 case report), which met our inclusion/exclusion criteria. A total of 32 patients (30 cases of tumors and 2 cavernomas) included in the analysis were divided into two cohorts - quantitative and qualitative, in accordance with the method of evaluating changes in the amplitude of CCEP after the lesion resection and postoperative alterations in speech function. Quantitative variables were studied using the Spearman rank correlation coefficient. Categorical variables were compared in groups by Fisher's exact test. We found a strong positive correlation between the decrease in the N1 wave amplitude and the severity of postoperative speech deficits (quantitative cohort: r = 0.57, p = 0.01; qualitative cohort: p = 0.02). Thus, the CCEP method using the N1 wave amplitude as a marker enables to effectively predict postoperative speech outcomes. Nevertheless, the low level of evidence for the included works indicated the necessity for additional research on this issue.
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Affiliation(s)
- Oleg Titov
- Burdenko Neurosurgery Center, Moscow, Russia. .,OPEN BRAIN - Neurosurgical Laboratory of Open Access, Moscow, Russia.
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9
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Kanaya K, Mitsuhashi T, Kiuchi T, Kobayashi S. The Efficacy of Intraoperative Passive Language Mapping for Glioma Surgery: A Case Report. Front Neurol 2021; 12:652401. [PMID: 34408717 PMCID: PMC8364957 DOI: 10.3389/fneur.2021.652401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Recently, electrocorticographic (ECoG) studies have emphasized the importance of gamma band-based functional mapping in the presurgical localization of the eloquent cortex. Passive functional mapping using ECoG signals provides a reliable method for identifying receptive language areas without many of the risks and limitations associated with electrical cortical stimulation. We report a surgical case of left temporal malignant glioma with intraoperative passive language mapping. Case Description: A 78-year-old woman was diagnosed with left temporal glioma with inspection of her language difficulty. MRI showed a left temporal tumor measuring 74.6 × 50.0 × 51.5 mm in size. Real-time CortiQ-based mapping using high-gamma activity by word-listening and story-listening tasks was performed. Significant listening task-evoked high gamma activities were detected in 5 channels in the superior temporal gyrus and one channel in the middle temporal gyrus. The tumor was grossly removed except for the region corresponding to listening task-evoked high gamma activities. Postoperatively, the patient's symptoms of language comprehension difficulty improved, and no new neurological deficits were observed. Conclusion: Intraoperative passive language mapping was successfully performed, and the patient's language function was well-preserved. Intraoperative passive language mapping, which is applicable in a short time and under general anesthesia, can be an important tool for detecting language areas.
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Affiliation(s)
- Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Neurosurgery, Iida Municipal Hospital, Nagano, Japan
| | | | - Takafumi Kiuchi
- Department of Neurosurgery, Iida Municipal Hospital, Nagano, Japan
| | - Sumio Kobayashi
- Department of Neurosurgery, Iida Municipal Hospital, Nagano, Japan
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Sun K, Wang H, Bai Y, Zhou W, Wang L. MRIES: A Matlab Toolbox for Mapping the Responses to Intracranial Electrical Stimulation. Front Neurosci 2021; 15:652841. [PMID: 34194294 PMCID: PMC8236813 DOI: 10.3389/fnins.2021.652841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
Propose Directed cortical responses to intracranial electrical stimulation are a good standard for mapping inter-regional direct connectivity. Cortico-cortical evoked potential (CCEP), elicited by single pulse electrical stimulation (SPES), has been widely used to map the normal and abnormal brain effective network. However, automated processing of CCEP datasets and visualization of connectivity results remain challenging for researchers and clinicians. In this study, we develop a Matlab toolbox named MRIES (Mapping the Responses to Intracranial Electrical Stimulation) to automatically process CCEP data and visualize the connectivity results. Method The MRIES integrates the processing pipeline of the CCEP datasets and various methods for connectivity calculation based on low- and high-frequency signals with stimulation artifacts removed. The connectivity matrices are saved in different folders for visualization. Different visualization patterns (connectivity matrix, circle map, surface map, and volume map) are also integrated to the graphical user interface (GUI), which makes it easy to intuitively display and compare different connectivity measurements. Furthermore, one sample CCEP data set collected from eight epilepsy patients is used to validate the MRIES toolbox. Result We show the GUI and visualization functions of MRIES using one example CCEP data that has been described in a complete tutorial. We applied this toolbox to the sample CCEP data set to investigate the direct connectivity between the medial temporal lobe and the insular cortex. We find bidirectional connectivity between MTL and insular that are consistent with the findings of previous studies. Conclusion MRIES has a friendly GUI and integrates the full processing pipeline of CCEP data and various visualization methods. The MRIES toolbox, tutorial, and example data can be freely downloaded. As an open-source package, MRIES is expected to improve the reproducibility of CCEP findings and facilitate clinical translation.
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Affiliation(s)
- Kaijia Sun
- School of Systems Science, Beijing Normal University, Beijing, China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Haixiang Wang
- Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing, China
| | - Yunxian Bai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Wenjing Zhou
- Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing, China
| | - Liang Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Yamao Y, Matsumoto R, Kunieda T, Nakae T, Nishida S, Inano R, Shibata S, Kikuchi T, Arakawa Y, Yoshida K, Ikeda A, Miyamoto S. Effects of propofol on cortico-cortical evoked potentials in the dorsal language white matter pathway. Clin Neurophysiol 2021; 132:1919-1926. [PMID: 34182277 DOI: 10.1016/j.clinph.2021.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/22/2021] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In order to evaluate the clinical utility even under general anesthesia, the present study aimed to clarify the effect of anesthesia on the cortico-cortical evoked potentials (CCEPs). METHODS We analyzed 14 patients' data in monitoring the integrity of the dorsal language pathway by using CCEPs both under general anesthesia with propofol and remifentanil and awake condition, with the main aim of clarifying the effect of anesthesia on the distribution and waveform of CCEPs. RESULTS The distribution of larger CCEP response sites, including the locus of the maximum CCEP response site, was marginally affected by anesthesia. With regard to similarity of waveforms, the mean waveform correlation coefficient indicated a strong agreement. CCEP N1 amplitude increased by an average of 25.8% from general anesthesia to waking, except three patients. CCEP N1 latencies had no correlation in changes between the two conditions. CONCLUSIONS We demonstrated that the distribution of larger CCEP responses was marginally affected by anesthesia and that the CCEP N1 amplitude had tendency to increase from general anesthesia to the awake condition. SIGNIFICANCE The CCEP method provides the efficiency of intraoperative monitoring for dorsal language white matter pathway even under general anesthesia.
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Affiliation(s)
- Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Takeharu Kunieda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takuro Nakae
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sei Nishida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Rika Inano
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sumiya Shibata
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Ikeda
- Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Erez Y, Assem M, Coelho P, Romero-Garcia R, Owen M, McDonald A, Woodberry E, Morris RC, Price SJ, Suckling J, Duncan J, Hart MG, Santarius T. Intraoperative mapping of executive function using electrocorticography for patients with low-grade gliomas. Acta Neurochir (Wien) 2021; 163:1299-1309. [PMID: 33222010 PMCID: PMC8053659 DOI: 10.1007/s00701-020-04646-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/09/2020] [Indexed: 01/03/2023]
Abstract
Background Intraoperative functional mapping with direct electrical stimulation during awake surgery for patients with diffuse low-grade glioma has been used in recent years to optimize the balance between surgical resection and quality of life following surgery. Mapping of executive functions is particularly challenging because of their complex nature, with only a handful of reports published so far. Here, we propose the recording of neural activity directly from the surface of the brain using electrocorticography to map executive functions and demonstrate its feasibility and potential utility. Methods To track a neural signature of executive function, we recorded neural activity using electrocorticography during awake surgery from the frontal cortex of three patients judged to have an appearance of diffuse low-grade glioma. Based on existing functional magnetic resonance imaging (fMRI) evidence from healthy participants for the recruitment of areas associated with executive function with increased task demands, we employed a task difficulty manipulation in two counting tasks performed intraoperatively. Following surgery, the data were extracted and analyzed offline to identify increases in broadband high-gamma power with increased task difficulty, equivalent to fMRI findings, as a signature of activity related to executive function. Results All three patients performed the tasks well. Data were recorded from five electrode strips, resulting in data from 15 channels overall. Eleven out of the 15 channels (73.3%) showed significant increases in high-gamma power with increased task difficulty, 26.6% of the channels (4/15) showed no change in power, and none of the channels showed power decrease. High-gamma power increases with increased task difficulty were more likely in areas that are within the canonical frontoparietal network template. Conclusions These results are the first step toward developing electrocorticography as a tool for mapping of executive function complementarily to direct electrical stimulation to guide resection. Further studies are required to establish this approach for clinical use.
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Wang Y, Hays MA, Coogan C, Kang JY, Flinker A, Arya R, Korzeniewska A, Crone NE. Spatial-Temporal Functional Mapping Combined With Cortico-Cortical Evoked Potentials in Predicting Cortical Stimulation Results. Front Hum Neurosci 2021; 15:661976. [PMID: 33935673 PMCID: PMC8079642 DOI: 10.3389/fnhum.2021.661976] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Functional human brain mapping is commonly performed during invasive monitoring with intracranial electroencephalographic (iEEG) electrodes prior to resective surgery for drug resistant epilepsy. The current gold standard, electrocortical stimulation mapping (ESM), is time consuming, sometimes elicits pain, and often induces after discharges or seizures. Moreover, there is a risk of overestimating eloquent areas due to propagation of the effects of stimulation to a broader network of language cortex. Passive iEEG spatial-temporal functional mapping (STFM) has recently emerged as a potential alternative to ESM. However, investigators have observed less correspondence between STFM and ESM maps of language than between their maps of motor function. We hypothesized that incongruities between ESM and STFM of language function may arise due to propagation of the effects of ESM to cortical areas having strong effective connectivity with the site of stimulation. We evaluated five patients who underwent invasive monitoring for seizure localization, whose language areas were identified using ESM. All patients performed a battery of language tasks during passive iEEG recordings. To estimate the effective connectivity of stimulation sites with a broader network of task-activated cortical sites, we measured cortico-cortical evoked potentials (CCEPs) elicited across all recording sites by single-pulse electrical stimulation at sites where ESM was performed at other times. With the combination of high gamma power as well as CCEPs results, we trained a logistic regression model to predict ESM results at individual electrode pairs. The average accuracy of the classifier using both STFM and CCEPs results combined was 87.7%, significantly higher than the one using STFM alone (71.8%), indicating that the correspondence between STFM and ESM results is greater when effective connectivity between ESM stimulation sites and task-activated sites is taken into consideration. These findings, though based on a small number of subjects to date, provide preliminary support for the hypothesis that incongruities between ESM and STFM may arise in part from propagation of stimulation effects to a broader network of cortical language sites activated by language tasks, and suggest that more studies, with larger numbers of patients, are needed to understand the utility of both mapping techniques in clinical practice.
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Affiliation(s)
- Yujing Wang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mark A Hays
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Christopher Coogan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Adeen Flinker
- Department of Neurology, New York University School of Medicine, New York, NY, United States
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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14
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Ghinda DC, Lambert B, Lu J, Jiang N, Tsai E, Sachs A, Wu JS, Northoff G. Scale-Free Analysis of Intraoperative ECoG During Awake Craniotomy for Glioma. Front Oncol 2021; 10:625474. [PMID: 33708619 PMCID: PMC7942167 DOI: 10.3389/fonc.2020.625474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Electrocorticography (ECoG) has been utilized in many epilepsy cases however, the use of this technique for evaluating electrophysiological changes within tumoral zones is spare. Nonetheless, epileptic activities seem to arise from the neocortex surrounding the gliomas suggesting a link between epileptogenesis and glioma cell infiltration in the peritumoral area. The purpose of this study was to implement novel scale-free measures to assess how cortical physiology is altered by the presence of an invasive brain tumor. METHODS Twelve patients undergoing an awake craniotomy for resection of a supratentorial glioma were included. ECoG data over the main tumor and the exposed surroundings was acquired intra-operatively just prior to tumor resection. Six of the patients presented with seizures and had data acquired both in the awake and anesthetic state. The corresponding anatomical location of each electrode in relation to the macroscopically-detectable tumor was recorded using the neuronavigation system based on structural anatomical images obtained pre-operatively. The electrodes were classified into tumoral, healthy or peritumoral based on the macroscopically detectable tumoral tissue from the pre-operative structural MRI. RESULTS The electrodes overlying the tumoral tissue revealed higher power law exponent (PLE) values across tumoral area compared to the surrounding tissues. The difference between the awake and anesthetic states was significant in the tumoral and healthy tissue (p < 0.05) but not in the peritumoral tissue. The absence of a significant PLE reduction in the peritumoral tissue from the anesthetic to the awake state could be considered as an index of the presence or absence of infiltration of tumor cells into the peritumoral tissue. CONCLUSIONS The current study portrays for the first time distinct power law exponent features in the tumoral tissue, which could provide a potential novel electrophysiological marker in the future. The distinct features seen in the peritumoral tissue of gliomas seem to indicate the area where both the onset of epileptiform activity and the tumor infiltration take place.
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Affiliation(s)
- Diana Cristina Ghinda
- Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Mind, Brain Imaging and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Ben Lambert
- Faculty of Engineering, Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Junfeng Lu
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ning Jiang
- Faculty of Engineering, Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Eve Tsai
- Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Adam Sachs
- Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jin-Song Wu
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
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15
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Yamao Y, Matsumoto R, Kikuchi T, Yoshida K, Kunieda T, Miyamoto S. Intraoperative Brain Mapping by Cortico-Cortical Evoked Potential. Front Hum Neurosci 2021; 15:635453. [PMID: 33679353 PMCID: PMC7930065 DOI: 10.3389/fnhum.2021.635453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 12/04/2022] Open
Abstract
To preserve postoperative brain function, it is important for neurosurgeons to fully understand the brain's structure, vasculature, and function. Intraoperative high-frequency electrical stimulation during awake craniotomy is the gold standard for mapping the function of the cortices and white matter; however, this method can only map the "focal" functions and cannot monitor large-scale cortical networks in real-time. Recently, an in vivo electrophysiological method using cortico-cortical evoked potentials (CCEPs) induced by single-pulse electrical cortical stimulation has been developed in an extraoperative setting. By using the CCEP connectivity pattern intraoperatively, mapping and real-time monitoring of the dorsal language pathway is available. This intraoperative CCEP method also allows for mapping of the frontal aslant tract, another language pathway, and detection of connectivity between the primary and supplementary motor areas in the frontal lobe network. Intraoperative CCEP mapping has also demonstrated connectivity between the frontal and temporal lobes, likely via the ventral language pathway. Establishing intraoperative electrophysiological monitoring is clinically useful for preserving brain function, even under general anesthesia. This CCEP technique demonstrates potential clinical applications for mapping and monitoring large-scale cortical networks.
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Affiliation(s)
- Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayuki Kikuchi
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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16
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Bykanov AE, Pitskhelauri DI, Titov OY, Lin MC, Gulaev EV, Ogurtsova AA, Maryashev SA, Zhukov VY, Buklina SB, Lubnin AY, Beshplav ST, Konakova TA, Pronin IN. [Broca's area intraoperative mapping with cortico-cortical evoked potentials]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:49-58. [PMID: 33306299 DOI: 10.17116/neiro20208406149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Mapping of effective speech connections between the frontal and temporal lobes with cortico-cortical evoked potentials. MATERIAL AND METHODS There were 3 patients with brain tumors in the left frontoparietal region. The neoplasms were localized in the dominant hemisphere near cortical speech centers and pathways. Cortico-cortical evoked potentials were intraoperatively recorded in response to bipolar stimulation with a direct current delivered through the subdural electrodes (single rectangular biphasic impulses with duration of 300 μs and frequency of 1 Hz). Stimulation intensity was gradually increased from 2 mA within 3-4 mA. Registration was carried out by averaging ECoG (30-50 stimuli in each session) in the 300-ms epoch after stimulus. Direct cortical stimulation was used to validate the results of cortico-cortical speech mapping with cortico-cortical evoked potentials. RESULTS In our cases, we obtained cortico-cortical evoked potentials from inferior frontal gyrus after stimulation of superior temporal gyrus. In one case, this effective relationship was unidirectional, in the other two patients reciprocal. Mean latency of N1 peak was 65 ms (range 49.6-90 ms), mean amplitude 71 µV (range 50-100 µV). Cortico-cortical mapping data were confirmed by detection of Broca's area in 2 out of 3 cases out during direct cortical stimulation with maximum amplitude of N1 wave. «Awake craniotomy» protocol was applied. In one case, Broca's area was not detected during direct stimulation. No postoperative speech impairment was noted. CONCLUSION Initial results of cortical mapping with cortico-cortical evoked potentials in a small sample confirmed its practical significance for analysis of cortical projections of effective speech communications between the frontal and temporal lobes. Further study of this method in large samples is required.
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Affiliation(s)
- A E Bykanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - O Yu Titov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - E V Gulaev
- Ivanovo Regional Hospital, Ivanovo, Russia
| | | | | | - V Yu Zhukov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - S B Buklina
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A Yu Lubnin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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17
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Roland JL, Hacker CD, Leuthardt EC. A Review of Passive Brain Mapping Techniques in Neurological Surgery. Neurosurgery 2020; 88:15-24. [DOI: 10.1093/neuros/nyaa361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/15/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
Brain mapping is a quintessential part of neurosurgical practice. Accordingly, much of our understanding of the brain's functional organization, and in particular the motor homunculus, is largely attributable to the clinical investigations of past neurosurgeons. Traditionally mapping was invasive and involved the application of electrical current to the exposed brain to observe focal disruption of function or to elicit overt actions. More recently, a wide variety of techniques have been developed that do not require electrical stimulation and often do not require any explicit participation by the subject. Collectively we refer to these as passive mapping modalities. Here we review the spectrum of passive mapping used by neurosurgeons for mapping and surgical planning that ranges from invasive intracranial recordings to noninvasive imaging as well as regimented task-based protocols to completely task-free paradigms that can be performed intraoperatively while under anesthesia.
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Affiliation(s)
- Jarod L Roland
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Carl D Hacker
- Department of Neurological Surgery, Washington University in St Louis, St Louis, Missouri
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University in St Louis, St Louis, Missouri
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18
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Ervin B, Buroker J, Rozhkov L, Holloway T, Horn PS, Scholle C, Byars AW, Mangano FT, Leach JL, Greiner HM, Holland KD, Arya R. High-gamma modulation language mapping with stereo-EEG: A novel analytic approach and diagnostic validation. Clin Neurophysiol 2020; 131:2851-2860. [PMID: 33137575 DOI: 10.1016/j.clinph.2020.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A novel analytic approach for task-related high-gamma modulation (HGM) in stereo-electroencephalography (SEEG) was developed and evaluated for language mapping. METHODS SEEG signals, acquired from drug-resistant epilepsy patients during a visual naming task, were analyzed to find clusters of 50-150 Hz power modulations in time-frequency domain. Classifier models to identify electrode contacts within the reference neuroanatomy and electrical stimulation mapping (ESM) speech/language sites were developed and validated. RESULTS In 21 patients (9 females), aged 4.8-21.2 years, SEEG HGM model predicted electrode locations within Neurosynth language parcels with high diagnostic odds ratio (DOR 10.9, p < 0.0001), high specificity (0.85), and fair sensitivity (0.66). Another SEEG HGM model classified ESM speech/language sites with significant DOR (5.0, p < 0.0001), high specificity (0.74), but insufficient sensitivity. Time to largest power change reliably localized electrodes within Neurosynth language parcels, while, time to center-of-mass power change identified ESM sites. CONCLUSIONS SEEG HGM mapping can accurately localize neuroanatomic and ESM language sites. SIGNIFICANCE Predictive modelling incorporating time, frequency, and magnitude of power change is a useful methodology for task-related HGM, which offers insights into discrepancies between HGM language maps and neuroanatomy or ESM.
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Affiliation(s)
- Brian Ervin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, OH, USA
| | - Jason Buroker
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Timothy Holloway
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Craig Scholle
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francesco T Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Division of Pediatric Neuro-radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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ReFaey K, Chaichana KL, Feyissa AM, Vivas-Buitrago T, Brinkmann BH, Middlebrooks EH, McKay JH, Lankford DJ, Tripathi S, Bojaxhi E, Roth GE, Tatum WO, Quiñones-Hinojosa A. A 360° electronic device for recording high-resolution intraoperative electrocorticography of the brain during awake craniotomy. J Neurosurg 2020; 133:443-450. [PMID: 31277069 DOI: 10.3171/2019.4.jns19261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy is common among patients with supratentorial brain tumors; approximately 40%-70% of patients with glioma develop brain tumor-related epilepsy (BTRE). Intraoperative localization of the epileptogenic zone during surgical tumor resection (real-time data) may improve intervention techniques in patients with lesional epilepsy, including BTRE. Accurate localization of the epileptogenic signals requires electrodes with high-density spatial organization that must be placed on the cortical surface during surgery. The authors investigated a 360° high-density ring-shaped cortical electrode assembly device, called the "circular grid," that allows for simultaneous tumor resection and real-time electrophysiology data recording from the brain surface. METHODS The authors collected data from 99 patients who underwent awake craniotomy from January 2008 to December 2018 (29 patients with the circular grid and 70 patients with strip electrodes), of whom 50 patients were matched-pair analyzed (25 patients with the circular grid and 25 patients with strip electrodes). Multiple variables were then retrospectively assessed to determine if utilization of this device provides more accurate real-time data and improves patient outcomes. RESULTS Matched-pair analysis showed higher extent of resection (p = 0.03) and a shorter transient motor recovery period during the hospitalization course (by approximately 6.6 days, p ≤ 0.05) in the circular grid patients. Postoperative versus preoperative Karnofsky Performance Scale (KPS) score difference/drop was greater for the strip electrode patients (p = 0.007). No significant difference in postoperative seizures between the 2 groups was present (p = 0.80). CONCLUSIONS The circular grid is a safe, feasible tool that grants direct access to the cortical surgical surface for tissue resection while simultaneously monitoring electrical activity. Application of the circular grid to different brain pathologies may improve intraoperative epileptogenic detection accuracy and functional outcomes, while decreasing postoperative complications.
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Affiliation(s)
| | | | | | | | - Benjamin H Brinkmann
- Departments of3Neurology and
- 4Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Shashwat Tripathi
- 6Department of Mathematics, University of Texas at Austin, Austin, Texas; and
| | - Elird Bojaxhi
- 7Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida
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Silverstein BH, Asano E, Sugiura A, Sonoda M, Lee MH, Jeong JW. Dynamic tractography: Integrating cortico-cortical evoked potentials and diffusion imaging. Neuroimage 2020; 215:116763. [PMID: 32294537 DOI: 10.1016/j.neuroimage.2020.116763] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/02/2020] [Accepted: 03/17/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Cortico-cortical evoked potentials (CCEPs) are utilized to identify effective networks in the human brain. Following single-pulse electrical stimulation of cortical electrodes, evoked responses are recorded from distant cortical areas. A negative deflection (N1) which occurs 10-50 ms post-stimulus is considered to be a marker for direct cortico-cortical connectivity. However, with CCEPs alone it is not possible to observe the white matter pathways that conduct the signal or accurately predict N1 amplitude and latency at downstream recoding sites. Here, we develop a new approach, termed "dynamic tractography," which integrates CCEP data with diffusion-weighted imaging (DWI) data collected from the same patients. This innovative method allows greater insights into cortico-cortical networks than provided by each method alone and may improve the understanding of large-scale networks that support cognitive functions. The dynamic tractography model produces several fundamental hypotheses which we investigate: 1) DWI-based pathlength predicts N1 latency; 2) DWI-based pathlength negatively predicts N1 voltage; and 3) fractional anisotropy (FA) along the white matter path predicts N1 propagation velocity. METHODS Twenty-three neurosurgical patients with drug-resistant epilepsy underwent both extraoperative CCEP recordings and preoperative DWI scans. Subdural grids of 3 mm diameter electrodes were used for stimulation and recording, with 98-128 eligible electrodes per patient. CCEPs were elicited by trains of 1 Hz stimuli with an intensity of 5 mA and recorded at a sample rate of 1 kHz. N1 peak and latency were defined as the maximum of a negative deflection within 10-50 ms post-stimulus with a z-score > 5 relative to baseline. Electrodes and DWI were coregistered to construct electrode connectomes for white matter quantification. RESULTS Clinical variables (age, sex, number of anti-epileptic drugs, handedness, and stimulated hemisphere) did not correlate with the key outcome measures (N1 peak amplitude, latency, velocity, or DWI pathlength). All subjects and electrodes were therefore pooled into a group-level analysis to determine overall patterns. As hypothesized, DWI path length positively predicted N1 latency (R2 = 0.81, β = 1.51, p = 4.76e-16) and negatively predicted N1 voltage (R2 = 0.79, β = -0.094, p = 9.30e-15), while FA predicted N1 propagation velocity (R2 = 0.35, β = 48.0, p = 0.001). CONCLUSION We have demonstrated that the strength and timing of the CCEP N1 is dependent on the properties of the underlying white matter network. Integrated CCEP and DWI visualization allows robust localization of intact axonal pathways which effectively interconnect eloquent cortex.
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Affiliation(s)
- Brian H Silverstein
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
| | - Eishi Asano
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA; Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Dept. of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Ayaka Sugiura
- Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Masaki Sonoda
- Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Min-Hee Lee
- Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Translational Imaging Laboratory, Wayne State University, Detroit, MI, USA
| | - Jeong-Won Jeong
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA; Dept. of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Dept. of Neurology, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA; Translational Imaging Laboratory, Wayne State University, Detroit, MI, USA.
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21
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Kamada K, Kapeller C, Takeuchi F, Gruenwald J, Guger C. Tailor-Made Surgery Based on Functional Networks for Intractable Epilepsy. Front Neurol 2020; 11:73. [PMID: 32117032 PMCID: PMC7031351 DOI: 10.3389/fneur.2020.00073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/21/2020] [Indexed: 12/13/2022] Open
Abstract
Normal and pathological networks related to seizure propagation have got attention to elucide complex seizure semiology and contribute to diagnosis and surgical monitoring in epilepsy treatment. Since focal and generalized epileptogenic syndromes abnormalities might involve multiple foci and large-scale networks, we applied electrophysiolpgy (cortco-cortico evoked potential; CCEP), and tractography to make detailed diagnosis for complex syndrome. All 14 epilepsy patients with no or little abnormality on images investigations underwent subdural grid implantation for epilepsy diagnosis. To perform quick network analysis, we recorded and analyzed high gamma activity (HGA) of epileptogenic activity and CCEPs to identify pathological activity distribution and network connectivity. [Results] Pathological CCEPs showed two negative deflections consisting of early (>40 ms) and late (>150 ms) components in electrically stable circumstance at bed side and early CCEPs appeared in 57% of the patients. On the basis of the CCEP findings, tractography detected anatomical connections. Early components of pathological CCEPs diminished after complete disconnection of tractoography-based fibers between the foci in seven of eight cases. One case with residual pathological CCEPs showed poorer outcome. Thirteen (92.8%) patients with or without CCEPs who underwent network surgery had favorable prognosis except for a case with wide traumatic epilepsy. Intraoperative CCEP measurements and HGA mapping enabled visualization of pathological networks and clinical impotence as a biomarker to improve functional prognosis. HGA/CCEP recording should shed light on pathological and complex propagation for epilepsy surgery.
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Affiliation(s)
- Kyousuke Kamada
- Department of Neurosurgery, Megumino Hospital, Eniwa, Japan.,ATR Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Christoph Kapeller
- g.tec Guger Technologies OG/g.tec Medical Engineering GmbH, Schiedlberg, Austria
| | - Fumiya Takeuchi
- Department of Research Promotion Center, Asahikawa Medical University, Asahikawa, Japan
| | - Johannes Gruenwald
- g.tec Guger Technologies OG/g.tec Medical Engineering GmbH, Schiedlberg, Austria
| | - Christoph Guger
- g.tec Guger Technologies OG/g.tec Medical Engineering GmbH, Schiedlberg, Austria
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22
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Beuter A, Balossier A, Vassal F, Hemm S, Volpert V. Cortical stimulation in aphasia following ischemic stroke: toward model-guided electrical neuromodulation. BIOLOGICAL CYBERNETICS 2020; 114:5-21. [PMID: 32020368 DOI: 10.1007/s00422-020-00818-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
The aim of this paper is to integrate different bodies of research including brain traveling waves, brain neuromodulation, neural field modeling and post-stroke language disorders in order to explore the opportunity of implementing model-guided, cortical neuromodulation for the treatment of post-stroke aphasia. Worldwide according to WHO, strokes are the second leading cause of death and the third leading cause of disability. In ischemic stroke, there is not enough blood supply to provide enough oxygen and nutrients to parts of the brain, while in hemorrhagic stroke, there is bleeding within the enclosed cranial cavity. The present paper focuses on ischemic stroke. We first review accumulating observations of traveling waves occurring spontaneously or triggered by external stimuli in healthy subjects as well as in patients with brain disorders. We examine the putative functions of these waves and focus on post-stroke aphasia observed when brain language networks become fragmented and/or partly silent, thus perturbing the progression of traveling waves across perilesional areas. Secondly, we focus on a simplified model based on the current literature in the field and describe cortical traveling wave dynamics and their modulation. This model uses a biophysically realistic integro-differential equation describing spatially distributed and synaptically coupled neural networks producing traveling wave solutions. The model is used to calculate wave parameters (speed, amplitude and/or frequency) and to guide the reconstruction of the perturbed wave. A stimulation term is included in the model to restore wave propagation to a reasonably good level. Thirdly, we examine various issues related to the implementation model-guided neuromodulation in the treatment of post-stroke aphasia given that closed-loop invasive brain stimulation studies have recently produced encouraging results. Finally, we suggest that modulating traveling waves by acting selectively and dynamically across space and time to facilitate wave propagation is a promising therapeutic strategy especially at a time when a new generation of closed-loop cortical stimulation systems is about to arrive on the market.
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Affiliation(s)
- Anne Beuter
- Bordeaux INP, University of Bordeaux, Bordeaux, France.
| | - Anne Balossier
- Service de neurochirurgie fonctionnelle et stéréotaxique, AP-HM La Timone, Aix-Marseille University, Marseille, France
| | - François Vassal
- INSERM U1028 Neuropain, UMR 5292, Centre de Recherche en Neurosciences, Universités Lyon 1 et Saint-Etienne, Saint-Étienne, France
- Service de Neurochirurgie, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Étienne, France
| | - Simone Hemm
- School of Life Sciences, Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts Northwestern Switzerland, 4132, Muttenz, Switzerland
| | - Vitaly Volpert
- Institut Camille Jordan, UMR 5208 CNRS, University Lyon 1, 69622, Villeurbanne, France
- INRIA Team Dracula, INRIA Lyon La Doua, 69603, Villeurbanne, France
- People's Friendship University of Russia (RUDN University), Miklukho-Maklaya St, Moscow, Russian Federation, 117198
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23
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Tatum WO, McKay JH, ReFaey K, Feyissa AM, Ryan D, Ritaccio A, Middlebrooks E, Yelvington K, Roth G, Acton E, Grewal S, Chaichana K, Quinones-Hinojosa A. Detection of after-discharges during intraoperative functional brain mapping in awake brain tumor surgery using a novel high-density circular grid. Clin Neurophysiol 2020; 131:828-835. [PMID: 32066101 DOI: 10.1016/j.clinph.2019.12.416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/21/2019] [Accepted: 12/14/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate intraoperative use of a novel high-density circular grid in detecting after-discharges (AD) on electrocorticography (ECoG) during functional brain mapping (FBM). METHODS FBM during glioma surgery (10/2016 to 5/2019) recorded ADs using a 22-channel circular grid compared to conventional strip electrodes. ADs were analyzed for detection, duration, amplitude, morphology, histology, direction, and clinical signs. RESULTS Thirty-two patients (mean age 54.2 years; r = 30-75) with glioma (WHO grade II-IV; 20 grade IV) had surgery. ADs during FBM were more likely in patients with wild-type as opposed to IDH-1 mutants (p < 0.0001) using more contacts compared with linear strip electrodes (p = 0.0001). More sensors tended to be involved in ADs detected by the circular grid vs strips (6.61 vs 3.43; p = 0.16) at lower stimulus intensity (3.14 mA vs 4.13 mA; p = 0.09). No difference in the number of cortical stimulations before resection was present (38.9 mA vs 47.9 mA; p = 0.26). ADs longer than 10 seconds were 32.5 seconds (circular grid) vs 58.4 (strips) (p = 0.12). CONCLUSIONS High-density circular grids detect ADs in 360 degrees during FBM for glioma resection. Provocation of ADs was more likely in patients with wild-type than IDH-1 mutation. SIGNIFICANCE Circular grids offer high-resolution ECoG during intraoperative FBM for detection of ADs.
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Affiliation(s)
- William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
| | - Jake H McKay
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Dan Ryan
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Kirsten Yelvington
- Department of Clinical Neurophysiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Emily Acton
- University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjeet Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
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24
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Huggins JE, Guger C, Aarnoutse E, Allison B, Anderson CW, Bedrick S, Besio W, Chavarriaga R, Collinger JL, Do AH, Herff C, Hohmann M, Kinsella M, Lee K, Lotte F, Müller-Putz G, Nijholt A, Pels E, Peters B, Putze F, Rupp R, Schalk G, Scott S, Tangermann M, Tubig P, Zander T. Workshops of the Seventh International Brain-Computer Interface Meeting: Not Getting Lost in Translation. BRAIN-COMPUTER INTERFACES 2019; 6:71-101. [PMID: 33033729 PMCID: PMC7539697 DOI: 10.1080/2326263x.2019.1697163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022]
Abstract
The Seventh International Brain-Computer Interface (BCI) Meeting was held May 21-25th, 2018 at the Asilomar Conference Grounds, Pacific Grove, California, United States. The interactive nature of this conference was embodied by 25 workshops covering topics in BCI (also called brain-machine interface) research. Workshops covered foundational topics such as hardware development and signal analysis algorithms, new and imaginative topics such as BCI for virtual reality and multi-brain BCIs, and translational topics such as clinical applications and ethical assumptions of BCI development. BCI research is expanding in the diversity of applications and populations for whom those applications are being developed. BCI applications are moving toward clinical readiness as researchers struggle with the practical considerations to make sure that BCI translational efforts will be successful. This paper summarizes each workshop, providing an overview of the topic of discussion, references for additional information, and identifying future issues for research and development that resulted from the interactions and discussion at the workshop.
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Affiliation(s)
- Jane E Huggins
- Department of Physical Medicine and Rehabilitation, Department of Biomedical Engineering, Neuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan, United States, 325 East Eisenhower, Room 3017; Ann Arbor, Michigan 48108-5744
| | - Christoph Guger
- g.tec medical engineering GmbH/Guger Technologies OG, Austria, Sierningstrasse 14, 4521 Schiedlberg, Austria
| | - Erik Aarnoutse
- UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Brendan Allison
- Dept. of Cognitive Science, Mail Code 0515, University of California at San Diego, La Jolla, United States
| | - Charles W Anderson
- Department of Computer Science, Molecular, Cellular and Integrative Neurosience Program, Colorado State University, Fort Collins, CO 80523
| | - Steven Bedrick
- Center for Spoken Language Understanding, Oregon Health & Science University, Portland, OR 97239
| | - Walter Besio
- Department of Electrical, Computer, & Biomedical Engineering and Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA, CREmedical Corp. Kingston, Rhode Island, USA
| | - Ricardo Chavarriaga
- Defitech Chair in Brain-Machine Interface (CNBI), Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne - EPFL, Switzerland
| | - Jennifer L Collinger
- University of Pittsburgh, Department of Physical Medicine and Rehabilitation, VA Pittsburgh Healthcare System, Department of Veterans Affairs, 3520 5th Ave, Pittsburgh, PA, 15213
| | - An H Do
- UC Irvine Brain Computer Interface Lab, Department of Neurology, University of California, Irvine
| | - Christian Herff
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Matthias Hohmann
- Max Planck Institute for Intelligent Systems, Department for Empirical Inference, Max-Planck-Ring 4, 72074 Tübingen, Germany
| | - Michelle Kinsella
- Oregon Health & Science University, Institute on Development & Disability, 707 SW Gaines St, #1290, Portland, OR 97239
| | - Kyuhwa Lee
- Swiss Federal Institute of Technology in Lausanne-EPFL
| | - Fabien Lotte
- Inria Bordeaux Sud-Ouest, LaBRI (Univ. Bordeaux/CNRS/Bordeaux INP), 200 avenue de la vieille tour, 33405, Talence Cedex, France
| | | | - Anton Nijholt
- Faculty EEMCS, University of Twente, Enschede, The Netherlands
| | - Elmar Pels
- UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Betts Peters
- Oregon Health & Science University, Institute on Development & Disability, 707 SW Gaines St, #1290, Portland, OR 97239
| | - Felix Putze
- University of Bremen, Germany, Cognitive Systems Lab, University of Bremen, Enrique-Schmidt-Straße 5 (Cartesium), 28359 Bremen
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital
| | - Gerwin Schalk
- National Center for Adaptive Neurotechnologies, Wadsworth Center, NYS Dept. of Health, Dept. of Neurology, Albany Medical College, Dept. of Biomed. Sci., State Univ. of New York at Albany, Center for Medical Sciences 2003, 150 New Scotland Avenue, Albany, New York 12208
| | - Stephanie Scott
- Department of Media Communications, Colorado State University, Fort Collins, CO 80523
| | - Michael Tangermann
- Brain State Decoding Lab, Cluster of Excellence BrainLinks-BrainTools, Computer Science Dept., University of Freiburg, Germany, Autonomous Intelligent Systems Lab, Computer Science Dept., University of Freiburg, Germany
| | - Paul Tubig
- Department of Philosophy, Center for Neurotechnology, University of Washington, Savery Hall, Room 361, Seattle, WA 98195
| | - Thorsten Zander
- Team PhyPA, Biological Psychology and Neuroergonomics, Technische Universität Berlin, Berlin, Germany, 7 Zander Laboratories B.V., Amsterdam, The Netherlands
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25
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Babajani-Feremi A, Fulton SP, Holder CM, Choudhri AF, Boop FA, Wheless JW. Localization of Expressive Language Cortex in a 2-Year-Old Child Using High-Gamma Electrocorticography. J Child Neurol 2019; 34:837-841. [PMID: 31339411 DOI: 10.1177/0883073819863999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cortical stimulation mapping is the gold standard for presurgical language mapping; however, it cannot be reliably performed in very young patients. Language mapping using noninvasive modalities is also challenging in very young patients. Although utility of language mapping using power of high-gamma in electrocorticographic recordings was demonstrated in adults and older children, there is a gap of knowledge in the ability of this procedure for localizing language-specific cortex in very young patients. We describe a case of a 2-year-old patient who, to our knowledge, is the youngest person to undergo successful high-gamma electrocorticographic presurgical language mapping for localization of the expressive language cortex (Broca area). The surgical plan was to resect a cortical tuber within the left inferior frontal gyrus and there was a strong concern about postoperative language deficit after resection. Presurgical language mapping using noninvasive modalities were attempted without success. Cortical stimulation mapping was not feasible in this patient. Therefore, high-gamma electrocorticography was the only viable option for language mapping, and it successfully localized the expressive language cortex. The patient underwent surgery for resection of the IFG tuber based on results of high-gamma electrocorticography and had no postoperative language deficit. High-gamma electrocorticography can be used for localizing language-specific cortex, especially Broca's area, in very young patients.
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Affiliation(s)
- Abbas Babajani-Feremi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.,Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephen P Fulton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Christen M Holder
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Asim F Choudhri
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Frederick A Boop
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - James W Wheless
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
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26
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Similarity of spatiotemporal dynamics of language-related ECoG high-gamma modulation in Japanese and English speakers. Clin Neurophysiol 2019; 130:1403-1404. [DOI: 10.1016/j.clinph.2019.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 11/17/2022]
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27
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Arya R, Ervin B, Wilson JA, Byars AW, Rozhkov L, Buroker J, Horn PS, Scholle C, Fujiwara H, Greiner HM, Leach JL, Rose DF, Mangano FT, Glauser TA, Holland KD. Development of information sharing in language neocortex in childhood-onset drug-resistant epilepsy. Epilepsia 2019; 60:393-405. [PMID: 30740659 DOI: 10.1111/epi.14661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We studied age-related dynamics of information sharing among cortical language regions with electrocorticographic high-gamma modulation during picture-naming and story-listening tasks. METHODS Seventeen epilepsy patients aged 4-19 years, undergoing extraoperative monitoring with left-hemispheric subdural electrodes, were included. Mutual information (MI), a nondirectional measure of shared information, between 16 pairs of cortical regions of interest, was computed from trial-averaged 70-150 Hz power modulations during language tasks. Impact of age on pairwise MI between language regions and their determinants were ascertained with regression analysis. RESULTS During picture naming, significant increase in MI with age was seen between pairwise combinations of Broca's area, inferior precentral gyrus (iPreC), and frontal association cortex (FAC); Wernicke's area and posterior association cortex (PAC); and Broca's and Wernicke's areas. During story listening, significant age-related increase in MI was seen between Wernicke's area and either Broca's area, FAC, or PAC; and between Broca's area and FAC. Significant impact of baseline intelligence quotient was seen on the relationship between age and MI for all pairs, except between Broca's area and iPreC. The mean MI was higher during naming compared to listening for pairs including iPreC with Broca's area, FAC, or PAC and was lower for pairs of Wernicke's area or PAC with anterior language regions. SIGNIFICANCE Information sharing matures with age "within" frontal and temporoparietal language cortices, and "between" Broca's and Wernicke's areas. This study provides evidence for distinct patterns of developmental plasticity within perisylvian language cortex and has implications for planning epilepsy surgery.
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Affiliation(s)
- Ravindra Arya
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brian Ervin
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Electrical Engineering and Computing Systems, University of Cincinnati, Cincinnati, Ohio
| | - J Adam Wilson
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anna W Byars
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Leonid Rozhkov
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jason Buroker
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul S Horn
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Craig Scholle
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hisako Fujiwara
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hansel M Greiner
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James L Leach
- Division of Pediatric Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Douglas F Rose
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Tracy A Glauser
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Katherine D Holland
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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28
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Kamada K, Ogawa H, Kapeller C, Prueckl R, Hiroshima S, Tamura Y, Takeuchi F, Guger C. Disconnection of the pathological connectome for multifocal epilepsy surgery. J Neurosurg 2018; 129:1182-1194. [PMID: 29271713 DOI: 10.3171/2017.6.jns17452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/02/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVERecent neuroimaging studies suggest that intractable epilepsy involves pathological functional networks as well as strong epileptogenic foci. Combining cortico-cortical evoked potential (CCEP) recording and tractography is a useful strategy for mapping functional connectivity in normal and pathological networks. In this study, the authors sought to demonstrate the efficacy of preoperative combined CCEP recording, high gamma activity (HGA) mapping, and tractography for surgical planning, and of intraoperative CCEP measures for confirmation of selective pathological network disconnection.METHODSThe authors treated 4 cases of intractable epilepsy. Diffusion tensor imaging-based tractography data were acquired before the first surgery for subdural grid implantation. HGA and CCEP investigations were done after the first surgery, before the second surgery was performed to resect epileptogenic foci, with continuous CCEP monitoring during resection.RESULTSAll 4 patients in this report had measurable pathological CCEPs. The mean negative peak-1 latency of normal CCEPs related to language functions was 22.2 ± 3.5 msec, whereas pathological CCEP latencies varied between 18.1 and 22.4 msec. Pathological CCEPs diminished after complete disconnection in all cases. At last follow-up, all of the patients were in long-term postoperative seizure-free status, although 1 patient still suffered from visual aura every other month.CONCLUSIONSCombined CCEP measurement, HGA mapping, and tractography greatly facilitated targeted disconnection of pathological networks in this study. Although CCEP recording requires technical expertise, it allows for assessment of pathological network involvement in intractable epilepsy and may improve seizure outcome.
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Affiliation(s)
| | | | | | | | | | | | - Fumiya Takeuchi
- 3Center for Advanced Research and Education, School of Medicine, Asahikawa Medical University, Hokkaido, Japan; and
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29
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A quantitative method for evaluating cortical responses to electrical stimulation. J Neurosci Methods 2018; 311:67-75. [PMID: 30292823 DOI: 10.1016/j.jneumeth.2018.09.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Electrical stimulation of the cortex using subdurally implanted electrodes can causally reveal structural connectivity by eliciting cortico-cortical evoked potentials (CCEPs). While many studies have demonstrated the potential value of CCEPs, the methods to evaluate them were often relatively subjective, did not consider potential artifacts, and did not lend themselves to systematic scientific investigations. NEW METHOD We developed an automated and quantitative method called SIGNI (Stimulation-Induced Gamma-based Network Identification) to evaluate cortical population-level responses to electrical stimulation that minimizes the impact of electrical artifacts. We applied SIGNI to electrocorticographic (ECoG) data from eight human subjects who were implanted with a total of 978 subdural electrodes. Across the eight subjects, we delivered 92 trains of approximately 200 discrete electrical stimuli each (amplitude 4-15 mA) to a total of 64 electrode pairs. RESULTS We verified SIGNI's efficacy by demonstrating a relationship between the magnitude of evoked cortical activity and stimulation amplitude, as well as between the latency of evoked cortical activity and the distance from the stimulated locations. CONCLUSIONS SIGNI reveals the timing and amplitude of cortical responses to electrical stimulation as well as the structural connectivity supporting these responses. With these properties, it enables exploration of new and important questions about the neurophysiology of cortical communication and may also be useful for pre-surgical planning.
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30
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Electrical Stimulation Mapping of the Brain: Basic Principles and Emerging Alternatives. J Clin Neurophysiol 2018; 35:86-97. [PMID: 29499015 DOI: 10.1097/wnp.0000000000000440] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The application of electrical stimulation mapping (ESM) of the brain for clinical use is approximating a century. Despite this long-standing history, the value of ESM for guiding surgical resections and sparing eloquent cortex is documented largely by small retrospective studies, and ESM protocols are largely inherited and lack standardization. Although models are imperfect and mechanisms are complex, the probabilistic causality of ESM has guaranteed its perpetuation into the 21st century. At present, electrical stimulation of cortical tissue is being revisited for network connectivity. In addition, noninvasive and passive mapping techniques are rapidly evolving to complement and potentially replace ESM in specific clinical situations. Lesional and epilepsy neurosurgery cases now offer different opportunities for multimodal functional assessments.
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31
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Ruis C. Monitoring cognition during awake brain surgery in adults: A systematic review. J Clin Exp Neuropsychol 2018; 40:1081-1104. [DOI: 10.1080/13803395.2018.1469602] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Carla Ruis
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Psychology, Utrecht University, Utrecht, The Netherlands
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32
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Mooij AH, Sterkman LCM, Zijlmans M, Huiskamp GJM. Electrocorticographic high gamma language mapping: Mind the pitfalls of comparison with electrocortical stimulation. Epilepsy Behav 2018. [PMID: 29525721 DOI: 10.1016/j.yebeh.2018.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A H Mooij
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - L C M Sterkman
- Faculty of Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M Zijlmans
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - G J M Huiskamp
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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33
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Arya R, Wilson JA, Fujiwara H, Vannest J, Byars AW, Rozhkov L, Leach JL, Greiner HM, Buroker J, Scholle C, Horn PS, Crone NE, Rose DF, Mangano FT, Holland KD. Electrocorticographic high-gamma modulation with passive listening paradigm for pediatric extraoperative language mapping. Epilepsia 2018; 59:792-801. [PMID: 29460482 DOI: 10.1111/epi.14029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This prospective study compared the topography of high-gamma modulation (HGM) during a story-listening task requiring negligible patient cooperation, with the conventional electrical stimulation mapping (ESM) using a picture-naming task, for presurgical language localization in pediatric drug-resistant epilepsy. METHODS Patients undergoing extraoperative monitoring with subdural electrodes were included. Electrocorticographic signals were recorded during quiet baseline and a story-listening task. The likelihood of 70- to 150-Hz power modulation during the listening task relative to the baseline was estimated for each electrode and plotted on a cortical surface model. Sensitivity, specificity, accuracy, and diagnostic odds ratio (DOR) were estimated compared to ESM, using a meta-analytic framework. RESULTS Nineteen patients (10 with left hemisphere electrodes) aged 4-19 years were analyzed. HGM during story listening was observed in bilateral posterior superior temporal, angular, supramarginal, and inferior frontal gyri, along with anatomically defined language association areas. Compared to either cognitive or both cognitive and orofacial sensorimotor interference with naming during ESM, left hemisphere HGM showed high specificity (0.82-0.84), good accuracy (0.66-0.70), and DOR of 2.23 and 3.24, respectively. HGM was a better classifier of ESM language sites in the left temporoparietal cortex compared to the frontal lobe. Incorporating visual naming with the story-listening task substantially improved the accuracy (0.80) and DOR (13.61) of HGM mapping, while the high specificity (0.85) was retained. In the right hemisphere, no ESM sites for aphasia were seen, and the results of HGM and ESM comparisons were not significant. SIGNIFICANCE HGM associated with story listening is a specific determinant of left hemisphere ESM language sites. It can be used for presurgical language mapping in children who cannot cooperate with conventional language tasks requiring active engagement. Incorporation of additional language tasks, if feasible, can further improve the diagnostic accuracy of language localization with HGM.
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Affiliation(s)
- Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Adam Wilson
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hisako Fujiwara
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Vannest
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Division of Pediatric Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jason Buroker
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Craig Scholle
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Douglas F Rose
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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ECoG high-gamma modulation versus electrical stimulation for presurgical language mapping. Epilepsy Behav 2018; 79:26-33. [PMID: 29247963 PMCID: PMC5815885 DOI: 10.1016/j.yebeh.2017.10.044] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/17/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This meta-analysis compared diagnostic validity of electrocorticographic (ECoG) high-γ modulation (HGM) with electrical stimulation mapping (ESM) for presurgical language localization. METHODS From a structured literature search, studies with electrode level data comparing ECoG HGM and ESM for language localization were included in the meta-analysis. Outcomes included global measures of diagnostic validity: area under the summary receiver operating characteristic (SROC) curve (AUC), and diagnostic odds ratio (DOR); as well as pooled estimates of sensitivity and specificity. Clinical and technical determinants of sensitivity/specificity were explored. RESULTS Fifteen studies were included in qualitative synthesis, and 10 studies included in the meta-analysis (number of patients 1-17, mean age 10.3-53.6years). Overt picture naming was the most commonly used task for language mapping with either method. Electrocorticographic high-γ modulation was analyzed at 50-400Hz with different bandwidths in individual studies. For ESM, pulse duration, train duration, and maximum current varied greatly among studies. Sensitivity (0.23-0.99), specificity (0.48-0.96), and DOR (1.45-376.28) varied widely across studies. The pooled estimates are: sensitivity 0.61 (95% CI 0.44, 0.76), specificity 0.79 (95% CI 0.68, 0.88), and DOR 6.44 (95% CI 3.47, 11.94). Area under the SROC curve was 0.77. Results of bivariate meta-regression were limited by small samples for individual variables. CONCLUSION Electrocorticographic high-γ modulation is a specific but not sensitive method for language localization compared with gold-standard ESM. Given the pooled DOR of 6.44 and AUC of 0.77, ECoG HGM can fairly reliably ascertain electrodes overlying ESM cortical language sites.
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Shimada S, Kunii N, Kawai K, Matsuo T, Ishishita Y, Ibayashi K, Saito N. Impact of volume-conducted potential in interpretation of cortico-cortical evoked potential: Detailed analysis of high-resolution electrocorticography using two mathematical approaches. Clin Neurophysiol 2017; 128:549-557. [PMID: 28226289 DOI: 10.1016/j.clinph.2017.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/22/2016] [Accepted: 01/15/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Cortico-cortical evoked potential (CCEP) has been utilized to evaluate connectivity between cortices. However, previous reports have rarely referred to the impact of volume-conducted potential (VCP) which must be a confounding factor of large potential around the stimulation site. To address this issue, we challenged the null hypothesis that VCP accounts for the majority of the recorded potential, particularly around the stimulation site. METHODS CCEP was recorded with high-density intracranial electrodes in 8 patients with intractable epilepsy. First, we performed regression analysis for describing the relationship between the distance and potential of each electrode. Second, we performed principal component analysis (PCA) to reveal the temporal features of recorded waveforms. RESULTS The regression curve, declining by the inverse square of the distance, fitted tightly to the plots (R2: 0.878-0.991) with outliers. PCA suggested the responses around the stimulation site had the same temporal features. We also observed the continuous declination over the anatomical gap and the phase reversal phenomena around the stimulation site. CONCLUSIONS These results were consistent with the null hypothesis. SIGNIFICANCE This study highlighted the risk of misinterpreting CCEP mapping, and proposed mathematical removal of VCP, which could lead to more reliable mapping based on CCEP.
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Affiliation(s)
- Seijiro Shimada
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naoto Kunii
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Kensuke Kawai
- Department of Neurosurgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Takeshi Matsuo
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Yohei Ishishita
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kenji Ibayashi
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Yamao Y, Suzuki K, Kunieda T, Matsumoto R, Arakawa Y, Nakae T, Nishida S, Inano R, Shibata S, Shimotake A, Kikuchi T, Sawamoto N, Mikuni N, Ikeda A, Fukuyama H, Miyamoto S. Clinical impact of intraoperative CCEP monitoring in evaluating the dorsal language white matter pathway. Hum Brain Mapp 2017; 38:1977-1991. [PMID: 28112455 DOI: 10.1002/hbm.23498] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/07/2016] [Indexed: 11/09/2022] Open
Abstract
In order to preserve postoperative language function, we recently proposed a new intraoperative method to monitor the integrity of the dorsal language pathway (arcuate fasciculus; AF) using cortico-cortical evoked potentials (CCEPs). Based on further investigations (20 patients, 21 CCEP investigations), including patients who were not suitable for awake surgery (five CCEP investigations) or those without preoperative neuroimaging data (eight CCEP investigations including four with untraceable tractography due to brain edema), we attempted to clarify the clinical impact of this new intraoperative method. We monitored the integrity of AF by stimulating the anterior perisylvian language area (AL) by recording CCEPs from the posterior perisylvian language area (PL) consecutively during both general anesthesia and awake condition. After tumor resection, single-pulse electrical stimuli were also applied to the floor of the removal cavity to record subcortico-cortical evoked potentials (SCEPs) at AL and PL in 12 patients (12 SCEP investigations). We demonstrated that (1) intraoperative dorsal language network monitoring was feasible even when patients were not suitable for awake surgery or without preoperative neuroimaging studies, (2) CCEP is a dynamic marker of functional connectivity or integrity of AF, and CCEP N1 amplitude could even become larger after reduction of brain edema, (3) a 50% CCEP N1 amplitude decline might be a cut-off value to prevent permanent language dysfunction due to impairment of AF, (4) a correspondence (<2.0 ms difference) of N1 onset latencies between CCEP and the sum of SCEPs indicates close proximity of the subcortical stimulus site to AF (<3.0 mm). Hum Brain Mapp 38:1977-1991, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kengo Suzuki
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takuro Nakae
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sei Nishida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Rika Inano
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sumiya Shibata
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Shimotake
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobukatsu Sawamoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenao Fukuyama
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Matsumoto R, Kunieda T, Nair D. Single pulse electrical stimulation to probe functional and pathological connectivity in epilepsy. Seizure 2016; 44:27-36. [PMID: 27939100 DOI: 10.1016/j.seizure.2016.11.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/02/2016] [Indexed: 12/12/2022] Open
Abstract
In the last decade, single pulse electrical stimulation (SPES) has been used as an investigational tool in the field of epilepsy surgery. Direct cortical stimulation applied at a frequency of ∼1Hz can probe cortico-cortical connections by averaging electrocorticogram time-lock to the stimuli (2×20-30 trials). These evoked potentials that emanate from adjacent and remote cortices have been termed cortico-cortical evoked potentials (CCEPs). Although limited to patients undergoing invasive presurgical evaluations with intracranial electrodes, CCEP provides a novel way to explore inter-areal connectivity in vivo in the living human brain to probe functional brain networks such as language and cognitive motor networks. In addition to its impact on systems neuroscience, this method, in combination with 50Hz electrical cortical stimulation, could contribute clinically to map the functional brain systems by tracking the cortico-cortical connections among the functional cortical regions in each individual patient. This approach may help identify the normal cortico-cortical network within pathology as well as reveal connections that might arise from neural plasticity. Because of its high practicality, it has been recently applied for intraoperative monitoring of the functional brain networks for patients with brain tumor. With regard to epilepsy, SPES has been used for the two major purposes, one to probe cortical excitability of the focus, namely, epileptogenicity, and the other to probe seizure networks. Both early (i.e., CCEP) and delayed responses, and probably their high frequency oscillation counterparts, are regarded as a surrogate marker of epileptogenicity. With regards to its impact on the human brain connectivity map, worldwide collaboration is warranted to establish the standardized CCEP connectivity map as a solid reference for non-invasive connectome researches.
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Affiliation(s)
- Riki Matsumoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, USA
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Hamberger MJ, Miozzo M, Schevon CA, Morrison C, Carlson C, Mehta AD, Klein GE, McKhann GM, Williams AC. Functional differences among stimulation-identified cortical naming sites in the temporal region. Epilepsy Behav 2016; 60:124-129. [PMID: 27206230 PMCID: PMC4912888 DOI: 10.1016/j.yebeh.2016.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 11/16/2022]
Abstract
To preserve postoperative language, electrical stimulation mapping is often conducted prior to surgery involving the language-dominant hemisphere. Object naming is the task most widely used to identify language cortex, and sites where stimulation elicits naming difficulty are typically spared from resection. In clinical practice, sites classified as positive undergo no further testing regarding the underlying cause of naming failure. Word production is a complex function involving multiple mechanisms that culminate in the identification of the target word. Two main mechanisms, i.e., semantic and phonological, underlie the retrieval of stored information regarding word meaning and word sounds, and naming can be hampered by disrupting either of these. These two mechanisms are likely mediated by different brain areas, and therefore, stimulation-identified naming sites might not be functionally equivalent. We investigated whether further testing at stimulation-identified naming sites would reveal an anatomical dissociation between these two mechanisms. In 16 patients with refractory temporal lobe epilepsy (TLE) with implanted subdural electrodes, we tested whether, despite inability to produce an item name, patients could reliably access semantic or phonological information regarding objects during cortical stimulation. We found that stimulation at naming sites in superior temporal cortex tended to impair phonological processing yet spared access to semantic information. By contrast, stimulation of inferior temporal naming sites revealed a greater proportion of sites where semantic access was impaired and a dissociation between sites where stimulation spared or disrupted semantic or phonological processing. These functional-anatomical dissociations reveal the more specific contribution to naming provided by these cortical areas and shed light on the often profound, interictal word-finding deficit observed in temporal lobe epilepsy. Additionally, these techniques potentially lay the groundwork for future studies to determine whether particular naming sites that fall within the margins of the desired clinical resection might be resected without significant risk of decline.
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Affiliation(s)
- Marla J Hamberger
- Department of Neurology, Columbia University Medical Center, New York, NY, United States.
| | - Michele Miozzo
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Catherine A Schevon
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Chris Morrison
- Department of Neurology, New York University Medical Center, New York, NY, United States
| | - Chad Carlson
- Department of Neurology, New York University Medical Center, New York, NY, United States
| | - Ashesh D Mehta
- Department of Neurological Surgery, North Shore LIJ Medical Center, New Hyde Park, NY, United States
| | - Gad E Klein
- Department of Neurological Surgery, North Shore LIJ Medical Center, New Hyde Park, NY, United States
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, United States
| | - Alicia C Williams
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
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de Pesters A, Taplin AM, Adamo MA, Ritaccio AL, Schalk G. Electrocorticographic mapping of expressive language function without requiring the patient to speak: A report of three cases. EPILEPSY & BEHAVIOR CASE REPORTS 2016; 6:13-8. [PMID: 27408803 PMCID: PMC4925928 DOI: 10.1016/j.ebcr.2016.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 01/24/2023]
Abstract
Objective Patients requiring resective brain surgery often undergo functional brain mapping during perioperative planning to localize expressive language areas. Currently, all established protocols to perform such mapping require substantial time and patient participation during verb generation or similar tasks. These issues can make language mapping impractical in certain clinical circumstances (e.g., during awake craniotomies) or with certain populations (e.g., pediatric patients). Thus, it is important to develop new techniques that reduce mapping time and the requirement for active patient participation. Several neuroscientific studies reported that the mere auditory presentation of speech stimuli can engage not only receptive but also expressive language areas. Here, we tested the hypothesis that submission of electrocorticographic (ECoG) recordings during a short speech listening task to an appropriate analysis procedure can identify eloquent expressive language cortex without requiring the patient to speak. Methods Three patients undergoing temporary placement of subdural electrode grids passively listened to stories while we recorded their ECoG activity. We identified those sites whose activity in the broadband gamma range (70–170 Hz) changed immediately after presentation of the speech stimuli with respect to a prestimulus baseline. Results Our analyses revealed increased broadband gamma activity at distinct locations in the inferior frontal cortex, superior temporal gyrus, and/or perisylvian areas in all three patients and premotor and/or supplementary motor areas in two patients. The sites in the inferior frontal cortex that we identified with our procedure were either on or immediately adjacent to locations identified using electrical cortical stimulation (ECS) mapping. Conclusions The results of this study provide encouraging preliminary evidence that it may be possible that a brief and practical protocol can identify expressive language areas without requiring the patient to speak. This protocol could provide the clinician with a map of expressive language cortex within a few minutes. This may be useful as an adjunct to ECS interrogation or as an alternative to mapping using functional magnetic resonance imaging (fMRI). In conclusion, with further development and validation in more subjects, the approach presented here could help in identifying expressive language areas in situations where patients cannot speak in response to task instructions.
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Affiliation(s)
- Adriana de Pesters
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA
| | - AmiLyn M Taplin
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Matthew A Adamo
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | | | - Gerwin Schalk
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA; Department of Neurology, Albany Medical College, Albany, NY, USA
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