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Wu S, Issa NP, Rose SL, Haider HA, Nordli DR, Towle VL, Warnke PC, Tao JX. Depth versus surface: A critical review of subdural and depth electrodes in intracranial electroencephalographic studies. Epilepsia 2024; 65:1868-1878. [PMID: 38722693 DOI: 10.1111/epi.18002] [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: 01/02/2024] [Revised: 04/05/2024] [Accepted: 04/24/2024] [Indexed: 07/17/2024]
Abstract
Intracranial electroencephalographic (IEEG) recording, using subdural electrodes (SDEs) and stereoelectroencephalography (SEEG), plays a pivotal role in localizing the epileptogenic zone (EZ). SDEs, employed for superficial cortical seizure foci localization, provide information on two-dimensional seizure onset and propagation. In contrast, SEEG, with its three-dimensional sampling, allows exploration of deep brain structures, sulcal folds, and bihemispheric networks. SEEG offers the advantages of fewer complications, better tolerability, and coverage of sulci. Although both modalities allow electrical stimulation, SDE mapping can tessellate cortical gyri, providing the opportunity for a tailored resection. With SEEG, both superficial gyri and deep sulci can be stimulated, and there is a lower risk of afterdischarges and stimulation-induced seizures. Most systematic reviews and meta-analyses have addressed the comparative effectiveness of SDEs and SEEG in localizing the EZ and achieving seizure freedom, although discrepancies persist in the literature. The combination of SDEs and SEEG could potentially overcome the limitations inherent to each technique individually, better delineating seizure foci. This review describes the strengths and limitations of SDE and SEEG recordings, highlighting their unique indications in seizure localization, as evidenced by recent publications. Addressing controversies in the perceived usefulness of the two techniques offers insights that can aid in selecting the most suitable IEEG in clinical practice.
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Affiliation(s)
- Shasha Wu
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Sandra L Rose
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Hiba A Haider
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Douglas R Nordli
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Vernon L Towle
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
| | - James X Tao
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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2
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Jaber K, Avigdor T, Mansilla D, Ho A, Thomas J, Abdallah C, Chabardes S, Hall J, Minotti L, Kahane P, Grova C, Gotman J, Frauscher B. A spatial perturbation framework to validate implantation of the epileptogenic zone. Nat Commun 2024; 15:5253. [PMID: 38897997 PMCID: PMC11187199 DOI: 10.1038/s41467-024-49470-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Stereo-electroencephalography (SEEG) is the gold standard to delineate surgical targets in focal drug-resistant epilepsy. SEEG uses electrodes placed directly into the brain to identify the seizure-onset zone (SOZ). However, its major constraint is limited brain coverage, potentially leading to misidentification of the 'true' SOZ. Here, we propose a framework to assess adequate SEEG sampling by coupling epileptic biomarkers with their spatial distribution and measuring the system's response to a perturbation of this coupling. We demonstrate that the system's response is strongest in well-sampled patients when virtually removing the measured SOZ. We then introduce the spatial perturbation map, a tool that enables qualitative assessment of the implantation coverage. Probability modelling reveals a higher likelihood of well-implanted SOZs in seizure-free patients or non-seizure free patients with incomplete SOZ resections, compared to non-seizure-free patients with complete resections. This highlights the framework's value in sparing patients from unsuccessful surgeries resulting from poor SEEG coverage.
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Affiliation(s)
- Kassem Jaber
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA
| | - Tamir Avigdor
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
| | - Daniel Mansilla
- Neurophysiology Unit, Institute of Neurosurgery Dr. Asenjo, Santiago, Chile
| | - Alyssa Ho
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - John Thomas
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA
| | - Chifaou Abdallah
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
| | - Stephan Chabardes
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Jeff Hall
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
| | - Lorella Minotti
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Philippe Kahane
- Grenoble Institute Neurosciences, Inserm, U1216, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Christophe Grova
- Multimodal Functional Imaging Lab, Biomedical Engineering Department, McGill University, Montréal, QC, Canada
- Multimodal Functional Imaging Lab, School of Health, Department of Physics, Concordia University, Montréal, QC, Canada
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Jean Gotman
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada.
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, NC, USA.
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.
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3
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Avenali M, Zangaglia R, Cuconato G, Palmieri I, Albanese A, Artusi CA, Bozzali M, Calandra-Buonaura G, Cavallieri F, Cilia R, Cocco A, Cogiamanian F, Colucci F, Cortelli P, Di Fonzo A, Eleopra R, Giannini G, Imarisio A, Imbalzano G, Ledda C, Lopiano L, Malaguti MC, Mameli F, Minardi R, Mitrotti P, Monfrini E, Spagnolo F, Tassorelli C, Valentino F, Valzania F, Pacchetti C, Valente EM. Are patients with GBA-Parkinson disease good candidates for deep brain stimulation? A longitudinal multicentric study on a large Italian cohort. J Neurol Neurosurg Psychiatry 2024; 95:309-315. [PMID: 37879897 PMCID: PMC10958298 DOI: 10.1136/jnnp-2023-332387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND GBA variants increase the risk of developing Parkinson disease (PD) and influence its outcome. Deep brain stimulation (DBS) is a recognised therapeutic option for advanced PD. Data on DBS long-term outcome in GBA carriers are scarce. OBJECTIVE To elucidate the impact of GBA variants on long-term DBS outcome in a large Italian cohort. METHODS We retrospectively recruited a multicentric Italian DBS-PD cohort and assessed: (1) GBA prevalence; (2) pre-DBS clinical features; and (3) outcomes of motor, cognitive and other non-motor features up to 5 years post-DBS. RESULTS We included 365 patients with PD, of whom 73 (20%) carried GBA variants. 5-year follow-up data were available for 173 PD, including 32 mutated subjects. GBA-PD had an earlier onset and were younger at DBS than non-GBA-PD. They also had shorter disease duration, higher occurrence of dyskinesias and orthostatic hypotension symptoms.At post-DBS, both groups showed marked motor improvement, a significant reduction of fluctuations, dyskinesias and impulsive-compulsive disorders (ICD) and low occurrence of most complications. Only cognitive scores worsened significantly faster in GBA-PD after 3 years. Overt dementia was diagnosed in 11% non-GBA-PD and 25% GBA-PD at 5-year follow-up. CONCLUSIONS Evaluation of long-term impact of GBA variants in a large Italian DBS-PD cohort supported the role of DBS surgery as a valid therapeutic strategy in GBA-PD, with long-term benefit on motor performance and ICD. Despite the selective worsening of cognitive scores since 3 years post-DBS, the majority of GBA-PD had not developed dementia at 5-year follow-up.
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Affiliation(s)
- Micol Avenali
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | | | - Giada Cuconato
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marco Bozzali
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Giovanna Calandra-Buonaura
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Cilia
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Antoniangela Cocco
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Filippo Cogiamanian
- Neurophysiopathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabiana Colucci
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alessio Di Fonzo
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Eleopra
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Giulia Giannini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alberto Imarisio
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Claudia Ledda
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Francesca Mameli
- Neurophysiopathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Minardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Edoardo Monfrini
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Cristina Tassorelli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | | | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Enza Maria Valente
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Frauscher B, Mansilla D, Abdallah C, Astner-Rohracher A, Beniczky S, Brazdil M, Gnatkovsky V, Jacobs J, Kalamangalam G, Perucca P, Ryvlin P, Schuele S, Tao J, Wang Y, Zijlmans M, McGonigal A. Learn how to interpret and use intracranial EEG findings. Epileptic Disord 2024; 26:1-59. [PMID: 38116690 DOI: 10.1002/epd2.20190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/21/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
Epilepsy surgery is the therapy of choice for many patients with drug-resistant focal epilepsy. Recognizing and describing ictal and interictal patterns with intracranial electroencephalography (EEG) recordings is important in order to most efficiently leverage advantages of this technique to accurately delineate the seizure-onset zone before undergoing surgery. In this seminar in epileptology, we address learning objective "1.4.11 Recognize and describe ictal and interictal patterns with intracranial recordings" of the International League against Epilepsy curriculum for epileptologists. We will review principal considerations of the implantation planning, summarize the literature for the most relevant ictal and interictal EEG patterns within and beyond the Berger frequency spectrum, review invasive stimulation for seizure and functional mapping, discuss caveats in the interpretation of intracranial EEG findings, provide an overview on special considerations in children and in subdural grids/strips, and review available quantitative/signal analysis approaches. To be as practically oriented as possible, we will provide a mini atlas of the most frequent EEG patterns, highlight pearls for its not infrequently challenging interpretation, and conclude with two illustrative case examples. This article shall serve as a useful learning resource for trainees in clinical neurophysiology/epileptology by providing a basic understanding on the concepts of invasive intracranial EEG.
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Affiliation(s)
- B Frauscher
- Department of Neurology, Duke University Medical Center and Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - D Mansilla
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
- Neurophysiology Unit, Institute of Neurosurgery Dr. Asenjo, Santiago, Chile
| | - C Abdallah
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - A Astner-Rohracher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - S Beniczky
- Danish Epilepsy Centre, Dianalund, Denmark
- Aarhus University, Aarhus, Denmark
| | - M Brazdil
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Member of the ERN-EpiCARE, Brno, Czechia
- Behavioral and Social Neuroscience Research Group, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - V Gnatkovsky
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - J Jacobs
- Department of Paediatrics and Department of Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - G Kalamangalam
- Department of Neurology, University of Florida, Gainesville, Florida, USA
- Wilder Center for Epilepsy Research, University of Florida, Gainesville, Florida, USA
| | - P Perucca
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - P Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - S Schuele
- Department of Neurology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - J Tao
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Y Wang
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Wilder Center for Epilepsy Research, University of Florida, Gainesville, Florida, USA
| | - M Zijlmans
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - A McGonigal
- Department of Neurosciences, Mater Misericordiae Hospital, Brisbane, Queensland, Australia
- Mater Research Institute, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
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5
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Goldenholz DM, Eccleston C, Moss R, Westover MB. Prospective validation of a seizure diary forecasting falls short. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.11.24301175. [PMID: 38260666 PMCID: PMC10802655 DOI: 10.1101/2024.01.11.24301175] [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
OBJECTIVE Recently, a deep learning AI model forecasted seizure risk using retrospective seizure diaries with higher accuracy than random forecasts. The present study sought to prospectively evaluate the same algorithm. METHODS We recruited a prospective cohort of 46 people with epilepsy; 25 completed sufficient data entry for analysis (median 5 months). We used the same AI method as in our prior study. Group-level and individual-level Brier Skill Scores (BSS) compared random forecasts and simple moving average forecasts to the AI. RESULTS The AI had an AUC of 0.82. At the group level, the AI outperformed random forecasting (BSS=0.53). At the individual level, AI outperformed random in 28% of cases. At the group and individual level, the moving average outperformed the AI. If pre-enrollment (non-verified) diaries (with presumed under-reporting) were included, the AI significantly outperformed both comparators. Surveys showed most did not mind poor quality LOW-RISK or HIGH-RISK forecasts, yet 91% wanted access to these forecasts. SIGNIFICANCE The previously developed AI forecasting tool did not outperform a very simple moving average forecasting this prospective cohort, suggesting that the AI model should be replaced.
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Affiliation(s)
- Daniel M Goldenholz
- Dept. of Neurology, Beth Israel Deaconess Medical Center, Boston 02215 MA
- Dept. of Neurology, Harvard Medical School, Boston 02215 MA
| | - Celena Eccleston
- Dept. of Neurology, Beth Israel Deaconess Medical Center, Boston 02215 MA
- Dept. of Neurology, Harvard Medical School, Boston 02215 MA
| | | | - M Brandon Westover
- Dept. of Neurology, Beth Israel Deaconess Medical Center, Boston 02215 MA
- Dept. of Neurology, Harvard Medical School, Boston 02215 MA
- Dept. of Neurology, Massachusetts General Hospital, Boston 02114 MA
- McCance Center for Brain Health, Boston, 02114 MA
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Arya R, Frink C, Kargol C, Byars AW, Huddleston D, Diedenhofer DB, Aungaroon G, Ervin B, Horn PS, Ihnen SKZ, Tenney JR, Kremer K, Fong S, Lin N, Liu W, Arthur TM, Skoch J, Leach JL, Mangano FT, Glauser TA, Greiner HM, Holland KD. Neuropsychological outcomes after epilepsy surgery: A comparison of stereo electroencephalography and subdural electrodes. Eur J Neurol 2023; 30:2986-2998. [PMID: 37329329 PMCID: PMC10529267 DOI: 10.1111/ene.15929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND PURPOSE We analyzed the association of neuropsychological outcomes after epilepsy surgery with the intracranial electrode type (stereo electroencephalography [SEEG] and subdural electrodes [SDE]), and electrical stimulation mapping (ESM) of speech/language. METHODS Drug-resistant epilepsy patients who underwent comprehensive neuropsychological evaluation before and 1 year after epilepsy surgery were included. SEEG and SDE subgroups were matched by age, handedness, operated hemisphere, and seizure freedom. Postsurgical neuropsychological outcomes (adjusted for presurgical scores) and reliable change indices were analyzed as functions of electrode type and ESM. RESULTS Ninety-nine patients aged 6-29 years were included with similar surgical resection/ablation volumes in the SEEG and SDE subgroups. Most of the neuropsychological outcomes were comparable between SEEG and SDE subgroups; however, Working Memory and Processing Speed were significantly improved in the SEEG subgroup. Undergoing language ESM was associated with significant improvements in Spelling, Letter-Word Identification, Vocabulary, Verbal Comprehension, Verbal Learning, and Story Memory scores, but a decline in Calculation scores. CONCLUSIONS Intracranial evaluations with SEEG and SDE are comparable in terms of long-term postsurgical neuropsychological outcomes. Our data suggest that SEEG may be associated with improvements in working memory and processing speed, representing cognitive domains served by spatially distributed networks. Our study also supports wider use of language ESM before epilepsy surgery, preferably using other language tasks in addition to visual naming. Rather than the type of electrode, postsurgical neuropsychological outcomes are driven by whether language ESM was performed or not, with beneficial effects of language mapping.
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Affiliation(s)
- Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, USA
| | - Clayton Frink
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christina Kargol
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anna W Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David Huddleston
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Donna B Diedenhofer
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brian Ervin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - S K Z Ihnen
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jeffrey R Tenney
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kelly Kremer
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susan Fong
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nan Lin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Wei Liu
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Todd M Arthur
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jesse Skoch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James L Leach
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pediatric Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Francesco T Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tracy A Glauser
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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7
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Joshi S, Stephens E, Bleasel A, Bartley M, Wijayath M, Rahman Z, Varikatt W, Dexter M, Wong C. Successful stereoelectroencephalography re-evaluation in epilepsy patients after failed initial subdural grid evaluation. Epileptic Disord 2023; 25:534-544. [PMID: 37265017 DOI: 10.1002/epd2.20084] [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: 12/06/2022] [Revised: 05/19/2023] [Accepted: 05/27/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Epilepsy surgery success is dependent on accurate localization of the epileptogenic zone. Despite the use of invasive EEG using subdural grids and strips, surgical failures can occur. In this series, we explore the utility of a second evaluation with stereoelectroencephalography in patients whose initial invasive evaluation with subdural grid electrodes was unsuccessful in localizing seizure origin. METHODS We conducted a retrospective review of patients who underwent subdural grid evaluation (SDE) at our center and identified patients who underwent a re-evaluation with stereoelectroencephalography (SEEG). RESULTS We identified three patients who had both subdural and SEEG electrodes in the region of the identified epileptogenic zone in whom the initial SDE evaluation failed to make the patients seizure-free. Two of these patients underwent a second resection and became seizure-free. SIGNIFICANCE Stereoelectroencephalography can be useful in the re-evaluation and re-operation of patients who previously had surgical failure using SDE.
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Affiliation(s)
- Stuti Joshi
- Department of Neurology and Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Eleanor Stephens
- Department of Neurology and Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Andrew Bleasel
- Department of Neurology and Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Melissa Bartley
- Department of Neurology and Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Manori Wijayath
- Department of Neurology and Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Zebunnessa Rahman
- Department of Neurology and Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Winny Varikatt
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Anatomical Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Mark Dexter
- Department of Neurology and Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Chong Wong
- Department of Neurology and Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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8
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Aungaroon G, Vedala K, Byars AW, Ervin B, Rozhkov L, Horn PS, Ihnen S, Holland KD, Tenney JR, Kremer K, Fong SL, Lin N, Liu W, Arthur TM, Fujiwara H, Skoch J, Leach JL, Mangano FT, Greiner HM, Arya R. Comparing electrical stimulation functional mapping with subdural electrodes and stereoelectroencephalography. Epilepsia 2023; 64:1527-1540. [PMID: 36872854 PMCID: PMC10239361 DOI: 10.1111/epi.17575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Electrical stimulation mapping (ESM) is the clinical standard for functional localization with subdural electrodes (SDE). As stereoelectroencephalography (SEEG) has emerged as an alternative option, we compared functional responses, afterdischarges (ADs), and unwanted ESM-induced seizures (EISs) between the two electrode types. METHODS Incidence and current thresholds for functional responses (sensory, motor, speech/language), ADs, and EISs were compared between SDE and SEEG using mixed models incorporating relevant covariates. RESULTS We identified 67 SEEG ESM and 106 SDE ESM patients (7207 and 4980 stimulated contacts, respectively). We found similar incidence of language and motor responses between electrode types; however, more SEEG patients reported sensory responses. ADs and EISs occurred less commonly with SEEG than SDE. Current thresholds for language, face motor, and upper extremity (UE) motor responses and EIS significantly decreased with age. However, they were not affected by electrode type, premedication, or dominant hemispheric stimulation. AD thresholds were higher with SEEG than with SDE. For SEEG ESM, language thresholds remained below AD thresholds up to 26 years of age, whereas this relationship was inverse for SDE. Also, face and UE motor thresholds fell below AD thresholds at earlier ages for SEEG than SDE. AD and EIS thresholds were not affected by premedication. SIGNIFICANCE SEEG and SDE have clinically relevant differences for functional brain mapping with electrical stimulation. Although evaluation of language and motor regions is comparable between SEEG and SDE, SEEG offers a higher likelihood of identifying sensory areas. A lower incidence of ADs and EISs, and a favorable relationship between functional and AD thresholds suggest superior safety and neurophysiologic validity for SEEG ESM than SDE ESM.
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Affiliation(s)
- Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Kishore Vedala
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Anna W. Byars
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Brian Ervin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Paul S. Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - S.K.Z. Ihnen
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katherine D. Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Jeffrey R. Tenney
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Kelly Kremer
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Susan L. Fong
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Nan Lin
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Wei Liu
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Todd M. Arthur
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Hisako Fujiwara
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Jesse Skoch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - James L. Leach
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neuroradiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Francesco T. Mangano
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Hansel M. Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, Ohio, U.S.A
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9
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Kassinopoulos M, Rolandi N, Alphan L, Harper RM, Oliveira J, Scott C, Kozák LR, Guye M, Lemieux L, Diehl B. Brain Connectivity Correlates of Breathing and Cardiac Irregularities in SUDEP: A Resting-State fMRI Study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.19.541412. [PMID: 37293113 PMCID: PMC10245782 DOI: 10.1101/2023.05.19.541412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of premature mortality among people with epilepsy. Evidence from witnessed and monitored SUDEP cases indicate seizure-induced cardiovascular and respiratory failures; yet, the underlying mechanisms remain obscure. SUDEP occurs often during the night and early morning hours, suggesting that sleep or circadian rhythm-induced changes in physiology contribute to the fatal event. Resting-state fMRI studies have found altered functional connectivity between brain structures involved in cardiorespiratory regulation in later SUDEP cases and in individuals at high-risk of SUDEP. However, those connectivity findings have not been related to changes in cardiovascular or respiratory patterns. Here, we compared fMRI patterns of brain connectivity associated with regular and irregular cardiorespiratory rhythms in SUDEP cases with those of living epilepsy patients of varying SUDEP risk, and healthy controls. We analysed resting-state fMRI data from 98 patients with epilepsy (9 who subsequently succumbed to SUDEP, 43 categorized as low SUDEP risk (no tonic-clonic seizures (TCS) in the year preceding the fMRI scan), and 46 as high SUDEP risk (>3 TCS in the year preceding the scan)) and 25 healthy controls. The global signal amplitude (GSA), defined as the moving standard deviation of the fMRI global signal, was used to identify periods with regular ('low state') and irregular ('high state') cardiorespiratory rhythms. Correlation maps were derived from seeds in twelve regions with a key role in autonomic or respiratory regulation, for the low and high states. Following principal component analysis, component weights were compared between the groups. We found widespread alterations in connectivity of precuneus/posterior cingulate cortex in epilepsy compared to controls, in the low state (regular cardiorespiratory activity). In the low state, and to a lesser degree in the high state, reduced anterior insula connectivity (mainly with anterior and posterior cingulate cortex) in epilepsy appeared, relative to healthy controls. For SUDEP cases, the insula connectivity differences were inversely related to the interval between the fMRI scan and death. The findings suggest that anterior insula connectivity measures may provide a biomarker of SUDEP risk. The neural correlates of autonomic brain structures associated with different cardiorespiratory rhythms may shed light on the mechanisms underlying terminal apnea observed in SUDEP.
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Affiliation(s)
- Michalis Kassinopoulos
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Chalfont St. Peter, Buckinghamshire, United Kingdom
| | - Nicolo Rolandi
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Chalfont St. Peter, Buckinghamshire, United Kingdom
| | - Laren Alphan
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Ronald M. Harper
- UCLA Brain Research Institute, Los Angeles, CA, United States
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Joana Oliveira
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, UCLH, London, United Kingdom
| | - Catherine Scott
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, UCLH, London, United Kingdom
| | - Lajos R. Kozák
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, CEMEREM, Marseille, France
| | - Louis Lemieux
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Chalfont St. Peter, Buckinghamshire, United Kingdom
| | - Beate Diehl
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Epilepsy Society, Chalfont St. Peter, Buckinghamshire, United Kingdom
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10
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Arrarte Terreros N, Bruggeman AAE, van Voorst H, Konduri PR, Jansen IGH, Kappelhof M, Tolhuisen ML, Boodt N, Dippel DWJ, van der Lugt A, van Zwam WH, van Oostenbrugge RJ, van der Worp HB, Emmer BJ, Meijer FJA, Roos YBWEM, van Bavel E, Marquering HA, Majoie CBLM. Bifurcation occlusions and endovascular treatment outcome in acute ischemic stroke. J Neurointerv Surg 2023; 15:355-362. [PMID: 35318957 PMCID: PMC10086510 DOI: 10.1136/neurintsurg-2021-018560] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/03/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND A thrombus in the M1 segment of the middle cerebral artery (MCA) can occlude this main stem only or extend into the M1-M2 bifurcation. The occlusion pattern may affect endovascular treatment (EVT) success, as a bifurcated thrombus may be more prone to fragmentation during retrieval. OBJECTIVE To investigate whether bifurcated thrombus patterns are associated with EVT procedural and clinical outcomes. METHODS Occlusion patterns of MCA thrombi on CT angiography from MR CLEAN Registry patients were classified into three groups: main stem occlusion, bifurcation occlusion extending into one M2 branch, and bifurcation occlusion extending into both M2 branches. Procedural parameters, procedural outcomes (reperfusion grade and embolization to new territory), and clinical outcomes (24-48 hour National Institutes of Health Stroke Scale [NIHSSFU] score, change in NIHSS scores between 24 and 48 hours and baseline ∆ [NIHSS], and 90-day modified Rankin Scale [mRS] scores) were compared between occlusion patterns. RESULTS We identified 1023 patients with an MCA occlusion of whom 370 (36%) had a main stem occlusion, 151 (15%) a single branch, and 502 (49%) a double branch bifurcation occlusion. There were no statistically significant differences in retrieval method, procedure time, number of retrieval attempts, reperfusion grade, and embolization to new territory between occlusion patterns. Patients with main stem occlusions had lower NIHSSFU scores than patients with single (7 vs 11, p=0.01) or double branch occlusions (7 vs 9, p=0.04). However, there were no statistically significant differences in ∆ NIHSS or in 90-day mRS scores. CONCLUSIONS In our population, EVT procedural and long-term clinical outcomes were similar for MCA bifurcation occlusions and MCA main stem occlusions.
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Affiliation(s)
- Nerea Arrarte Terreros
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands .,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Agnetha A E Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Henk van Voorst
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Praneeta R Konduri
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Ivo G H Jansen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Manon Kappelhof
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Manon L Tolhuisen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Nikki Boodt
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Wim H van Zwam
- Department of Radiology, Maastricht UMC, Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht UMC, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery Brain Center, UMC Utrecht, Utrecht, The Netherlands
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | | | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Ed van Bavel
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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11
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Coorg R, Seto ES. Invasive Epilepsy Monitoring: The Switch from Subdural Electrodes to Stereoelectroencephalography. JOURNAL OF PEDIATRIC EPILEPSY 2023. [DOI: 10.1055/s-0042-1760105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractStereoelectroencephalography (SEEG) has experienced an explosion in use due to a shifting understanding of epileptic networks and wider application of minimally invasive epilepsy surgery techniques. Both subdural electrode (SDE) monitoring and SEEG serve important roles in defining the epileptogenic zone, limiting functional deficits, and formulating the most effective surgical plan. Strengths of SEEG include the ability to sample difficult to reach, deep structures of the brain without a craniotomy and without disrupting the dura. SEEG is complementary to minimally invasive epilepsy treatment options and may reduce the treatment gap in patients who are hesitant about craniotomy and surgical resection. Understanding the strengths and limitations of SDE monitoring and SEEG allows epileptologists to choose the best modality of invasive monitoring for each patient living with drug-resistant seizures.
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Affiliation(s)
- Rohini Coorg
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas, United States
| | - Elaine S. Seto
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas, United States
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12
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Assouly K, Smit AL, Stegeman I. Effect of electrical stimulation with a cochlear implant on tinnitus impact: protocol of an individual patient data meta-analysis. BMJ Open 2022; 12:e063432. [PMID: 35715189 PMCID: PMC9208004 DOI: 10.1136/bmjopen-2022-063432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/31/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Tinnitus is the perception of sound without an external stimulus, often experienced as a ringing, buzzing sound. While several studies have shown a reduction in tinnitus distress following cochlear implantation, others showed an increase or no change after implantation. At this stage, clinicians have little certainty when counselling their patients prior to implantation regarding tinnitus post-implantation. To help clinicians to counsel cochlear implant (CI) candidates on the risk of developing or improving tinnitus after implantation, we aim to assess the effect of electrical stimulation with a CI on tinnitus impact for individual adult patients with tinnitus. We will also apply prediction models to individual patient data (IPD) of clinical trials to find predictive factors of the effect of electrical stimulation on tinnitus impact. METHOD AND ANALYSIS The IPD meta-analysis is a follow-up project of the systematic review on cochlear implantation in patients with tinnitus as a primary complaint. First, the systematic searches will be updated to date. Methodological quality of eligible studies will be assessed using the Risk of Bias In Non-randomised Studies of Intervention tool (ROBINS-I). Based on a data-sharing agreement, authors of the eligible studies will be invited to share their deidentified and complete IPD. The primary outcome is the effect of electrical stimulation with a CI on tinnitus impact 1 month or more post-implantation. IPD meta-analysis will be used to assess the primary outcome, while differentiating the tinnitus impact questionnaires. Second, linear regression analyses will be used to model the effect of electrical stimulation on tinnitus impact based on relevant predictors. ETHICS AND DISSEMINATION The Medical Research Involving Human Subject Act does not apply, and ethical approval is not required. The study results will be made accessible to the public in a peer-review open access journal. PROSPERO REGISTRATION NUMBER CRD42022319367, review ongoing.
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Affiliation(s)
- Kelly Assouly
- Department of Otorhinolaryngology and Head & Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
- Cochlear Technology Centre Belgium, Mechelen, Belgium
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
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13
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Arturo Larco JL, Madhani SI, Liu Y, Abbasi M, Shahid AH, Mereuta OM, Kadirvel R, Cloft HJ, Kallmes DF, Brinjikji W, Savastano L. Human "live cadaver" neurovascular model for proximal and distal mechanical thrombectomy in stroke. J Neurointerv Surg 2022; 15:465-472. [PMID: 35418449 DOI: 10.1136/neurintsurg-2022-018686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/30/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Preclinical testing platforms that accurately replicate complex human cerebral vasculature are critical to advance neurointerventional knowledge, tools, and techniques. Here, we introduced and validated a human "live cadaveric" head-and-neck neurovascular model optimized for proximal and distal vascular occlusion and recanalization techniques. METHODS Human cadaveric head-and-neck specimens were cannulated bilaterally in the jugular veins, carotid, and vertebral arteries. Specimens were then coupled with modular glass models of the aorta and extracranial carotid arteries, as well as radial and femoral access ports. Intracranial physiological flow was simulated using a flow-delivery system and blood-mimicking fluid. Baseline anatomy, histological, and mechanical properties of cerebral arteries were compared with those of fresh specimens. Radiopaque clot analogs were embolized to replicate proximal and distal arterial occlusions, followed by thrombectomy. Experienced interventionalists scored the model on different aspects. RESULTS Compared with counterpart fresh human arteries, formalin-fixed arteries showed similar mechanical properties, including maximum stretch, increased tensile strength/stiffness, and friction coefficients were also not significantly different. On histology, minimal endothelial damage was noted in arteries after 3 months of light fixation, otherwise the arterial wall maintained the structural integrity. Contrast angiographies showed no micro- or macro-vasculature obstruction. Proximal and distal occlusions created within the middle cerebral arteries were consistently obtained and successfully recanalized. Additionally, interventionists scored the model highly realistic, indicating great similarity to patients' vasculature. CONCLUSIONS The human "live cadaveric" neurovascular model accurately replicates the anatomy, mechanics, and hemodynamics of cerebral vasculature and allows the performance of neurointerventional procedures equivalent to those done in patients.
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Affiliation(s)
- Jorge L Arturo Larco
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Yang Liu
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mehdi Abbasi
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Oana Madalina Mereuta
- Radiology, Mayo Clinic, Rochester, Minnesota, USA.,CÚRAM-SFI Research Centre for Medical Devices and Physiology Department, National University of Ireland Galway, Galway, Ireland
| | | | | | | | - Waleed Brinjikji
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis Savastano
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA .,Radiology, Mayo Clinic, Rochester, Minnesota, USA
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14
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Carrington M, Pereira AR, Mendes IC, Anjos R. Intracardiac versus extracardiac shunt in a young man with ischaemic stroke. BMJ Case Rep 2022; 15:e247877. [PMID: 35260403 PMCID: PMC8905973 DOI: 10.1136/bcr-2021-247877] [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] [Accepted: 01/26/2022] [Indexed: 11/03/2022] Open
Abstract
A 24-year-old man with a history of recent ischaemic stroke was diagnosed with patent foramen ovale (PFO) and referred for closure at our hospital. At admission, besides low peripheral oxygen saturation (88%), physical examination was otherwise normal. We performed intraprocedural transoesophageal echocardiogram that revealed no PFO, although agitated saline injection demonstrated bubbles lately on the left atrium. The atrial septum could not be crossed. We suspected an extracardiac shunt, so pulmonary angiograms were performed that revealed the presence of a left pulmonary arteriovenous malformation (PAVM). A Konar-MF Occluder was used to occlude the PAVM, with a satisfactory result. At 6 months follow-up, the patient had normal peripheral oxygen saturation and a new pulmonary angiogram showed no residual shunt. Intrapulmonary shunts are a rare and under-recognised cause of paradoxical emboli in young patients; physicians should be aware of this diagnosis as percutaneous occlusion is indicated and critical to avoid recurrent ischaemic episodes.
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Affiliation(s)
| | | | - Inês Carmo Mendes
- Pediatric Cardiology Department and Reference Center for Congenital Heart Diseases, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Lisboa, Portugal
| | - Rui Anjos
- Pediatric Cardiology Department and Reference Center for Congenital Heart Diseases, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Lisboa, Portugal
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15
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Anderson DN, Charlebois CM, Smith EH, Arain AM, Davis TS, Rolston JD. Probabilistic comparison of gray and white matter coverage between depth and surface intracranial electrodes in epilepsy. Sci Rep 2021; 11:24155. [PMID: 34921176 PMCID: PMC8683494 DOI: 10.1038/s41598-021-03414-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/23/2021] [Indexed: 11/20/2022] Open
Abstract
In this study, we quantified the coverage of gray and white matter during intracranial electroencephalography in a cohort of epilepsy patients with surface and depth electrodes. We included 65 patients with strip electrodes (n = 12), strip and grid electrodes (n = 24), strip, grid, and depth electrodes (n = 7), or depth electrodes only (n = 22). Patient-specific imaging was used to generate probabilistic gray and white matter maps and atlas segmentations. Gray and white matter coverage was quantified using spherical volumes centered on electrode centroids, with radii ranging from 1 to 15 mm, along with detailed finite element models of local electric fields. Gray matter coverage was highly dependent on the chosen radius of influence (RoI). Using a 2.5 mm RoI, depth electrodes covered more gray matter than surface electrodes; however, surface electrodes covered more gray matter at RoI larger than 4 mm. White matter coverage and amygdala and hippocampal coverage was greatest for depth electrodes at all RoIs. This study provides the first probabilistic analysis to quantify coverage for different intracranial recording configurations. Depth electrodes offer increased coverage of gray matter over other recording strategies if the desired signals are local, while subdural grids and strips sample more gray matter if the desired signals are diffuse.
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Affiliation(s)
- Daria Nesterovich Anderson
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA. .,Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, USA.
| | - Chantel M Charlebois
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Elliot H Smith
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Amir M Arain
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Tyler S Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA. .,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
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