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Downey JE, Schone HR, Foldes ST, Greenspon C, Liu F, Verbaarschot C, Biro D, Satzer D, Moon CH, Coffman BA, Youssofzadeh V, Fields D, Hobbs TG, Okorokova E, Tyler-Kabara EC, Warnke PC, Gonzalez-Martinez J, Hatsopoulos NG, Bensmaia SJ, Boninger ML, Gaunt RA, Collinger JL. A roadmap for implanting microelectrode arrays to evoke tactile sensations through intracortical microstimulation. medRxiv 2024:2024.04.26.24306239. [PMID: 38712177 PMCID: PMC11071570 DOI: 10.1101/2024.04.26.24306239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Intracortical microstimulation (ICMS) is a method for restoring sensation to people with paralysis as part of a bidirectional brain-computer interface to restore upper limb function. Evoking tactile sensations of the hand through ICMS requires precise targeting of implanted electrodes. Here we describe the presurgical imaging procedures used to generate functional maps of the hand area of the somatosensory cortex and subsequent planning that guided the implantation of intracortical microelectrode arrays. In five participants with cervical spinal cord injury, across two study locations, this procedure successfully enabled ICMS-evoked sensations localized to at least the first four digits of the hand. The imaging and planning procedures developed through this clinical trial provide a roadmap for other brain-computer interface studies to ensure successful placement of stimulation electrodes.
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Shelchkova ND, Downey JE, Greenspon CM, Okorokova EV, Sobinov AR, Verbaarschot C, He Q, Sponheim C, Tortolani AF, Moore DD, Kaufman MT, Lee RC, Satzer D, Gonzalez-Martinez J, Warnke PC, Miller LE, Boninger ML, Gaunt RA, Collinger JL, Hatsopoulos NG, Bensmaia SJ. Microstimulation of human somatosensory cortex evokes task-dependent, spatially patterned responses in motor cortex. Nat Commun 2023; 14:7270. [PMID: 37949923 PMCID: PMC10638421 DOI: 10.1038/s41467-023-43140-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
The primary motor (M1) and somatosensory (S1) cortices play critical roles in motor control but the signaling between these structures is poorly understood. To fill this gap, we recorded - in three participants in an ongoing human clinical trial (NCT01894802) for people with paralyzed hands - the responses evoked in the hand and arm representations of M1 during intracortical microstimulation (ICMS) in the hand representation of S1. We found that ICMS of S1 activated some M1 neurons at short, fixed latencies consistent with monosynaptic activation. Additionally, most of the ICMS-evoked responses in M1 were more variable in time, suggesting indirect effects of stimulation. The spatial pattern of M1 activation varied systematically: S1 electrodes that elicited percepts in a finger preferentially activated M1 neurons excited during that finger's movement. Moreover, the indirect effects of S1 ICMS on M1 were context dependent, such that the magnitude and even sign relative to baseline varied across tasks. We tested the implications of these effects for brain-control of a virtual hand, in which ICMS conveyed tactile feedback. While ICMS-evoked activation of M1 disrupted decoder performance, this disruption was minimized using biomimetic stimulation, which emphasizes contact transients at the onset and offset of grasp, and reduces sustained stimulation.
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Affiliation(s)
- Natalya D Shelchkova
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
| | - John E Downey
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA.
| | - Charles M Greenspon
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | | | - Anton R Sobinov
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Ceci Verbaarschot
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Qinpu He
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
| | - Caleb Sponheim
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
| | - Ariana F Tortolani
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
| | - Dalton D Moore
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
| | - Matthew T Kaufman
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
- Neuroscience Institute, University of Chicago, Chicago, IL, USA
| | - Ray C Lee
- Schwab Rehabilitation Hospital, Chicago, IL, USA
| | - David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA
| | | | - Peter C Warnke
- Neuroscience Institute, University of Chicago, Chicago, IL, USA
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA
| | - Lee E Miller
- Department of Physiology, Northwestern University, Chicago, IL, USA
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Nicholas G Hatsopoulos
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
- Neuroscience Institute, University of Chicago, Chicago, IL, USA
| | - Sliman J Bensmaia
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
- Neuroscience Institute, University of Chicago, Chicago, IL, USA
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Greenspon CM, Shelchkova ND, Valle G, Hobbs TG, Berger-Wolf EI, Hutchison BC, Dogruoz E, Verbarschott C, Callier T, Sobinov AR, Okorokova EV, Jordan PM, Prasad D, He Q, Liu F, Kirsch RF, Miller JP, Lee RC, Satzer D, Gonzalez-Martinez J, Warnke PC, Miller LE, Boninger ML, Ajiboye AB, Graczyk EL, Downey JE, Collinger JL, Hatsopoulos NG, Gaunt RA, Bensmaia SJ. Tessellation of artificial touch via microstimulation of human somatosensory cortex. bioRxiv 2023:2023.06.23.545425. [PMID: 37425877 PMCID: PMC10327055 DOI: 10.1101/2023.06.23.545425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
When we interact with objects, we rely on signals from the hand that convey information about the object and our interaction with it. A basic feature of these interactions, the locations of contacts between the hand and object, is often only available via the sense of touch. Information about locations of contact between a brain-controlled bionic hand and an object can be signaled via intracortical microstimulation (ICMS) of somatosensory cortex (S1), which evokes touch sensations that are localized to a specific patch of skin. To provide intuitive location information, tactile sensors on the robotic hand drive ICMS through electrodes that evoke sensations at skin locations matching sensor locations. This approach requires that ICMS-evoked sensations be focal, stable, and distributed over the hand. To systematically investigate the localization of ICMS-evoked sensations, we analyzed the projected fields (PFs) of ICMS-evoked sensations - their location and spatial extent - from reports obtained over multiple years from three participants implanted with microelectrode arrays in S1. First, we found that PFs vary widely in their size across electrodes, are highly stable within electrode, are distributed over large swaths of each participant's hand, and increase in size as the amplitude or frequency of ICMS increases. Second, while PF locations match the locations of the receptive fields (RFs) of the neurons near the stimulating electrode, PFs tend to be subsumed by the corresponding RFs. Third, multi-channel stimulation gives rise to a PF that reflects the conjunction of the PFs of the component channels. By stimulating through electrodes with largely overlapping PFs, then, we can evoke a sensation that is experienced primarily at the intersection of the component PFs. To assess the functional consequence of this phenomenon, we implemented multichannel ICMS-based feedback in a bionic hand and demonstrated that the resulting sensations are more localizable than are those evoked via single-channel ICMS.
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Affiliation(s)
- Charles M Greenspon
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | | | - Giacomo Valle
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Taylor G Hobbs
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Ev I Berger-Wolf
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Brianna C Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Efe Dogruoz
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Ceci Verbarschott
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
| | - Thierri Callier
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Anton R Sobinov
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | | | - Patrick M Jordan
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Dillan Prasad
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Qinpu He
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
| | - Fang Liu
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Robert F Kirsch
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland, OH
- The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Ray C Lee
- Schwab Rehabilitation Hospital, Chicago, IL
| | - David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | | | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | - Lee E Miller
- Department of Neuroscience, Northwestern University, Chicago, IL
- Department of Biomedical Engineering, Northwestern University, Evanston, IL
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
- Shirley Ryan Ability Lab, Chicago, IL
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Abidemi B Ajiboye
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Emily L Graczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - John E Downey
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Nicholas G Hatsopoulos
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
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Greenspon CM, Valle G, Hobbs TG, Verbaarschot C, Callier T, Okorokova EV, Shelchkova ND, Sobinov AR, Jordan PM, Weiss JM, Fitzgerald EE, Prasad D, van Driesche A, Lee RC, Satzer D, Gonzalez-Martinez J, Warnke PC, Miller LE, Boninger ML, Collinger JL, Gaunt RA, Downey JE, Hatsopoulos NG, Bensmaia SJ. Biomimetic multi-channel microstimulation of somatosensory cortex conveys high resolution force feedback for bionic hands. bioRxiv 2023:2023.02.18.528972. [PMID: 36824713 PMCID: PMC9949113 DOI: 10.1101/2023.02.18.528972] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Manual interactions with objects are supported by tactile signals from the hand. This tactile feedback can be restored in brain-controlled bionic hands via intracortical microstimulation (ICMS) of somatosensory cortex (S1). In ICMS-based tactile feedback, contact force can be signaled by modulating the stimulation intensity based on the output of force sensors on the bionic hand, which in turn modulates the perceived magnitude of the sensation. In the present study, we gauged the dynamic range and precision of ICMS-based force feedback in three human participants implanted with arrays of microelectrodes in S1. To this end, we measured the increases in sensation magnitude resulting from increases in ICMS amplitude and participant's ability to distinguish between different intensity levels. We then assessed whether we could improve the fidelity of this feedback by implementing "biomimetic" ICMS-trains, designed to evoke patterns of neuronal activity that more closely mimic those in natural touch, and by delivering ICMS through multiple channels at once. We found that multi-channel biomimetic ICMS gives rise to stronger and more distinguishable sensations than does its single-channel counterpart. Finally, we implemented biomimetic multi-channel feedback in a bionic hand and had the participant perform a compliance discrimination task. We found that biomimetic multi-channel tactile feedback yielded improved discrimination over its single-channel linear counterpart. We conclude that multi-channel biomimetic ICMS conveys finely graded force feedback that more closely approximates the sensitivity conferred by natural touch.
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Affiliation(s)
- Charles M. Greenspon
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Giacomo Valle
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Taylor G. Hobbs
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
| | - Ceci Verbaarschot
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Thierri Callier
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
| | | | | | - Anton R. Sobinov
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Patrick M. Jordan
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Jeffrey M. Weiss
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
| | - Emily E. Fitzgerald
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Dillan Prasad
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Ashley van Driesche
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Ray C. Lee
- Schwab Rehabilitation Hospital, Chicago, IL
| | - David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | | | - Peter C. Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | - Lee E. Miller
- Department of Neuroscience, Northwestern University, Chicago, IL
- Department of Biomedical Engineering, Northwestern University, Evanston, IL
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
- Shirley Ryan Ability Lab, Chicago, IL
| | - Michael L. Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer L. Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Robert A. Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - John E. Downey
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Nicholas G. Hatsopoulos
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
| | - Sliman J. Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
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Mendoza-Elias N, Satzer D, Henry J, Nordli DR, Warnke PC. Tailored Hemispherotomy Using Tractography-Guided Laser Interstitial Thermal Therapy. Oper Neurosurg (Hagerstown) 2023; 24:e407-e413. [PMID: 36807222 DOI: 10.1227/ons.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/06/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Medically refractory hemispheric epilepsy is a devastating disease with significant lifetime costs and social burden. Functional hemispherotomy is a highly effective treatment for hemispheric epilepsy but is associated with significant complication rates. Percutaneous hemispherotomy through laser interstitial thermal therapy (LITT) based on morphological MRI has been recently described in a single patient but not replicated in the literature. OBJECTIVE To describe the first 2 cases of tractography-guided interstitial laser hemispherotomy and their short-term outcomes. METHODS Two 11-year-old male patients with medically refractory epilepsy secondary to perinatal large vessel infarcts were referred for hemispherotomy. Both patients underwent multitrajectory LITT to disconnect the remaining pathological hemisphere, using tractography to define targets and assess structural outcomes. RESULTS Both cases had minor complication of small intraventricular/subarachnoid hemorrhage not requiring additional intervention. Both patients remain seizure-free at all follow-up visits. CONCLUSION LITT hemispherotomy can produce seizure freedom with short hospitalization and recovery. Tractography allows surgical planning to be tailored according to individual patient anatomy, which often is distorted in perinatal stroke. Minimally invasive procedures offer the greatest potential for seizure freedom without the risks of an open hemispherotomy.
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Affiliation(s)
- Nasya Mendoza-Elias
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
| | - David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
| | - Julia Henry
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Douglas R Nordli
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
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Satzer D, Wu S, Henry J, Doll E, Issa NP. Ambulatory Local Field Potential Recordings from the Thalamus in Epilepsy: A Feasibility Study. Stereotact Funct Neurosurg 2023; 101:195-206. [PMID: 37232010 DOI: 10.1159/000529961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/24/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Stimulation of the thalamus is gaining favor in the treatment of medically refractory multifocal and generalized epilepsy. Implanted brain stimulators capable of recording ambulatory local field potentials (LFPs) have recently been introduced, but there is little information to guide their use in thalamic stimulation for epilepsy. This study sought to assess the feasibility of chronically recording ambulatory interictal LFP from the thalamus in patients with epilepsy. METHODS In this pilot study, ambulatory LFP was recorded from patients who underwent sensing-enabled deep brain stimulation (DBS, 2 participants) or responsive neurostimulation (RNS, 3 participants) targeting the anterior nucleus of the thalamus (ANT, 2 electrodes), centromedian nucleus (CM, 7 electrodes), or medial pulvinar (PuM, 1 electrode) for multifocal or generalized epilepsy. Time-domain and frequency-domain LFP was investigated for epileptiform discharges, spectral peaks, circadian variation, and peri-ictal patterns. RESULTS Thalamic interictal discharges were visible on ambulatory recordings from both DBS and RNS. At-home interictal frequency-domain data could be extracted from both devices. Spectral peaks were noted at 10-15 Hz in CM, 6-11 Hz in ANT, and 19-24 Hz in PuM but varied in prominence and were not visible in all electrodes. In CM, 10-15 Hz power exhibited circadian variation and was attenuated by eye opening. CONCLUSION Chronic ambulatory recording of thalamic LFP is feasible. Common spectral peaks can be observed but vary between electrodes and across neural states. DBS and RNS devices provide a wealth of complementary data that have the potential to better inform thalamic stimulation for epilepsy.
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Affiliation(s)
- David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Julia Henry
- Department of Pediatrics, Child Neurology Section, University of Chicago, Chicago, Illinois, USA
| | - Emily Doll
- Department of Pediatrics, Child Neurology Section, University of Chicago, Chicago, Illinois, USA
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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Satzer D, Esengul YT, Warnke PC, Issa NP, Nordli DR. Source localization of ictal SEEG to predict postoperative seizure outcome. Clin Neurophysiol 2022; 144:142-150. [PMID: 36088217 DOI: 10.1016/j.clinph.2022.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Stereo-electroencephalography (SEEG) is inherently-three-dimensional and can be modeled using source localization. This study aimed to assess the validity of ictal SEEG source localization. METHODS The dominant frequency at ictal onset was used for source localization in the time and frequency domains using rotating dipoles and current density maps. Validity was assessed by concordance with the epileptologist-defined seizure onset zone (conventional SOZ) and the surgical treatment volume (TV) of seizure-free versus non-seizure-free patients. RESULTS Source localization was performed on 68 seizures from 27 patients. Median distance to nearest contact in the conventional SOZ was 7 (IQR 6-12) mm for time-domain dipoles. Current density predicted ictal activity with up to 86 % (60-87 %) accuracy. Distance from time-domain dipoles to the TV was smaller (P = 0.045) in seizure-free (2 [0-4] mm) versus non-seizure-free (12 [2-17] mm) patients, and predicted surgical outcome with 91 % sensitivity and 63 % specificity. Removing near-field data from contacts within the TV negated outcome prediction (P = 0.51). CONCLUSIONS Source localization of SEEG accurately mapped ictal onset compared with conventional interpretation. Proximity of dipoles to the TV predicted seizure outcome when near-field recordings were analyzed. SIGNIFICANCE Ictal SEEG source localization is useful in corroborating the epileptogenic zone, assuming near-field recordings are obtained.
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Affiliation(s)
- David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA.
| | - Yasar T Esengul
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Douglas R Nordli
- Section of Child Neurology, Department of Pediatrics, University of Chicago, Chicago, IL, USA
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Satzer D, Mahavadi A, Lacy M, Grant JE, Warnke P. Interstitial laser anterior capsulotomy for obsessive-compulsive disorder: lesion size and tractography correlate with outcome. J Neurol Neurosurg Psychiatry 2022; 93:317-323. [PMID: 34716192 DOI: 10.1136/jnnp-2021-327730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anterior capsulotomy is a well-established treatment for refractory obsessive-compulsive disorder (OCD). MRI-guided laser interstitial thermal therapy (LITT) allows creation of large, sharply demarcated lesions with the safeguard of real-time imaging. OBJECTIVE To characterise the outcomes of laser anterior capsulotomy, including radiographical predictors of improvement. METHODS Patients with severe OCD refractory to pharmacotherapy and cognitive-behavioural therapy underwent bilateral anterior capsulotomy via LITT. The primary outcome was per cent reduction in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score over time. Lesion size was measured on postablation MRI. Disconnection of the anterior limb of the internal capsule (ALIC) was assessed via individual and normative tractography. RESULTS Eighteen patients underwent laser anterior capsulotomy. Median follow-up was 6 months (range 3-51 months). Time occupied by obsessions improved immediately (median Y-BOCS item 1 score 4-1, p=0.002). Mean (±SD) decrease in Y-BOCS score at last follow-up was 46%±32% (16±11 points, p<0.0001). Sixty-one per cent of patients were responders. Seven patients (39%) exhibited transient postoperative apathy. One patient had an asymptomatic intracerebral haemorrhage. Reduction in Y-BOCS score was positively associated with ablation volume (p=0.006). Individual tractography demonstrated durable ALIC disconnection. Normative tractography revealed a dorsal-ventral gradient, with disconnection of orbitofrontal streamlines most strongly associated with a positive response (p<0.0001). CONCLUSIONS Laser anterior capsulotomy resulted in immediate, marked improvement in OCD symptom severity. Larger lesions permit greater disconnection of prefrontal-subcortical pathways involved in OCD. The importance of greater disconnection is presumably related to variation in ALIC structure and the complex role of the PFC in OCD.
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Affiliation(s)
- David Satzer
- Neurosurgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Anil Mahavadi
- Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maureen Lacy
- Psychaitry and Behavioral Neuroscience, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Jon E Grant
- Psychiatry, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Peter Warnke
- Neurosurgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
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Satzer D, Esengul YT, Warnke PC, Issa NP, Nordli DR. SEEG in 3D: Interictal Source Localization From Intracerebral Recordings. Front Neurol 2022; 13:782880. [PMID: 35211078 PMCID: PMC8861202 DOI: 10.3389/fneur.2022.782880] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stereo-electroencephalography (SEEG) uses a three-dimensional configuration of depth electrodes to localize epileptiform activity, but traditional analysis of SEEG is spatially restricted to the point locations of the electrode contacts. Interpolation of brain activity between contacts might allow for three-dimensional representation of epileptiform activity and avoid pitfalls of SEEG interpretation. OBJECTIVE The goal of this study was to validate SEEG-based interictal source localization and assess the ability of this technique to monitor far-field activity in non-implanted brain regions. METHODS Interictal epileptiform discharges were identified on SEEG in 26 patients who underwent resection, ablation, or disconnection of the suspected epileptogenic zone. Dipoles without (free) and with (scan) gray matter restriction, and current density (sLORETA and SWARM methods), were calculated using a finite element head model. Source localization results were compared to the conventional irritative zone (IZ) and the surgical treatment volumes (TV) of seizure-free vs. non-seizure-free patients. RESULTS The median distance from dipole solutions to the nearest contact in the conventional IZ was 7 mm (interquartile range 4-15 mm for free dipoles and 4-14 mm for scan dipoles). The IZ modeled with SWARM predicted contacts within the conventional IZ with 83% (75-100%) sensitivity and 94% (88-100%) specificity. The proportion of current within the TV was greater in seizure-free patients (P = 0.04) and predicted surgical outcome with 45% sensitivity and 93% specificity. Dipole solutions and sLORETA results did not correlate with seizure outcome. Addition of scalp EEG led to more superficial modeled sources (P = 0.03) and negated the ability to predict seizure outcome (P = 0.23). Removal of near-field data from contacts within the TV resulted in smearing of the current distribution (P = 0.007) and precluded prediction of seizure freedom (P = 0.20). CONCLUSIONS Source localization accurately represented interictal discharges from SEEG. The proportion of current within the TV distinguished between seizure-free and non-seizure-free patients when near-field recordings were obtained from the surgical target. The high prevalence of deep sources in this cohort likely obscured any benefit of concurrent scalp EEG. SEEG-based interictal source localization is useful in illustrating and corroborating the epileptogenic zone. Additional techniques are needed to localize far-field epileptiform activity from non-implanted brain regions.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Chicago, Chicago, IL, United States
| | - Yasar T Esengul
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Peter C Warnke
- Department of Neurosurgery, University of Chicago, Chicago, IL, United States
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Douglas R Nordli
- Section of Child Neurology, Department of Pediatrics, University of Chicago, Chicago, IL, United States
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Xie T, Padmanaban M, Javed A, Satzer D, Towle TE, Warnke P, Towle VL. Effect of Deep Brain Stimulation on Cerebellar Tremor Compared to Non-Cerebellar Tremor Using a Wearable Device in a Patient With Multiple Sclerosis: Case Report. Front Hum Neurosci 2022; 15:754091. [PMID: 35095448 PMCID: PMC8792598 DOI: 10.3389/fnhum.2021.754091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/24/2021] [Indexed: 12/02/2022] Open
Abstract
Tremor of the upper extremity is a significant cause of disability in some patients with multiple sclerosis (MS). The MS tremor is complex because it contains an ataxic intentional tremor component due to the involvement of the cerebellum and cerebellar outflow pathways by MS plaques, which makes the MS tremor, in general, less responsive to medications or deep brain stimulation (DBS) than those associated with essential tremor or Parkinson's disease. The cerebellar component has been thought to be the main reason for making DBS less effective, although it is not clear whether it is due to the lack of suppression of the ataxic tremor by DBS or else. The goal of this study was to clarify the effect of DBS on cerebellar tremor compared to non-cerebellar tremor in a patient with MS. By wearing an accelerometer on the index finger of each hand, we were able to quantitatively characterize kinetic tremor by frequency and amplitude, with cerebellar ataxia component on one hand and that without cerebellar component on the other hand, at the beginning and end of the hand movement approaching a target at DBS Off and On status. We found that cerebellar tremor surprisingly had as good a response to DBS as the tremor without a cerebellar component, but the function control on cerebellar tremor was not as good due to its distal oscillation, which made the amplitude of tremor increasingly greater as it approached the target. This explains why cerebellar tremor or MS tremor with cerebellar component has a poor functional transformation even with a good percentage of tremor control. This case study provides a better understanding of the effect of DBS on cerebellar tremor and MS tremor by using a wearable device, which could help future studies improve patient selection and outcome prediction for DBS treatment of this disabling tremor.
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Affiliation(s)
- Tao Xie
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
- *Correspondence: Tao Xie
| | - Mahesh Padmanaban
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
| | - Adil Javed
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
| | - David Satzer
- Department of Neurosurgery, University of Chicago Medicine, Chicago, IL, United States
| | - Theresa E. Towle
- Department of Neurosurgery, University of Chicago Medicine, Chicago, IL, United States
| | - Peter Warnke
- Department of Neurosurgery, University of Chicago Medicine, Chicago, IL, United States
| | - Vernon L. Towle
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
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Satzer D, Tao JX, Warnke PC. Extent of parahippocampal ablation is associated with seizure freedom after laser amygdalohippocampotomy. J Neurosurg 2021:1-10. [PMID: 34087803 DOI: 10.3171/2020.11.jns203261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to examine the relationship between mesial temporal subregion ablation volume and seizure outcome in a diverse cohort of patients who underwent stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE). METHODS Seizure outcomes and pre- and postoperative images were retrospectively reviewed in patients with MTLE who underwent SLAH at a single institution. Mesial temporal subregions and the contrast-enhancing ablation volume were manually segmented. Pre- and postoperative MR images were coregistered to assess anatomical ablation. Postoperative MRI and ablation volumes were also spatially normalized, enabling the assessment of seizure outcome with heat maps. RESULTS Twenty-eight patients with MTLE underwent SLAH, 15 of whom had mesial temporal sclerosis (MTS). The rate of Engel class I outcome at 1 year after SLAH was 39% overall: 47% in patients with MTS and 31% in patients without MTS. The percentage of parahippocampal gyrus (PHG) ablated was higher in patients with an Engel class I outcome (40% vs 25%, p = 0.04). Subregion analysis revealed that extent of ablation in the parahippocampal cortex (35% vs 19%, p = 0.03) and angular bundle (64% vs 43%, p = 0.02) was positively associated with Engel class I outcome. The degree of amygdalohippocampal complex (AHC) ablated was not associated with seizure outcome (p = 0.30). CONCLUSIONS Although the AHC was the described target of SLAH, seizure outcome in this cohort was associated with degree of ablation for the PHG, not the AHC. Complete coverage of both the AHC and PHG is technically challenging, and more work is needed to optimize seizure outcome after SLAH.
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12
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Wu S, Issa NP, Lacy M, Satzer D, Rose SL, Yang CW, Collins JM, Liu X, Sun T, Towle VL, Nordli DR, Warnke PC, Tao JX. Surgical Outcomes and EEG Prognostic Factors After Stereotactic Laser Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy. Front Neurol 2021; 12:654668. [PMID: 34079512 PMCID: PMC8165234 DOI: 10.3389/fneur.2021.654668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To assess the seizure outcomes of stereotactic laser amygdalohippocampectomy (SLAH) in consecutive patients with mesial temporal lobe epilepsy (mTLE) in a single center and identify scalp EEG and imaging factors in the presurgical evaluation that correlate with post-surgical seizure recurrence. Methods: We retrospectively reviewed the medical and EEG records of 30 patients with drug-resistant mTLE who underwent SLAH and had at least 1 year of follow-up. Surgical outcomes were classified using the Engel scale. Univariate hazard ratios were used to evaluate the risk factors associated with seizure recurrence after SLAH. Results: The overall Engel class I outcome after SLAH was 13/30 (43%), with a mean postoperative follow-up of 48.9 ± 17.6 months. Scalp EEG findings of interictal regional slow activity (IRSA) on the side of surgery (HR = 4.05, p = 0.005) and non-lateralizing or contra-lateralizing seizure onset (HR = 4.31, p = 0.006) were negatively correlated with postsurgical seizure freedom. Scalp EEG with either one of the above features strongly predicted seizure recurrence after surgery (HR = 7.13, p < 0.001) with 100% sensitivity and 71% specificity. Significance: Understanding the factors associated with good or poor surgical outcomes can help choose the best candidates for SLAH. Of the variables assessed, scalp EEG findings were the most clearly associated with seizure outcomes after SLAH.
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Affiliation(s)
- Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, IL, United States
| | - Naoum P Issa
- Department of Neurology, The University of Chicago, Chicago, IL, United States
| | - Maureen Lacy
- Department of Psychiatry, The University of Chicago, Chicago, IL, United States
| | - David Satzer
- Department of Neurosurgery, The University of Chicago, Chicago, IL, United States
| | - Sandra L Rose
- Department of Neurology, The University of Chicago, Chicago, IL, United States
| | - Carina W Yang
- Department of Radiology, The University of Chicago, Chicago, IL, United States
| | - John M Collins
- Department of Radiology, The University of Chicago, Chicago, IL, United States
| | - Xi Liu
- Department of Neurology, Wuhan University, Wuhan, China
| | - Taixin Sun
- Department of Neurology, Beijing Electric Power Hospital, Beijing, China
| | - Vernon L Towle
- Department of Neurology, The University of Chicago, Chicago, IL, United States
| | - Douglas R Nordli
- Department of Pediatric Neurology, The University of Chicago, Chicago, IL, United States
| | - Peter C Warnke
- Department of Neurosurgery, The University of Chicago, Chicago, IL, United States
| | - James X Tao
- Department of Neurology, The University of Chicago, Chicago, IL, United States
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13
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Satzer D, Yu H, Wells M, Padmanaban M, Burns MR, Warnke PC, Xie T. Deep Brain Stimulation Impedance Decreases Over Time Even When Stimulation Settings Are Held Constant. Front Hum Neurosci 2020; 14:584005. [PMID: 33240066 PMCID: PMC7680729 DOI: 10.3389/fnhum.2020.584005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: To study whether and to what extent the therapeutic impedance and current change under long-term deep brain stimulation (DBS) with constant stimulation settings, which could inform the role of constant current stimulation. Methods: Therapy impedance and current measurements were retrospectively collected from patients with Parkinson’s disease (PD) undergoing DBS of the subthalamic nucleus (STN) or essential tremor (ET) undergoing ventral intermediate nucleus (VIM). Baseline and follow-up measurements were obtained for intervals of at least 6 months without changes in stimulation settings. The single longest interval of constant stimulation for each electrode was included. Temporal trends in impedance and current were analyzed as absolute and relative differences and as the rate of change. Results: Impedance and current data from 79 electrodes (60 in STN, 19 in VIM) in 44 patients (32 with PD, 12 with ET) met inclusion criteria. The duration between baseline and follow-up measurements with constant stimulation settings was 17 months (median, with an interquartile range of 12–26 months) in the mixed group. Therapy impedance decreased by 27 ± 12 Ω/year (mean ± 2 standard errors; p < 0.0001), and therapy current increased at a rate of 0.142 ± 0.063 mA/year (p < 0.0001). Similar results were observed in the STN and VIM subgroups. Conclusions: Impedance decreases gradually over time, even when stimulation settings are kept constant. The rate of decrease is smaller than previously reported, suggesting that changes in stimulation settings contribute to impedance drift. Stimulation-independent impedance drift is gradual but relevant to constant-current programming.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Chicago Medicine, Chicago, IL, United States
| | - Huiyan Yu
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China.,Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
| | - Meredith Wells
- Department of Neurobiology, University of Chicago Medicine, Chicago, IL, United States
| | - Mahesh Padmanaban
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
| | - Matthew R Burns
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States.,Department of Neurology, University of Florida College of Medicine, Chicago, IL, United States
| | - Peter C Warnke
- Department of Neurosurgery, University of Chicago Medicine, Chicago, IL, United States
| | - Tao Xie
- Department of Neurology, University of Chicago Medicine, Chicago, IL, United States
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14
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Tao JX, Satzer D, Issa NP, Collins J, Wu S, Rose S, Henry J, Santos de Lima F, Nordli D, Warnke PC. Stereotactic laser anterior corpus callosotomy for Lennox‐Gastaut syndrome. Epilepsia 2020; 61:1190-1200. [DOI: 10.1111/epi.16535] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/27/2022]
Affiliation(s)
- James X. Tao
- Department of Neurology University of Chicago Chicago IL USA
| | - David Satzer
- Department of Neurosurgery University of Chicago Chicago IL USA
| | - Naoum P. Issa
- Department of Neurology University of Chicago Chicago IL USA
| | - John Collins
- Department of Radiology University of Chicago Chicago IL USA
| | - Shasha Wu
- Department of Neurology University of Chicago Chicago IL USA
| | - Sandra Rose
- Department of Neurology University of Chicago Chicago IL USA
| | - Julia Henry
- Department of Pediatrics University of Chicago Chicago IL USA
| | | | - Douglas Nordli
- Department of Pediatrics University of Chicago Chicago IL USA
| | - Peter C. Warnke
- Department of Neurosurgery University of Chicago Chicago IL USA
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15
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Satzer D, Tao JX, Issa NP, Chen Z, Wu S, Rose S, Collins J, Awad IA, Warnke PC. Stereotactic laser interstitial thermal therapy for epilepsy associated with solitary and multiple cerebral cavernous malformations. Neurosurg Focus 2020; 48:E12. [DOI: 10.3171/2020.1.focus19866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe authors sought to perform a preliminary assessment of the safety and effectiveness of stereotactic laser interstitial thermal therapy (LITT) for patients with cerebral cavernous malformation (CCM)–related epilepsy.METHODSThe authors retrospectively analyzed 6 patients with CCM-related epilepsy who underwent LITT. Pre-, intra-, and postoperative brain MRI studies were used to characterize preoperative CCM volume, ablation volume, and postablation hemosiderin volume. Clinical outcomes were assessed postoperatively during clinic follow-up visits or phone interviews.RESULTSLITT was performed in 7 CCMs in 6 patients. Two patients had familial CCM disease with multifocal lesions. Four treated CCMs were extratemporal, and 3 were in or near the visual pathways. The median follow-up was 25 (range 12–39) months. Five of 6 (83%) patients achieved seizure freedom (Engel I classification), of whom 4 (67%) were Engel IA and 1 was Engel IC after a single seizure on postoperative day 4. The remaining patient had rare seizures (Engel II). One patient had a nondisabling visual field deficit. There were no hemorrhagic complications. All patients were discharged within 24 hours postablation. MRI 3–11 months after ablation demonstrated expected focal necrosis and trace hemosiderin-related T2 hypointensity measuring 9%–44% (median 24%) of the original lesion volume, with significant (p = 0.04) volume reduction.CONCLUSIONSLITT is a minimally invasive option for treating CCM-related epilepsy with seizure outcomes comparable to those achieved with open lesionectomy. The precision of LITT allows for the obliteration of eloquent, deep, small, and multifocal lesions with low complication rates, minimal postoperative discomfort, and short hospital stays. In this study the feasibility and benefits of this method were demonstrated in 2 patients with multifocal lesions.
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Affiliation(s)
| | | | | | - Ziyi Chen
- 4Department of Neurology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | | | | | - John Collins
- 3Radiology, University of Chicago, Illinois; and
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Satzer D, Warnke PC. Technical note: accuracy and precision in stereotactic stem cell transplantation. Acta Neurochir (Wien) 2019; 161:2059-2064. [PMID: 31273445 DOI: 10.1007/s00701-019-03964-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND While multiple trials have employed stereotactic stem cell transplantation, injection techniques have received little critical attention. Precise cell delivery is critical for certain applications, particularly when targeting deep nuclei. METHODS Ten patients with a history of ischemic stroke underwent CT-guided stem cell transplantation. Cells were delivered along 3 tracts adjacent to the infarcted area. Intraoperative air deposits and postoperative T2-weighted MRI fluid signals were mapped in relation to calculated targets. RESULTS The deepest air deposit was found 4.5 ± 1.0 mm (mean ± 2 SEM) from target. The apex of the T2-hyperintense tract was found 2.8 ± 0.8 mm from target. On average, air pockets were found anterior (1.2 ± 1.1 mm, p = 0.04) and superior (2.4 ± 1.0 mm, p < 0.001) to the target; no directional bias was noted for the apex of the T2-hyperintense tract. Location and distribution of air deposits were variable and were affected by the relationship of cannula trajectory to stroke cavity. CONCLUSIONS Precise stereotactic cell transplantation is a little-studied technical challenge. Reflux of cell suspension and air, and the structure of the injection tract affect delivery of cell suspensions. Intraoperative CT allows assessment of delivery and potential trajectory correction.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Chicago, 5841 S. Maryland Avenue, MC 3026, Chicago, IL, 60637, USA.
| | - Peter C Warnke
- Department of Neurosurgery, University of Chicago, 5841 S. Maryland Avenue, MC 3026, Chicago, IL, 60637, USA
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17
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Xie T, Bloom L, Padmanaban M, Bertacchi B, Kang W, MacCracken E, Dachman A, Vigil J, Satzer D, Zadikoff C, Markopoulou K, Warnke P, Kang UJ. Long-term effect of low frequency stimulation of STN on dysphagia, freezing of gait and other motor symptoms in PD. J Neurol Neurosurg Psychiatry 2018; 89:989-994. [PMID: 29654112 DOI: 10.1136/jnnp-2018-318060] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/01/2018] [Accepted: 03/24/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the long-term effect of 60 Hz stimulation of the subthalamic nucleus (STN) on dysphagia, freezing of gait (FOG) and other motor symptoms in patients with Parkinson's disease (PD) who have FOG at the usual 130 Hz stimulation. METHODS This is a prospective, sequence randomised, crossover, double-blind study. PD patients with medication refractory FOG at 130 Hz stimulation of the STN were randomised to the sequences of 130 Hz, 60 Hz or deep brain stimulation off to assess swallowing function (videofluoroscopic evaluation and swallowing questionnaire), FOG severity (stand-walk-sit test and FOG questionnaire) and motor function (Unified PD Rating Scale, Part III motor examination (UPDRS-III)) at initial visit (V1) and follow-up visit (V2, after being on 60 Hz stimulation for an average of 14.5 months), in their usual medications on state. The frequency of aspiration events, perceived swallowing difficulty and FOG severity at 60 Hz compared with 130 Hz stimulation at V2, and their corresponding changes at V2 compared with V1 at 60 Hz were set as primary outcomes, with similar comparisons in UPDRS-III and its subscores as secondary outcomes. RESULTS All 11 enrolled participants completed V1 and 10 completed V2. We found the benefits of 60 Hz stimulation compared with 130 Hz in reducing aspiration frequency, perceived swallowing difficulty, FOG severity, bradykinesia and overall axial and motor symptoms at V1 and persistent benefits on all of them except dysphagia at V2, with overall decreasing efficacy when comparing V2 to V1. CONCLUSIONS The 60 Hz stimulation, when compared with 130 Hz, has long-term benefits on reducing FOG, bradykinesia and overall axial and motor symptoms except dysphagia, although the overall benefits decrease with long-term use. CLINICAL TRIAL REGISTRATION NCT02549859; Pre-results.
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Affiliation(s)
- Tao Xie
- Department of Neurology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Lisa Bloom
- Speech and Swallowing Section, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Mahesh Padmanaban
- Department of Neurology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Breanna Bertacchi
- Department of Neurology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Wenjun Kang
- Center for Research Informatics, University of Chicago, Chicago, Illinois, USA
| | - Ellen MacCracken
- Speech and Swallowing Section, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Abraham Dachman
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Julie Vigil
- Speech and Swallowing Section, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - David Satzer
- Department of Neurosurgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Cindy Zadikoff
- Department of Neurology, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Katerina Markopoulou
- Department of Neurology, NorthShore University HealthSystem, Glenview, Illinois, USA
| | - Peter Warnke
- Department of Neurosurgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Un Jung Kang
- Department of Neurology, Columbia University Medical Center, New York City, New York, USA
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Satzer D, Bond DJ. Mania secondary to focal brain lesions: implications for understanding the functional neuroanatomy of bipolar disorder. Bipolar Disord 2016; 18:205-20. [PMID: 27112231 DOI: 10.1111/bdi.12387] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/22/2016] [Accepted: 03/18/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Approximately 3.5 million Americans will experience a manic episode during their lifetimes. The most common causes are psychiatric illnesses such as bipolar I disorder and schizoaffective disorder, but mania can also occur secondary to neurological illnesses, brain injury, or neurosurgical procedures. METHODS For this narrative review, we searched Medline for articles on the association of mania with stroke, brain tumors, traumatic brain injury, multiple sclerosis, neurodegenerative disorders, epilepsy, and neurosurgical interventions. We discuss the epidemiology, features, and treatment of these cases. We also review the anatomy of the lesions, in light of what is known about the neurobiology of bipolar disorder. RESULTS The prevalence of mania in patients with brain lesions varies widely by condition, from <2% in stroke to 31% in basal ganglia calcification. Mania occurs most commonly with lesions affecting frontal, temporal, and subcortical limbic brain areas. Right-sided lesions causing hypo-functionality or disconnection (e.g., stroke; neoplasms) and left-sided excitatory lesions (e.g., epileptogenic foci) are frequently observed. CONCLUSIONS Secondary mania should be suspected in patients with neurological deficits, histories atypical for classic bipolar disorder, and first manic episodes after the age of 40 years. Treatment with antimanic medications, along with specific treatment for the underlying neurologic condition, is typically required. Typical lesion locations fit with current models of bipolar disorder, which implicate hyperactivity of left-hemisphere reward-processing brain areas and hypoactivity of bilateral prefrontal emotion-modulating regions. Lesion studies complement these models by suggesting that right-hemisphere limbic-brain hypoactivity, or a left/right imbalance, may be relevant to the pathophysiology of mania.
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Affiliation(s)
- David Satzer
- Medical School, University of Minnesota, Minneapolis, MN, USA
| | - David J Bond
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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Satzer D, Miller C, Maxon J, Voth J, DiBartolomeo C, Mahoney R, Dutton JR, Low WC, Parr AM. T cell deficiency in spinal cord injury: altered locomotor recovery and whole-genome transcriptional analysis. BMC Neurosci 2015; 16:74. [PMID: 26546062 PMCID: PMC4635574 DOI: 10.1186/s12868-015-0212-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 10/23/2015] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND T cells undergo autoimmunization following spinal cord injury (SCI) and play both protective and destructive roles during the recovery process. T cell-deficient athymic nude (AN) rats exhibit improved functional recovery when compared to immunocompetent Sprague-Dawley (SD) rats following spinal cord transection. METHODS In the present study, we evaluated locomotor recovery in SD and AN rats following moderate spinal cord contusion. To explain variable locomotor outcome, we assessed whole-genome expression using RNA sequencing, in the acute (1 week post-injury) and chronic (8 weeks post-injury) phases of recovery. RESULTS Athymic nude rats demonstrated greater locomotor function than SD rats only at 1 week post-injury, coinciding with peak T cell infiltration in immunocompetent rats. Genetic markers for T cells and helper T cells were acutely enriched in SD rats, while AN rats expressed genes for T(h)2 cells, cytotoxic T cells, NK cells, mast cells, IL-1a, and IL-6 at higher levels. Acute enrichment of cell death-related genes suggested that SD rats undergo secondary tissue damage from T cells. Additionally, SD rats exhibited increased acute expression of voltage-gated potassium (Kv) channel-related genes. However, AN rats demonstrated greater chronic expression of cell death-associated genes and less expression of axon-related genes. Immunostaining for macrophage markers revealed no T cell-dependent difference in the acute macrophage infiltrate. CONCLUSIONS We put forth a model in which T cells facilitate early tissue damage, demyelination, and Kv channel dysregulation in SD rats following contusion SCI. However, compensatory features of the immune response in AN rats cause delayed tissue death and limit long-term recovery. T cell inhibition combined with other neuroprotective treatment may thus be a promising therapeutic avenue.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Minnesota, D429 Mayo Memorial Building, MMC 96, 420 Delaware Street, SE, Minneapolis, MN, 55455, USA.
| | - Catherine Miller
- Department of Neurosurgery, University of Minnesota, D429 Mayo Memorial Building, MMC 96, 420 Delaware Street, SE, Minneapolis, MN, 55455, USA.
| | - Jacob Maxon
- Department of Neurosurgery, University of Minnesota, D429 Mayo Memorial Building, MMC 96, 420 Delaware Street, SE, Minneapolis, MN, 55455, USA.
| | - Joseph Voth
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - Christina DiBartolomeo
- Department of Neurosurgery, University of Minnesota, D429 Mayo Memorial Building, MMC 96, 420 Delaware Street, SE, Minneapolis, MN, 55455, USA.
| | - Rebecca Mahoney
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - James R Dutton
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - Walter C Low
- Department of Neurosurgery, University of Minnesota, D429 Mayo Memorial Building, MMC 96, 420 Delaware Street, SE, Minneapolis, MN, 55455, USA.
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - Ann M Parr
- Department of Neurosurgery, University of Minnesota, D429 Mayo Memorial Building, MMC 96, 420 Delaware Street, SE, Minneapolis, MN, 55455, USA.
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, 55455, USA.
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Abstract
BACKGROUND The location of the optimal target for deep brain stimulation (DBS) of the subthalamic nucleus (STN) remains controversial. Electrode impedance affects tissue activation by DBS and has been found to vary by contact number, but no studies have examined association between impedance and anatomic location. OBJECTIVES To evaluate the relationship between electrode impedance and anatomic contact location, and to assess the clinical significance of impedance. METHODS We gathered retrospective impedance data from 101 electrodes in 73 patients with Parkinson's disease. We determined contact location using microelectrode recording (MER) and high-field 7T MRI, and assessed the relationship between impedance and contact location. RESULTS For contact location as assessed via MER, impedance was significantly higher for contacts in STN, at baseline (111 Ω vs STN border, p=0.03; 169 Ω vs white matter, p<0.001) and over time (90 Ω vs STN border, p<0.001; 54 Ω vs white matter, p<0.001). Over time, impedance was lowest in contacts situated at STN border (p=0.03). Impedance did not vary by contact location as assessed via imaging. Location determination was 75% consistent between MER and imaging. Impedance was inversely related to absolute symptom reduction during stimulation (-2.5 motor portion of the Unified Parkinson's Disease Rating Scale (mUPDRS) points per 1000 Ω, p=0.01). CONCLUSIONS In the vicinity of DBS electrodes chronically implanted in STN, impedance is lower at the rostral STN border and in white matter, than in STN. This finding suggests that current reaches white matter fibres more readily than neuronal cell bodies in STN, which may help explain anatomic variation in stimulation efficacy.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eric W Maurer
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - David Lanctin
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Weihua Guan
- Department of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aviva Abosch
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA Department of Neurosurgery, University of Colorado, Denver, Colorado, USA
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Satzer D, DiBartolomeo C, Ritchie MM, Storino C, Liimatainen T, Hakkarainen H, Idiyatullin D, Mangia S, Michaeli S, Parr AM, Low WC. Assessment of dysmyelination with RAFFn MRI: application to murine MPS I. PLoS One 2015; 10:e0116788. [PMID: 25680196 PMCID: PMC4334512 DOI: 10.1371/journal.pone.0116788] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 11/11/2014] [Indexed: 12/17/2022] Open
Abstract
Type I mucopolysaccharidosis (MPS I) is an autosomal recessive lysosomal storage disorder with neurological features. Humans and laboratory animals with MPS I exhibit various white matter abnormalities involving the corpus callosum and other regions. In this study, we first validated a novel MRI technique, entitled Relaxation Along a Fictitious Field in the rotating frame of rank n (RAFFn), as a measure of myelination and dysmyelination in mice. We then examined differences between MPS I mice and heterozygotes using RAFF5 and histology. RAFF5 (i.e., RAFFn with n = 5) relaxation time constants were highly correlated with histological myelin density (R2 = 0.68, P<0.001), and RAFF5 clearly distinguished between the hypomyelinated and dysmyelinated shiverer mouse and the wild-type mouse. Bloch-McConnell theoretical analysis revealed slower exchange correlation times and smaller exchange-induced relaxation rate constants for RAFF4 and RAFF5 compared to RAFF1-3, T1ρ, and T2ρ. These data suggest that RAFF5 may assess methylene protons in myelin lipids and proteins, though other mechanisms (e.g. detection of myelin-bound water) may also explain the sensitivity of RAFF5 to myelin. In MPS I mice, mean RAFF5 relaxation time constants were significantly larger for the striatum (P = 0.004) and internal capsule (P = 0.039), and marginally larger for the fornix (P = 0.15). Histological assessment revealed no differences between MPS I mice and heterozygotes in myelin density or corpus callosum thickness. Taken together, these findings support subtle dysmyelination in the brains of mice with MPS I. Dysmyelination may result from myelin lipid abnormalities caused by the absence of α-L-iduronidase. Our findings may help to explain locomotor and cognitive deficits seen in mice with MPS I.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Christina DiBartolomeo
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Michael M. Ritchie
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Christine Storino
- Center of Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Timo Liimatainen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Hanne Hakkarainen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Djaudat Idiyatullin
- Center of Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Silvia Mangia
- Center of Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Shalom Michaeli
- Center of Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Ann M. Parr
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Walter C. Low
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, United States of America
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Abstract
OBJECT Brainstem dysfunction occurs in a minority of patients with myelomeningocele (MMC), most of whom have Chiari Type II malformation. Some surgeons advocate early identification of these patients for craniocervical decompression to avoid significant mortality. The auditory brainstem response has been found to be abnormal in most children with MMC. The present study examines whether failure of routine newborn hearing screening (NHS) predicts brainstem dysfunction in MMC patients. METHODS The charts of 40 newborns with MMC and 50 newborns without MMC who stayed in the neonatal intensive care unit were reviewed. Results of NHS, brainstem symptoms, birth demographics, and surgical history were retrospectively examined. Differences in the presence and onset of brainstem symptoms by NHS result were assessed. RESULTS Failure of NHS was more common among newborns with MMC who developed brainstem symptoms (31%, 4 of 13 patients) than among newborns without MMC (0%, 0 of 50 patients; p = 0.001). Among the 40 newborns with MMC, brainstem symptoms were more common in those who failed NHS (80%, 4 of 5 patients) than in those who passed (26%, 9 of 35 patients; p = 0.031). Respiratory symptom onset occurred later in patients who failed NHS (median 16 months) than among those who passed (median 0 months; p = 0.022). The positive and negative predictive values of NHS for brainstem dysfunction in MMC were 0.80 and 0.74, respectively. CONCLUSIONS Results of NHS may help predict future brainstem dysfunction in patients with MMC and may be useful to incorporate into prognostic assessment and surgical decision making.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
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Satzer D, Lanctin D, Eberly LE, Abosch A. Variation in deep brain stimulation electrode impedance over years following electrode implantation. Stereotact Funct Neurosurg 2014; 92:94-102. [PMID: 24503709 DOI: 10.1159/000358014] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 12/16/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) electrode impedance is a major determinant of current delivery to target tissues, but long-term variation in impedance has received little attention. OBJECTIVES To assess the relationship between electrode impedance and time in a large DBS patient population and characterize the relationship between contact activity and impedance. METHODS We collected retrospective impedance and programming data from 128 electrodes in 84 patients with Parkinson's disease, essential tremor or dystonia. Effects of time, contact activity, stimulation voltage and other parameters on impedance were assessed. We also examined impedance changes following contact activation and deactivation. RESULTS Impedance decreased by 73 Ω/year (p < 0.001), with 72% of contacts following a downward trend. Impedance was on average 163 Ω lower in active contacts (p < 0.001). Contact activation and inactivation were associated with a more (p < 0.001) and less (p = 0.016) rapid decline in impedance, respectively. Higher stimulation voltages were associated with lower impedance values (p < 0.001). Contact number and electrode model were also significant predictors of impedance. CONCLUSIONS Impedance decreases gradually in a stimulation-dependent manner. These trends have implications for long-term programming, the development of a closed-loop DBS device and current understanding of the electrode-tissue interface.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minn., USA
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