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Berry B, Varatharajah Y, Kremen V, Kucewicz M, Guragain H, Brinkmann B, Duque J, Carvalho DZ, Stead M, Sieck G, Worrell G. Phase-Amplitude Coupling Localizes Pathologic Brain with Aid of Behavioral Staging in Sleep. Life (Basel) 2023; 13:life13051186. [PMID: 37240831 DOI: 10.3390/life13051186] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/28/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Low frequency brain rhythms facilitate communication across large spatial regions in the brain and high frequency rhythms are thought to signify local processing among nearby assemblies. A heavily investigated mode by which these low frequency and high frequency phenomenon interact is phase-amplitude coupling (PAC). This phenomenon has recently shown promise as a novel electrophysiologic biomarker, in a number of neurologic diseases including human epilepsy. In 17 medically refractory epilepsy patients undergoing phase-2 monitoring for the evaluation of surgical resection and in whom temporal depth electrodes were implanted, we investigated the electrophysiologic relationships of PAC in epileptogenic (seizure onset zone or SOZ) and non-epileptogenic tissue (non-SOZ). That this biomarker can differentiate seizure onset zone from non-seizure onset zone has been established with ictal and pre-ictal data, but less so with interictal data. Here we show that this biomarker can differentiate SOZ from non-SOZ interictally and is also a function of interictal epileptiform discharges. We also show a differential level of PAC in slow-wave-sleep relative to NREM1-2 and awake states. Lastly, we show AUROC evaluation of the localization of SOZ is optimal when utilizing beta or alpha phase onto high-gamma or ripple band. The results suggest an elevated PAC may reflect an electrophysiology-based biomarker for abnormal/epileptogenic brain regions.
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Affiliation(s)
- Brent Berry
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Yogatheesan Varatharajah
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Biomedical and Electrical/Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Vaclav Kremen
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University, 160 00 Prague, Czech Republic
| | - Michal Kucewicz
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Hari Guragain
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin Brinkmann
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Juliano Duque
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Computing and Mathematics, FFCLRP, University of São Paulo, Ribeirão Preto 14040-901, SP, Brazil
| | | | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Gary Sieck
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Gregory Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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Pal Attia T, Crepeau D, Kremen V, Nasseri M, Guragain H, Steele SW, Sladky V, Nejedly P, Mivalt F, Herron JA, Stead M, Denison T, Worrell GA, Brinkmann BH. Epilepsy Personal Assistant Device-A Mobile Platform for Brain State, Dense Behavioral and Physiology Tracking and Controlling Adaptive Stimulation. Front Neurol 2021; 12:704170. [PMID: 34393981 PMCID: PMC8358117 DOI: 10.3389/fneur.2021.704170] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/21/2021] [Indexed: 12/04/2022] Open
Abstract
Epilepsy is one of the most common neurological disorders, and it affects almost 1% of the population worldwide. Many people living with epilepsy continue to have seizures despite anti-epileptic medication therapy, surgical treatments, and neuromodulation therapy. The unpredictability of seizures is one of the most disabling aspects of epilepsy. Furthermore, epilepsy is associated with sleep, cognitive, and psychiatric comorbidities, which significantly impact the quality of life. Seizure predictions could potentially be used to adjust neuromodulation therapy to prevent the onset of a seizure and empower patients to avoid sensitive activities during high-risk periods. Long-term objective data is needed to provide a clearer view of brain electrical activity and an objective measure of the efficacy of therapeutic measures for optimal epilepsy care. While neuromodulation devices offer the potential for acquiring long-term data, available devices provide very little information regarding brain activity and therapy effectiveness. Also, seizure diaries kept by patients or caregivers are subjective and have been shown to be unreliable, in particular for patients with memory-impairing seizures. This paper describes the design, architecture, and development of the Mayo Epilepsy Personal Assistant Device (EPAD). The EPAD has bi-directional connectivity to the implanted investigational Medtronic Summit RC+STM device to implement intracranial EEG and physiological monitoring, processing, and control of the overall system and wearable devices streaming physiological time-series signals. In order to mitigate risk and comply with regulatory requirements, we developed a Quality Management System (QMS) to define the development process of the EPAD system, including Risk Analysis, Verification, Validation, and protocol mitigations. Extensive verification and validation testing were performed on thirteen canines and benchtop systems. The system is now under a first-in-human trial as part of the US FDA Investigational Device Exemption given in 2018 to study modulated responsive and predictive stimulation using the Mayo EPAD system and investigational Medtronic Summit RC+STM in ten patients with non-resectable dominant or bilateral mesial temporal lobe epilepsy. The EPAD system coupled with an implanted device capable of EEG telemetry represents a next-generation solution to optimizing neuromodulation therapy.
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Affiliation(s)
- Tal Pal Attia
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Daniel Crepeau
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Vaclav Kremen
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Cognitive Systems and Neurosciences, Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czechia
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Mona Nasseri
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- School of Engineering, University of North Florida, Jacksonville, FL, United States
| | - Hari Guragain
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Steven W. Steele
- Division of Engineering, Mayo Clinic, Rochester, MN, United States
| | - Vladimir Sladky
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czechia
| | - Petr Nejedly
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Filip Mivalt
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Jeffrey A. Herron
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Matt Stead
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Timothy Denison
- Engineering Sciences and Clinical Neurosciences, Oxford University, Oxford, United Kingdom
| | - Gregory A. Worrell
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Benjamin H. Brinkmann
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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Lavrov I, Latypov T, Mukhametova E, Lundstrom B, Sandroni P, Lee K, Klassen B, Stead M. Pre-motor versus motor cerebral cortex neuromodulation for chronic neuropathic pain. Sci Rep 2021; 11:12688. [PMID: 34135363 PMCID: PMC8209192 DOI: 10.1038/s41598-021-91872-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/21/2021] [Indexed: 11/13/2022] Open
Abstract
Electrical stimulation of the cerebral cortex (ESCC) has been used to treat intractable neuropathic pain for nearly two decades, however, no standardized approach for this technique has been developed. In order to optimize targeting and validate the effect of ESCC before placing the permanent grid, we introduced initial assessment with trial stimulation, using a temporary grid of subdural electrodes. In this retrospective study we evaluate the role of electrode location on cerebral cortex in control of neuropathic pain and the role of trial stimulation in target-optimization for ESCC. Location of the temporary grid electrodes and location of permanent electrodes were evaluated in correlation with the long-term efficacy of ESCC. The results of this study demonstrate that the long-term effect of subdural pre-motor cortex stimulation is at least the same or higher compare to effect of subdural motor or combined pre-motor and motor cortex stimulation. These results also demonstrate that the initial trial stimulation helps to optimize permanent electrode positions in relation to the optimal functional target that is critical in cases when brain shift is expected. Proposed methodology and novel results open a new direction for development of neuromodulation techniques to control chronic neuropathic pain.
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Affiliation(s)
- Igor Lavrov
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.
- Skolkovo Institute of Science and Technology, Moscow, Russia.
| | - Timur Latypov
- Division of Brain, Imaging, and Behaviour Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elvira Mukhametova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | | | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kendall Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bryan Klassen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Alcala-Zermeno JL, Gregg NM, Van Gompel JJ, Stead M, Worrell GA, Lundstrom BN. Cortical and thalamic electrode implant followed by temporary continuous subthreshold stimulation yields long-term seizure freedom: A case report. Epilepsy Behav Rep 2020; 14:100390. [PMID: 32995742 PMCID: PMC7501416 DOI: 10.1016/j.ebr.2020.100390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 11/27/2022] Open
Abstract
Neuromodulation strategies that target the epileptogenic network are options for treating focal drug-resistant epilepsy. These brain stimulation approaches include responsive neurostimulation and more recently, chronic subthreshold stimulation. Long-term seizure freedom with neuromodulation is uncommon. Seizure control typically requires ongoing froms of electrical stimulation. Here, we present the case of a patient implanted with three cortical electrodes targeting the inferior frontal lobe, insula, and one subcortical electrode targeting the ipsilateral anterior thalamic nucleus. This patient received continuous subthreshold electrical stimulation to the frontal electrodes for 7 months, at which time stimulation was inadvertently stopped. He has now been free of seizures for 42 months. This case suggests the possibility that neuromodulation can alter epileptogenic networks and lead to seizure freedom without ongoing electrical stimulation.
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Affiliation(s)
| | | | | | - Matt Stead
- Dark Horse Neuro, Inc., Bozeman, MT, USA
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Critchlow N, Moodie C, Stead M, Morgan A, Newall PWS, Dobbie F. Visibility of age restriction warnings, harm reduction messages and terms and conditions: a content analysis of paid-for gambling advertising in the United Kingdom. Public Health 2020; 184:79-88. [PMID: 32402595 DOI: 10.1016/j.puhe.2020.04.004] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/23/2020] [Accepted: 04/02/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The inclusion and design of age restriction warnings, harm reduction messages and terms and conditions (T&Cs) in gambling advertising is self-regulated in the United Kingdom. Our study examines the visibility and nature of this information in a sample of paid-for gambling adverts. STUDY DESIGN A content analysis of a stratified random sample of gambling adverts (n = 300) in the United Kingdom from eight paid-for advertising channels (March 2018). METHODS For each advert, we assessed whether any age restriction warnings, harm reduction messages and T&Cs were present. If so, visibility was scored on a five-point scale ranging from very poor (≤10% of advert space) to very good (≥26% of advert), which had high inter-rater reliability. Descriptive information on position, design and tone of language was recorded. RESULTS One in seven adverts (14%) did not feature an age restriction warning or harm reduction message. In adverts that did, 84% of age restriction warnings and 54% of harm reduction messages had very poor visibility. At least one in ten adverts did not contain T&Cs. In adverts that did, 73% had very poor visibility. For age restriction warnings, harm reduction messages and T&Cs, most appeared in small fonts and outside the main advert frame. Most harm reduction messages did not actually reference gambling-related harms. CONCLUSION Age restriction warnings, harm reduction messages and T&Cs do not always appear in paid-for gambling advertising. When they do, visibility is often very poor and the messaging not clear. The findings do not support a self-regulatory approach to managing this information in gambling adverts.
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Affiliation(s)
- N Critchlow
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, FK9 4LA, UK.
| | - C Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, FK9 4LA, UK
| | - M Stead
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, FK9 4LA, UK
| | - A Morgan
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, FK9 4LA, UK
| | - P W S Newall
- Applied Psychology, WMG, University of Warwick, Coventry, Scotland, CV4 7AL, UK
| | - F Dobbie
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
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Purves RI, Critchlow N, Morgan A, Stead M, Dobbie F. Examining the frequency and nature of gambling marketing in televised broadcasts of professional sporting events in the United Kingdom. Public Health 2020; 184:71-78. [PMID: 32248984 DOI: 10.1016/j.puhe.2020.02.012] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/23/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Gambling operators in the United Kingdom have introduced a voluntary ban on adverts broadcast during televised sport before 21:00 (the 'whistle-to-whistle' ban). To inform debates around the potential effectiveness of this ban, we examine the frequency and nature of gambling marketing in televised broadcasts across professional sporting events. STUDY DESIGN Frequency analysis of verbal and visual gambling marketing references during television broadcasts of football (n = 5), tennis, Formula 1, boxing and rugby union (each n = 1) from 2018. METHODS For each gambling reference, we coded: whether it appeared in-play or out-of-play; location (e.g. pitch-side advertising); format (e.g. branded merchandise); duration (s); number of identical references visible simultaneously; brand; and presence of age restriction or harm-reduction messages. RESULTS Boxing contained the most gambling references, on average, per broadcast minute (4.70 references), followed by football (2.75), rugby union (0.55) and tennis (0.11). Formula 1 contained no gambling references. In boxing, references most frequently appeared within the area-of-play. For football and rugby union, references most frequently appeared around the pitch border or within the area-of-play (e.g. branded shirts). Only a small minority of references were for adverts during commercial breaks that would be subject to the whistle-to-whistle ban (e.g. 2% of references in football). Less than 1% of references in boxing and only 3% of references in football contained age restriction or harm-reduction messages. CONCLUSIONS As gambling sponsorship extends much beyond adverts in commercial breaks, the 'whistle-to-whistle' ban will have limited effect on gambling exposure. Gambling sponsorship activities rarely contain harm-reduction messages.
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Affiliation(s)
- R I Purves
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, UK.
| | - N Critchlow
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, UK
| | - A Morgan
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, UK
| | - M Stead
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, UK
| | - F Dobbie
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
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Wang YC, Kremen V, Brinkmann BH, Middlebrooks EH, Lundstrom BN, Grewal SS, Guragain H, Wu MH, Van Gompel JJ, Klassen BT, Stead M, Worrell GA. Probing circuit of Papez with stimulation of anterior nucleus of the thalamus and hippocampal evoked potentials. Epilepsy Res 2019; 159:106248. [PMID: 31841958 DOI: 10.1016/j.eplepsyres.2019.106248] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 10/18/2019] [Revised: 11/21/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Despite documented clinical effectiveness, deep brain stimulation (DBS) therapy for drug-resistant epilepsy rarely yields long-term seizure free outcomes. METHODS This pilot study in five patients investigated circuit of Papez evoked potentials (EPs) using hippocampal sensing during anterior nucleus of the thalamus (ANT) electrical stimulation. We hypothesize that hippocampal EP is a potential biomarker that could be useful for ANT electrode targeting and improving seizure reduction. We obtained bilateral circuit of Papez EPs in five patients with bilateral temporal lobe epilepsy (TLE). The circuit of Papez EPs were measured and assessed by signal amplitude. Volumetric analysis of relevant mesial temporal structures and ANT stimulation analysis was performed on immediate post-implantation images. RESULTS The patient with the most favorable seizure outcome, which meant long-term seizure reduction greater than 50 % compared to baseline, had strong bilateral EPs and normal hippocampal structure. Conversely, those without clinical benefit with ANT DBS had absent or weak bilateral EPs as well as MRI findings consistent with mesial temporal sclerosis (MTS). CONCLUSION The data support the hypothesis that hippocampal EPs with ANT stimulation may be used to as a surrogate marker to probe circuit of Papez and predict ANT DBS efficacy.
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Affiliation(s)
- Yu-Chi Wang
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, Chang Gung Memorial Hospital in Linkou, PhD. Program of Biomedical Engineering, Chang Gung University, Taiwan
| | - Vaclav Kremen
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - Benjamin H Brinkmann
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Brian N Lundstrom
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Hari Guragain
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Min-Hsien Wu
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taiwan
| | | | - Bryan T Klassen
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matt Stead
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Gregory A Worrell
- Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
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Lundstrom BN, Gompel JV, Khadjevand F, Worrell G, Stead M. Chronic subthreshold cortical stimulation and stimulation-related EEG biomarkers for focal epilepsy. Brain Commun 2019; 1:fcz010. [PMID: 31667473 PMCID: PMC6798788 DOI: 10.1093/braincomms/fcz010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 04/17/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 01/05/2023] Open
Abstract
Brain stimulation offers an alternative to focal resection for the treatment of focal drug-resistant epilepsy. Chronic subthreshold cortical stimulation is an individualized biomarker-informed open-loop continuous electrical stimulation approach targeting the seizure onset zone and surrounding areas. Before permanent implantation, trial stimulation is performed during invasive monitoring to assess stimulation efficacy as well as to optimize stimulation location and parameters by modifying interictal EEG biomarkers. We present clinical and neurophysiological results from a retrospective analysis of 21 patients, showing a median percent reduction in seizure frequency of 100% and responder rate of 89% with a median follow-up of 27 months. About 40% of patients were free of disabling seizures for a 12-month period or longer. We find that stimulation-induced decreases in delta (1–4 Hz) power and increases in alpha and beta (8–20 Hz) power during trial stimulation correlate with improved long-term clinical outcomes. These results suggest chronic subthreshold cortical stimulation may be an effective alternative approach to treating focal drug-resistant epilepsy and that short-term stimulation-related changes in spectral power may be a useful interictal biomarker and relate to long-term clinical outcome.
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Affiliation(s)
| | - Jamie Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Fatemeh Khadjevand
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Tufts University School of Medicine, Boston, MA, USA
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Lavrov I, Lundstrom BN, Klassen BT, Lee KH, Stead M. Proceedings #56: Motor cortex stimulation for treatment of neuropathic pain: the role of pain assessment and trial-stimulation. Brain Stimul 2019. [DOI: 10.1016/j.brs.2019.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Starnes K, Brinkmann BH, Burkholder D, Van Gompel J, Stead M, Lundstrom BN. Two cases of beneficial side effects from chronic electrical stimulation for treatment of focal epilepsy. Brain Stimul 2019; 12:1077-1079. [PMID: 30981622 DOI: 10.1016/j.brs.2019.03.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Keith Starnes
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Benjamin H Brinkmann
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Jamie Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Wang YC, Grewal SS, Middlebrooks EH, Worrell GA, Stead M, Lundstrom BN, Britton JW, Wu MH, Van Gompel JJ. Targeting analysis of a novel parietal approach for deep brain stimulation of the anterior nucleus of the thalamus for epilepsy. Epilepsy Res 2019; 153:1-6. [PMID: 30913474 DOI: 10.1016/j.eplepsyres.2019.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 10/26/2018] [Revised: 02/02/2019] [Accepted: 03/18/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a promising treatment for refractory epilepsy; however, it remains challenging to successfully target the ANT. The results of Medtronic Registry for Epilepsy (MORE) supported a frontal transventricular(TV) compared to frontal extraventricular (EV) lead trajectory for ANT DBS may have better coverage of the ANT. Here we report the safety and targeting efficacy of a novel, posterior parietal extraventricular (PEV) approach to the ANT. METHODS We conducted a retrospective analysis of ten patients who underwent bilateral ANT DBS (20 total trajectories) for medically-refractory epilepsy. Similar targeting methodology as the MORE trial was used, and the DBS Intrinsic Template Atlas (DISTAL) was utilized for ANT localization and contact position relative to ANT. Clinical data were assessed for DBS targeting efficacy and surgical complications. RESULTS The demonstrated PEV trajectory showed a successful ANT targeting rate of 90% bilaterally. Two or more contacts within ANT were presented in 75% of all leads. Mean contact number in ANT was 2.2+ 1.2. There were no intracranial hemorrhages, cerebrospinal fluid leakage, or permanent neurologic deficits. CONCLUSION In this small series, the novel PEV for ANT DBS is feasible with good targeting accuracy and potential safety advantages. The high accuracy of the PEV trajectory suggests that it is a reasonable alternative trajectory for ANT DBS. Larger studies will be needed to assess this trajectory on clinical outcome of DBS treatment to epilepsy.
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Affiliation(s)
- Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital in Linkou, Chang Gung University, Taiwan; Program of Biomedical Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taiwan
| | | | - Erik H Middlebrooks
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA; Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Min-Hsien Wu
- Program of Biomedical Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taiwan
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Lundstrom B, Van Gompel J, Khadjevand F, Worrell G, Stead M. Trial stimulation and chronic subthreshold cortical stimulation to treat focal epilepsy. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Starnes K, Burkholder D, Shin C, Van Gompel J, Stead M, Lundstrom B. Improvement of neurological function with chronic subthreshold cortical stimulation. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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14
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Pearce J, Cherrie M, Best C, Eadie D, Stead M, Amos A, MacGregor A, Currie D, Ozakinci G, Haw S. Has point-of-sale legislation led to a reduction in exposure to tobacco retailing? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Pearce
- University of Edinburgh, Edinburgh, UK
| | - M Cherrie
- University of Edinburgh, Edinburgh, UK
| | - C Best
- University of Stirling, Stirling, UK
| | - D Eadie
- University of Stirling, Stirling, UK
| | - M Stead
- University of Stirling, Stirling, UK
| | - A Amos
- University of Stirling, Stirling, UK
| | | | - D Currie
- University of St Andrews, St Andrews, UK
| | - G Ozakinci
- University of St Andrews, St Andrews, UK
| | - S Haw
- University of Stirling, Stirling, UK
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15
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Kremen V, Brinkmann BH, Van Gompel JJ, Stead M, St Louis EK, Worrell GA. Automated unsupervised behavioral state classification using intracranial electrophysiology. J Neural Eng 2018; 16:026004. [PMID: 30277223 DOI: 10.1088/1741-2552/aae5ab] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Automated behavioral state classification in intracranial EEG (iEEG) recordings may be beneficial for iEEG interpretation and quantifying sleep patterns to enable behavioral state dependent neuromodulation therapy in next generation implantable brain stimulation devices. Here, we introduce a fully automated unsupervised framework to differentiate between awake (AW), sleep (N2), and slow wave sleep (N3) using intracranial EEG (iEEG) only and validated with expert scored polysomnography. APPROACH Data from eight patients undergoing evaluation for epilepsy surgery (age [Formula: see text], three female) with intracranial depth electrodes for iEEG monitoring were included. Spectral power features (0.1-235 Hz) spanning several frequency bands from a single electrode were used to classify behavioral states of patients into AW, N2, and N3. MAIN RESULTS Overall, classification accuracy of 94%, with 94% sensitivity and 93% specificity across eight subjects using multiple spectral power features from a single electrode was achieved. Classification performance of N3 sleep was significantly better (95%, sensitivity 95%, specificity 93%) than that of the N2 sleep phase (87%, sensitivity 78%, specificity 96%). SIGNIFICANCE Automated, unsupervised, and robust classification of behavioral states based on iEEG data is possible, and it is feasible to incorporate these algorithms into future implantable devices with limited computational power, memory, and number of electrodes for brain monitoring and stimulation.
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Affiliation(s)
- Vaclav Kremen
- Department of Neurology, Mayo Systems Electrophysiology Laboratory, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America. Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Jugoslavskych Partyzanu 1580/3, 160 00 Prague 6, Czechia. Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America
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16
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Kremen V, Brinkmann BH, Kim I, Guragain H, Nasseri M, Magee AL, Pal Attia T, Nejedly P, Sladky V, Nelson N, Chang SY, Herron JA, Adamski T, Baldassano S, Cimbalnik J, Vasoli V, Fehrmann E, Chouinard T, Patterson EE, Litt B, Stead M, Van Gompel J, Sturges BK, Jo HJ, Crowe CM, Denison T, Worrell GA. Integrating Brain Implants With Local and Distributed Computing Devices: A Next Generation Epilepsy Management System. IEEE J Transl Eng Health Med 2018; 6:2500112. [PMID: 30310759 PMCID: PMC6170139 DOI: 10.1109/jtehm.2018.2869398] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/18/2018] [Accepted: 08/16/2018] [Indexed: 12/16/2022]
Abstract
Brain stimulation has emerged as an effective treatment for a wide range of neurological and psychiatric diseases. Parkinson’s disease, epilepsy, and essential tremor have FDA indications for electrical brain stimulation using intracranially implanted electrodes. Interfacing implantable brain devices with local and cloud computing resources have the potential to improve electrical stimulation efficacy, disease tracking, and management. Epilepsy, in particular, is a neurological disease that might benefit from the integration of brain implants with off-the-body computing for tracking disease and therapy. Recent clinical trials have demonstrated seizure forecasting, seizure detection, and therapeutic electrical stimulation in patients with drug-resistant focal epilepsy. In this paper, we describe a next-generation epilepsy management system that integrates local handheld and cloud-computing resources wirelessly coupled to an implanted device with embedded payloads (sensors, intracranial EEG telemetry, electrical stimulation, classifiers, and control policy implementation). The handheld device and cloud computing resources can provide a seamless interface between patients and physicians, and realtime intracranial EEG can be used to classify brain state (wake/sleep, preseizure, and seizure), implement control policies for electrical stimulation, and track patient health. This system creates a flexible platform in which low demand analytics requiring fast response times are embedded in the implanted device and more complex algorithms are implemented in offthebody local and distributed cloud computing environments. The system enables tracking and management of epileptic neural networks operating over time scales ranging from milliseconds to months.
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Affiliation(s)
- Vaclav Kremen
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague160 00PrahaCzech Republic.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA
| | - Benjamin H Brinkmann
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA
| | - Inyong Kim
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA
| | - Hari Guragain
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA
| | - Mona Nasseri
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA
| | - Abigail L Magee
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA
| | - Tal Pal Attia
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA
| | - Petr Nejedly
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA.,International Clinical Research CenterSt. Anne's University Hospital656 91BrnoCzech Republic
| | - Vladimir Sladky
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA.,International Clinical Research CenterSt. Anne's University Hospital656 91BrnoCzech Republic
| | - Nathanial Nelson
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA
| | - Su-Youne Chang
- Department of NeurosurgeryMayo ClinicRochesterMN55905USA
| | - Jeffrey A Herron
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Tom Adamski
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Steven Baldassano
- Center for Neuroengineering and TherapeuticsDepartment of BioengineeringUniversity of PennsylvaniaPhiladelphiaPA19104USA
| | - Jan Cimbalnik
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,International Clinical Research CenterSt. Anne's University Hospital656 91BrnoCzech Republic
| | - Vince Vasoli
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Elizabeth Fehrmann
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Tom Chouinard
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Edward E Patterson
- Department of Veterinary Clinical SciencesUniversity of Minnesota College of Veterinary MedicineSt. PaulMN55108USA
| | - Brian Litt
- Center for Neuroengineering and TherapeuticsDepartment of BioengineeringUniversity of PennsylvaniaPhiladelphiaPA19104USA
| | - Matt Stead
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA
| | | | - Beverly K Sturges
- Department of Surgical and Radiological SciencesUniversity of California at DavisDavisCA95616USA
| | - Hang Joon Jo
- Department of NeurosurgeryMayo ClinicRochesterMN55905USA.,Department of NeurologyMayo ClinicRochesterMN55905USA
| | - Chelsea M Crowe
- Veterinary Medical Teaching HospitalUniversity of California at DavisDavisCA95616USA
| | - Timothy Denison
- Research and Core TechnologyRestorative Therapy Group, MedtronicMinneapolisMN55432-3568USA
| | - Gregory A Worrell
- Mayo Systems Electrophysiology LaboratoryDepartment of NeurologyMayo ClinicRochesterMN55905USA.,Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMN55905USA
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17
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Lundstrom BN, Van Gompel J, Britton J, Nickels K, Wetjen N, Worrell G, Stead M. Chronic Subthreshold Cortical Stimulation to Treat Focal Epilepsy. JAMA Neurol 2018; 73:1370-1372. [PMID: 27654625 DOI: 10.1001/jamaneurol.2016.2857] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Jamie Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Nicholas Wetjen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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18
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Cimbalnik J, Brinkmann B, Kremen V, Jurak P, Berry B, Gompel JV, Stead M, Worrell G. Physiological and pathological high frequency oscillations in focal epilepsy. Ann Clin Transl Neurol 2018; 5:1062-1076. [PMID: 30250863 PMCID: PMC6144446 DOI: 10.1002/acn3.618] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 03/21/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/19/2022] Open
Abstract
Objective This study investigates high‐frequency oscillations (HFOs; 65–600 Hz) as a biomarker of epileptogenic brain and explores three barriers to their clinical translation: (1) Distinguishing pathological HFOs (pathHFO) from physiological HFOs (physHFO). (2) Classifying tissue under individual electrodes as epileptogenic (3) Reproducing results across laboratories. Methods We recorded HFOs using intracranial EEG (iEEG) in 90 patients with focal epilepsy and 11 patients without epilepsy. In nine patients with epilepsy putative physHFOs were induced by cognitive or motor tasks. HFOs were identified using validated detectors. A support vector machine (SVM) using HFO features was developed to classify tissue under individual electrodes as normal or epileptogenic. Results There was significant overlap in the amplitude, frequency, and duration distributions for spontaneous physHFO, task induced physHFO, and pathHFO, but the amplitudes of the pathHFO were higher (P < 0.0001). High gamma pathHFO had the strongest association with seizure onset zone (SOZ), and were elevated on SOZ electrodes in 70% of epilepsy patients (P < 0.0001). Failure to resect tissue generating high gamma pathHFO was associated with poor outcomes (P < 0.0001). A SVM classified individual electrodes as epileptogenic with 63.9% sensitivity and 73.7% specificity using SOZ as the target. Interpretation A broader range of interictal pathHFO (65–600 Hz) than previously recognized are biomarkers of epileptogenic brain, and are associated with SOZ and surgical outcome. Classification of HFOs into physiological or pathological remains challenging. Classification of tissue under individual electrodes was demonstrated to be feasible. The open source data and algorithms provide a resource for future studies.
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Affiliation(s)
- Jan Cimbalnik
- Mayo Systems Electrophysiology Laboratory Department of Neurology Mayo Clinic 200 First St SW Rochester Minnesota 55905.,International Clinical Research Center St. Anne's University Hospital Brno Czech Republic
| | - Benjamin Brinkmann
- Mayo Systems Electrophysiology Laboratory Department of Neurology Mayo Clinic 200 First St SW Rochester Minnesota 55905.,Department of Physiology and Biomedical Engineering Mayo Clinic 200 First St SW Rochester Minnesota 55905
| | - Vaclav Kremen
- Mayo Systems Electrophysiology Laboratory Department of Neurology Mayo Clinic 200 First St SW Rochester Minnesota 55905.,Department of Physiology and Biomedical Engineering Mayo Clinic 200 First St SW Rochester Minnesota 55905.,Czech Institute of Informatics, Robotics, and Cybernetics Czech Technical University in Prague Prague Czech Republic
| | - Pavel Jurak
- International Clinical Research Center St. Anne's University Hospital Brno Czech Republic.,Institute of Scientific Instruments The Czech Academy of Sciences Brno Czech Republic
| | - Brent Berry
- Mayo Systems Electrophysiology Laboratory Department of Neurology Mayo Clinic 200 First St SW Rochester Minnesota 55905.,Department of Neurology University of Minnesota Minneapolis Minnesota 55455
| | - Jamie Van Gompel
- Department of Neurosurgery Mayo Clinic 200 First St SW Rochester Minnesota 55905
| | - Matt Stead
- Mayo Systems Electrophysiology Laboratory Department of Neurology Mayo Clinic 200 First St SW Rochester Minnesota 55905.,Department of Physiology and Biomedical Engineering Mayo Clinic 200 First St SW Rochester Minnesota 55905
| | - Greg Worrell
- Mayo Systems Electrophysiology Laboratory Department of Neurology Mayo Clinic 200 First St SW Rochester Minnesota 55905.,Department of Physiology and Biomedical Engineering Mayo Clinic 200 First St SW Rochester Minnesota 55905
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19
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Varatharajah Y, Berry B, Cimbalnik J, Kremen V, Van Gompel J, Stead M, Brinkmann B, Iyer R, Worrell G. Integrating artificial intelligence with real-time intracranial EEG monitoring to automate interictal identification of seizure onset zones in focal epilepsy. J Neural Eng 2018; 15:046035. [PMID: 29855436 DOI: 10.1088/1741-2552/aac960] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE An ability to map seizure-generating brain tissue, i.e. the seizure onset zone (SOZ), without recording actual seizures could reduce the duration of invasive EEG monitoring for patients with drug-resistant epilepsy. A widely-adopted practice in the literature is to compare the incidence (events/time) of putative pathological electrophysiological biomarkers associated with epileptic brain tissue with the SOZ determined from spontaneous seizures recorded with intracranial EEG, primarily using a single biomarker. Clinical translation of the previous efforts suffers from their inability to generalize across multiple patients because of (a) the inter-patient variability and (b) the temporal variability in the epileptogenic activity. APPROACH Here, we report an artificial intelligence-based approach for combining multiple interictal electrophysiological biomarkers and their temporal characteristics as a way of accounting for the above barriers and show that it can reliably identify seizure onset zones in a study cohort of 82 patients who underwent evaluation for drug-resistant epilepsy. MAIN RESULTS Our investigation provides evidence that utilizing the complementary information provided by multiple electrophysiological biomarkers and their temporal characteristics can significantly improve the localization potential compared to previously published single-biomarker incidence-based approaches, resulting in an average area under ROC curve (AUC) value of 0.73 in a cohort of 82 patients. Our results also suggest that recording durations between 90 min and 2 h are sufficient to localize SOZs with accuracies that may prove clinically relevant. SIGNIFICANCE The successful validation of our approach on a large cohort of 82 patients warrants future investigation on the feasibility of utilizing intra-operative EEG monitoring and artificial intelligence to localize epileptogenic brain tissue. Broadly, our study demonstrates the use of artificial intelligence coupled with careful feature engineering in augmenting clinical decision making.
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Affiliation(s)
- Yogatheesan Varatharajah
- Electrical and Computer Engineering, University of Illinois, Urbana, IL 61801, United States of America
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20
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Lundstrom BN, Meisel C, Van Gompel J, Stead M, Worrell G. Comparing spiking and slow wave activity from invasive electroencephalography in patients with and without seizures. Clin Neurophysiol 2018; 129:909-919. [PMID: 29550651 DOI: 10.1016/j.clinph.2018.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 10/03/2017] [Revised: 12/29/2017] [Accepted: 02/02/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To develop quantitative measures for estimating seizure probability, we examine intracranial EEG data from patient groups with three qualitative seizure probabilities: patients with drug resistant focal epilepsy (high), these patients during cortical stimulation (intermediate), and patients who have no history of seizures (low). METHODS Patients with focal epilepsy were implanted with subdural electrodes during presurgical evaluation. Patients without seizures were implanted during treatment with motor cortex stimulation for atypical facial pain. RESULTS The rate and amplitude of spikes correlate with qualitative seizure probability across patient groups and with proximity to the seizure onset zone in focal epilepsy patients. Spikes occur earlier during the negative oscillation of underlying slow activity (0.5-2 Hz) when seizure probability is increased. Similarly, coupling between slow and fast activity is increased. CONCLUSIONS There is likely a continuum of sharply contoured activity between non-epileptiform and epileptiform. Characteristics of spiking and how spikes relate to slow activity can be combined to predict seizure onset zones. SIGNIFICANCE Intracranial EEG data from patients without seizures represent a unique comparison group and highlight changes seen in spiking and slow wave activity with increased seizure probability. Slow wave activity and related physiology are an important potential biomarker for estimating seizure probability.
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Affiliation(s)
| | - Christian Meisel
- Department of Neurology, University Clinic Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Jamie Van Gompel
- Department of Neurosurgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Matt Stead
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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21
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Guragain H, Cimbalnik J, Stead M, Groppe DM, Berry BM, Kremen V, Kenney-Jung D, Britton J, Worrell GA, Brinkmann BH. Spatial variation in high-frequency oscillation rates and amplitudes in intracranial EEG. Neurology 2018; 90:e639-e646. [PMID: 29367441 PMCID: PMC5818159 DOI: 10.1212/wnl.0000000000004998] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/02/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the variation in baseline and seizure onset zone interictal high-frequency oscillation (HFO) rates and amplitudes across different anatomic brain regions in a large cohort of patients. METHODS Seventy patients who had wide-bandwidth (5 kHz) intracranial EEG (iEEG) recordings during surgical evaluation for drug-resistant epilepsy between 2005 and 2014 who had high-resolution MRI and CT imaging were identified. Discrete HFOs were identified in 2-hour segments of high-quality interictal iEEG data with an automated detector. Electrode locations were determined by coregistering the patient's preoperative MRI with an X-ray CT scan acquired immediately after electrode implantation and correcting electrode locations for postimplant brain shift. The anatomic locations of electrodes were determined using the Desikan-Killiany brain atlas via FreeSurfer. HFO rates and mean amplitudes were measured in seizure onset zone (SOZ) and non-SOZ electrodes, as determined by the clinical iEEG seizure recordings. To promote reproducible research, imaging and iEEG data are made freely available (msel.mayo.edu). RESULTS Baseline (non-SOZ) HFO rates and amplitudes vary significantly in different brain structures, and between homologous structures in left and right hemispheres. While HFO rates and amplitudes were significantly higher in SOZ than non-SOZ electrodes when analyzed regardless of contact location, SOZ and non-SOZ HFO rates and amplitudes were not separable in some lobes and structures (e.g., frontal and temporal neocortex). CONCLUSIONS The anatomic variation in SOZ and non-SOZ HFO rates and amplitudes suggests the need to assess interictal HFO activity relative to anatomically accurate normative standards when using HFOs for presurgical planning.
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Affiliation(s)
- Hari Guragain
- From Mayo Systems Electrophysiology Laboratory, Department of Neurology (H.G., M.S., B.M.B., V.K., D.K.-J., J.B., G.A.W., B.H.B.), and Department of Physiology & Biomedical Engineering (B.M.B., V.K., G.A.W., B.H.B.), Mayo Clinic, Rochester, MN; International Clinical Research Center (J.C.), St. Anne's University Hospital, Brno, Czech Republic; The Krembil Neuroscience Centre (D.M.G.), Toronto, Canada; and Czech Institute of Informatics, Robotics, and Cybernetics (V.K.), Czech Technical University in Prague, Czech Republic
| | - Jan Cimbalnik
- From Mayo Systems Electrophysiology Laboratory, Department of Neurology (H.G., M.S., B.M.B., V.K., D.K.-J., J.B., G.A.W., B.H.B.), and Department of Physiology & Biomedical Engineering (B.M.B., V.K., G.A.W., B.H.B.), Mayo Clinic, Rochester, MN; International Clinical Research Center (J.C.), St. Anne's University Hospital, Brno, Czech Republic; The Krembil Neuroscience Centre (D.M.G.), Toronto, Canada; and Czech Institute of Informatics, Robotics, and Cybernetics (V.K.), Czech Technical University in Prague, Czech Republic
| | - Matt Stead
- From Mayo Systems Electrophysiology Laboratory, Department of Neurology (H.G., M.S., B.M.B., V.K., D.K.-J., J.B., G.A.W., B.H.B.), and Department of Physiology & Biomedical Engineering (B.M.B., V.K., G.A.W., B.H.B.), Mayo Clinic, Rochester, MN; International Clinical Research Center (J.C.), St. Anne's University Hospital, Brno, Czech Republic; The Krembil Neuroscience Centre (D.M.G.), Toronto, Canada; and Czech Institute of Informatics, Robotics, and Cybernetics (V.K.), Czech Technical University in Prague, Czech Republic
| | - David M Groppe
- From Mayo Systems Electrophysiology Laboratory, Department of Neurology (H.G., M.S., B.M.B., V.K., D.K.-J., J.B., G.A.W., B.H.B.), and Department of Physiology & Biomedical Engineering (B.M.B., V.K., G.A.W., B.H.B.), Mayo Clinic, Rochester, MN; International Clinical Research Center (J.C.), St. Anne's University Hospital, Brno, Czech Republic; The Krembil Neuroscience Centre (D.M.G.), Toronto, Canada; and Czech Institute of Informatics, Robotics, and Cybernetics (V.K.), Czech Technical University in Prague, Czech Republic
| | - Brent M Berry
- From Mayo Systems Electrophysiology Laboratory, Department of Neurology (H.G., M.S., B.M.B., V.K., D.K.-J., J.B., G.A.W., B.H.B.), and Department of Physiology & Biomedical Engineering (B.M.B., V.K., G.A.W., B.H.B.), Mayo Clinic, Rochester, MN; International Clinical Research Center (J.C.), St. Anne's University Hospital, Brno, Czech Republic; The Krembil Neuroscience Centre (D.M.G.), Toronto, Canada; and Czech Institute of Informatics, Robotics, and Cybernetics (V.K.), Czech Technical University in Prague, Czech Republic
| | - Vaclav Kremen
- From Mayo Systems Electrophysiology Laboratory, Department of Neurology (H.G., M.S., B.M.B., V.K., D.K.-J., J.B., G.A.W., B.H.B.), and Department of Physiology & Biomedical Engineering (B.M.B., V.K., G.A.W., B.H.B.), Mayo Clinic, Rochester, MN; International Clinical Research Center (J.C.), St. Anne's University Hospital, Brno, Czech Republic; The Krembil Neuroscience Centre (D.M.G.), Toronto, Canada; and Czech Institute of Informatics, Robotics, and Cybernetics (V.K.), Czech Technical University in Prague, Czech Republic
| | - Daniel Kenney-Jung
- From Mayo Systems Electrophysiology Laboratory, Department of Neurology (H.G., M.S., B.M.B., V.K., D.K.-J., J.B., G.A.W., B.H.B.), and Department of Physiology & Biomedical Engineering (B.M.B., V.K., G.A.W., B.H.B.), Mayo Clinic, Rochester, MN; International Clinical Research Center (J.C.), St. Anne's University Hospital, Brno, Czech Republic; The Krembil Neuroscience Centre (D.M.G.), Toronto, Canada; and Czech Institute of Informatics, Robotics, and Cybernetics (V.K.), Czech Technical University in Prague, Czech Republic
| | - Jeffrey Britton
- From Mayo Systems Electrophysiology Laboratory, Department of Neurology (H.G., M.S., B.M.B., V.K., D.K.-J., J.B., G.A.W., B.H.B.), and Department of Physiology & Biomedical Engineering (B.M.B., V.K., G.A.W., B.H.B.), Mayo Clinic, Rochester, MN; International Clinical Research Center (J.C.), St. Anne's University Hospital, Brno, Czech Republic; The Krembil Neuroscience Centre (D.M.G.), Toronto, Canada; and Czech Institute of Informatics, Robotics, and Cybernetics (V.K.), Czech Technical University in Prague, Czech Republic
| | - Gregory A Worrell
- From Mayo Systems Electrophysiology Laboratory, Department of Neurology (H.G., M.S., B.M.B., V.K., D.K.-J., J.B., G.A.W., B.H.B.), and Department of Physiology & Biomedical Engineering (B.M.B., V.K., G.A.W., B.H.B.), Mayo Clinic, Rochester, MN; International Clinical Research Center (J.C.), St. Anne's University Hospital, Brno, Czech Republic; The Krembil Neuroscience Centre (D.M.G.), Toronto, Canada; and Czech Institute of Informatics, Robotics, and Cybernetics (V.K.), Czech Technical University in Prague, Czech Republic
| | - Benjamin H Brinkmann
- From Mayo Systems Electrophysiology Laboratory, Department of Neurology (H.G., M.S., B.M.B., V.K., D.K.-J., J.B., G.A.W., B.H.B.), and Department of Physiology & Biomedical Engineering (B.M.B., V.K., G.A.W., B.H.B.), Mayo Clinic, Rochester, MN; International Clinical Research Center (J.C.), St. Anne's University Hospital, Brno, Czech Republic; The Krembil Neuroscience Centre (D.M.G.), Toronto, Canada; and Czech Institute of Informatics, Robotics, and Cybernetics (V.K.), Czech Technical University in Prague, Czech Republic.
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Pearce J, Best C, Haseen F, Currie D, MacKintosh1 AM, Stead M, Eadie D, MacGregor A, Amos A, Frank J, Haw S. Electronic cigarette use and smoking initiation in Scottish adolescents: a cohort study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Pearce
- University of Edinburgh, Edinburgh, UK
| | - C Best
- University of Stirling, Stirling, UK
| | - F Haseen
- University of St Andrews, St Andrews, UK
| | - D Currie
- University of St Andrews, St Andrews, UK
| | | | - M Stead
- University of Stirling, Stirling, UK
| | - D Eadie
- University of Stirling, Stirling, UK
| | | | - A Amos
- University of Edinburgh, Edinburgh, UK
| | - J Frank
- University of Edinburgh, Edinburgh, UK
| | - S Haw
- University of Stirling, Stirling, UK
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Perevezentsev A, Bell A, Brennan PD, Gibbons C, Hemmerich J, Knipe S, Miller A, Stead M, Walsh P, Yorkshades J. Dedicated Facility and Glovebox for Tritium Recovery from Carbon Flakes. Fusion Science and Technology 2017. [DOI: 10.13182/fst02-a22699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. Perevezentsev
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, 0X14 3DB, UK (01235)464484
| | - A. Bell
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, 0X14 3DB, UK (01235)464484
| | - P. D. Brennan
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, 0X14 3DB, UK (01235)464484
| | - C. Gibbons
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, 0X14 3DB, UK (01235)464484
| | | | - S. Knipe
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, 0X14 3DB, UK (01235)464484
| | - A. Miller
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, 0X14 3DB, UK (01235)464484
| | - M. Stead
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, 0X14 3DB, UK (01235)464484
| | - P. Walsh
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, 0X14 3DB, UK (01235)464484
| | - J. Yorkshades
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, 0X14 3DB, UK (01235)464484
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Lundstrom BN, Worrell GA, Stead M, Van Gompel JJ. Chronic subthreshold cortical stimulation: a therapeutic and potentially restorative therapy for focal epilepsy. Expert Rev Neurother 2017; 17:661-666. [PMID: 28532252 DOI: 10.1080/14737175.2017.1331129] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Approximately one third of patients with focal epilepsy continue to have ongoing seizures despite adequate trials of anti-seizure medications. Surgery to remove the epileptogenic zone remains the most efficacious treatment option for focal drug-resistant epilepsy. However, when cortical areas are eloquent or there are multiple epileptogenic zones, surgical resection is not an ideal approach. Cortical stimulation provides an attractive alternative. Area covered: Here, the authors describe Chronic Subthreshold Cortical Stimulation (CSCS), which uses continuous intracranial electrical stimulation applied near the epileptogenic zone to lower seizure probability. The authors review literature related to CSCS. One challenge is finding the most efficacious set of stimulation parameters for each patient. Expert commentary: Data supporting CSCS are limited but promising for the treatment of patients with focal drug resistant epilepsy who are not surgical candidates. Additional electrophysiological biomarkers to estimate cortical excitability are needed.
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Affiliation(s)
| | - Gregory A Worrell
- a Department of Neurology , Mayo Clinic , Rochester , Minnesota , USA
| | - Matt Stead
- a Department of Neurology , Mayo Clinic , Rochester , Minnesota , USA
| | - Jamie J Van Gompel
- b Department of Neurosurgery , Mayo Clinic , Rochester , Minnesota , USA
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25
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Stead M, MacKintosh AM, Findlay A, Sparks L, Anderson AS, Barton K, Eadie D. Impact of a targeted direct marketing price promotion intervention (Buywell) on food-purchasing behaviour by low income consumers: a randomised controlled trial. J Hum Nutr Diet 2017; 30:524-533. [DOI: 10.1111/jhn.12441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M. Stead
- Institute for Social Marketing; Faculty of Health Sciences and Sport; University of Stirling; Stirling UK
| | - A. M. MacKintosh
- Institute for Social Marketing; Faculty of Health Sciences and Sport; University of Stirling; Stirling UK
| | - A. Findlay
- Institute for Retail Studies; Stirling Management School; University of Stirling; Stirling UK
| | - L. Sparks
- Institute for Retail Studies; Stirling Management School; University of Stirling; Stirling UK
| | - A. S. Anderson
- Centre for Public Health Nutrition Research and Centre for Research into Cancer Prevention and Screening; University of Dundee; Ninewells Hospital and Medical School; Dundee UK
| | - K. Barton
- Centre for Public Health Nutrition Research and Centre for Research into Cancer Prevention and Screening; University of Dundee; Ninewells Hospital and Medical School; Dundee UK
| | - D. Eadie
- Institute for Social Marketing; Faculty of Health Sciences and Sport; University of Stirling; Stirling UK
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26
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Kremen V, Duque JJ, Brinkmann BH, Berry BM, Kucewicz MT, Khadjevand F, Van Gompel J, Stead M, St Louis EK, Worrell GA. Behavioral state classification in epileptic brain using intracranial electrophysiology. J Neural Eng 2017; 14:026001. [PMID: 28050973 DOI: 10.1088/1741-2552/aa5688] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Automated behavioral state classification can benefit next generation implantable epilepsy devices. In this study we explored the feasibility of automated awake (AW) and slow wave sleep (SWS) classification using wide bandwidth intracranial EEG (iEEG) in patients undergoing evaluation for epilepsy surgery. APPROACH Data from seven patients (age [Formula: see text], 4 women) who underwent intracranial depth electrode implantation for iEEG monitoring were included. Spectral power features (0.1-600 Hz) spanning several frequency bands from a single electrode were used to train and test a support vector machine classifier. MAIN RESULTS Classification accuracy of 97.8 ± 0.3% (normal tissue) and 89.4 ± 0.8% (epileptic tissue) across seven subjects using multiple spectral power features from a single electrode was achieved. Spectral power features from electrodes placed in normal temporal neocortex were found to be more useful (accuracy 90.8 ± 0.8%) for sleep-wake state classification than electrodes located in normal hippocampus (87.1 ± 1.6%). Spectral power in high frequency band features (Ripple (80-250 Hz), Fast Ripple (250-600 Hz)) showed comparable performance for AW and SWS classification as the best performing Berger bands (Alpha, Beta, low Gamma) with accuracy ⩾90% using a single electrode contact and single spectral feature. SIGNIFICANCE Automated classification of wake and SWS should prove useful for future implantable epilepsy devices with limited computational power, memory, and number of electrodes. Applications include quantifying patient sleep patterns and behavioral state dependent detection, prediction, and electrical stimulation therapies.
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Affiliation(s)
- Vaclav Kremen
- Department of Neurology, Mayo Systems Electrophysiology Laboratory, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Zikova street 1903/4, 166 36 Prague 6, Czech Republic. Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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27
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Bower MR, Kucewicz MT, St Louis EK, Meyer FB, Marsh WR, Stead M, Worrell GA. Reactivation of seizure-related changes to interictal spike shape and synchrony during postseizure sleep in patients. Epilepsia 2016; 58:94-104. [PMID: 27859029 DOI: 10.1111/epi.13614] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Local field potentials (LFPs) arise from synchronous activation of millions of neurons, producing seemingly consistent waveform shapes and relative synchrony across electrodes. Interictal spikes (IISs) are LFPs associated with epilepsy that are commonly used to guide surgical resection. Recently, changes in neuronal firing patterns observed in the minutes preceding seizure onset were found to be reactivated during postseizure sleep, a process called seizure-related consolidation (SRC), due to similarities with learning-related consolidation. Because IISs arise from summed neural activity, we hypothesized that changes in IIS shape and relative synchrony would be observed in the minutes preceding seizure onset and would be reactivated preferentially during postseizure slow-wave sleep (SWS). METHODS Scalp and intracranial recordings were obtained continuously across multiple days from clinical macroelectrodes implanted in patients undergoing treatment for intractable epilepsy. Data from scalp electrodes were used to stage sleep. Data from intracranial electrodes were used to detect IISs using a previously established algorithm. Partial correlations were computed for sleep and wake periods before and after seizures as a function of correlations observed in the minutes preceding seizures. Magnetic resonance imaging (MRI) and computed tomography (CT) scans were co-registered with electroencephalography (EEG) to determine the location of the seizure-onset zone (SOZ). RESULTS Changes in IIS shape and relative synchrony were observed on a subset of macroelectrodes minutes before seizure onset, and these changes were reactivated preferentially during postseizure SWS. Changes in synchrony were greatest for pairs of electrodes where at least one electrode was located in the SOZ. SIGNIFICANCE These data suggest preseizure changes in neural activity and their subsequent reactivation occur across a broad spatiotemporal scale: from single neurons to LFPs, both within and outside the SOZ. The preferential reactivation of seizure-related changes in IISs during postseizure SWS adds to a growing body of literature suggesting that pathologic neural processes may utilize physiologic mechanisms of synaptic plasticity.
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Affiliation(s)
- Mark R Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, U.S.A.,Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michal T Kucewicz
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A.,Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Erik K St Louis
- Department of Medicine and Neurology, Sleep and Cognitive Neurophysiology Laboratory and Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Fredric B Meyer
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - W Richard Marsh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A.,Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Gregory A Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A.,Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
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Matsumoto JY, Fossett T, Kim M, Duffy JR, Strand E, McKeon A, Lee KH, Stead M, Burnett M, Adams AC, Klassen BT. Precise stimulation location optimizes speech outcomes in essential tremor. Parkinsonism Relat Disord 2016; 32:60-65. [DOI: 10.1016/j.parkreldis.2016.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/16/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022]
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Chambers S, Ford A, Boydell N, Moore L, Stead M, Eadie D. Universal free school meals in Scotland: A process evaluation of implementation and uptake. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Stead M, Eadie D, MacKintosh AM, Best C, Miller M, Haseen F, Pearce JR, Tisch C, Macdonald L, MacGregor A, Amos A, van der Sluijs W, Frank JW, Haw S. Young people's exposure to point-of-sale tobacco products and promotions. Public Health 2016; 136:48-56. [PMID: 27178132 DOI: 10.1016/j.puhe.2016.03.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 11/02/2015] [Revised: 03/22/2016] [Accepted: 03/26/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Point of sale (POS) displays are one of the most important forms of tobacco marketing still permitted in many countries. Reliable methods for measuring exposure to such displays are needed in order to assess their potential impact, particularly on smoking attitudes and uptake among young people. In this study we use a novel method for evaluating POS exposure based on young people's use of retail outlets and recall of tobacco displays and observational data on the characteristics of displays. STUDY DESIGN Observational audit of retail outlets (n = 96) and school-based pupil survey (n = 1482) in four Scottish communities reflecting different levels of social deprivation and urbanisation, conducted in 2013 before legislation to remove POS displays was implemented in supermarkets. METHODS Measures were taken of: visibility and placement of tobacco displays; internal and external advertising; display unit size, branding and design; visibility of pack warnings; proximity of tobacco products to products of potential interest to children and young people; pupils' self-reported frequency of visiting retail outlets; and pupils' recall of tobacco displays. Variation in POS exposure across social and demographic groups was assessed. RESULTS Displays were highly visible within outlets and, in over half the stores, from the public footway outside. Tobacco products were displayed in close proximity to products of interest to children (e.g. confectionery, in 70% of stores). Eighty percent of pupils recalled seeing tobacco displays, with those from deprived areas more likely to recall displays in small shops. When confectioners, tobacconists and newsagents (CTNs) and grocery/convenience stores (two of the outlet types most often visited by young people) were examined separately, average tobacco display unit sizes were significantly larger in those outlets in more deprived areas. CONCLUSIONS POS displays remain a key vector in most countries for advertising tobacco products, and it is important to develop robust measures of exposure. The data reported in this paper provide a baseline measure for evaluating the efficacy of legislation prohibiting such displays.
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Affiliation(s)
- M Stead
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - D Eadie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - A M MacKintosh
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - C Best
- School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - M Miller
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| | - F Haseen
- Child and Adolescent Health Research Unit (CAHRU), School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews KY16 9TF, UK.
| | - J R Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, EH8 9XP, UK.
| | - C Tisch
- Institute of Geography, University of Edinburgh, Drummond Street, Edinburgh EH8 9XP, UK.
| | - L Macdonald
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - A MacGregor
- ScotCen Social Research, Scotiabank House (2nd Floor), 6 South Charlotte Street, Edinburgh EH2 4AW, UK.
| | - A Amos
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| | - W van der Sluijs
- Child and Adolescent Health Research Unit (CAHRU), School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews KY16 9TF, UK.
| | - J W Frank
- University of Edinburgh, 30 West Richmond Street, Edinburgh EH8 9DX, UK.
| | - S Haw
- School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
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31
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Van Gompel JJ, Klassen BT, Worrell GA, Lee KH, Shin C, Zhao CZ, Brown DA, Goerss SJ, Kall BA, Stead M. Anterior nuclear deep brain stimulation guided by concordant hippocampal recording. Neurosurg Focus 2016; 38:E9. [PMID: 26030709 DOI: 10.3171/2015.3.focus1541] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Anterior nuclear (AN) stimulation has been reported to reduce the frequency of seizures, in some cases dramatically; however, it has not been approved by the US Food and Drug Administration. The anterior nucleus is difficult to target because of its sequestered location, partially surrounded by the ventricle. It has traditionally been targeted by using transventricular or lateral transcortical routes. Here, the authors report a novel approach to targeting the anterior nucleus and neurophysiologically confirming effective stimulation of the target, namely evoked potentials in the hippocampus. METHODS Bilateral AN 3389 electrodes were placed in a novel trajectory followed by bilateral hippocampal 3391 electrodes from a posterior trajectory. Each patient was implanted bilaterally with a Medtronic Activa PC+S device under an investigational device exemption approval. Placement was confirmed with CT. AN stimulation-induced hippocampal evoked potentials were measured to functionally confirm placement in the anterior nucleus. RESULTS Two patients had implantations by way of a novel AN trajectory with concomitant hippocampal electrodes. There were no lead misplacements. Postoperative stimulation of the anterior nucleus with a PC+S device elicited evoked potentials in the hippocampus. Thus far, both patients have reported a > 50% improvement in seizure frequency. CONCLUSIONS Placing AN electrodes posteriorly may provide a safer trajectory than that used for traditionally placed AN electrodes. In addition, with a novel battery that is capable of electroencephalographic recording, evoked potentials can be used to functionally assess the Papez circuit. This treatment paradigm may offer increased AN stimulation efficacy for medically intractable epilepsy by assessing functional placement more effectively and thus far has proven safe.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Matt Stead
- 2Neurology, Mayo Clinic, Rochester, Minnesota
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32
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Klimes P, Duque JJ, Brinkmann B, Van Gompel J, Stead M, St Louis EK, Halamek J, Jurak P, Worrell G. The functional organization of human epileptic hippocampus. J Neurophysiol 2016; 115:3140-5. [PMID: 27030735 DOI: 10.1152/jn.00089.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 02/01/2016] [Accepted: 03/29/2016] [Indexed: 12/12/2022] Open
Abstract
The function and connectivity of human brain is disrupted in epilepsy. We previously reported that the region of epileptic brain generating focal seizures, i.e., the seizure onset zone (SOZ), is functionally isolated from surrounding brain regions in focal neocortical epilepsy. The modulatory effect of behavioral state on the spatial and spectral scales over which the reduced functional connectivity occurs, however, is unclear. Here we use simultaneous sleep staging from scalp EEG with intracranial EEG recordings from medial temporal lobe to investigate how behavioral state modulates the spatial and spectral scales of local field potential synchrony in focal epileptic hippocampus. The local field spectral power and linear correlation between adjacent electrodes provide measures of neuronal population synchrony at different spatial scales, ∼1 and 10 mm, respectively. Our results show increased connectivity inside the SOZ and low connectivity between electrodes in SOZ and outside the SOZ. During slow-wave sleep, we observed decreased connectivity for ripple and fast ripple frequency bands within the SOZ at the 10 mm spatial scale, while the local synchrony remained high at the 1 mm spatial scale. Further study of these phenomena may prove useful for SOZ localization and help understand seizure generation, and the functional deficits seen in epileptic eloquent cortex.
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Affiliation(s)
- Petr Klimes
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Institute of Scientific Instruments of the CAS, Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Juliano J Duque
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Department of Computing and Mathematics, FFCLRP, University of São Paulo, Ribeirão Preto SP, Brazil
| | - Ben Brinkmann
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota; and
| | - Jamie Van Gompel
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Matt Stead
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota; and
| | - Erik K St Louis
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic, Rochester, Minnesota
| | - Josef Halamek
- Institute of Scientific Instruments of the CAS, Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments of the CAS, Brno, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Gregory Worrell
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, Minnesota; Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota; and
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Best C, van der Sluijs W, Haseen F, Eadie D, Stead M, MacKintosh AM, Pearce J, Tisch C, MacGregor A, Amos A, Miller M, Frank J, Haw S. Does exposure to cigarette brands increase the likelihood of adolescent e-cigarette use? A cross-sectional study. BMJ Open 2016; 6:e008734. [PMID: 26908512 PMCID: PMC4769402 DOI: 10.1136/bmjopen-2015-008734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/17/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the relationship between tobacco cigarette brand recognition, and e-cigarette use in adolescents. DESIGN Cross-sectional observational study. SETTING High schools in Scotland. PARTICIPANTS Questionnaires were administered to pupils in Secondary 2 (S2 mean age: 14.0 years) and Secondary 4 (S4 mean age: 15.9 years) across 4 communities in Scotland. An 86% response rate with a total sample of 1404 pupils was achieved. MAIN OUTCOME MEASURES Self-reported previous use of e-cigarettes and self-reported intention to try e-cigarettes in the next 6 months. RESULTS 75% (1029/1377) of respondents had heard of e-cigarettes (69.5% S2, 81.1% S4), and of these, 17.3% (10.6% S2, 24.3% S4 n=1020) had ever tried an e-cigarette. 6.8% (3.7% S2, 10.0% S4 n=1019) reported that they intended to try an e-cigarette in the next 6 months. Recognition of more cigarette brands was associated with greater probability of previous e-cigarette use (OR 1.20, 99% CI 1.05 to 1.38) as was having a best friend who smoked (OR 3.17, 99% CI 1.42 to 7.09). Intention to try e-cigarettes was related to higher cigarette brand recognition (OR 1.41, 99% CI 1.07 to 1.87), hanging around in the street or park more than once a week (OR 3.78, 99% CI 1.93 to 7.39) and living in areas of high tobacco retail density (OR 1.20, 99% CI 1.08 to 1.34). Never having smoked was a protective factor for both future intention to try, and past e-cigarette use (OR 0.07, 99% CI 0.02 to 0.25; and OR 0.10, 99% CI 0.07 to 0.16, respectively). CONCLUSIONS Higher cigarette brand recognition was associated with increased probability of previous use and of intention to use e-cigarettes. The impact of tobacco control measures such as restricting point-of-sale displays on the uptake of e-cigarettes in young people should be evaluated.
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Affiliation(s)
- C Best
- School of Health Sciences, University of Stirling, Stirling, UK
| | - W van der Sluijs
- Child and Adolescent Health Research Unit, University of St Andrews, St Andrews, UK
| | - F Haseen
- Child and Adolescent Health Research Unit, University of St Andrews, St Andrews, UK
| | - D Eadie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - M Stead
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - AM MacKintosh
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - J Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - C Tisch
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | | | - A Amos
- Usher Institute of Population Health Sciences and Informatics, School of Medicine, University of Edinburgh, Edinburgh, UK
| | - M Miller
- Usher Institute of Population Health Sciences and Informatics, School of Medicine, University of Edinburgh, Edinburgh, UK
| | - J Frank
- Public Health Research and Policy, The Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - S Haw
- School of Health Sciences, University of Stirling, Stirling, UK
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Testini P, Zhao CZ, Stead M, Duffy PS, Klassen BT, Lee KH. Centromedian-Parafascicular Complex Deep Brain Stimulation for Tourette Syndrome: A Retrospective Study. Mayo Clin Proc 2016; 91:218-25. [PMID: 26848003 PMCID: PMC4765735 DOI: 10.1016/j.mayocp.2015.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 12/24/2022]
Abstract
Deep brain stimulation (DBS) of the thalamic centromedian/parafascicular (CM-Pf) complex has been reported as a promising treatment for patients with severe, treatment-resistant Tourette syndrome (TS). In this study, safety and clinical outcomes of bilateral thalamic CM-Pf DBS were reviewed in a series of 12 consecutive patients with medically refractory TS, 11 of whom met the criteria of postsurgical follow-up at our institution for at least 2 months. Five patients were followed for a year or longer. Consistent with many patients with TS, all patients had psychiatric comorbidities. Tic severity and frequency were measured by using the Yale Global Tic Severity Scale (YGTSS) over time (average, 26 months) in 10 subjects. One patient was tested at 2-week follow-up only and thus was excluded from group YGTSS analysis. Final YGTSS scores differed significantly from the preoperative baseline score. The average (n=10) improvement relative to baseline in the total score was 54% (95% CI, 37-70); average improvement relative to baseline in the YGTSS Motor tic, Phonic tic, and Impairment subtests was 46% (95% CI, 34-64), 52% (95% CI, 34-72), and 59% (95% CI, 39-78), respectively. There were no intraoperative complications. After surgery, 1 subject underwent wound revision because of a scalp erosion and wound infection; the implanted DBS system was successfully salvaged with surgical revision and combined antibiotic therapy. Stimulation-induced adverse effects did not prevent the use of the DBS system, although 1 subject is undergoing a trial period with the stimulator off. This surgical series adds to the literature on CM-Pf DBS and supports its use as an effective and safe therapeutic option for severe refractory TS.
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Affiliation(s)
- Paola Testini
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Cong Z Zhao
- Department of Medicine, University of California San Francisco, Fresno, CA
| | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.
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Eadie D, Stead M, MacKintosh AM, MacDonald L, Purves R, Pearce J, Tisch C, van der Sluijis W, Amos A, MacGregor A, Haw S. E-cigarette marketing in UK stores: an observational audit and retailers' views. BMJ Open 2015; 5:e008547. [PMID: 26362665 PMCID: PMC4567676 DOI: 10.1136/bmjopen-2015-008547] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/16/2015] [Accepted: 08/04/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To explore how e-cigarettes are being promoted at point of sale in the UK and how retailers perceive market trends. SETTING Fixed retail outlets subject to a ban on the display of tobacco products. PARTICIPANTS Observational audit of all stores selling tobacco products (n=96) in 4 Scottish communities, conducted over 2 waves 12 months apart (2013-2014), and qualitative interviews with small retailers (n=25) in 4 matched communities. PRIMARY AND SECONDARY OUTCOME MEASURES The audit measured e-cigarette display characteristics, advertising materials and proximity to other products, and differences by area-level disadvantage. Interviews explored retailers' perceptions of e-cigarette market opportunities and risks, and customer responses. RESULTS The number of e-cigarette point-of-sale display units and number of brands displayed increased between waves. E-cigarettes were displayed close to products of interest to children in 36% of stores. Stores in more affluent areas were less likely to have external e-cigarette advertising than those in deprived areas. Although e-cigarettes delivered high profit margins, retailers were confused by the diversity of brands and products, and uncertain of the sector's viability. Some customers were perceived to purchase e-cigarettes as cessation aids, and others, particularly low-income smokers, as a cheaper adjunct to conventional tobacco. CONCLUSIONS E-cigarette point-of-sale displays and number of brands displayed increased over 12 months, a potential cause for concern given their lack of regulation. Further scrutiny is needed of the content and effects of such advertising, and the potentially normalising effects of placing e-cigarettes next to products of interest to children.
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Affiliation(s)
- D Eadie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - M Stead
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - A M MacKintosh
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - L MacDonald
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - R Purves
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - J Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - C Tisch
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - W van der Sluijis
- Child and Adolescent Health Research Unit, University of St Andrews, St Andrews, UK
| | - A Amos
- Centre for Population Health Sciences, School of Molecular Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - S Haw
- School of Health Sciences, University of Stirling, Stirling, UK
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Zhang JG, Ge Y, Stead M, Zhang K, Yan SS, Hu W, Meng FG. Long-term outcome of globus pallidus internus deep brain stimulation in patients with Tourette syndrome. Mayo Clin Proc 2014; 89:1506-14. [PMID: 25444487 DOI: 10.1016/j.mayocp.2014.05.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 03/28/2014] [Accepted: 05/28/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of deep brain stimulation (DBS) of the globus pallidus internus (GPi) on tic severity and common comorbidities in patients with severe Tourette syndrome that is refractory to pharmacological treatment and psychotherapy. PATIENTS AND METHODS We retrospectively assessed the long-term clinical outcomes of 13 patients with treatment-refractory Tourette syndrome who underwent DBS targeting the GPi at the Beijing Tiantan Hospital from January 1, 2006, through May 31, 2013. The primary outcome was a change in tic severity as measured by the Yale Global Tic Severity Scale, and the secondary outcome was a change in associated behavioral disorders and mood as measured by the Gilles de la Tourette Syndrome-Quality of Life Scale assessment. RESULTS Compared with baseline, the mean reduction in the total Yale Global Tic Severity Scale scores at last follow-up (mean, 41.9 months; range, 13-80 months) was 52.1% (range, 4.3%-83.6%), and the mean improvement rates at 1 month, 6 months, 12 months, 18 months, 24 months, 30 months, and 36 or more months were 11.8%, 20.0%, 26.8%, 36.7%, 44.7%, 49.0%, and 56.7%, respectively. A paired-sample t test revealed significant improvement of tic symptoms after 6 months of DBS programming (P<.05). The Gilles de la Tourette Syndrome-Quality of Life Scale score improved by a mean of 45.7% (range, 11.0%-77.2%). CONCLUSION This study is currently the largest reported GPi DBS case series of patients with treatment-refractory TS with the longest follow-up. Our results support the potential beneficial effect of GPi DBS on disabling tic reduction and improvement of quality of life.
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Affiliation(s)
- Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan Ge
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuang-shuang Yan
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Wei Hu
- Department of Neurology, Mayo Clinic, Rochester, MN.
| | - Fan-Gang Meng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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Janca R, Jezdik P, Cmejla R, Tomasek M, Worrell GA, Stead M, Wagenaar J, Jefferys JGR, Krsek P, Komarek V, Jiruska P, Marusic P. Detection of interictal epileptiform discharges using signal envelope distribution modelling: application to epileptic and non-epileptic intracranial recordings. Brain Topogr 2014; 28:172-83. [PMID: 24970691 DOI: 10.1007/s10548-014-0379-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
Interictal epileptiform discharges (spikes, IEDs) are electrographic markers of epileptic tissue and their quantification is utilized in planning of surgical resection. Visual analysis of long-term multi-channel intracranial recordings is extremely laborious and prone to bias. Development of new and reliable techniques of automatic spike detection represents a crucial step towards increasing the information yield of intracranial recordings and to improve surgical outcome. In this study, we designed a novel and robust detection algorithm that adaptively models statistical distributions of signal envelopes and enables discrimination of signals containing IEDs from signals with background activity. This detector demonstrates performance superior both to human readers and to an established detector. It is even capable of identifying low-amplitude IEDs which are often missed by experts and which may represent an important source of clinical information. Application of the detector to non-epileptic intracranial data from patients with intractable facial pain revealed the existence of sharp transients with waveforms reminiscent of interictal discharges that can represent biological sources of false positive detections. Identification of these transients enabled us to develop and propose secondary processing steps, which may exclude these transients, improving the detector's specificity and having important implications for future development of spike detectors in general.
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Affiliation(s)
- Radek Janca
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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Abstract
In patients being evaluated for epilepsy and in animal models of epilepsy, electrophysiological recordings are carried to capture seizures to determine the existence of epilepsy. Electroencephalography recordings from the scalp, or sometimes directly from the brain, are also used to locate brain areas where seizure begins, and in surgical treatment help plan the area for resection. As seizures are unpredictable and can occur infrequently, ictal recordings are not ideal in terms of time, cost, or risk when, for example, determining the efficacy of existing or new anti-seizure drugs, evaluating potential anti-epileptogenic interventions, or for prolonged intracerebral electrode studies. Thus, there is a need to identify and validate other electrophysiological biomarkers of epilepsy that could be used to diagnose, treat, cure, and prevent epilepsy. Electroencephalography recordings in the epileptic brain contain other interictal electrophysiological disturbances that can occur more frequently than seizures, such as interictal spikes (IIS) and sharp waves, and from invasive studies using wide bandwidth recording and small diameter electrodes, the discovery of pathological high-frequency oscillations (HFOs) and microseizures. Of IIS, HFOs, and microseizures, a significant amount of recent research has focused on HFOs in the pathophysiology of epilepsy. Results from studies in animals with epilepsy and presurgical patients have consistently found a strong association between HFOs and epileptogenic brain tissue that suggest HFOs could be a potential biomarker of epileptogenicity and epileptogenesis. Here, we discuss several aspects of HFOs, as well as IIS and microseizures, and the evidence that supports their role as biomarkers of epilepsy.
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Affiliation(s)
- Richard J Staba
- David Geffen School of Medicine at UCLA, Department of Neurology, Room 2-155, 710 Westwood Plaza, Los Angeles, CA, 90095, USA,
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Child ND, Stead M, Wirrell EC, Nickels KC, Wetjen NM, Lee KH, Klassen BT. Chronic subthreshold subdural cortical stimulation for the treatment of focal epilepsy originating from eloquent cortex. Epilepsia 2014; 55:e18-21. [PMID: 24571166 DOI: 10.1111/epi.12525] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 11/28/2022]
Abstract
Medically refractory epilepsy remains a major medical problem worldwide. Although some patients are eligible for surgical resection of seizure foci, a proportion of patients are ineligible for a variety of reasons. One such reason is that the foci reside in eloquent cortex of the brain and therefore resection would result in significant morbidity. This retrospective study reports our experience with a novel neurostimulation technique for the treatment of these patients. We identified three patients who were ineligible for surgical resection of the intracranially identified seizure focus because it resided in eloquent cortex, who underwent therapeutic trial of focal cortical stimulation delivered through the subdural monitoring grid. All three patients had a significant reduction in seizures, and two went on to permanent implantation, which resulted in long-term reduction in seizure frequency. In conclusion, this small case report provides some evidence of proof of concept of the role of targeted continuous neocortical neurostimulation in the treatment of medically refractory focal epilepsy, and provides support for ongoing investigations into this treatment modality.
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Affiliation(s)
- Nicholas D Child
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A
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Van Gompel JJ, Bower MR, Worrell GA, Stead M, Chang SY, Goerss SJ, Kim I, Bennet KE, Meyer FB, Marsh WR, Blaha CD, Lee KH. Increased cortical extracellular adenosine correlates with seizure termination. Epilepsia 2014; 55:233-44. [PMID: 24483230 DOI: 10.1111/epi.12511] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Seizures are currently defined by their electrographic features. However, neuronal networks are intrinsically dependent on neurotransmitters of which little is known regarding their periictal dynamics. Evidence supports adenosine as having a prominent role in seizure termination, as its administration can terminate and reduce seizures in animal models. Furthermore, microdialysis studies in humans suggest that adenosine is elevated periictally, but the relationship to the seizure is obscured by its temporal measurement limitations. Because electrochemical techniques can provide vastly superior temporal resolution, we test the hypothesis that extracellular adenosine concentrations rise during seizure termination in an animal model and humans using electrochemistry. METHODS White farm swine (n = 45) were used in an acute cortical model of epilepsy, and 10 human epilepsy patients were studied during intraoperative electrocorticography (ECoG). Wireless Instantaneous Neurotransmitter Concentration Sensor (WINCS)-based fast scan cyclic voltammetry (FSCV) and fixed potential amperometry were obtained utilizing an adenosine-specific triangular waveform or biosensors, respectively. RESULTS Simultaneous ECoG and electrochemistry demonstrated an average adenosine increase of 260% compared to baseline, at 7.5 ± 16.9 s with amperometry (n = 75 events) and 2.6 ± 11.2 s with FSCV (n = 15 events) prior to electrographic seizure termination. In agreement with these animal data, adenosine elevation prior to seizure termination in a human patient utilizing FSCV was also seen. SIGNIFICANCE Simultaneous ECoG and electrochemical recording supports the hypothesis that adenosine rises prior to seizure termination, suggesting that adenosine itself may be responsible for seizure termination. Future work using intraoperative WINCS-based FSCV recording may help to elucidate the precise relationship between adenosine and seizure termination.
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Affiliation(s)
- Jamie J Van Gompel
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Abstract
Deep brain stimulation (DBS) is an effective surgical treatment for medication-refractory movement disorders, and has been approved by the United States Food and Drug Administration for treatment of dystonia. The success of DBS in the treatment of dystonia depends on our understanding of the anatomy and physiology of this disorder and close collaboration between neurosurgeons, neurologists, clinical neurophysiologists, neuroradiologists and neuropsychologists. Currently, pallidal DBS is an established treatment option for medically refractive dystonia. This review is intended to provide a comprehensive review of the use of DBS for dystonia, focusing mainly on the surgical aspects, clinical outcome, MRI findings and side effects of DBS.
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Affiliation(s)
- Wei Hu
- Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55901, USA.
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Noe K, Sulc V, Wong-Kisiel L, Wirrell E, Van Gompel JJ, Wetjen N, Britton J, So E, Cascino GD, Marsh WR, Meyer F, Horinek D, Giannini C, Watson R, Brinkmann BH, Stead M, Worrell GA. Long-term outcomes after nonlesional extratemporal lobe epilepsy surgery. JAMA Neurol 2013; 70:1003-8. [PMID: 23732844 DOI: 10.1001/jamaneurol.2013.209] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A focal lesion detected by use of magnetic resonance imaging (MRI) is a favorable prognostic finding for epilepsy surgery. Patients with normal MRI findings and extratemporal lobe epilepsy have less favorable outcomes. Most studies investigating the outcomes of patients with normal MRI findings who underwent (nonlesional) extratemporal epilepsy surgery are confined to a highly select group of patients with limited follow-up. OBJECTIVE To evaluate noninvasive diagnostic test results and their association with excellent surgical outcomes (defined using Engel classes I-IIA of surgical outcomes) in a group of patients with medically resistant nonlesional extratemporal epilepsy. DESIGN A retrospective study. SETTING Mayo Clinic, Rochester, Minnesota. PARTICIPANTS From 1997 through 2002, we identified 85 patients with medically resistant extratemporal lobe epilepsy who had normal MRI findings. Based on a standardized presurgical evaluation and review at a multidisciplinary epilepsy surgery conference, some of these patients were selected for intracranial electroencephalographic (EEG) monitoring and epilepsy surgery. EXPOSURE Nonlesional extratemporal lobe epilepsy surgery. MAIN OUTCOMES AND MEASURES The results of noninvasive diagnostic tests and the clinical variables potentially associated with excellent surgical outcome were examined in patients with a minimum follow-up of 1 year (mean follow-up, 9 years). RESULTS Based on the noninvasive diagnostic test results, a clear hypothesis for seizure origin was possible for 47 of the 85 patients (55%), and 31 of these 47 patients (66%) proceeded to intracranial EEG monitoring. For 24 of these 31 patients undergoing long-term intracranial EEG (77%), a seizure focus was identified and surgically resected. Of these 24 patients, 9 (38%) had an excellent outcome after resective epilepsy surgery. All patients with an excellent surgical outcome had at least 10 years of follow-up. Univariate analysis showed that localized interictal epileptiform discharges on scalp EEGs were associated with an excellent surgical outcome. CONCLUSIONS AND RELEVANCE Scalp EEG was the most useful test for identifying patients with normal MRI findings and extratemporal lobe epilepsy who were likely to have excellent outcomes after epilepsy surgery. Extending outcome analysis beyond the resective surgery group to the entire group of patients who were evaluated further highlights the challenge that these patients pose. Although 9 of 24 patients undergoing resective surgery (38%) had excellent outcomes, only 9 of 31 patients undergoing intracranial EEG (29%) and only 9 of 85 patient with nonlesional extratemporal lobe epilepsy (11%) had long-term excellent outcomes.
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Affiliation(s)
- Katherine Noe
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
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Brazdil M, Cimbalnik J, Roman R, Stead M, Daniel P, Halamek J, Jurak P. Effect of cognitive stimulation on hippocampal ripples in epileptic patients. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Matsumoto JY, Stead M, Kucewicz MT, Matsumoto AJ, Peters PA, Brinkmann BH, Danstrom JC, Goerss SJ, Marsh WR, Meyer FB, Worrell GA. Network oscillations modulate interictal epileptiform spike rate during human memory. ACTA ACUST UNITED AC 2013; 136:2444-56. [PMID: 23803305 DOI: 10.1093/brain/awt159] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Eleven patients being evaluated with intracranial electroencephalography for medically resistant temporal lobe epilepsy participated in a visual recognition memory task. Interictal epileptiform spikes were manually marked and their rate of occurrence compared between baseline and three 2 s periods spanning a 6 s viewing period. During successful, but not unsuccessful, encoding of the images there was a significant reduction in interictal epileptiform spike rate in the amygdala, hippocampus, and temporal cortex. During the earliest encoding period (0-2000 ms after image presentation) in these trials there was a widespread decrease in the power of theta, alpha and beta band local field potential oscillations that coincided with emergent focal gamma frequency activity. Interictal epileptiform spike rate correlated with spectral band power changes and broadband (4-150 Hz) desynchronization, which predicted significant reduction in interictal epileptiform spike rate. Spike-triggered averaging of the field potential power spectrum detected a burst of low frequency synchronization 200 ms before the interictal epileptiform spikes that arose during this period of encoding. We conclude that interictal epileptiform spikes are modulated by the patterns of network oscillatory activity that accompany human memory offering a new mechanistic insight into the interplay of cognitive processing, local field potential dynamics and interictal epileptiform spike generation.
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Affiliation(s)
- Joseph Y Matsumoto
- Mayo Systems Electrophysiology Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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45
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Bower MR, Stead M, Van Gompel JJ, Bower RS, Sulc V, Asirvatham SJ, Worrell GA. Intravenous recording of intracranial, broadband EEG. J Neurosci Methods 2013; 214:21-6. [PMID: 23313850 DOI: 10.1016/j.jneumeth.2012.12.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/30/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022]
Abstract
The most direct evaluation of human brain activity has been obtained from intracranial electrodes placed either on the surface of the brain or inserted into the brain to record from deep brain structures. Currently, the placement of intracranial electrodes implies transcranial surgery, either through a burr hole or a craniotomy, but the high degree of invasiveness and potential for morbidity of such major surgical procedures limits the applicability of intracranial recording. The vascular system provides a natural avenue to reach many brain regions that currently are reached by transcranial approaches, along with deep brain structures that cannot be reached via a transcranial approach without significant risk. To determine the applicability of intravascular approaches to high-frequency intracranial monitoring, a catheter containing multiple macro- and micro-electrodes was placed into the superior sagittal sinus of anesthetized pigs in parallel with clinical, subdural electrode grids to record epileptiform activity induced by direct, cortical injection of penicillin and to record responses to electrical stimulation. Intravascular electrodes recorded epileptiform spikes with similar magnitudes and waveshapes to those obtained by surface electrodes, both for macroelectrodes and microelectrodes, including the spatiotemporal evolution of epileptiform activity, suggesting that intravascular electrodes might provide localizing information regarding seizure foci. Sinusoidal electrical stimulation showed that intravascular electrodes provide sufficient broadband fidelity to record high-frequency, physiological events that may also prove useful in localizing seizure onset zones. As intravascular techniques have transformed cardiology, so intravascular neurophysiology may transform intracranial monitoring, in general, and the treatment of epilepsy, in particular.
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Affiliation(s)
- Mark R Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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Abstract
BACKGROUND Deep-brain stimulation (DBS) is an established treatment for medically refractory essential tremor (ET). This article reviews the current evidence supporting the efficacy and safety of DBS targets, including the ventral intermediate (VIM) nucleus and posterior subthalamic area (PSA) in treatment of ET. METHODS A structured PubMed search was performed through December 2012 with keywords "deep brain stimulation (DBS)," "essential tremor (ET)," "ventral intermediate (VIM) nucleus," "posterior subthalamic area (PSA)," "safety," and "efficacy." RESULTS Based on level IV evidence, both VIM and PSA DBS targets appear to be safe and efficacious in ET patients in tremor reduction and improving activities of daily living, though the literature on PSA DBS is limited in terms of bilateral stimulation and long-term follow-up. DBS-related adverse effects are typically mild and stimulation-related. Hardware-related complications after DBS may not be uncommon, and often require additional surgical procedures. Few studies assessed quality-of-life and cognition outcomes in ET patients undergoing DBS stimulation. CONCLUSION DBS appears to be a safe and effective treatment for medically refractory ET. More systematic studies comparing VIM and PSA targets are needed to ascertain the most safe and effective DBS treatment for medically refractory ET. More research is warranted to assess quality-of-life and cognition outcomes in ET patients undergoing DBS.
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Affiliation(s)
- Amit Chopra
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Abstract
PURPOSE Focal seizures are thought to reflect simultaneous activation of a large population of neurons within a discrete region of pathologic brain. Resective surgery targeting this focus is an effective treatment in carefully selected patients, but not all. Although in vivo recordings of single-neuron (i.e., "unit") activity in patients with epilepsy have a long history, no studies have examined long-term firing rates leading into seizures and the spatial relationship of unit activity with respect to the seizure-onset zone. METHODS Microelectrode arrays recorded action potentials from neurons in mesial temporal structures (often including contralateral mesial temporal structures) in seven patients with mesial temporal lobe epilepsy. KEY FINDINGS Only 7.6% of microelectrode recordings showed increased firing rates before seizure onset and only 32.4% of microelectrodes showed any seizure-related activity changes. Surprisingly, firing rates on the majority of microelectrodes (67.6%) did not change throughout the seizure, including some microelectrodes located within the seizure-onset zone. Furthermore, changes in firing rate before and at seizure onset were observed on microelectrodes located outside the seizure-onset zone and even in contralateral mesial temporal lobe. These early changes varied from seizure to seizure, demonstrating the heterogeneity of ensemble activity underlying the generation of focal seizures. Increased neuronal synchrony was primarily observed only following seizure onset. SIGNIFICANCE These results suggest that cellular correlates of seizure initiation and sustained ictal discharge in mesial temporal lobe epilepsy involve a small subset of the neurons within and outside the seizure-onset zone. These results further suggest that the "epileptic ensemble or network" responsible for seizure generation are more complex and heterogeneous than previously thought and that future studies may find mechanistic insights and therapeutic treatments outside the clinical seizure-onset zone.
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Affiliation(s)
- Mark R Bower
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, U.S.A.
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Darbyshire J, Sitzia J, Cameron D, Ford G, Littlewood S, Kaplan R, Johnston D, Matthews D, Holloway J, Chaturvedi N, Morgan C, Riley A, Rossor M, Kotting P, McKeith I, Smye S, Gower J, Brown V, Smyth R, Poustie V, van't Hoff W, Wallace P, Ellis T, Wykes T, Burns S, Rosenberg W, Lester N, Stead M, Potts V, Johns C, Campbell H, Hamilton R, Sheffield J, Selby P. Extending the clinical research network approach to all of healthcare. Ann Oncol 2012; 22 Suppl 7:vii36-vii43. [PMID: 22039143 DOI: 10.1093/annonc/mdr424] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The development of Clinical Research Networks (CRN) has been central to the work conducted by Health Departments and research funders to promote and support clinical research within the NHS in the UK. In England, the National Institute for Health Research has supported the delivery of clinical research within the NHS primarily through CRN. CRN provide the essential infrastructure within the NHS for the set up and delivery of clinical research within a high-quality peer-reviewed portfolio of studies. The success of the National Cancer Research Network is summarized in Chapter 5. In this chapter progress in five other topics, and more recently in primary care and comprehensively across the NHS, is summarized. In each of the 'topic-specific' networks (Dementias and Neurodegenerative Diseases, Diabetes, Medicines for Children, Mental Health, Stroke) there has been a rapid and substantial increase in portfolios and in the recruitment of patients into studies in these portfolios. The processes and the key success factors are described. The CRN have worked to support research supported by pharmaceutical, biotechnology and medical device companies and there has been substantial progress in improving the speed, cost and delivery of these 'industry' studies. In particular, work to support the increased speed of set up and delivery of industry studies, and to embed this firmly in the NHS, was explored in the North West of England in an Exemplar Programme which showed substantial reductions in study set-up times and improved recruitment into studies and showed how healthcare (NHS) organizations can overcome delays in set up times when they actively manage the process. Seven out of 20 international studies reported that the first patient to be entered anywhere in the world was from the UK. In addition, the CRN have supported research management and governance, workforce development and clinical trials unit collaboration and coordination. International peer reviews of all of the CRN have been positive and resulted in the continuation of the system for a further 5 years in all cases.
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Cameron D, Stead M, Lester N, Parmar M, Haward R, Maughan T, Wilson R, Spaull A, Campbell H, Hamilton R, Stewart D, O'Toole L, Kerr D, Potts V, Moser R, Cooper M, Poole K, Darbyshire J, Kaplan R, Seymour M, Selby P. Research-intensive cancer care in the NHS in the UK. Ann Oncol 2012; 22 Suppl 7:vii29-vii35. [PMID: 22039142 DOI: 10.1093/annonc/mdr423] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the late 1990 s, in response to poor national cancer survival figures, government monies were invested to enhance recruitment to clinical cancer research. Commencing with England in 2001 and then rolling out across all four countries, a network of clinical cancer research infrastructure was created, the new staff being linked to existing clinical care structures including multi-disciplinary teams. In parallel, a UK-wide co-ordination of cancer research funders driven by the 'virtual' National Cancer Research Institute, combined to create a 'whole-system approach' linking research funders, researchers and NHS clinicians all working to the same ends. Over the next 10 years, recruitment to clinical trials and other well-designed studies, increased 4-fold, reaching 17% of the incident cancer population, the highest national rate world-wide. The additional resources led to more studies opened, and more patients recruited across the country, for all types of cancers and irrespective of additional clinical research staff in some hospitals. In 2006, a co-ordinated decision was made to increasingly focus on randomized trials, leading to increased recruitment, without any fall-off in accrual to non-randomized and observational studies. The National Cancer Research Network has supported large successful trials which are changing clinical practice in many cancers.
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Affiliation(s)
- D Cameron
- National Cancer Research Network, Leeds, UK
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Hu W, Klassen B, Stead M. 2.336 PSYCHOGENIC LEVODOPA-INDUCED DYSKINESIA EMERGING AFTER SUCCESSFUL SUBTHALAMIC NUCLEUS DEEP BRAIN STIMULATION (STN-DBS): CASE REPORT AND VIDEO. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70659-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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