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Wu H, Cai C, Ming W, Chen W, Zhu Z, Feng C, Jiang H, Zheng Z, Sawan M, Wang T, Zhu J. Speech decoding using cortical and subcortical electrophysiological signals. Front Neurosci 2024; 18:1345308. [PMID: 38486966 PMCID: PMC10937352 DOI: 10.3389/fnins.2024.1345308] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Language impairments often result from severe neurological disorders, driving the development of neural prosthetics utilizing electrophysiological signals to restore comprehensible language. Previous decoding efforts primarily focused on signals from the cerebral cortex, neglecting subcortical brain structures' potential contributions to speech decoding in brain-computer interfaces. Methods In this study, stereotactic electroencephalography (sEEG) was employed to investigate subcortical structures' role in speech decoding. Two native Mandarin Chinese speakers, undergoing sEEG implantation for epilepsy treatment, participated. Participants read Chinese text, with 1-30, 30-70, and 70-150 Hz frequency band powers of sEEG signals extracted as key features. A deep learning model based on long short-term memory assessed the contribution of different brain structures to speech decoding, predicting consonant articulatory place, manner, and tone within single syllable. Results Cortical signals excelled in articulatory place prediction (86.5% accuracy), while cortical and subcortical signals performed similarly for articulatory manner (51.5% vs. 51.7% accuracy). Subcortical signals provided superior tone prediction (58.3% accuracy). The superior temporal gyrus was consistently relevant in speech decoding for consonants and tone. Combining cortical and subcortical inputs yielded the highest prediction accuracy, especially for tone. Discussion This study underscores the essential roles of both cortical and subcortical structures in different aspects of speech decoding.
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Affiliation(s)
- Hemmings Wu
- Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Clinical Research Center for Neurological Disease of Zhejiang Province, Hangzhou, China
| | - Chengwei Cai
- Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenjie Ming
- Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wangyu Chen
- Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhoule Zhu
- Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chen Feng
- Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongjie Jiang
- Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhe Zheng
- Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mohamad Sawan
- CenBRAIN Lab, School of Engineering, Westlake University, Hangzhou, China
| | - Ting Wang
- School of Foreign Languages, Tongji University, Shanghai, China
- Center for Speech and Language Processing, Tongji University, Shanghai, China
| | - Junming Zhu
- Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Kullmann A, Akberali F, Van Gompel JJ, McGovern RA, Marsh WR, Kridner D, Diaz-Botia CA, Park MC. Implantation accuracy of novel polyimide stereotactic electroencephalographic depth electrodes-a human cadaveric study. Front Med Technol 2024; 6:1320762. [PMID: 38456122 PMCID: PMC10917981 DOI: 10.3389/fmedt.2024.1320762] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Stereoelectroencephalography (sEEG) is a minimally invasive procedure that uses depth electrodes stereotactically implanted into brain structures to map the origin and propagation of seizures in epileptic patients. Implantation accuracy of sEEG electrodes plays a critical role in the safety and efficacy of the procedure. This study used human cadaver heads, simulating clinical practice, to evaluate (1) neurosurgeon's ability to implant a new thin-film polyimide sEEG electrode according to the instructions for use (IFU), and (2) implantation accuracy. Methods Four neurosurgeons (users) implanted 24 sEEG electrodes into two cadaver heads with the aid of the ROSA robotic system. Usability was evaluated using a questionnaire that assessed completion of all procedure steps per IFU and user errors. For implantation accuracy evaluation, planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative computer tomography (CT) images. Implantation accuracy was quantified using the Euclidean distance for entry point error (EPE) and target point error (TPE). Results All sEEG electrodes were successfully placed following the IFU without user errors, and post-implant survey of users showed favorable handling characteristics. The EPE was 1.28 ± 0.86 mm and TPE was 1.61 ± 0.89 mm. Long trajectories (>50 mm) had significantly larger EPEs and TPEs than short trajectories (<50 mm), and no differences were found between orthogonal and oblique trajectories. Accuracies were similar or superior to those reported in the literature when using similar experimental conditions, and in the same range as those reported in patients. Discussion The results demonstrate that newly developed polyimide sEEG electrodes can be implanted as accurately as similar devices in the marker without user errors when following the IFU in a simulated clinical environment. The human cadaver ex-vivo test system provided a realistic test system, owing to the size, anatomy and similarity of tissue composition to that of the live human brain.
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Affiliation(s)
- Aura Kullmann
- NeuroOne Medical Technologies, Eden Prairie, MN, United States
| | | | | | - Robert A. McGovern
- Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis, MN, United States
| | - W. Richard Marsh
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Debra Kridner
- NeuroOne Medical Technologies, Eden Prairie, MN, United States
| | | | - Michael C. Park
- Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis, MN, United States
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, United States
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Niznik T, Grossen A, Shi H, Stephens M, Herren C, Desai VR. Learning Curve in Robotic Stereoelectroencephalography: Single Platform Experience. World Neurosurg 2024; 182:e442-e452. [PMID: 38030071 DOI: 10.1016/j.wneu.2023.11.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Learning curve, training, and cost impede widespread implementation of new technology. Neurosurgical robotic technology introduces challenges to visuospatial reasoning and requires the acquisition of new fine motor skills. Studies detailing operative workflow, learning curve, and patient outcomes are needed to describe the utility and cost-effectiveness of new robotic technology. METHODS A retrospective analysis was performed of pediatric patients who underwent robotic stereoelectroencephalography (sEEG) with the Medtronic Stealth Autoguide. Workflow, total operative time, and time per electrode were evaluated alongside target accuracy assessed via error measurements and root sum square. Patient demographics and clinical outcomes related to sEEG were also assessed. RESULTS Robot-assisted sEEG was performed in 12 pediatric patients. Comparison of cases over time demonstrated a mean operative time of 363.3 ± 109.5 minutes for the first 6 cases and 256.3 ± 59.1 minutes for the second 6 cases, with reduced operative time per electrode (P = 0.037). Mean entry point error, target point error, and depth point error were 1.82 ± 0.77 mm, 2.26 ± 0.71 mm, and 1.27 ± 0.53 mm, respectively, with mean root sum square of 3.23 ± 0.97 mm. Error measurements between magnetic resonance imaging and computed tomography angiography found computed tomography angiography to be more accurate with significant differences in mean entry point error (P = 0.043) and mean target point error (P = 0.035). The epileptogenic zone was identified in 11 patients, with therapeutic surgeries following in 9 patients, of whom 78% achieved an Engel class I. CONCLUSIONS This study demonstrated institutional workflow evolution and learning curve for the Autoguide in pediatric sEEG, resulting in reduced operative times and increased accuracy over a small number of cases. The platform may seamlessly and quickly be incorporated into clinical practice, and the provided workflow can facilitate a smooth transition.
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Affiliation(s)
- Taylor Niznik
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Audrey Grossen
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Helen Shi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Mark Stephens
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Cherie Herren
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Virendra R Desai
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA.
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Gatesman TA, Hect JL, Phillips HW, Johnson BJ, Wald AI, McClung C, Nikiforova MN, Skaugen JM, Pollack IF, Abel TJ, Agnihotri S. Characterization of low-grade epilepsy-associated tumor from implanted stereoelectroencephalography electrodes. Epilepsia Open 2024; 9:409-416. [PMID: 37798921 PMCID: PMC10839351 DOI: 10.1002/epi4.12840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
Low-grade epilepsy-associated tumors (LEATs) are a common cause of drug-resistant epilepsy in children. Herein, we demonstrate the feasibility of using tumor tissue derived from stereoelectroencephalography (sEEG) electrodes upon removal to molecularly characterize tumors and aid in diagnosis. An 18-year-old male with focal epilepsy and MRI suggestive of a dysembryoplastic neuroepithelial tumor (DNET) in the left posterior temporal lobe underwent implantation of seven peri-tumoral sEEG electrodes for peri-operative language mapping and demarcation of the peri-tumoral ictal zone prior to DNET resection. Using electrodes that passed through tumor tissue, we show successful isolation of tumor DNA and subsequent analysis using standard methods for tumor classification by DNA, including Glioseq targeted sequencing and DNA methylation array analysis. This study provides preliminary evidence for the feasibility of molecular diagnosis of LEATs or other lesions using a minimally invasive method with microscopic tissue volumes. The implications of sEEG electrodes in tumor characterization are broad but would aid in diagnosis and subsequent targeted therapeutic strategies.
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Affiliation(s)
- Taylor A. Gatesman
- Department of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Department of Cellular and Molecular PathologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- John G. Rangos Sr. Research CenterChildren's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Jasmine L. Hect
- Department of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- John G. Rangos Sr. Research CenterChildren's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - H. Westley Phillips
- Department of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Brenden J. Johnson
- Department of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- John G. Rangos Sr. Research CenterChildren's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Abigail I. Wald
- Molecular and Genomic PathologyUniversity of Pittsburgh Medical Center Health SystemPittsburghPennsylvaniaUSA
| | - Colleen McClung
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Marina N. Nikiforova
- Molecular and Genomic PathologyUniversity of Pittsburgh Medical Center Health SystemPittsburghPennsylvaniaUSA
| | - John M. Skaugen
- Molecular and Genomic PathologyUniversity of Pittsburgh Medical Center Health SystemPittsburghPennsylvaniaUSA
| | - Ian F. Pollack
- Department of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- John G. Rangos Sr. Research CenterChildren's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Taylor J. Abel
- Department of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Sameer Agnihotri
- Department of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Department of Cellular and Molecular PathologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- John G. Rangos Sr. Research CenterChildren's Hospital of PittsburghPittsburghPennsylvaniaUSA
- Department of NeurobiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
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Paulk AC, Salami P, Zelmann R, Cash SS. Electrode Development for Epilepsy Diagnosis and Treatment. Neurosurg Clin N Am 2024; 35:135-149. [PMID: 38000837 DOI: 10.1016/j.nec.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Recording neural activity has been a critical aspect in the diagnosis and treatment of patients with epilepsy. For those with intractable epilepsy, intracranial neural monitoring has been of substantial importance. Clinically, however, methods for recording neural information have remained essentially unchanged for decades. Over the last decade or so, rapid advances in electrode technology have begun to change this landscape. New systems allow for the observation of neural activity with high spatial resolution and, in some cases, at the level of the activity of individual neurons. These new tools have contributed greatly to our understanding of brain function and dysfunction. Here, the authors review the primary technologies currently in use in humans. The authors discuss other possible systems, some of the challenges which come along with these devices, and how they will become incorporated into the clinical workflow. Ultimately, the expectation is that these new, high-density, high-spatial-resolution recording systems will become a valuable part of the clinical arsenal used in the diagnosis and surgical management of epilepsy.
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Affiliation(s)
- Angelique C Paulk
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Pariya Salami
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Rina Zelmann
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Sydney S Cash
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Kokkinos V, Hussein H, Sakelliadou DG, Mark Richardson R, Bagić AΙ, Urban A. Hippocampal barques and their manifestation as 14&6 Hz positive spikes during sleep. Clin Neurophysiol 2024; 157:37-43. [PMID: 38042011 DOI: 10.1016/j.clinph.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/22/2023] [Accepted: 11/10/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE This study investigates variations in hippocampal barque occurrence during sleep and compares findings to respective variations of their scalp manifestation as 14&6/sec positive spikes. METHODS From 11 epilepsy patients, 12 non-epileptogenic hippocampi with barques were identified for this study. Using the first seizure-free whole-night sleep stereo-encephalography (sEEG) recording, we performed sleep staging and measured the occurrence of barques and 14&6/sec positive spikes variants. RESULTS Hippocampal barques (total count: 9,183; mean count per record: 765.2 ± 251.2) occurred predominantly during non-rapid eye movement (NREM) II sleep (total: 5,744; mean: 478.6 ± 176.1; 62.2 ± 6.0%) and slow-wave sleep (SWS) (total: 2,950; mean: 245.83 ± 92.9; 32.0 ± 6.2%), with rare to occasional occurrence in NREM I (total: 85; mean: 7.0 ± 2.8; 0.9 ± 0.4%), rapid eye movement (REM) (total: 153; mean: 12.75 ± 4.0; 1.7 ± 0.6) and wakefulness (total: 251; mean: 20.9 ± 6.3; 2.9 ± 0.9%). Barque rate increased during SWS (mean: 2.7 ± 1.0 per min) compared to NREM II (2.2 ± 1.0 per min) and other states (wakefulness: 0.1 ± 0.0 per min; NREM I: 0.3 ± 0.1 per min; REM: 0.1 ± 0.0 per min). The 14&6/sec positive spikes variant (total count: 2,406; mean: 343.7 ± 106.7) was present in NREM II (total: 2,059; mean: 249.1 ± 100.2, 84.9 ± 3.6%) and SWS (total: 347; mean: 49.5 ± 12.8, 15.0 ± 3.6%) stages, and absent from the rest of sleep and wakefulness. While all 14&6/sec positive spikes correlated with barques, only 44.7 ± 6.1% of barques manifested as 14&6/sec positive spikes. CONCLUSIONS Hippocampal barques are predominant in NREM II and SWS, and tend to increase their presence during SWS. Their scalp manifestation as 14&6/sec positive spikes is confounded by wakefulness, REM and NREM I stages, and "masked" by the co-occurrence of NREM II and SWS slow waves, and overlapping reactive micro-arousal elements. SIGNIFICANCE Our study highlighted the overnight profile of hippocampal barques, in relation to the respective profile of their scalp manifestation, the 14&6/sec positive spikes variant.
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Affiliation(s)
- Vasileios Kokkinos
- Department of Neurology, Feinberg School of Medicine, Northwestern University, IL, USA; Comprehensive Epilepsy Center, Northwestern Memorial Hospital, Chicago, IL, USA.
| | - Helweh Hussein
- Department of General Surgery, Trident Medical Center, North Charleston, SC, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Anto Ι Bagić
- Department of Neurology, School of Medicine, University of Pittsburgh, PA, USA; University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - Alexandra Urban
- Department of Neurology, School of Medicine, University of Pittsburgh, PA, USA; University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
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Hines K, Wu C. Epilepsy Networks and Their Surgical Relevance. Brain Sci 2023; 14:31. [PMID: 38248246 PMCID: PMC10813558 DOI: 10.3390/brainsci14010031] [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: 11/09/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
Surgical epilepsy is a rapidly evolved field. As the understanding and concepts of epilepsy shift towards a network disorder, surgical outcomes may shed light on numerous components of these systems. This review documents the evolution of the understanding of epilepsy networks and examines the data generated by resective, ablative, neuromodulation, and invasive monitoring surgeries in epilepsy patients. As these network tools are better integrated into epilepsy practice, they may eventually inform surgical decisions and improve clinical outcomes.
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Affiliation(s)
- Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA;
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Brimley C, Shimony N. Accuracy and Utility of Frameless Stereotactic Placement of Stereoelectroencephalography Electrodes. World Neurosurg 2023; 180:e226-e232. [PMID: 37739177 DOI: 10.1016/j.wneu.2023.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Successful surgery for epilepsy hinges on identification of the epileptogenic focus. Stereoelectroencephalography (sEEG) is the most effective way to identify most seizure foci. There are multiple methods of inserting depth electrodes, including frame-based, frameless, and robot-assisted techniques. Studies have shown the accuracy of frame-based and robotic-assisted techniques to be statistically similar, while only one study has detailed the frameless sEEG insertion technique. METHODS Patients underwent placement of sEEG depth electrodes using frameless stereotaxy from September 2019 to September 2021 at Geisinger Medical Center by a single surgeon. Seizure history, electrode placement accuracy relative to the planned trajectories, surgical times, success rate of identifying the epileptogenic focus, and subsequent seizure control rates after surgical treatment were documented. RESULTS Data were available for 21 patients and 181 electrodes inserted using the VarioGuide frameless stereotactic system. Each insertion took an average of 14.5 minutes per lead. Average entry variance was 2.7 mm with an average target variance of 4.6 mm. The epileptogenic focus was identified in 19 of 21 patients, and further surgical treatment was performed in 18 of 21 patients (85.7%). CONCLUSIONS VarioGuide frameless stereotaxy for sEEG placement is comparable to frame-based and robotic-assisted techniques with statistically similar rates of epileptic focus identification. Lead placement accuracy is slightly lower and time per lead is slightly higher relative to robot-assisted surgeries. When a robot system is unavailable, surgeons can consider using a frameless stereotactic technique for sEEG insertion, allowing patients to benefit from a similarly high rate of epileptic zone identification.
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Affiliation(s)
- Cameron Brimley
- Geisinger Neuroscience Institute, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania, USA; Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA; Department of Neurosurgery, University of Tennessee Health Science Center/Semmes-Murphey Clinic, Memphis, Tennessee, USA.
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA; Department of Neurosurgery, University of Tennessee Health Science Center/Semmes-Murphey Clinic, Memphis, Tennessee, USA
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Parrott A, Tavakol SA, Zieles K, Jea A, Desai VR. The evolution of stereoelectroencephalography: symbiotic progress in medical imaging and procedural technologies. J Neurosurg Pediatr 2023; 32:545-552. [PMID: 37728396 DOI: 10.3171/2023.7.peds2344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 09/21/2023]
Abstract
Stereoelectroencephalography (sEEG) was pioneered in France, at a time when cerebral anatomy was invisible to contemporaneous imaging modalities. Epilepsy surgeons relied on indirect targeting techniques to identify epileptogenic tissue. Since then, alongside the rapid rise of medical imaging technology, sEEG has experienced dramatic stepwise progress. A flurry of advancements has pushed this technique to its current-day standards, enabling neurosurgeons to access any intracranial location in a safe, highly precise, and expeditious manner. Presently, epilepsy surgeons throughout the world apply robot-assisted sEEG. Herein, the authors chronicle this incredible evolution.
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Noecker AM, Mlakar J, Bijanki KR, Griswold MA, Pouratian N, Sheth SA, McIntyre CC. Stereo-EEG-guided network modulation for psychiatric disorders: Interactive holographic planning. Brain Stimul 2023; 16:1799-1805. [PMID: 38135359 PMCID: PMC10784872 DOI: 10.1016/j.brs.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Connectomic modeling studies are expanding understanding of the brain networks that are modulated by deep brain stimulation (DBS) therapies. However, explicit integration of these modeling results into prospective neurosurgical planning is only beginning to evolve. One challenge of employing connectomic models in patient-specific surgical planning is the inherent 3D nature of the results, which can make clinically useful data integration and visualization difficult. METHODS We developed a holographic stereotactic neurosurgery research tool (HoloSNS) that integrates patient-specific brain models into a group-based visualization environment for interactive surgical planning using connectomic hypotheses. HoloSNS currently runs on the HoloLens 2 platform and it enables remote networking between headsets. This allowed us to perform surgical planning group meetings with study co-investigators distributed across the country. RESULTS We used HoloSNS to plan stereo-EEG and DBS electrode placements for each patient participating in a clinical trial (NCT03437928) that is targeting both the subcallosal cingulate and ventral capsule for the treatment of depression. Each patient model consisted of multiple components of scientific data and anatomical reconstructions of the head and brain (both patient-specific and atlas-based), which far exceed the data integration capabilities of traditional neurosurgical planning workstations. This allowed us to prospectively discuss and evaluate the positioning of the electrodes based on novel connectomic hypotheses. CONCLUSIONS The 3D nature of the surgical procedure, brain imaging data, and connectomic modeling results all highlighted the utility of employing holographic visualization to support the design of unique clinical experiments to explore brain network modulation with DBS.
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Affiliation(s)
- Angela M Noecker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jeffrey Mlakar
- Interactive Commons, Case Western Reserve University, Cleveland, OH, USA
| | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Mark A Griswold
- Interactive Commons, Case Western Reserve University, Cleveland, OH, USA; Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University, Durham, NC, USA.
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Cameron N, Fry L, Kabangu JL, Schatmeyer BA, Miller C, Ulloa CM, Uysal U, Cheng JJ, Kinsman MJ, Rouse AG, Landazuri P. Using pre-surgical suspicion to guide insula implantation strategy. Heliyon 2023; 9:e18284. [PMID: 37539155 PMCID: PMC10395527 DOI: 10.1016/j.heliyon.2023.e18284] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023] Open
Abstract
Rationale Insular epilepsy can be a challenging diagnosis due to overlapping semiology and scalp EEG findings with frontal, temporal, and parietal lobe epilepsies. Stereotactic electroencephalography (sEEG) provides an opportunity to better localize seizure onset. The possibility of improved localization is balanced by implantation risk in this vascularly rich anatomic region. We review both safety and pre-implantation factors involved in insular electrode placement across four years at an academic medical center. Methods Presurgical data, operative reports, and invasive EEG summaries were retrospectively reviewed for patients undergoing invasive epilepsy monitoring on the insula from 2016 through 2019. EEG reports were reviewed to record the presence of insula ictal and interictal involvement. We recorded which presurgical findings suggested insular involvement (insula lesion on MRI, insula changes on PET/SPECT/scalp EEG, characteristic semiology, or history of failed anterior temporal lobectomy). The likelihood of pre-sEEG insular onset was categorized as low suspicion if no presurgical findings were present ("rule out"), moderate suspicion if one finding was present, and high suspicion if two or more findings were present. Results 76 patients received 189 insular electrodes as part of their implantation strategy for 79 surgical cases. Seven patients (8.9%) had insular ictal onset. One clinically significant complication (left hemiparesis) occurred in a patient with moderate suspicion for insular onset. There were 38 low suspicion cases, 36 moderate suspicion cases, and 5 high suspicion cases for pre-sEEG insula ictal onset. Two low suspicion (5.3%), three moderate suspicion (8.6%), and two high suspicion (40%) cases had insular ictal onset. Conclusions The insula can safely receive sEEG. Having two or more presurgical factors indicating insular onset is a strong, albeit incomplete, predictor of insular seizure onset. Using pre-implantation clinical findings can offer clinicians predictive value for targeting the insula during invasive EEG monitoring.
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Affiliation(s)
- Nathaniel Cameron
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Lane Fry
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Jean-Luc Kabangu
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | | | - Christopher Miller
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Carol M. Ulloa
- Dept. of Neurology, University of Kansas Medical Center, United States
| | - Utku Uysal
- Dept. of Neurology, University of Kansas Medical Center, United States
| | - Jennifer J. Cheng
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Michael J. Kinsman
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
| | - Adam G. Rouse
- Dept. of Neurosurgery, University of Kansas Medical Center, United States
- Dept. of Cell Biology & Physiology, University of Kansas Medical Center, United States
- Dept. of Electrical Engineering and Computer Science, University of Kansas, United States
| | - Patrick Landazuri
- Dept. of Neurology, University of Kansas Medical Center, United States
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12
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Abstract
Computational psychiatry, a relatively new yet prolific field that aims to understand psychiatric disorders with formal theories about the brain, has seen tremendous growth in the past decade. Despite initial excitement, actual progress made by computational psychiatry seems stagnant. Meanwhile, understanding of the human brain has benefited tremendously from recent progress in intracranial neuroscience. Specifically, invasive techniques such as stereotactic electroencephalography, electrocorticography, and deep brain stimulation have provided a unique opportunity to precisely measure and causally modulate neurophysiological activity in the living human brain. In this review, we summarize progress and drawbacks in both computational psychiatry and invasive electrophysiology and propose that their combination presents a highly promising new direction-invasive computational psychiatry. The value of this approach is at least twofold. First, it advances our mechanistic understanding of the neural computations of mental states by providing a spatiotemporally precise depiction of neural activity that is traditionally unattainable using noninvasive techniques with human subjects. Second, it offers a direct and immediate way to modulate brain states through stimulation of algorithmically defined neural regions and circuits (i.e., algorithmic targeting), thus providing both causal and therapeutic insights. We then present depression as a use case where the combination of computational and invasive approaches has already shown initial success. We conclude by outlining future directions as a road map for this exciting new field as well as presenting cautions about issues such as ethical concerns and generalizability of findings.
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Affiliation(s)
- Ignacio Saez
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Xiaosi Gu
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
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13
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Subritzky-Katz V, Sampson AL, Emeric E, Lipski W, Moreira-González S, González-Martínez J, Sarma S, Stuphorn V, Niebur E. Quantifying Phase-Amplitude Modulation in Neural Data. Annu Conf Inf Sci Syst 2023; 2023:10.1109/CISS56502.2023.10089691. [PMID: 38250522 PMCID: PMC10799684 DOI: 10.1109/ciss56502.2023.10089691] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Phase-amplitude modulation (the modulation of the amplitude of higher frequency oscillations by the phase of lower frequency oscillations) is a specific type of cross-frequency coupling that has been observed in neural recordings from multiple species in a range of behavioral contexts. Given its potential importance, care must be taken with how it is measured and quantified. Previous studies have quantified phase-amplitude modulation by measuring the distance of the amplitude distribution from a uniform distribution. While this method is of general applicability, it is not targeted to the specific modulation pattern frequently observed with low-frequency oscillations. Here we develop a new method that has increased specificity to detect modulation in the sinusoidal shape commonly observed in neural data.
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Affiliation(s)
| | - Aaron L Sampson
- Zanvyl Krieger Mind/Brain Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Erik Emeric
- Zanvyl Krieger Mind/Brain Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Witold Lipski
- Cortical Systems Lab, University of Pittsburgh Medical School, Pittsburgh, PA, USA
| | | | | | - Sridevi Sarma
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Veit Stuphorn
- Zanvyl Krieger Mind/Brain Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Ernst Niebur
- Zanvyl Krieger Mind/Brain Institute, Johns Hopkins University, Baltimore, MD, USA
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14
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Chilukuri AS, Awkwayena E, Abel TJ. Insulo-opercular stereoelectroencephalography exploration in children and young adults: Indications, techniques, and safety. Epilepsia Open 2022; 7:729-736. [PMID: 36161288 PMCID: PMC9712468 DOI: 10.1002/epi4.12651] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/21/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Sampling the insulo-opercular region with invasive recordings is crucial given the importance of this region in epileptic networks and a variety of electroclinical presentations. However, implantation of the insulo-opercular region via stereoelectroencephalography (sEEG) is considered technically challenging given complex vascular and gray matter relationships in this region. We investigated the safety of insulo-opercular sEEG exploration in children and young adults using standard sEEG approaches: (1) orthogonal insulo-opercular (including the pseudo-orthogonal insulo-opercular approach) and (2) medial-lateral insular oblique approach. METHODS We performed a retrospective cohort study of 30 consecutive patients who underwent 33 sEEG implantations. All patients had drug-resistant focal epilepsy, were between the ages of 4 and 21, and were operated at one institution between January 2019 and March 2021. Medical records and neuroimaging were reviewed. Hemorrhage, infection, and other complications were considered as outcome variables. RESULTS A total of 519 electrodes were placed. Eighty-one were placed orthogonally into the temporal operculum, 53 orthogonally into the frontal operculum, and 19 obliquely into the insula. sEEG electrodes localized seizure onset to the insulo-opercular region in eight patients, leading to a resection three times, an ablation four times, and one peri-insular hemispherectomy. Of the 519 electrodes placed, none of them exhibited hemorrhage or serious complications. Of the 153 electrodes placed into the insula, none had any permanent deficits or complications and one had minor bleeding due to the electrode breaking. SIGNIFICANCE These results demonstrate that the orthogonal (including pseudo-orthogonal) and medial approaches to sampling the insula are safe.
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Affiliation(s)
| | - Emefa Awkwayena
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Taylor J. Abel
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA,Department of BioengineeringUniversity of PittsburghPittsburghPennsylvaniaUSA
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15
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Fan X, Guo Q, Zhang X, Fei L, He S, Weng X. Top-down modulation and cortical-AMG/HPC interaction in familiar face processing. Cereb Cortex 2022; 33:4677-4687. [PMID: 36156127 DOI: 10.1093/cercor/bhac371] [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: 05/17/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Humans can accurately recognize familiar faces in only a few hundred milliseconds, but the underlying neural mechanism remains unclear. Here, we recorded intracranial electrophysiological signals from ventral temporal cortex (VTC), superior/middle temporal cortex (STC/MTC), medial parietal cortex (MPC), and amygdala/hippocampus (AMG/HPC) in 20 epilepsy patients while they viewed faces of famous people and strangers as well as common objects. In posterior VTC and MPC, familiarity-sensitive responses emerged significantly later than initial face-selective responses, suggesting that familiarity enhances face representations after they are first being extracted. Moreover, viewing famous faces increased the coupling between cortical areas and AMG/HPC in multiple frequency bands. These findings advance our understanding of the neural basis of familiar face perception by identifying the top-down modulation in local face-selective response and interactions between cortical face areas and AMG/HPC.
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Affiliation(s)
- Xiaoxu Fan
- Department of Psychology, University of Washington, Seattle, WA, 98105, United States
| | - Qiang Guo
- Epilepsy Center, Guangdong Sanjiu Brain Hospital, Guangzhou, Guangdong, 510510, China
| | - Xinxin Zhang
- Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education,Guangzhou, Guangdong, 510898, China
| | - Lingxia Fei
- Epilepsy Center, Guangdong Sanjiu Brain Hospital, Guangzhou, Guangdong, 510510, China
| | - Sheng He
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Xuchu Weng
- Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education,Guangzhou, Guangdong, 510898, China
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16
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Katz CN, Schjetnan AGP, Patel K, Barkley V, Hoffman KL, Kalia SK, Duncan KD, Valiante TA. A corollary discharge mediates saccade-related inhibition of single units in mnemonic structures of the human brain. Curr Biol 2022; 32:3082-3094.e4. [PMID: 35779529 DOI: 10.1016/j.cub.2022.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/11/2021] [Revised: 04/04/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022]
Abstract
Despite the critical link between visual exploration and memory, little is known about how neuronal activity in the human mesial temporal lobe (MTL) is modulated by saccades. Here, we characterize saccade-associated neuronal modulations, unit-by-unit, and contrast them to image onset and to occipital lobe neurons. We reveal evidence for a corollary discharge (CD)-like modulatory signal that accompanies saccades, inhibiting/exciting a unique population of broad-/narrow-spiking units, respectively, before and during saccades and with directional selectivity. These findings comport well with the timing, directional nature, and inhibitory circuit implementation of a CD. Additionally, by linking neuronal activity to event-related potentials (ERPs), which are directionally modulated following saccades, we recontextualize the ERP associated with saccades as a proxy for both the strength of inhibition and saccade direction, providing a mechanistic underpinning for the more commonly recorded saccade-related ERP in the human brain.
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Affiliation(s)
- Chaim N Katz
- Krembil Brain Institute, Toronto Western Hospital (TWH), Toronto, ON M5T 1M8, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada; CRANIA, University Health Network and University of Toronto, Toronto, ON M5G 2A2, Canada; Faculty of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Andrea G P Schjetnan
- Krembil Brain Institute, Toronto Western Hospital (TWH), Toronto, ON M5T 1M8, Canada; CRANIA, University Health Network and University of Toronto, Toronto, ON M5G 2A2, Canada
| | - Kramay Patel
- Krembil Brain Institute, Toronto Western Hospital (TWH), Toronto, ON M5T 1M8, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada; Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; CRANIA, University Health Network and University of Toronto, Toronto, ON M5G 2A2, Canada
| | - Victoria Barkley
- Krembil Brain Institute, Toronto Western Hospital (TWH), Toronto, ON M5T 1M8, Canada; CRANIA, University Health Network and University of Toronto, Toronto, ON M5G 2A2, Canada
| | - Kari L Hoffman
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA
| | - Suneil K Kalia
- Krembil Brain Institute, Toronto Western Hospital (TWH), Toronto, ON M5T 1M8, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada; CRANIA, University Health Network and University of Toronto, Toronto, ON M5G 2A2, Canada; The KITE Research Institute, University Health Network, Toronto, ON M5G 2A2, Canada
| | - Katherine D Duncan
- Department of Psychology, University of Toronto, Toronto, ON M5S 3G3, Canada
| | - Taufik A Valiante
- Krembil Brain Institute, Toronto Western Hospital (TWH), Toronto, ON M5T 1M8, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada; Electrical and Computer Engineering, University of Toronto, Toronto, ON M5S 3G4, Canada; CRANIA, University Health Network and University of Toronto, Toronto, ON M5G 2A2, Canada; The KITE Research Institute, University Health Network, Toronto, ON M5G 2A2, Canada; Max Planck-University of Toronto Center for Neural Science and Technology, Toronto, ON, Canada.
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17
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Lehongre K, Lambrecq V, Whitmarsh S, Frazzini V, Cousyn L, Soleil D, Fernandez-Vidal S, Mathon B, Houot M, Lemarechal JD, Clemenceau S, Hasboun D, Adam C, Navarro V. Long-term deep intracerebral microelectrode recordings in patients with drug-resistant epilepsy: proposed guidelines based on 10-year experience. Neuroimage 2022; 254:119116. [PMID: 35318150 DOI: 10.1016/j.neuroimage.2022.119116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/23/2022] [Accepted: 03/15/2022] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Human neuronal activity, recorded in vivo from microelectrodes, may offer valuable insights into physiological mechanisms underlying human cognition and pathophysiological mechanisms of brain diseases, in particular epilepsy. Continuous and long-term recordings are necessary to monitor non predictable pathological and physiological activities like seizures or sleep. Because of their high impedance, microelectrodes are more sensitive to noise than macroelectrodes. Low noise levels are crucial to detect action potentials from background noise, and to further isolate single neuron activities. Therefore, long-term recordings of multi-unit activity remains a challenge. We shared here our experience with microelectrode recordings and our efforts to reduce noise levels in order to improve signal quality. We also provided detailed technical guidelines for the connection, recording, imaging and signal analysis of microelectrode recordings. RESULTS During the last 10 years, we implanted 122 bundles of Behnke-Fried hybrid macro-microelectrodes, in 56 patients with pharmacoresistant focal epilepsy. Microbundles were implanted in the temporal lobe (74%), as well as frontal (15%), parietal (6%) and occipital (5%) lobes. Low noise levels depended on our technical setup. The noise reduction was mainly obtained after electrical insulation of the patient's recording room and the use of a reinforced microelectrode model, reaching median root mean square values of 5.8 µV. Seventy percent of the bundles could record multi-units activities (MUA), on around 3 out of 8 wires per bundle and for an average of 12 days. Seizures were recorded by microelectrodes in 91% of patients, when recorded continuously, and MUA were recorded during seizures for 75 % of the patients after the insulation of the room. Technical guidelines are proposed for (i) electrode tails manipulation and protection during surgical bandage and connection to both clinical and research amplifiers, (ii) electrical insulation of the patient's recording room and shielding, (iii) data acquisition and storage, and (iv) single-units activities analysis. CONCLUSIONS We progressively improved our recording setup and are now able to record (i) microelectrode signals with low noise level up to 3 weeks duration, and (ii) MUA from an increased number of wires . We built a step by step procedure from electrode trajectory planning to recordings. All these delicate steps are essential for continuous long-term recording of units in order to advance in our understanding of both the pathophysiology of ictogenesis and the neuronal coding of cognitive and physiological functions.
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Affiliation(s)
- Katia Lehongre
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France
| | - Virginie Lambrecq
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Département de Neurophysiologie, Hôpital Pitié-Salpêtrière, DMU Neurosciences, Paris, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France
| | - Stephen Whitmarsh
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France
| | - Valerio Frazzini
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Département de Neurophysiologie, Hôpital Pitié-Salpêtrière, DMU Neurosciences, Paris, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France
| | - Louis Cousyn
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France
| | - Daniel Soleil
- Bureau d'Etudes CEMS, 801 Route d'Eyguieres, 13 560 Senas, France
| | - Sara Fernandez-Vidal
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France
| | - Bertrand Mathon
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Service de Neurochirurgie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marion Houot
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.; Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital Paris, France
| | - Jean-Didier Lemarechal
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; Institut de Neurosciences des Systèmes, Aix-Marseille Université, Marseille, France
| | | | - Dominique Hasboun
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Service de Neuroradiologie, Pitié-Salpêtrière Hospital, Paris, France
| | - Claude Adam
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France
| | - Vincent Navarro
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, APHP, Pitié-Salpêtrière Hospital, Paris France; AP-HP, Département de Neurophysiologie, Hôpital Pitié-Salpêtrière, DMU Neurosciences, Paris, France; AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France; AP-HP, Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France.
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18
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Gadot R, Korst G, Shofty B, Gavvala JR, Sheth SA. Thalamic stereoelectroencephalography in epilepsy surgery: a scoping literature review. J Neurosurg 2022; 137:1-16. [PMID: 35276641 DOI: 10.3171/2022.1.jns212613] [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: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (sEEG) is a well-established surgical method for defining the epileptogenic network. Traditionally reserved for identifying discrete cortical regions for resection or ablation, sEEG in current practice is also used for identifying more broadly involved subcortical epileptic network components, driven by the availability of brain-based neuromodulation strategies. In particular, sEEG investigations including thalamic nuclei are becoming more frequent in parallel with the increase in therapeutic strategies involving thalamic targets such as deep brain stimulation (DBS) and responsive neurostimulation (RNS). The objective to this study was to evaluate existing evidence and trends regarding the purpose, techniques, and relevant electrographic findings of thalamic sEEG. METHODS MEDLINE and Embase databases were systematically queried for eligible peer-reviewed studies involving sEEG electrode implantation into thalamic nuclei of patients with epilepsy. Available data were abstracted concerning preoperative workup and purpose for implanting the thalamus, thalamic targets and trajectories, and electrophysiological methodology and findings. RESULTS sEEG investigations have included thalamic targets for both basic and clinical research purposes. Medial pulvinar, dorsomedial, anterior, and centromedian nuclei have been the most frequently studied. Few studies have reported any complications with thalamic sEEG implantation, and no studies have reported long-term complications. Various methods have been utilized to characterize thalamic activity in epileptic disorders including evoked potentials, power spectrograms, synchronization indices, and the epileptogenicity index. Thalamic intracranial recordings are beginning to be used to guide neuromodulation strategies including RNS and DBS, as well as to understand complex, network-dependent seizure disorders. CONCLUSIONS Inclusion of thalamic coverage during sEEG evaluation in drug-resistant epilepsy is a growing practice and is amenable to various methods of electrographic data analysis. Further study is required to establish well-defined criteria for thalamic implantation during invasive investigations as well as safety and ethical considerations.
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Affiliation(s)
| | | | | | - Jay R Gavvala
- 2Neurology, Baylor College of Medicine, Houston, Texas
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19
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Boop S, Barkley A, Emerson S, Prolo LM, Goldstein H, Ojemann JG, Hauptman JS. Robot-assisted stereoelectroencephalography in young children: technical challenges and considerations. Childs Nerv Syst 2022; 38:263-267. [PMID: 34716458 DOI: 10.1007/s00381-021-05384-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
Robot-assisted stereoelectroencephalography (sEEG) is frequently employed to localize epileptogenic zones in patients with medically refractory epilepsy (MRE). Its methodology is well described in adults, but less so in children. Given the limited information available on pediatric applications, the objective is to describe the unique technical challenges and considerations of sEEG in the pediatric population. In this report, we describe our institutional experience with the technical aspects of robot-assisted sEEG in an exclusively pediatric epilepsy surgery unit, focusing on pre-, intra-, and post-operative nuances that are particular to the pediatric population. The pediatric population presents several unique challenges in sEEG, including reduced skull thickness relative to adults, incomplete neurologic development, and often special behavioral considerations. Pre-operative selection of putative epileptogenic zones requires careful multidisciplinary decision-making. Intraoperative attention to nuances in positioning, clamp selection, registration, and electrode placement are necessary. Activity considerations and electrode migration and removal are key post-operative considerations. Robot-assisted sEEG is a valuable tool in the armamentarium of techniques to characterize MRE. However, special considerations must be given to the pediatric population to optimize safety and efficacy.
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Affiliation(s)
- Scott Boop
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Ariana Barkley
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Samuel Emerson
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Laura M Prolo
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Hannah Goldstein
- Department of Neurosurgery, Seattle Children's Hospital, 4800 Sand Point Way NE, OA.9.220, Seattle, WA, 98105, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA.,Department of Neurosurgery, Seattle Children's Hospital, 4800 Sand Point Way NE, OA.9.220, Seattle, WA, 98105, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA. .,Department of Neurosurgery, Seattle Children's Hospital, 4800 Sand Point Way NE, OA.9.220, Seattle, WA, 98105, USA.
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Kokkinos V, Hussein H, Frauscher B, Simon M, Urban A, Bush A, Bagić AI, Richardson RM. Hippocampal spindles and barques are normal intracranial electroencephalographic entities. Clin Neurophysiol 2021; 132:3002-3009. [PMID: 34715425 DOI: 10.1016/j.clinph.2021.09.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess whether hippocampal spindles and barques are markers of epileptogenicity. METHODS Focal epilepsy patients that underwent stereo-electroencephalography implantation with at least one electrode in their hippocampus were selected (n = 75). The occurrence of spindles and barques in the hippocampus was evaluated in each patient. We created pairs of pathologic and pathology-free groups according to two sets of criteria: 1. Non-invasive diagnostic criteria (patients grouped according to focal epilepsy classification). 2. Intracranial neurophysiological criteria (patient's hippocampi grouped according to their seizure onset involvement). RESULTS Hippocampal spindles and barques appear equally often in both pathologic and pathology-free groups, both for non-invasive (Pspindles = 0.73; Pbarques = 0.46) and intracranial criteria (Pspindles = 0.08; Pbarques = 0.26). In Engel Class I patients, spindles occurred with similar incidence both within the non-invasive (P = 0.67) and the intracranial criteria group (P = 0.20). Barques were significantly more frequent in extra-temporal lobe epilepsy defined by either non-invasive (P = 0.01) or intracranial (P = 0.01) criteria. CONCLUSIONS Both spindles and barques are normal entities of the hippocampal intracranial electroencephalogram. The presence of barques may also signify lack of epileptogenic properties in the hippocampus. SIGNIFICANCE Understanding that hippocampal spindles and barques do not reflect epileptogenicity is critical for correct interpretation of epilepsy surgery evaluations and appropriate surgical treatment selection.
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Affiliation(s)
- Vasileios Kokkinos
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Helweh Hussein
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Mirela Simon
- Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra Urban
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - Alan Bush
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Anto I Bagić
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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21
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Karthik G, Plass J, Beltz AM, Liu Z, Grabowecky M, Suzuki S, Stacey WC, Wasade VS, Towle VL, Tao JX, Wu S, Issa NP, Brang D. Visual speech differentially modulates beta, theta, and high gamma bands in auditory cortex. Eur J Neurosci 2021; 54:7301-7317. [PMID: 34587350 DOI: 10.1111/ejn.15482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/01/2021] [Revised: 08/20/2021] [Accepted: 08/28/2021] [Indexed: 12/13/2022]
Abstract
Speech perception is a central component of social communication. Although principally an auditory process, accurate speech perception in everyday settings is supported by meaningful information extracted from visual cues. Visual speech modulates activity in cortical areas subserving auditory speech perception including the superior temporal gyrus (STG). However, it is unknown whether visual modulation of auditory processing is a unitary phenomenon or, rather, consists of multiple functionally distinct processes. To explore this question, we examined neural responses to audiovisual speech measured from intracranially implanted electrodes in 21 patients with epilepsy. We found that visual speech modulated auditory processes in the STG in multiple ways, eliciting temporally and spatially distinct patterns of activity that differed across frequency bands. In the theta band, visual speech suppressed the auditory response from before auditory speech onset to after auditory speech onset (-93 to 500 ms) most strongly in the posterior STG. In the beta band, suppression was seen in the anterior STG from -311 to -195 ms before auditory speech onset and in the middle STG from -195 to 235 ms after speech onset. In high gamma, visual speech enhanced the auditory response from -45 to 24 ms only in the posterior STG. We interpret the visual-induced changes prior to speech onset as reflecting crossmodal prediction of speech signals. In contrast, modulations after sound onset may reflect a decrease in sustained feedforward auditory activity. These results are consistent with models that posit multiple distinct mechanisms supporting audiovisual speech perception.
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Affiliation(s)
- G Karthik
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - John Plass
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Adriene M Beltz
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Zhongming Liu
- Department of Biomedical Engineering and Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan, USA
| | - Marcia Grabowecky
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Satoru Suzuki
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - William C Stacey
- Department of Neurology and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Vibhangini S Wasade
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Vernon L Towle
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - James X Tao
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Naoum P Issa
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - David Brang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
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22
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Miller C, Schatmeyer B, Landazuri P, Uysal U, Nazzaro J, Kinsman MJ, Camarata PJ, Ulloa CM, Hammond N, Pearson C, Shah V, Cheng JJ. sEEG for Expansion of a Surgical Epilepsy Program: Safety and Efficacy in 152 Consecutive Cases. Epilepsia Open 2021; 6:694-702. [PMID: 34388309 PMCID: PMC8633478 DOI: 10.1002/epi4.12535] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/18/2021] [Revised: 06/13/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022] Open
Abstract
Objective Stereoelectroencephalography (sEEG) is an intracranial encephalography method of expanding use. The need for increased epilepsy surgery access has led to the consideration of sEEG adoption by new or expanding surgical epilepsy programs. Data regarding safety and efficacy are uncommon outside of high‐volume, well‐established centers, which may be less applicable to newer or low‐volume centers. The objective of this study was to add to the sEEG outcomes in the literature from the perspective of a rapidly expanding center. Methods A retrospective chart review of consecutive sEEG cases from January 2016 to December 2019 was performed. Data extraction included demographic data, surgical data, and outcome data, which pertinently examined surgical method, progression to therapeutic procedure, clinically significant adverse events, and Engel outcomes. Results One hundred and fifty‐two sEEG procedures were performed on 131 patients. Procedures averaged 10.5 electrodes for a total of 1603 electrodes. The majority (84%) of patients progressed to a therapeutic procedure. Six clinically significant complications occurred: three retained electrodes, two hemorrhages, and one failure to complete investigation. Only one complication resulted in a permanent deficit. Engel 1 outcome was achieved in 63.3% of patients reaching one‐year follow‐up after a curative procedure. Significance New or expanding epilepsy surgery centers can appropriately consider the use of sEEG. The complication rate is low and the majority of patients progress to therapeutic surgery. Procedural safety, progression to therapeutic intervention, and Engel outcomes are comparable to cohorts from long‐established epilepsy surgery programs.
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Affiliation(s)
- Christopher Miller
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Bryan Schatmeyer
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Patrick Landazuri
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Utku Uysal
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jules Nazzaro
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Michael J Kinsman
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Paul J Camarata
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Carol M Ulloa
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Nancy Hammond
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Caleb Pearson
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Vishal Shah
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jennifer J Cheng
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
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23
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Mandel M, Lamsam L, Farooque P, Spencer D, Damisah E. Depth Electrode Guided Anterior Insulectomy: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E121. [PMID: 33885821 DOI: 10.1093/ons/opab112] [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: 10/12/2020] [Accepted: 02/08/2021] [Indexed: 11/12/2022] Open
Abstract
The insula is well established as an epileptogenic area.1 Insular epilepsy surgery demands precise anatomic knowledge2-4 and tailored removal of the epileptic zone with careful neuromonitoring.5 We present an operative video illustrating an intracranial electroencephalogram (EEG) depth electrode guided anterior insulectomy. We report a 17-yr-old right-handed woman with a 4-yr history of medically refractory epilepsy. The patient reported daily nocturnal ictal vocalization preceded by an indescribable feeling. Preoperative evaluation was suggestive of a right frontal-temporal onset, but the noninvasive results were discordant. She underwent a combined intracranial EEG study with a frontal-parietal grid, with strips and depth electrodes covering the entire right hemisphere. Epileptiform activity was observed in contact 6 of the anterior insula electrode. The patient consented to the procedure and to the publication of her images. A right anterior insulectomy was performed. First, a portion of the frontal operculum was resected and neuronavigation was used for the initial insula localization. However, due to unreliable neuronavigation (ie, brain shift), the medial and anterior borders of the insular resection were guided by the depth electrode reference. The patient was discharged 3 d after surgery with no neurological deficits and remains seizure free. We demonstrate that depth electrode guided insular surgery is a safe and precise technique, leading to an optimal outcome.
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Affiliation(s)
- Mauricio Mandel
- Department of Neurosurgery, Yale New Haven Hospital, New Haven, Connecticut, USA.,Yale Comprehensive Epilepsy Center, New Haven, Connecticut, USA
| | - Layton Lamsam
- Department of Neurosurgery, Yale New Haven Hospital, New Haven, Connecticut, USA.,Yale Comprehensive Epilepsy Center, New Haven, Connecticut, USA
| | - Pue Farooque
- Yale Comprehensive Epilepsy Center, New Haven, Connecticut, USA
| | - Dennis Spencer
- Department of Neurosurgery, Yale New Haven Hospital, New Haven, Connecticut, USA.,Yale Comprehensive Epilepsy Center, New Haven, Connecticut, USA
| | - Eyiyemisi Damisah
- Department of Neurosurgery, Yale New Haven Hospital, New Haven, Connecticut, USA.,Yale Comprehensive Epilepsy Center, New Haven, Connecticut, USA
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24
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Shamim D, Cheng J, Pearson C, Landazuri P. Network radiofrequency ablation for drug resistant epilepsy. Epilepsy Behav Rep 2021; 16:100471. [PMID: 34381989 PMCID: PMC8335629 DOI: 10.1016/j.ebr.2021.100471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 10/31/2022] Open
Abstract
Radiofrequency ablation (RFA) is a minimally invasive procedure for drug-resistant focal epilepsy. Although well tolerated, seizure outcomes are less favorable than standard resection. RFA is commonly performed following stereoencephalography (sEEG) identification of the seizure onset zone (SOZ). We hypothesized RFA outcomes can improve by adding RFA of seizure spread regions to the SOZ as identified by sEEG, an approach we term network RFA. Four patients underwent network RFA at our institution from 8/2017 to 9/2019. There were two Engel IB outcomes and two Engel III outcomes. The median follow-up length was 25.5 months (range 17-35). No permanent neurological deficits occurred. Etiologies consisted of polymicrogyria (1), mixed malformation of cortical development (MCD) (2), and cryptogenic (1). This study provides descriptive results regarding the efficacy and safety of network RFA. Network RFA can be considered in patients with focal epilepsies with large MCDs that may not be amenable to standard resection.
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Affiliation(s)
- Daniah Shamim
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, United States
| | - Jennifer Cheng
- University of Kansas Medical Center, Department of Neurosurgery, Kansas City, KS, United States
| | - Caleb Pearson
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, United States
| | - Patrick Landazuri
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, United States
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25
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Crocker B, Ostrowski L, Williams ZM, Dougherty DD, Eskandar EN, Widge AS, Chu CJ, Cash SS, Paulk AC. Local and distant responses to single pulse electrical stimulation reflect different forms of connectivity. Neuroimage 2021; 237:118094. [PMID: 33940142 DOI: 10.1016/j.neuroimage.2021.118094] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 10/31/2020] [Revised: 03/13/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022] Open
Abstract
Measuring connectivity in the human brain involves innumerable approaches using both noninvasive (fMRI, EEG) and invasive (intracranial EEG or iEEG) recording modalities, including the use of external probing stimuli, such as direct electrical stimulation. To examine how different measures of connectivity correlate with one another, we compared 'passive' measures of connectivity during resting state conditions to the more 'active' probing measures of connectivity with single pulse electrical stimulation (SPES). We measured the network engagement and spread of the cortico-cortico evoked potential (CCEP) induced by SPES at 53 out of 104 total sites across the brain, including cortical and subcortical regions, in patients with intractable epilepsy (N=11) who were undergoing intracranial recordings as a part of their clinical care for identifying seizure onset zones. We compared the CCEP network to functional, effective, and structural measures of connectivity during a resting state in each patient. Functional and effective connectivity measures included correlation or Granger causality measures applied to stereoEEG (sEEGs) recordings. Structural connectivity was derived from diffusion tensor imaging (DTI) acquired before intracranial electrode implant and monitoring (N=8). The CCEP network was most similar to the resting state voltage correlation network in channels near to the stimulation location. In contrast, the distant CCEP network was most similar to the DTI network. Other connectivity measures were not as similar to the CCEP network. These results demonstrate that different connectivity measures, including those derived from active stimulation-based probing, measure different, complementary aspects of regional interrelationships in the brain.
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Affiliation(s)
- Britni Crocker
- Harvard-MIT Health Sciences and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139; Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Lauren Ostrowski
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ziv M Williams
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, 02129
| | - Emad N Eskandar
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Department of Neurosurgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467
| | - Alik S Widge
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, 02129; Picower Institute for Learning & Memory, Massachusetts Institute of Technology, Cambridge, MA 02124; Department of Psychiatry, University of Minnesota, Minneapolis, MN 55455
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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26
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Philipp LR, Matias CM, Thalheimer S, Mehta SH, Sharan A, Wu C. Robot-Assisted Stereotaxy Reduces Target Error: A Meta-Analysis and Meta-Regression of 6056 Trajectories. Neurosurgery 2021; 88:222-233. [PMID: 33045739 DOI: 10.1093/neuros/nyaa428] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/07/2019] [Accepted: 07/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The pursuit of improved accuracy for localization and electrode implantation in deep brain stimulation (DBS) and stereoelectroencephalography (sEEG) has fostered an abundance of disparate surgical/stereotactic practices. Specific practices/technologies directly modify implantation accuracy; however, no study has described their respective influence in multivariable context. OBJECTIVE To synthesize the known literature to statistically quantify factors affecting implantation accuracy. METHODS A systematic review and meta-analysis was conducted to determine the inverse-variance weighted pooled mean target error (MTE) of implanted electrodes among patients undergoing DBS or sEEG. MTE was defined as Euclidean distance between planned and final electrode tip. Meta-regression identified moderators of MTE in a multivariable-adjusted model. RESULTS A total of 37 eligible studies were identified from a search return of 2,901 potential articles (2002-2018) - 27 DBS and 10 sEEG. Random-effects pooled MTE = 1.91 mm (95% CI: 1.7-2.1) for DBS and 2.34 mm (95% CI: 2.1-2.6) for sEEG. Meta-regression identified study year, robot use, frame/frameless technique, and intraoperative electrophysiologic testing (iEPT) as significant multivariable-adjusted moderators of MTE (P < .0001, R2 = 0.63). Study year was associated with a 0.92-mm MTE reduction over the 16-yr study period (P = .0035), and robot use with a 0.79-mm decrease (P = .0019). Frameless technique was associated with a mean 0.50-mm (95% CI: 0.17-0.84) increase, and iEPT use with a 0.45-mm (95% CI: 0.10-0.80) increase in MTE. Registration method, imaging type, intraoperative imaging, target, and demographics were not significantly associated with MTE on multivariable analysis. CONCLUSION Robot assistance for stereotactic electrode implantation is independently associated with improved accuracy and reduced target error. This remains true regardless of other procedural factors, including frame-based vs frameless technique.
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Affiliation(s)
- Lucas R Philipp
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Caio M Matias
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Sara Thalheimer
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Shyle H Mehta
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Ashwini Sharan
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
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27
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Triano MJ, Schupper AJ, Ghatan S, Panov F. Hemorrhage Rates After Implantation and Explantation of Stereotactic Electroencephalography: Reevaluating Patients' Risk. World Neurosurg 2021; 151:e100-e108. [PMID: 33819712 DOI: 10.1016/j.wneu.2021.03.139] [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: 02/19/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (sEEG), despite its established usefulness, has not been thoroughly evaluated for its adverse events profile. In this study, hemorrhage rates were evaluated both per patient and per lead placed not only in the immediate postoperative period, but also over the course of admission and after explantation when available. METHODS This is a single-center retrospective study of pediatric and adult patients undergoing sEEG lead placement at a large urban hospital. All available postoperative imaging was reviewed for the presence of hemorrhage, including any imaging occurring throughout admission as well as within 1 month of lead explantation. Age and number of leads placed per procedure were compared using an unpaired t test assuming unequal variance. RESULTS A total of 1855 leads were placed in 147 cases. The mean age was 30.4 ±15.0 and the male/female ratio was 47:53. 9 leads (0.49%) in 9 cases (6.12%) were involved with postimplantation hemorrhage occurring on postoperative day 0.44 on average. Postexplantation imaging was available for 45 cases. Seven leads (1.40%) in 7 cases (15.56%) were involved with postexplantation hemorrhage occurring on average on postoperative day 1.42. There was a significant difference in mean age between patients with postexplantation hemorrhage versus control (45.0 vs. 32.2; P = 0.0277). No cases of hemorrhage required surgical intervention and no patients had permanent neurologic deficit. CONCLUSIONS Hemorrhage after sEEG lead implantation and explantation may be more common than previously reported. Consistent postexplantation imaging may be of clinical benefit in detecting hemorrhage that precludes patients from immediate discharge, particularly in older patients.
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Affiliation(s)
- Matthew J Triano
- Department of Neurosurgery, Georgetown University School of Medicine Washington, D.C., USA
| | - Alexander J Schupper
- Department of Neurosurgery, Mount Sinai Hospital System, New York, New York, USA
| | - Saadi Ghatan
- Department of Neurosurgery, Mount Sinai Hospital System, New York, New York, USA
| | - Fedor Panov
- Department of Neurosurgery, Mount Sinai Hospital System, New York, New York, USA.
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28
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Seethaler M, Lauseker M, Ernst K, Rémi J, Vollmar C, Noachtar S, Kaufmann E. Hemispheric differences in the duration of focal onset seizures. Acta Neurol Scand 2021; 143:248-255. [PMID: 33011970 DOI: 10.1111/ane.13356] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess hemispheric differences in the duration of focal onset seizures and its association with clinical and demographic factors. METHODS A retrospective analysis was performed on adult patients with drug-resistant unifocal epilepsy, who underwent intracranial EEG recording between 01/2006 and 06/2016. Seizure duration was determined based on the subdural and/or stereo-EEG (sEEG) recordings. Hemispheric differences in seizure duration were statistically evaluated with regard to clinical and demographic data. RESULTS In total, 69 patients and 654 focal onset seizures were included. The duration of seizures with left-hemispheric onset (n = 297) was by trend longer (91.88 ± 93.92 s) than of right-hemispheric seizures (n = 357; 71.03 ± 68.53 s; p = .193). Significant hemispheric differences in seizures duration were found in temporal lobe seizures (n = 225; p = .013), especially those with automotor manifestation (n = 156; p = .045). A prolonged duration was also found for left-hemispheric onset seizures with secondary generalized commencing during waking state (n = 225; p = .034), but not during sleep. A similar hemispheric difference in seizure duration was found in female patients (p = .040), but not in men. CONCLUSIONS Hemispheric differences in seizure duration were revealed with significantly longer durations in case of left-hemispheric seizure onset. The observed differences in seizure duration might result from brain asymmetry and add new aspects to the understanding of seizure propagation and termination.
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Affiliation(s)
- Magdalena Seethaler
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
- Department of Psychiatry and Psychotherapy Charité University Medicine and St. Hedwig Hospital Berlin Germany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry, and Epidemiology LMU Munich Munich Germany
| | - Katharina Ernst
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Jan Rémi
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Christian Vollmar
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
| | - Elisabeth Kaufmann
- Epilepsy Center, Department of Neurology University Hospital, LMU Munich Munich Germany
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29
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Johnson M, Samudra N, Gallagher MJ, Abou-Khalil B, Nobis WP. Near SUDEP during bilateral stereo-EEG monitoring characterized by diffuse postictal EEG suppression. Epilepsia 2021; 62:e60-e64. [PMID: 33617691 DOI: 10.1111/epi.16852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/01/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in patients with refractory epilepsy. The pathophysiology of SUDEP is unknown. Postictal phenomena such as postconvulsive immobility (PI), postictal generalized electroencephalography (EEG) suppression (PGES), arousal deficits, cardiac arrhythmias, central apneas, and obstructive apneas due to laryngospasms have been suggested to contribute to SUDEP. We present, to our knowledge, the first case of a near-SUDEP event in a patient undergoing intracranial, stereotactic EEG (sEEG) monitoring. This case spotlights potential mediators of SUDEP, most notably the striking PGES and postictal apnea. The nature of the sEEG investigation illustrates the extent of cortical and subcortical postictal EEG suppression and showcases a transient return of cerebral activity likely to be missed on scalp-EEG recording. Critically, this case emphasizes the importance of continuous cardiorespiratory monitoring and underscores the importance of postictal arousal as a pathophysiological mechanism in SUDEP.
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Affiliation(s)
- Michael Johnson
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niyatee Samudra
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Martin J Gallagher
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bassel Abou-Khalil
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William P Nobis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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30
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Singh TD, Sabsevitz DS, Desai NN, Middlebrooks EH, Feyissa AM, Grewal S, Wharen RE, Tatum WO, Ritaccio AL. Crying with depressed affect induced by electrical stimulation of the anterior insula: A stereo EEG case study. Epilepsy Behav Rep 2021; 15:100421. [PMID: 33511338 DOI: 10.1016/j.ebr.2020.100421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/22/2023] Open
Abstract
Anterior insular stimulation produces reproducible episodes of emotional crying. This is due to activation of complex neural network with its connectivity to the anterior cingulate cortex. This study increases our understanding of the complex functionality of the insula.
Stereo-EEG (sEEG) is an invasive recording technique used to localize the seizure-onset zone for epilepsy surgery in people with drug-resistant focal seizures. Pathological crying reflects disordered emotional expression and the anterior insula is known to play a role in empathy and socio-emotional processing. We describe a patient where electrical stimulation mapping (ESM) of the anterior insula during sEEG generated pathological crying and profound sadness that was time-locked to the electrical stimulus. We evaluated a 35-year-old left-handed female for repeat epilepsy surgery. The patient had drug resistant focal impaired awareness seizures despite a previous left temporal neocortical resection informed by an invasive study using subdural grid and strip electrodes seven years earlier. She was studied invasively with 10 sEEG electrodes sampling temporal, occipital, and insular targets. In the process of functional mapping, stimulation of the anterior insular cortex provoked tearful crying with sad affect, reproducible upon repeat stimulation. Our case is unique in demonstrating transitory pathological crying with profound sadness provoked by ESM of the left anterior insula. Furthermore we demonstrate repeated time-synched crying from electrical stimulation, which supports the hypothesis that the anterior insula in the brain plays an important role in the biology of emotion, as implicated by previous studies.
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Lu J, Luo L, Wang Q, Fang F, Chen N. Cue-triggered activity replay in human early visual cortex. Sci China Life Sci 2020; 64:144-151. [PMID: 32557289 DOI: 10.1007/s11427-020-1726-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
The recall of learned temporal sequences by a visual cue is an important form of experience-based neural plasticity. Here we observed such reactivation in awake human visual cortex using intracranial recording. After repeated exposure to a moving dot, a flash of the dot was able to trigger neural reactivation in the downstream receptive field along the motion path. This effect was observed only when the cue appeared near the receptive field. The estimated traveling speed was faster compared to the activation induced by the real motion. We suggest a range-limited, time-compressed reactivation as a result of repeated visual exposure in awake human visual cortex.
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Affiliation(s)
- Junshi Lu
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, 100871, China.,IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China
| | - Lu Luo
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, 100871, China.,IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China
| | - Qian Wang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, 100871, China.,Department of Clinical Neuropsychology, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Fang Fang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, 100871, China. .,IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China. .,Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, 100871, China.
| | - Nihong Chen
- Department of Psychology, School of Social Sciences, Tsinghua University, Beijing, 100084, China. .,IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing, 100084, China.
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Lu L, Wang Q, Sheng J, Liu Z, Qin L, Li L, Gao JH. Neural tracking of speech mental imagery during rhythmic inner counting. eLife 2019; 8:48971. [PMID: 31635693 PMCID: PMC6805153 DOI: 10.7554/elife.48971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/09/2019] [Indexed: 11/13/2022] Open
Abstract
The subjective inner experience of mental imagery is among the most ubiquitous human experiences in daily life. Elucidating the neural implementation underpinning the dynamic construction of mental imagery is critical to understanding high-order cognitive function in the human brain. Here, we applied a frequency-tagging method to isolate the top-down process of speech mental imagery from bottom-up sensory-driven activities and concurrently tracked the neural processing time scales corresponding to the two processes in human subjects. Notably, by estimating the source of the magnetoencephalography (MEG) signals, we identified isolated brain networks activated at the imagery-rate frequency. In contrast, more extensive brain regions in the auditory temporal cortex were activated at the stimulus-rate frequency. Furthermore, intracranial stereotactic electroencephalogram (sEEG) evidence confirmed the participation of the inferior frontal gyrus in generating speech mental imagery. Our results indicate that a disassociated neural network underlies the dynamic construction of speech mental imagery independent of auditory perception.
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Affiliation(s)
- Lingxi Lu
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China.,Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Qian Wang
- Department of Clinical Neuropsychology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jingwei Sheng
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Zhaowei Liu
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Lang Qin
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,Department of Linguistics, The University of Hong Kong, Hong Kong, China
| | - Liang Li
- Speech and Hearing Research Center, School of Psychological and Cognitive Sciences, Peking University, Beijing, China
| | - Jia-Hong Gao
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China.,Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
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Willems LM, Reif PS, Spyrantis A, Cattani A, Freiman TM, Seifert V, Wagner M, You SJ, Schubert-Bast S, Bauer S, Klein KM, Rosenow F, Strzelczyk A. Invasive EEG-electrodes in presurgical evaluation of epilepsies: Systematic analysis of implantation-, video-EEG-monitoring- and explantation-related complications, and review of literature. Epilepsy Behav 2019; 91:30-37. [PMID: 29907526 DOI: 10.1016/j.yebeh.2018.05.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stereoelectroencephalography (sEEG) is a diagnostic procedure for patients with refractory focal epilepsies that is performed to localize and define the epileptogenic zone. In contrast to grid electrodes, sEEG electrodes are implanted using minimal invasive operation techniques without large craniotomies. Previous studies provided good evidence that sEEG implantation is a safe and effective procedure; however, complications in asymptomatic patients after explantation may be underreported. The aim of this analysis was to systematically analyze clinical and imaging data following implantation and explantation. RESULTS We analyzed 18 consecutive patients (mean age: 30.5 years, range: 12-46; 61% female) undergoing invasive presurgical video-EEG monitoring via sEEG electrodes (n = 167 implanted electrodes) over a period of 2.5 years with robot-assisted implantation. There were no neurological deficits reported after implantation or explantation in any of the enrolled patients. Postimplantation imaging showed a minimal subclinical subarachnoid hemorrhage in one patient and further workup revealed a previously unknown factor VII deficiency. No injuries or status epilepticus occurred during video-EEG monitoring. In one patient, a seizure-related asymptomatic cross break of two fixation screws was found and led to revision surgery. Unspecific symptoms like headaches or low-grade fever were present in 10 of 18 (56%) patients during the first days of video-EEG monitoring and were transient. Postexplantation imaging showed asymptomatic and small bleedings close to four electrodes (2.8%). CONCLUSION Overall, sEEG is a safe and well-tolerated procedure. Systematic imaging after implantation and explantation helps to identify clinically silent complications of sEEG. In the literature, complication rates of up to 4.4% in sEEG and in 49.9% of subdural EEG are reported; however, systematic imaging after explantation was not performed throughout the studies, which may have led to underreporting of associated complications.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany.
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Andrea Spyrantis
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Marlies Wagner
- Department of Neuroradiology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Se-Jong You
- Department of Neuroradiology, Goethe-University, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Karl Martin Klein
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
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Thorsteinsdottir J, Vollmar C, Tonn JC, Kreth FW, Noachtar S, Peraud A. Outcome after individualized stereoelectroencephalography ( sEEG) implantation and navigated resection in patients with lesional and non-lesional focal epilepsy. J Neurol 2019; 266:910-20. [PMID: 30701313 DOI: 10.1007/s00415-019-09213-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/20/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Refined localization of the epileptogenic zone (EZ) in patients with pharmacoresistant focal epilepsy proceeding to resective surgery might improve postoperative outcome. We here report seizure outcome after stereo EEG (sEEG) evaluation with individually planned stereotactically implanted depth electrodes and subsequent tailored resection. METHODS A cohort of consecutive patients with pharmacoresistant focal epilepsy, evaluated with a non-invasive evaluation protocol and invasive monitoring with personalized, stereotactically implanted depth electrodes for sEEG was analyzed. Co-registration of post-implantation CT scan to presurgical MRI data was used for 3D reconstructions of the patients' brain surface and mapping of neurophysiology data. Individual multimodal 3D maps of the EZ were used to guide subsequent tailored resections. The outcome was rated according to the Engel classification. RESULTS Out of 914 patients who underwent non-invasive presurgical evaluation, 85 underwent sEEG, and 70 were included in the outcome analysis. Median follow-up was 31.5 months. Seizure-free outcome (Engel class I A-C, ILAE class 1-2) was achieved in 83% of the study cohort. Patients exhibiting lesional and non-lesional (n = 42, 86% vs. n = 28, 79%), temporal and extratemporal (n = 45, 80% vs. n = 25, 84%), and right- and left-hemispheric epilepsy (n = 44, 82% vs. n = 26, 85%) did similarly well. This remains also true for those with an EZ adjacent to or distant from eloquent cortex (n = 21, 86% vs. n = 49, 82%). Surgical outcome was independent of resected tissue volume. CONCLUSION Favourable post-surgical outcome can be achieved in patients with resistant focal epilepsy, using individualized sEEG evaluation and tailored navigated resection, even in patients with non-lesional or extratemporal focal epilepsy.
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Schurr R, Nitzan M, Eliahou R, Spinelli L, Seeck M, Blanke O, Arzy S. Temporal Dissociation of Neocortical and Hippocampal Contributions to Mental Time Travel Using Intracranial Recordings in Humans. Front Comput Neurosci 2018. [PMID: 29541024 PMCID: PMC5835533 DOI: 10.3389/fncom.2018.00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Indexed: 11/13/2022] Open
Abstract
In mental time travel (MTT) one is “traveling” back-and-forth in time, remembering, and imagining events. Despite intensive research regarding memory processes in the hippocampus, it was only recently shown that the hippocampus plays an essential role in encoding the temporal order of events remembered, and therefore plays an important role in MTT. Does it also encode the temporal relations of these events to the remembering self? We asked patients undergoing pre-surgical evaluation with depth electrodes penetrating the temporal lobes bilaterally toward the hippocampus to project themselves in time to a past, future, or present time-point, and then make judgments regarding various events. Classification analysis of intracranial evoked potentials revealed clear temporal dissociation in the left hemisphere between lateral-temporal electrodes, activated at ~100–300 ms, and hippocampal electrodes, activated at ~400–600 ms. This dissociation may suggest a division of labor in the temporal lobe during self-projection in time, hinting toward the different roles of the lateral-temporal cortex and the hippocampus in MTT and the temporal organization of the related events with respect to the experiencing self.
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Affiliation(s)
- Roey Schurr
- Neuropsychiatry Lab, Department of Neurology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hadassah Hebrew University Medical School, Jerusalem, Israel
| | - Mor Nitzan
- Faculty of Medicine, Hadassah Hebrew University Medical School, Jerusalem, Israel.,Racah Institute of Physics, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruth Eliahou
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Laurent Spinelli
- Department of Neurology, University Hospital, Geneva, Switzerland
| | - Margitta Seeck
- Department of Neurology, University Hospital, Geneva, Switzerland
| | - Olaf Blanke
- Department of Neurology, University Hospital, Geneva, Switzerland.,Laboratory of Cognitive Neuroscience, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Shahar Arzy
- Neuropsychiatry Lab, Department of Neurology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hadassah Hebrew University Medical School, Jerusalem, Israel
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Bradley C, Bastuji H, Garcia-Larrea L. Evidence-based source modeling of nociceptive cortical responses: A direct comparison of scalp and intracranial activity in humans. Hum Brain Mapp 2017; 38:6083-6095. [PMID: 28925006 DOI: 10.1002/hbm.23812] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/27/2017] [Accepted: 09/05/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Source modeling of EEG traditionally relies on interplay between physiological hypotheses and mathematical estimates. We propose to optimize the process by using evidence gathered from brain imaging and intracortical recordings. METHODS We recorded laser-evoked potentials in 18 healthy participants, using high-density EEG. Brain sources were modeled during the first second poststimulus, constraining their initial position to regions where nociceptive-related activity has been ascertained by intracranial EEG. These comprised the two posterior operculo-insular regions, primary sensorimotor, posterior parietal, anterior cingulate/supplementary motor (ACC/SMA), bilateral frontal/anterior insular, and posterior cingulate (PCC) cortices. RESULTS The model yielded an average goodness of fit of 91% for individual and 95.8% for grand-average data. When compared with intracranial recordings from 27 human subjects, no significant difference in peak latencies was observed between modeled and intracranial data for 5 of the 6 assessable regions. Morphological match was excellent for operculo-insular, frontal, ACC/SMA and PCC regions (cross-correlation > 0.7) and fair for sensori-motor and posterior parietal cortex (c-c ∼ 0.5). CONCLUSIONS Multiple overlapping activities evoked by nociceptive input can be disentangled from high-density scalp EEG guided by intracranial data. Modeled sources accurately described the timing and morphology of most activities recorded with intracranial electrodes, including those coinciding with the emergence of stimulus awareness. Hum Brain Mapp 38:6083-6095, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Claire Bradley
- NEUROPAIN lab, Centre de Recherche en Neurosciences de Lyon, Inserm U1028 - CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France
| | - Hélène Bastuji
- NEUROPAIN lab, Centre de Recherche en Neurosciences de Lyon, Inserm U1028 - CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France
| | - Luis Garcia-Larrea
- NEUROPAIN lab, Centre de Recherche en Neurosciences de Lyon, Inserm U1028 - CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France
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