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Schmid W, Danstrom IA, Crespo Echevarria M, Adkinson J, Mattar L, Banks GP, Sheth SA, Watrous AJ, Heilbronner SR, Bijanki KR, Alabastri A, Bartoli E. A biophysically constrained brain connectivity model based on stimulation-evoked potentials. J Neurosci Methods 2024; 405:110106. [PMID: 38453060 DOI: 10.1016/j.jneumeth.2024.110106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/24/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Single-pulse electrical stimulation (SPES) is an established technique used to map functional effective connectivity networks in treatment-refractory epilepsy patients undergoing intracranial-electroencephalography monitoring. While the connectivity path between stimulation and recording sites has been explored through the integration of structural connectivity, there are substantial gaps, such that new modeling approaches may advance our understanding of connectivity derived from SPES studies. NEW METHOD Using intracranial electrophysiology data recorded from a single patient undergoing stereo-electroencephalography (sEEG) evaluation, we employ an automated detection method to identify early response components, C1, from pulse-evoked potentials (PEPs) induced by SPES. C1 components were utilized for a novel topology optimization method, modeling 3D electrical conductivity to infer neural pathways from stimulation sites. Additionally, PEP features were compared with tractography metrics, and model results were analyzed with respect to anatomical features. RESULTS The proposed optimization model resolved conductivity paths with low error. Specific electrode contacts displaying high error correlated with anatomical complexities. The C1 component strongly correlated with additional PEP features and displayed stable, weak correlations with tractography measures. COMPARISON WITH EXISTING METHOD Existing methods for estimating neural signal pathways are imaging-based and thus rely on anatomical inferences. CONCLUSIONS These results demonstrate that informing topology optimization methods with human intracranial SPES data is a feasible method for generating 3D conductivity maps linking electrical pathways with functional neural ensembles. PEP-estimated effective connectivity is correlated with but distinguished from structural connectivity. Modeled conductivity resolves connectivity pathways in the absence of anatomical priors.
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Affiliation(s)
- William Schmid
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Isabel A Danstrom
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Maria Crespo Echevarria
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Joshua Adkinson
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Layth Mattar
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Garrett P Banks
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Andrew J Watrous
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Sarah R Heilbronner
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Alessandro Alabastri
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA.
| | - Eleonora Bartoli
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
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Schmid W, Danstrom IA, Echevarria MC, Adkinson J, Mattar L, Banks GP, Sheth SA, Watrous AJ, Heilbronner SR, Bijanki KR, Alabastri A, Bartoli E. A biophysically constrained brain connectivity model based on stimulation-evoked potentials. bioRxiv 2023:2023.11.03.565525. [PMID: 37986830 PMCID: PMC10659345 DOI: 10.1101/2023.11.03.565525] [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: 11/22/2023]
Abstract
Background Single-pulse electrical stimulation (SPES) is an established technique used to map functional effective connectivity networks in treatment-refractory epilepsy patients undergoing intracranial-electroencephalography monitoring. While the connectivity path between stimulation and recording sites has been explored through the integration of structural connectivity, there are substantial gaps, such that new modeling approaches may advance our understanding of connectivity derived from SPES studies. New Method Using intracranial electrophysiology data recorded from a single patient undergoing sEEG evaluation, we employ an automated detection method to identify early response components, C1, from pulse-evoked potentials (PEPs) induced by SPES. C1 components were utilized for a novel topology optimization method, modeling 3D conductivity propagation from stimulation sites. Additionally, PEP features were compared with tractography metrics, and model results were analyzed with respect to anatomical features. Results The proposed optimization model resolved conductivity paths with low error. Specific electrode contacts displaying high error correlated with anatomical complexities. The C1 component strongly correlates with additional PEP features and displayed stable, weak correlations with tractography measures. Comparison with existing methods Existing methods for estimating conductivity propagation are imaging-based and thus rely on anatomical inferences. Conclusions These results demonstrate that informing topology optimization methods with human intracranial SPES data is a feasible method for generating 3D conductivity maps linking electrical pathways with functional neural ensembles. PEP-estimated effective connectivity is correlated with but distinguished from structural connectivity. Modeled conductivity resolves connectivity pathways in the absence of anatomical priors.
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Affiliation(s)
- William Schmid
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston 77005, Texas, USA
| | - Isabel A. Danstrom
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Maria Crespo Echevarria
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Joshua Adkinson
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Layth Mattar
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Garrett P. Banks
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Andrew J. Watrous
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Sarah R. Heilbronner
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Kelly R. Bijanki
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
| | - Alessandro Alabastri
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston 77005, Texas, USA
| | - Eleonora Bartoli
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston 77030, Texas, USA
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Sheth SA, Shofty B, Allawala A, Xiao J, Adkinson JA, Mathura RK, Pirtle V, Myers J, Oswalt D, Provenza NR, Giridharan N, Noecker AM, Banks GP, Gadot R, Najera RA, Anand A, Devara E, Dang H, Bartoli E, Watrous A, Cohn J, Borton D, Mathew SJ, McIntyre CC, Goodman W, Bijanki K, Pouratian N. Stereo-EEG-guided network modulation for psychiatric disorders: Surgical considerations. Brain Stimul 2023; 16:1792-1798. [PMID: 38135358 PMCID: PMC10787578 DOI: 10.1016/j.brs.2023.07.057] [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: 07/30/2023] [Accepted: 07/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) and other neuromodulatory techniques are being increasingly utilized to treat refractory neurologic and psychiatric disorders. OBJECTIVE /Hypothesis: To better understand the circuit-level pathophysiology of treatment-resistant depression (TRD) and treat the network-level dysfunction inherent to this challenging disorder, we adopted an approach of inpatient intracranial monitoring borrowed from the epilepsy surgery field. METHODS We implanted 3 patients with 4 DBS leads (bilateral pair in both the ventral capsule/ventral striatum and subcallosal cingulate) and 10 stereo-electroencephalography (sEEG) electrodes targeting depression-relevant network regions. For surgical planning, we used an interactive, holographic visualization platform to appreciate the 3D anatomy and connectivity. In the initial surgery, we placed the DBS leads and sEEG electrodes using robotic stereotaxy. Subjects were then admitted to an inpatient monitoring unit for depression-specific neurophysiological assessments. Following these investigations, subjects returned to the OR to remove the sEEG electrodes and internalize the DBS leads to implanted pulse generators. RESULTS Intraoperative testing revealed positive valence responses in all 3 subjects that helped verify targeting. Given the importance of the network-based hypotheses we were testing, we required accurate adherence to the surgical plan (to engage DBS and sEEG targets) and stability of DBS lead rotational position (to ensure that stimulation field estimates of the directional leads used during inpatient monitoring were relevant chronically), both of which we confirmed (mean radial error 1.2±0.9 mm; mean rotation 3.6±2.6°). CONCLUSION This novel hybrid sEEG-DBS approach allows detailed study of the neurophysiological substrates of complex neuropsychiatric disorders.
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Affiliation(s)
- Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Anusha Allawala
- Department of Engineering, Brown University, Providence, RI, USA
| | - Jiayang Xiao
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Joshua A Adkinson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Raissa K Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Victoria Pirtle
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - John Myers
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Denise Oswalt
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole R Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nisha Giridharan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Angela M Noecker
- Departments of Biomedical Engineering and Neurosurgery, Duke University, Durham, NC, USA
| | - Garrett P Banks
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ricardo A Najera
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ethan Devara
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Huy Dang
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Eleonora Bartoli
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Andrew Watrous
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey Cohn
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Borton
- Department of Engineering, Brown University, Providence, RI, USA
| | - Sanjay J Mathew
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | | | - Wayne Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Kelly Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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Michalak AJ, Greenblatt A, Wu S, Tobochnik S, Dave H, Raghupathi R, Esengul YT, Guerra A, Tao JX, Issa NP, Cosgrove GR, Lega B, Warnke P, Chen HI, Lucas T, Sheth SA, Banks GP, Kwon CS, Feldstein N, Youngerman B, McKhann G, Davis KA, Schevon C. Seizure onset patterns predict outcome after stereo-electroencephalography-guided laser amygdalohippocampotomy. Epilepsia 2023; 64:1568-1581. [PMID: 37013668 PMCID: PMC10247471 DOI: 10.1111/epi.17602] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (stereo-EEG) may miss seizure onset elsewhere. We hypothesized that stereo-EEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control. In this study, we characterized the 2-year outcomes of patients who underwent single-fiber SLAH after stereo-EEG and evaluated whether stereo-EEG SOPs predict postoperative seizure freedom. METHODS This retrospective five-center study included patients with or without mesial temporal sclerosis (MTS) who underwent stereo-EEG followed by single-fiber SLAH between August 2014 and January 2022. Patients with causative hippocampal lesions apart from MTS or for whom the SLAH was considered palliative were excluded. An SOP catalogue was developed based on literature review. The dominant pattern for each patient was used for survival analysis. The primary outcome was 2-year Engel I classification or recurrent seizures before then, stratified by SOP category. RESULTS Fifty-eight patients were included, with a mean follow-up duration of 39 ± 12 months after SLAH. Overall 1-, 2-, and 3-year Engel I seizure freedom probability was 54%, 36%, and 33%, respectively. Patients with SOPs, including low-voltage fast activity or low-frequency repetitive spiking, had a 46% 2-year seizure freedom probability, compared to 0% for patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (log-rank test, p = .00015). SIGNIFICANCE Patients who underwent SLAH after stereo-EEG had a low probability of seizure freedom at 2 years, but SOPs successfully predicted seizure recurrence in a subset of patients. This study provides proof of concept that SOPs distinguish between hippocampal seizure onset and spread and supports using SOPs to improve selection of SLAH candidates.
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Affiliation(s)
- Andrew J. Michalak
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam Greenblatt
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Steven Tobochnik
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Hina Dave
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ramya Raghupathi
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Yasar T. Esengul
- Department of Neurology, University of Toledo College of Medicine, Toledo, OH, USA
| | - Antonio Guerra
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James X. Tao
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Naoum P. Issa
- Department of Neurology, University of Chicago, Chicago, NY, USA
| | - Garth R. Cosgrove
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Bradley Lega
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter Warnke
- Department of Neurosurgery, University of Chicago, Chicago, NY, USA
| | - H. Isaac Chen
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Timothy Lucas
- Department of Neurosurgery & Biomedical Engineering, Ohio State University; Neurotech Institute, Columbus, OH, USA
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Garrett P. Banks
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Churl-Su Kwon
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Gertrude H Sergievsky Center, New York, NY, USA
| | - Neil Feldstein
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Brett Youngerman
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Guy McKhann
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Kathryn A. Davis
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, NY, USA
| | - Catherine Schevon
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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McLaughlin NCR, Magnotti JF, Banks GP, Nanda P, Hoexter MQ, Lopes AC, Batistuzzo MC, Asaad WF, Stewart C, Paulo D, Noren G, Greenberg BD, Malloy P, Salloway S, Correia S, Pathak Y, Sheehan J, Marsland R, Gorgulho A, De Salles A, Miguel EC, Rasmussen SA, Sheth SA. Gamma knife capsulotomy for intractable OCD: Neuroimage analysis of lesion size, location, and clinical response. Transl Psychiatry 2023; 13:134. [PMID: 37185805 PMCID: PMC10130137 DOI: 10.1038/s41398-023-02425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 02/27/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) affects 2-3% of the population. One-third of patients are poorly responsive to conventional therapies, and for a subgroup, gamma knife capsulotomy (GKC) is an option. We examined lesion characteristics in patients previously treated with GKC through well-established programs in Providence, RI (Butler Hospital/Rhode Island Hospital/Alpert Medical School of Brown University) and São Paulo, Brazil (University of São Paolo). Lesions were traced on T1 images from 26 patients who had received GKC targeting the ventral half of the anterior limb of the internal capsule (ALIC), and the masks were transformed into MNI space. Voxel-wise lesion-symptom mapping was performed to assess the influence of lesion location on Y-BOCS ratings. General linear models were built to compare the relationship between lesion size/location along different axes of the ALIC and above or below-average change in Y-BOCS ratings. Sixty-nine percent of this sample were full responders (≥35% improvement in OCD). Lesion occurrence anywhere within the targeted region was associated with clinical improvement, but modeling results demonstrated that lesions occurring posteriorly (closer to the anterior commissure) and dorsally (closer to the mid-ALIC) were associated with the greatest Y-BOCS reduction. No association was found between Y-BOCS reduction and overall lesion volume. GKC remains an effective treatment for refractory OCD. Our data suggest that continuing to target the bottom half of the ALIC in the coronal plane is likely to provide the dorsal-ventral height required to achieve optimal outcomes, as it will cover the white matter pathways relevant to change. Further analysis of individual variability will be essential for improving targeting and clinical outcomes, and potentially further reducing the lesion size necessary for beneficial outcomes.
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Affiliation(s)
- N C R McLaughlin
- Butler Hospital, Providence, RI, USA.
- Alpert Medical School of Brown University, Providence, RI, USA.
| | - J F Magnotti
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - G P Banks
- Columbia University Medical Center, New York, NY, USA
| | - P Nanda
- Columbia University Medical Center, New York, NY, USA
| | - M Q Hoexter
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - A C Lopes
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - M C Batistuzzo
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, SP, Brazil
| | - W F Asaad
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - C Stewart
- Boston University School of Public Health, Boston, MA, USA
| | - D Paulo
- Columbia University Medical Center, New York, NY, USA
| | - G Noren
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - B D Greenberg
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
- Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - P Malloy
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | - S Salloway
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | - S Correia
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Y Pathak
- Columbia University Medical Center, New York, NY, USA
| | - J Sheehan
- University of Virginia, Charlottesville, VA, USA
| | | | - A Gorgulho
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - A De Salles
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - E C Miguel
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - S A Rasmussen
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - S A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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Dang HQ, Provenza NR, Banks GP, Giridharan N, Avendano-Ortega M, McKay SA, Devara E, Shofty B, Storch EA, Sheth SA, Goodman WK. Attenuating side effects of deep brain stimulation in the bed nucleus of the stria terminalis for obsessive compulsive disorder using current-steering strategies. Brain Stimul 2023; 16:650-652. [PMID: 36958600 DOI: 10.1016/j.brs.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023] Open
Affiliation(s)
- Huy Q Dang
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nicole R Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Garrett P Banks
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nisha Giridharan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Michelle Avendano-Ortega
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sarah A McKay
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ethan Devara
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
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Banks GP, Heilbronner SR, Goodman W, Sheth SA. A population-normalized tractographic fiber atlas of the anterior limb of the internal capsule: relevance to surgical neuromodulation. J Neurosurg 2022; 137:1278-1288. [PMID: 35395627 DOI: 10.3171/2022.1.jns211935] [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: 08/29/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The anterior limb of the internal capsule (ALIC) is a white matter highway that connects several subcortical structures to the prefrontal cortex. Although surgical interventions in the ALIC have been used to treat a number of psychiatric illnesses, there is significant debate regarding what fibers are targeted for intervention. This debate is partially due to an incomplete understanding of connectivity in the region. METHODS To better understand this complex structure, the authors employed a novel tractography-based approach to examine how fibers from the thalamus and subthalamic nucleus (STN) traverse the ALIC. Furthermore, the authors analyzed connections from the medial dorsal nucleus, anterior nucleus, and ventral anterior nucleus of the thalamus. RESULTS The results showed that there is an organizational gradient of thalamic fibers medially and STN fibers laterally in the ALIC that fades more anteriorly. These findings, in combination with the known corticotopic organization described by previous studies, allow for a more thorough understanding of the organization of the white matter fibers in the ALIC. CONCLUSIONS These results are important for understanding and targeting of neuromodulatory therapies in the ALIC and may help explain why differences in therapeutic effect are observed for different areas of the ALIC.
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Affiliation(s)
- Garrett P Banks
- 1Department of Neurosurgery, Columbia University Medical Center, New York, New York
| | - Sarah R Heilbronner
- 2Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota
| | - Wayne Goodman
- 3Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; and
| | - Sameer A Sheth
- 4Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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8
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Haegens S, Pathak YJ, Smith EH, Mikell CB, Banks GP, Yates M, Bijanki KR, Schevon CA, McKhann GM, Schroeder CE, Sheth SA. Alpha and broadband high-frequency activity track task dynamics and predict performance in controlled decision-making. Psychophysiology 2021; 59:e13901. [PMID: 34287923 PMCID: PMC8770721 DOI: 10.1111/psyp.13901] [Citation(s) in RCA: 5] [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: 12/01/2020] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
Intracranial recordings in human subjects provide a unique, fine-grained temporal and spatial resolution inaccessible to conventional non-invasive methods. A prominent signal in these recordings is broadband high-frequency activity (approx. 70-150 Hz), generally considered to reflect neuronal excitation. Here we explored the use of this broadband signal to track, on a single-trial basis, the temporal and spatial distribution of task-engaged areas involved in decision-making. We additionally focused on the alpha rhythm (8-14 Hz), thought to regulate the (dis)engagement of neuronal populations based on task demands. Using these signals, we characterized activity across cortex using intracranial recordings in patients with intractable epilepsy performing the Multi-Source Interference Task, a Stroop-like decision-making paradigm. We analyzed recordings both from grid electrodes placed over cortical areas including frontotemporal and parietal cortex, and depth electrodes in prefrontal regions, including cingulate cortex. We found a widespread negative relationship between alpha power and broadband activity, substantiating the gating role of alpha in regions beyond sensory/motor cortex. Combined, these signals reflect the spatio-temporal pattern of task-engagement, with alpha decrease signifying task-involved regions and broadband increase temporally locking to specific task aspects, distributed over cortical sites. We report sites that only respond to stimulus presentation or to the decision report and, interestingly, sites that reflect the time-on-task. The latter predict the subject's reaction times on a trial-by-trial basis. A smaller subset of sites showed modulation with task condition. Taken together, alpha and broadband signals allow tracking of neuronal population dynamics across cortex on a fine temporal and spatial scale.
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Affiliation(s)
- Saskia Haegens
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.,Translational Neuroscience Division, Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute, Orangeburg, NY, USA.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Yagna J Pathak
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Elliot H Smith
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Charles B Mikell
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Garrett P Banks
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Mark Yates
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Catherine A Schevon
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Charles E Schroeder
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.,Translational Neuroscience Division, Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute, Orangeburg, NY, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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9
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Smith EH, Horga G, Yates MJ, Mikell CB, Banks GP, Pathak YJ, Schevon CA, McKhann GM, Hayden BY, Botvinick MM, Sheth SA. Widespread temporal coding of cognitive control in the human prefrontal cortex. Nat Neurosci 2019; 22:1883-1891. [PMID: 31570859 PMCID: PMC8855692 DOI: 10.1038/s41593-019-0494-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/09/2019] [Indexed: 01/06/2023]
Abstract
When making decisions we often face the need to adjudicate between conflicting strategies or courses of action. Our ability to understand the neuronal processes underlying conflict processing is limited on the one hand by the spatiotemporal resolution of fMRI and, on the other, by imperfect cross-species homologies in animal model systems. Here we examine responses of single neurons and local field potentials in human neurosurgical patients in two prefrontal regions critical to controlled decision-making, dorsal anterior cingulate cortex (dACC) and dorsolateral prefrontal cortex (dlPFC). While we observe typical modest conflict related firing rate effects, we find a widespread effect of conflict on spike-phase coupling in dACC and on driving spike-field coherence in dlPFC. These results support the hypothesis that a cross-areal rhythmic neuronal coordination is intrinsic to cognitive control in response to conflict, and provide new evidence to support the hypothesis that conflict processing involves modulation of dlPFC by dACC.
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Abstract
Peripheral nerve stimulation is the direct electrical stimulation of named nerves outside the central neuraxis to alleviate pain in the distribution of the targeted peripheral nerve. These treatments have shown efficacy in treating a variety of neuropathic, musculoskeletal, and visceral refractory pain pathologies; although not first line, these therapies are an important part of the treatment repertoire for chronic pain. With careful patient selection and judicious choice of stimulation technique, excellent results can be achieved for a variety of pain etiologies and distributions. This article reviews current and past practices of peripheral nerve stimulation and upcoming advancements in the field.
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Affiliation(s)
- Garrett P Banks
- Department of Neurosurgery, Columbia University, 710 West 168 Street, 4th Floor, New York, NY 10032, USA.
| | - Christopher J Winfree
- Department of Neurosurgery, Columbia University, 710 West 168 Street, 4th Floor, New York, NY 10032, USA
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11
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Sheth SA, Pathak Y, Paddick I, Anbarasan D, Wang TJ, Lopes A, Hoexter MQ, Greenberg B, Rasmussen S, Miguel E, McLaughlin N, Banks GP. 207 Stereotactic Radiosurgical Capsulotomy for Obsessive-Compulsive Disorder. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Nanda P, Banks GP, Pathak YJ, Sheth SA. Connectivity-based parcellation of the anterior limb of the internal capsule. Hum Brain Mapp 2017; 38:6107-6117. [PMID: 28913860 PMCID: PMC6206867 DOI: 10.1002/hbm.23815] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 05/23/2017] [Revised: 08/21/2017] [Accepted: 09/07/2017] [Indexed: 01/05/2023] Open
Abstract
The anterior limb of the internal capsule (ALIC) is an important locus of frontal-subcortical fiber tracts involved in cognitive and limbic feedback loops. However, the structural organization of its component fiber tracts remains unclear. Therefore, although the ALIC is a promising target for various neurosurgical procedures for psychiatric disorders, more precise understanding of its organization is required to optimize target localization. Using diffusion tensor imaging (DTI) collected on healthy subjects by the Human Connectome Project (HCP), we generated parcellations of the ALIC by dividing it according to structural connectivity to various frontal regions. We then compared individuals' parcellations to evaluate the ALIC's structural consistency. All 40 included subjects demonstrated a posterior-superior to anterior-inferior axis of tract organization in the ALIC. Nonetheless, subdivisions of the ALIC were found to vary substantially, as voxels in the average parcellation were accurately assigned for a mean of only 66.2% of subjects. There were, however, some loci of consistency, most notably in the region maximally connected to orbitofrontal cortex. These findings clarify the highly variable organization of the ALIC and may represent a tool for patient-specific targeting of neuromodulation. Hum Brain Mapp 38:6107-6117, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Pranav Nanda
- Department of Neurological SurgeryColumbia University Medical CenterNew YorkNew York
| | - Garrett P. Banks
- Department of Neurological SurgeryColumbia University Medical CenterNew YorkNew York
| | - Yagna J. Pathak
- Department of Neurological SurgeryColumbia University Medical CenterNew YorkNew York
| | - Sameer A. Sheth
- Department of Neurological SurgeryColumbia University Medical CenterNew YorkNew York
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13
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Youngerman BE, Oh J, Pathak Y, Banks GP, Sheth SA, Feldstein NA, McKhann GM. 350 Stereoelectroencephalography for Refractory Localization-related Epilepsy. Neurosurgery 2017. [DOI: 10.1093/neuros/nyx417.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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MPhil PN, Banks GP, Oh J, Pathak Y, Sheth SA. 146 Prefrontal Cortical Connectivity-Based Segmentation of the Anterior Limb of the Internal Capsule. Neurosurgery 2017. [DOI: 10.1093/neuros/nyx417.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Abstract
While open surgical resection for medically refractory epilepsy remains the gold standard in current neurosurgical practice, modern techniques have targeted areas for improvement over open surgical resection. This review focuses on how a variety of these new techniques are attempting to address these various limitations. Stereotactic electroencephalography offers the possibility of localizing deep epileptic foci, improving upon subdural grid placement which limits localization to neocortical regions. Laser interstitial thermal therapy (LITT) and stereotactic radiosurgery can minimally or non-invasively ablate specific regions of interest, with near real-time feedback for laser interstitial thermal therapy. Finally, neurostimulation offers the possibility of seizure reduction without needing to ablate or resect any tissue. However, because these techniques are still being evaluated in current practice, there are no evidence-based guidelines for their use, and more research is required to fully evaluate their proper role in the current management of medically refractory epilepsy.
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Affiliation(s)
- Robert A McGovern
- Department of Neurological Surgery, The Neurological Institute, Columbia University Medical Center, 710 W. 168th St, New York, NY, 10032, USA.
| | - Garrett P Banks
- Department of Neurological Surgery, The Neurological Institute, Columbia University Medical Center, 710 W. 168th St, New York, NY, 10032, USA
| | - Guy M McKhann
- Department of Neurological Surgery, The Neurological Institute, Columbia University Medical Center, 710 W. 168th St, New York, NY, 10032, USA
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Sklar S, Walmer M, Sacre P, Schevon CA, Srinivasan S, Banks GP, Yates MJ, McKhann GM, Sheth SA, Sarma SV, Smith EH. Neuronal activity in human anterior cingulate cortex modulates with internal cognitive state during multi-source interference task. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:962-965. [PMID: 29060033 DOI: 10.1109/embc.2017.8036985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The dorsal anterior cingulate cortex (dACC) is thought to be essential for normal adaptation of one's behavior to difficult decisions, errors, and reinforcement. Here we examine single neurons from the human dACC in the context of a statistical model, including a cognitive state that varies with changes in cognitive interference induced by a Stroop-like task. We then include this cognitive state in point process models of single unit activity and subject reaction time. These results suggest that consideration of a latent cognitive state can explain additional variance in neural and behavioral dynamics.
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Nanda P, Banks GP, Pathak Y, Paulo DL, Horga G, Hoexter MQ, Xu Z, Lopes A, McLaughlin N, Greenberg B, Sheehan JP, Miguel EC, Sheth SA. 205 Tractography Characterizing Lesions Differentiating Responders to Stereotactic Capsulotomy for Obsessive-Compulsive Disorder. Neurosurgery 2016. [DOI: 10.1227/01.neu.0000489774.66889.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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Abstract
The limbic system is a network of interconnected brain regions regulating emotion, memory, and behavior. Pathology of the limbic system can manifest as psychiatric disease, including obsessive-compulsive disorder and major depressive disorder. For patients with these disorders who have not responded to standard pharmacological and cognitive behavioral therapy, ablative surgery is a neurosurgical treatment option. The major ablative limbic system procedures currently used are anterior capsulotomy, dorsal anterior cingulotomy, subcaudate tractotomy, and limbic leucotomy. In this review, we include a brief history of ablative limbic system surgery leading up to its current form. Mechanistic justification for these procedures is considered in a discussion of the pathophysiology of psychiatric disease. We then discuss therapeutic efficacy as demonstrated by recent trials. Finally, we consider future directions, including the search for predictors of treatment response, the development of more precise targeting methods, and the use of advances in neuroimaging to track treatment response.
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Affiliation(s)
- Saurabh Sinha
- Division of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Robert A. McGovern
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY
| | - Charles B. Mikell
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY
| | - Garrett P. Banks
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY
| | - Sameer A. Sheth
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY
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19
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Weiss SA, Lemesiou A, Connors R, Banks GP, McKhann GM, Goodman RR, Zhao B, Filippi CG, Nowell M, Rodionov R, Diehl B, McEvoy AW, Walker MC, Trevelyan AJ, Bateman LM, Emerson RG, Schevon CA. Seizure localization using ictal phase-locked high gamma: A retrospective surgical outcome study. Neurology 2015; 84:2320-8. [PMID: 25972493 DOI: 10.1212/wnl.0000000000001656] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 03/02/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether resection of areas with evidence of intense, synchronized neural firing during seizures is an accurate indicator of postoperative outcome. METHODS Channels meeting phase-locked high gamma (PLHG) criteria were identified retrospectively from intracranial EEG recordings (102 seizures, 46 implantations, 45 patients). Extent of removal of both the seizure onset zone (SOZ) and PLHG was correlated with seizure outcome, classified as good (Engel class I or II, n = 32) or poor (Engel class III or IV, n = 13). RESULTS Patients with good outcomes had significantly greater proportions of both SOZ and the first 4 (early) PLHG sites resected. Improved outcome classification was noted with early PLHG, as measured by the area under the receiver operating characteristic curves (PLHG 0.79, SOZ 0.68) and by odds ratios for resections including at least 75% of sites identified by each measure (PLHG 9.7 [95% CI: 2.3-41.5], SOZ 5.3 [95% CI: 1.2-23.3]). Among patients with resection of at least 75% of the SOZ, 78% (n = 30) had good outcomes, increasing to 91% when the resection also included at least 75% of early PLHG sites (n = 22). CONCLUSIONS This study demonstrates the localizing value of early PLHG, which is comparable to that provided by the SOZ. Incorporation of PLHG into the clinical evaluation may improve surgical efficacy and help to focus resections on the most critical areas.
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Affiliation(s)
- Shennan A Weiss
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Athena Lemesiou
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Robert Connors
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Garrett P Banks
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Guy M McKhann
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Robert R Goodman
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Binsheng Zhao
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Christopher G Filippi
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Mark Nowell
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Roman Rodionov
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Beate Diehl
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Andrew W McEvoy
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Matthew C Walker
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Andrew J Trevelyan
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Lisa M Bateman
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Ronald G Emerson
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Catherine A Schevon
- From the Departments of Neurology (R.C., L.M.B., R.G.E., C.A.S.), Neurological Surgery (G.P.B., G.M.M., R.R.G.), and Radiology (B.Z., C.G.F.), Columbia University, New York; Hospital for Special Surgery (R.G.E.), Cornell University, New York, NY; Department of Clinical and Experimental Epilepsy (A.L., M.N., R.R., B.D., A.W.M., M.C.W.), Institute of Neurology, University College London; Institute for Neuroscience (A.J.T.), Newcastle University, UK; and Department of Neurology (S.A.W.), UCLA David Geffen School of Medicine, Los Angeles, CA.
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20
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Banks GP, Mikell CB, Youngerman BE, Henriques B, Kelly KM, Chan AK, Herrera D, Dougherty DD, Eskandar EN, Sheth SA. Neuroanatomical characteristics associated with response to dorsal anterior cingulotomy for obsessive-compulsive disorder. JAMA Psychiatry 2015; 72:127-35. [PMID: 25536384 DOI: 10.1001/jamapsychiatry.2014.2216] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Approximately 10% of patients with obsessive-compulsive disorder (OCD) have symptoms that are refractory to pharmacologic and cognitive-behavioral therapies. Neurosurgical interventions can be effective therapeutic options in these patients, but not all individuals respond. The mechanisms underlying this response variability are poorly understood. OBJECTIVE To identify neuroanatomical characteristics on preoperative imaging that differentiate responders from nonresponders to dorsal anterior cingulotomy, a neurosurgical lesion procedure used to treat refractory OCD. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed preoperative T1 and diffusion magnetic resonance imaging sequences from 15 patients (9 men and 6 women) who underwent dorsal anterior cingulotomy. Eight of the 15 patients (53%) responded to the procedure. MAIN OUTCOMES AND MEASURES We used voxel-based morphometry (VBM) and diffusion tensor imaging to identify structural and connectivity variations that could differentiate eventual responders from nonresponders. The VBM and probabilistic tractography metrics were correlated with clinical response to the cingulotomy procedure as measured by changes in the Yale-Brown Obsessive Compulsive Scale score. RESULTS Voxel-based morphometry analysis revealed a gray matter cluster in the right anterior cingulate cortex, anterior to the eventual lesion, for which signal strength correlated with poor response (P = .017). Decreased gray matter in this region of the dorsal anterior cingulate cortex predicted improved response (mean [SD] gray matter partial volume for responders vs nonresponders, 0.47 [0.03] vs 0.66 [0.03]; corresponding to mean Yale-Brown Obsessive Compulsive Scale score change, -60% [19] vs -11% [9], respectively). Hemispheric asymmetry in connectivity between the eventual lesion and the caudate (for responders vs nonresponders, mean [SD] group laterality for individual lesion seeds, -0.79 [0.18] vs -0.08 [0.65]; P = .04), putamen (-0.55 [0.35] vs 0.50 [0.33]; P = .001), thalamus (-0.82 [0.19] vs 0.41 [0.24]; P = .001), pallidum (-0.78 [0.18] vs 0.43 [0.48]; P = .001), and hippocampus (-0.66 [0.33] vs 0.33 [0.18]; P = .001) also correlated significantly with clinical response, with increased right-sided connectivity predicting greater response. CONCLUSIONS AND RELEVANCE We identified features of anterior cingulate cortex structure and connectivity that predict clinical response to dorsal anterior cingulotomy for refractory OCD. These results suggest that the variability seen in individual responses to a highly consistent, stereotyped procedure may be due to neuroanatomical variation in the patients. Furthermore, these variations may allow us to predict which patients are most likely to respond to cingulotomy, thereby refining our ability to individualize this treatment for refractory psychiatric disorders.
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Affiliation(s)
- Garrett P Banks
- Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York
| | - Charles B Mikell
- Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York
| | - Brett E Youngerman
- Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York
| | - Bryan Henriques
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kathleen M Kelly
- Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York
| | - Andrew K Chan
- Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York
| | - Diana Herrera
- Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York
| | | | - Emad N Eskandar
- Department of Neurosurgery, Massachusetts General Hospital, Boston
| | - Sameer A Sheth
- Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York
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Mikell CB, Banks GP, Frey HP, Youngerman BE, Nelp TB, Karas PJ, Chan AK, Voss HU, Connolly ES, Claassen J. Frontal networks associated with command following after hemorrhagic stroke. Stroke 2014; 46:49-57. [PMID: 25492905 DOI: 10.1161/strokeaha.114.007645] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Level of consciousness is frequently assessed by command-following ability in the clinical setting. However, it is unclear what brain circuits are needed to follow commands. We sought to determine what networks differentiate command following from noncommand following patients after hemorrhagic stroke. METHODS Structural MRI, resting-state functional MRI, and electroencephalography were performed on 25 awake and unresponsive patients with acute intracerebral and subarachnoid hemorrhage. Structural injury was assessed via volumetric T1-weighted MRI analysis. Functional connectivity differences were analyzed against a template of standard resting-state networks. The default mode network (DMN) and the task-positive network were investigated using seed-based functional connectivity. Networks were interrogated by pairwise coherence of electroencephalograph leads in regions of interest defined by functional MRI. RESULTS Functional imaging of unresponsive patients identified significant differences in 6 of 16 standard resting-state networks. Significant voxels were found in premotor cortex, dorsal anterior cingulate gyrus, and supplementary motor area. Direct interrogation of the DMN and task-positive network revealed loss of connectivity between the DMN and the orbitofrontal cortex and new connections between the task-positive network and DMN. Coherence between electrodes corresponding to right executive network and visual networks was also decreased in unresponsive patients. CONCLUSIONS Resting-state functional MRI and electroencephalography coherence data support a model in which multiple, chiefly frontal networks are required for command following. Loss of DMN anticorrelation with task-positive network may reflect a loss of inhibitory control of the DMN by motor-executive regions. Frontal networks should thus be a target for future investigations into the mechanism of responsiveness in the intensive care unit environment.
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Affiliation(s)
- Charles B Mikell
- From the Department of Neurological Surgery, Columbia University Medical Center, New York (C.B.M., G.P.B., B.E.Y., T.B.N., P.J.K., A.K.C., E.S.C.); Department of Radiology, Weill Cornell Medical College, Cornell University, New York (H.U.V.); and Division of Neurocritical Care, Department of Neurology, Columbia University Medical Center, New York (H.-P.F., J.C.).
| | - Garrett P Banks
- From the Department of Neurological Surgery, Columbia University Medical Center, New York (C.B.M., G.P.B., B.E.Y., T.B.N., P.J.K., A.K.C., E.S.C.); Department of Radiology, Weill Cornell Medical College, Cornell University, New York (H.U.V.); and Division of Neurocritical Care, Department of Neurology, Columbia University Medical Center, New York (H.-P.F., J.C.)
| | - Hans-Peter Frey
- From the Department of Neurological Surgery, Columbia University Medical Center, New York (C.B.M., G.P.B., B.E.Y., T.B.N., P.J.K., A.K.C., E.S.C.); Department of Radiology, Weill Cornell Medical College, Cornell University, New York (H.U.V.); and Division of Neurocritical Care, Department of Neurology, Columbia University Medical Center, New York (H.-P.F., J.C.)
| | - Brett E Youngerman
- From the Department of Neurological Surgery, Columbia University Medical Center, New York (C.B.M., G.P.B., B.E.Y., T.B.N., P.J.K., A.K.C., E.S.C.); Department of Radiology, Weill Cornell Medical College, Cornell University, New York (H.U.V.); and Division of Neurocritical Care, Department of Neurology, Columbia University Medical Center, New York (H.-P.F., J.C.)
| | - Taylor B Nelp
- From the Department of Neurological Surgery, Columbia University Medical Center, New York (C.B.M., G.P.B., B.E.Y., T.B.N., P.J.K., A.K.C., E.S.C.); Department of Radiology, Weill Cornell Medical College, Cornell University, New York (H.U.V.); and Division of Neurocritical Care, Department of Neurology, Columbia University Medical Center, New York (H.-P.F., J.C.)
| | - Patrick J Karas
- From the Department of Neurological Surgery, Columbia University Medical Center, New York (C.B.M., G.P.B., B.E.Y., T.B.N., P.J.K., A.K.C., E.S.C.); Department of Radiology, Weill Cornell Medical College, Cornell University, New York (H.U.V.); and Division of Neurocritical Care, Department of Neurology, Columbia University Medical Center, New York (H.-P.F., J.C.)
| | - Andrew K Chan
- From the Department of Neurological Surgery, Columbia University Medical Center, New York (C.B.M., G.P.B., B.E.Y., T.B.N., P.J.K., A.K.C., E.S.C.); Department of Radiology, Weill Cornell Medical College, Cornell University, New York (H.U.V.); and Division of Neurocritical Care, Department of Neurology, Columbia University Medical Center, New York (H.-P.F., J.C.)
| | - Henning U Voss
- From the Department of Neurological Surgery, Columbia University Medical Center, New York (C.B.M., G.P.B., B.E.Y., T.B.N., P.J.K., A.K.C., E.S.C.); Department of Radiology, Weill Cornell Medical College, Cornell University, New York (H.U.V.); and Division of Neurocritical Care, Department of Neurology, Columbia University Medical Center, New York (H.-P.F., J.C.)
| | - E Sander Connolly
- From the Department of Neurological Surgery, Columbia University Medical Center, New York (C.B.M., G.P.B., B.E.Y., T.B.N., P.J.K., A.K.C., E.S.C.); Department of Radiology, Weill Cornell Medical College, Cornell University, New York (H.U.V.); and Division of Neurocritical Care, Department of Neurology, Columbia University Medical Center, New York (H.-P.F., J.C.)
| | - Jan Claassen
- From the Department of Neurological Surgery, Columbia University Medical Center, New York (C.B.M., G.P.B., B.E.Y., T.B.N., P.J.K., A.K.C., E.S.C.); Department of Radiology, Weill Cornell Medical College, Cornell University, New York (H.U.V.); and Division of Neurocritical Care, Department of Neurology, Columbia University Medical Center, New York (H.-P.F., J.C.)
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Banks GP, Mikell CB, McKhann GM. Inducing the "will to persevere": electric stimulation as a potential treatment for apathy. Neurosurgery 2014; 75:N11-2. [PMID: 25033356 DOI: 10.1227/01.neu.0000452311.68989.00] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Banks GP, Mikell CB, Mckhann GM. Practice Makes Efficient. Neurosurgery 2014; 74:N12-4. [DOI: 10.1227/01.neu.0000445334.50327.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Weiss SA, Banks GP, McKhann GM, Goodman RR, Emerson RG, Trevelyan AJ, Schevon CA. Ictal high frequency oscillations distinguish two types of seizure territories in humans. ACTA ACUST UNITED AC 2013; 136:3796-808. [PMID: 24176977 DOI: 10.1093/brain/awt276] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
High frequency oscillations have been proposed as a clinically useful biomarker of seizure generating sites. We used a unique set of human microelectrode array recordings (four patients, 10 seizures), in which propagating seizure wavefronts could be readily identified, to investigate the basis of ictal high frequency activity at the cortical (subdural) surface. Sustained, repetitive transient increases in high gamma (80-150 Hz) amplitude, phase-locked to the low-frequency (1-25 Hz) ictal rhythm, correlated with strong multi-unit firing bursts synchronized across the core territory of the seizure. These repetitive high frequency oscillations were seen in recordings from subdural electrodes adjacent to the microelectrode array several seconds after seizure onset, following ictal wavefront passage. Conversely, microelectrode recordings demonstrating only low-level, heterogeneous neural firing correlated with a lack of high frequency oscillations in adjacent subdural recording sites, despite the presence of a strong low-frequency signature. Previously, we reported that this pattern indicates a failure of the seizure to invade the area, because of a feedforward inhibitory veto mechanism. Because multi-unit firing rate and high gamma amplitude are closely related, high frequency oscillations can be used as a surrogate marker to distinguish the core seizure territory from the surrounding penumbra. We developed an efficient measure to detect delayed-onset, sustained ictal high frequency oscillations based on cross-frequency coupling between high gamma amplitude and the low-frequency (1-25 Hz) ictal rhythm. When applied to the broader subdural recording, this measure consistently predicted the timing or failure of ictal invasion, and revealed a surprisingly small and slowly spreading seizure core surrounded by a far larger penumbral territory. Our findings thus establish an underlying neural mechanism for delayed-onset, sustained ictal high frequency oscillations, and provide a practical, efficient method for using them to identify the small ictal core regions. Our observations suggest that it may be possible to reduce substantially the extent of cortical resections in epilepsy surgery procedures without compromising seizure control.
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Affiliation(s)
- Shennan A Weiss
- 1 Department of Neurology, Columbia University, New York, NY, USA
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Banks GP, Weiss SA, Pisapia D, Willey JZ. A case of late-onset leukoencephalopathy, calcifications, and cysts presenting with intracerebral hemorrhage resembling a neoplasm. Cerebrovasc Dis 2013; 35:396-7. [PMID: 23635489 DOI: 10.1159/000348312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Garrett P Banks
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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