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Parvizi J, Lyu D, Stieger J, Lusk Z, Buch V. Causal Cortical and Thalamic Connections in the Human Brain. RESEARCH SQUARE 2024:rs.3.rs-4366486. [PMID: 38853954 PMCID: PMC11160924 DOI: 10.21203/rs.3.rs-4366486/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
The brain's functional architecture is intricately shaped by causal connections between its cortical and subcortical structures. Here, we studied 27 participants with 4864 electrodes implanted across the anterior, mediodorsal, and pulvinar thalamic regions, and the cortex. Using data from electrical stimulation procedures and a data-driven approach informed by neurophysiological standards, we dissociated three unique spectral patterns generated by the perturbation of a given brain area. Among these, a novel waveform emerged, marked by delayed-onset slow oscillations in both ipsilateral and contralateral cortices following thalamic stimulations, suggesting a mechanism by which a thalamic site can influence bilateral cortical activity. Moreover, cortical stimulations evoked earlier signals in the thalamus than in other connected cortical areas suggesting that the thalamus receives a copy of signals before they are exchanged across the cortex. Our causal connectivity data can be used to inform biologically-inspired computational models of the functional architecture of the brain.
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Zou Y, He X, Ye Z, Li Z, Guo Q, Zou W, Peng Q. Inhibition of the glutamatergic PVT-NAc projections attenuates local anesthetic-induced neurotoxic behaviors. Reg Anesth Pain Med 2024:rapm-2023-104964. [PMID: 38233353 DOI: 10.1136/rapm-2023-104964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Local anesthetic-induced neurotoxicity contributes to perioperative nerve damage; however, the underlying mechanisms remain unclear. Here, we investigated the role of the paraventricular thalamus (PVT)-nucleus accumbens (NAc) projections in neurotoxicity induced by ropivacaine, a local anesthetic agent. METHODS Ropivacaine (58 mg/kg, intraperitoneal administration) was used to construct the local anesthetic systemic toxicity (LAST) mice model. We first identified neural projections from the PVT to the NAc through the expression of a retrograde tracer and virus. The inhibitory viruses (rAAV-EF1α-DIO-hm4D(Gi)-mCherry-WPREs: AAV2/retro and rAAV-CaMKII-CRE-WPRE-hGh: AAV2/9) were injected into the mice model to assess the effects of the specific inhibition of the PVT-NAc pathway on neurological behaviors in the presence of clozapine-N-oxide. The inhibition of the PVT-NAc pathway was evaluated by immunofluorescence staining of c-Fos-positive neurons and Ca2+ signals in CaMKIIa neurons. RESULTS We successfully identified a circuit connecting the PVT and NAc in C57BL/6 mice. Ropivacaine administration induced the activation of the PVT-NAc pathway and seizures. Specific inhibition of NAc-projecting CaMKII neurons in the PVT was sufficient to inhibit the neuronal activity in the NAc, which subsequently decreased ropivacaine-induced neurotoxicity. CONCLUSION These results reveal the presence of a dedicated PVT-NAc circuit that regulates local anesthetic-induced neurotoxicity and provide a potential mechanistic explanation for the treatment and prevention of LAST.
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Affiliation(s)
- Yu Zou
- Department of Anesthesia, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Xin He
- Department of Anesthesia, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Zhiwen Ye
- Department of Critical Care Medicine, Xiangya Hospital Central South University, Changsha, Hunan Province, China
- Xiangya Hospital Central South University National Clinical Research Center for Geriatric Disorders, Changsha, Hunan Province, China
| | - Zhengyiqi Li
- Department of Anesthesia, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Qulian Guo
- Department of Anesthesia, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Wangyuan Zou
- Department of Anesthesia, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Qianyi Peng
- Department of Critical Care Medicine, Xiangya Hospital Central South University, Changsha, Hunan Province, China
- Xiangya Hospital Central South University National Clinical Research Center for Geriatric Disorders, Changsha, Hunan Province, China
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Tung H, Tsai SC, Huang PR, Hsieh PF, Lin YC, Peng SJ. Morphological and metabolic asymmetries of the thalamic subregions in temporal lobe epilepsy predict cognitive functions. Sci Rep 2023; 13:22611. [PMID: 38114641 PMCID: PMC10730825 DOI: 10.1038/s41598-023-49856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
Both morphological and metabolic imaging were used to determine how asymmetrical changes of thalamic subregions are involved in cognition in temporal lobe epilepsy (TLE). We retrospectively recruited 24 left-TLE and 15 right-TLE patients. Six thalamic subnuclei were segmented by magnetic resonance imaging, and then co-registered onto Positron emission tomography images. We calculated the asymmetrical indexes of the volumes and normalized standard uptake value ratio (SUVR) of the entire and individual thalamic subnuclei. The SUVR of ipsilateral subnuclei were extensively and prominently decreased compared with the volume loss. The posterior and medial subnuclei had persistently lower SUVR in both TLE cases. Processing speed is the cognitive function most related to the metabolic asymmetry. It negatively correlated with the metabolic asymmetrical indexes of subregions in left-TLE, while positively correlated with the subnuclei volume asymmetrical indexes in right-TLE. Epilepsy duration negatively correlated with the volume asymmetry of most thalamic subregions in left-TLE and the SUVR asymmetry of ventral and intralaminar subnuclei in right-TLE. Preserved metabolic activity of contralateral thalamic subregions is the key to maintain the processing speed in both TLEs. R-TLE had relatively preserved volume of the ipsilateral thalamic volume, while L-TLE had relatively decline of volume and metabolism in posterior subnucleus.
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Affiliation(s)
- Hsin Tung
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Center of Faculty Development, Taichung Veterans General Hospital, Taichung, Taiwan
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Chuan Tsai
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Imaging and Radiological Technology, Institute of Radiological Science, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Pu-Rong Huang
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Peiyuan F Hsieh
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ching Lin
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Imaging and Radiological Technology, Institute of Radiological Science, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan.
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
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4
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Wu TQ, Kaboodvand N, McGinn RJ, Veit M, Davey Z, Datta A, Graber KD, Meador KJ, Fisher R, Buch V, Parvizi J. Multisite thalamic recordings to characterize seizure propagation in the human brain. Brain 2023; 146:2792-2802. [PMID: 37137813 PMCID: PMC10316776 DOI: 10.1093/brain/awad121] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 03/23/2023] [Indexed: 05/05/2023] Open
Abstract
Neuromodulation of the anterior nuclei of the thalamus (ANT) has shown to be efficacious in a subset of patients with refractory focal epilepsy. One important uncertainty is to what extent thalamic subregions other than the ANT could be recruited more prominently in the propagation of focal onset seizures. We designed the current study to simultaneously monitor the engagement of the ANT, mediodorsal (MD) and pulvinar (PUL) nuclei during seizures in patients who could be candidates for thalamic neuromodulation. We studied 11 patients with clinical manifestations of presumed temporal lobe epilepsy (TLE) undergoing invasive stereo-encephalography (sEEG) monitoring to confirm the source of their seizures. We extended cortical electrodes to reach the ANT, MD and PUL nuclei of the thalamus. More than one thalamic subdivision was simultaneously interrogated in nine patients. We recorded seizures with implanted electrodes across various regions of the brain and documented seizure onset zones (SOZ) in each recorded seizure. We visually identified the first thalamic subregion to be involved in seizure propagation. Additionally, in eight patients, we applied repeated single pulse electrical stimulation in each SOZ and recorded the time and prominence of evoked responses across the implanted thalamic regions. Our approach for multisite thalamic sampling was safe and caused no adverse events. Intracranial EEG recordings confirmed SOZ in medial temporal lobe, insula, orbitofrontal and temporal neocortical sites, highlighting the importance of invasive monitoring for accurate localization of SOZs. In all patients, seizures with the same propagation network and originating from the same SOZ involved the same thalamic subregion, with a stereotyped thalamic EEG signature. Qualitative visual reviews of ictal EEGs were largely consistent with the quantitative analysis of the corticothalamic evoked potentials, and both documented that thalamic nuclei other than ANT could have the earliest participation in seizure propagation. Specifically, pulvinar nuclei were involved earlier and more prominently than ANT in more than half of the patients. However, which specific thalamic subregion first demonstrated ictal activity could not be reliably predicted based on clinical semiology or lobar localization of SOZs. Our findings document the feasibility and safety of bilateral multisite sampling from the human thalamus. This may allow more personalized thalamic targets to be identified for neuromodulation. Future studies are needed to determine if a personalized thalamic neuromodulation leads to greater improvements in clinical outcome.
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Affiliation(s)
- Teresa Q Wu
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Neda Kaboodvand
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Ryan J McGinn
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Mike Veit
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Zachary Davey
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Anjali Datta
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurosurgery, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Kevin D Graber
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Robert Fisher
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Vivek Buch
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurosurgery, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
| | - Josef Parvizi
- Laboratory of Behavioral and Cognitive Neuroscience, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Human Intracranial Cognitive Electrophysiology Program, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
- Department of Neurosurgery, Stanford University, Stanford School of Medicine, Palo Alto, CA 94305, USA
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Miller KJ, Müller KR, Valencia GO, Huang H, Gregg NM, Worrell GA, Hermes D. Canonical Response Parameterization: Quantifying the structure of responses to single-pulse intracranial electrical brain stimulation. PLoS Comput Biol 2023; 19:e1011105. [PMID: 37228169 DOI: 10.1371/journal.pcbi.1011105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Single-pulse electrical stimulation in the nervous system, often called cortico-cortical evoked potential (CCEP) measurement, is an important technique to understand how brain regions interact with one another. Voltages are measured from implanted electrodes in one brain area while stimulating another with brief current impulses separated by several seconds. Historically, researchers have tried to understand the significance of evoked voltage polyphasic deflections by visual inspection, but no general-purpose tool has emerged to understand their shapes or describe them mathematically. We describe and illustrate a new technique to parameterize brain stimulation data, where voltage response traces are projected into one another using a semi-normalized dot product. The length of timepoints from stimulation included in the dot product is varied to obtain a temporal profile of structural significance, and the peak of the profile uniquely identifies the duration of the response. Using linear kernel PCA, a canonical response shape is obtained over this duration, and then single-trial traces are parameterized as a projection of this canonical shape with a residual term. Such parameterization allows for dissimilar trace shapes from different brain areas to be directly compared by quantifying cross-projection magnitudes, response duration, canonical shape projection amplitudes, signal-to-noise ratios, explained variance, and statistical significance. Artifactual trials are automatically identified by outliers in sub-distributions of cross-projection magnitude, and rejected. This technique, which we call "Canonical Response Parameterization" (CRP) dramatically simplifies the study of CCEP shapes, and may also be applied in a wide range of other settings involving event-triggered data.
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Affiliation(s)
- Kai J Miller
- Dept of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, United States of America
- Dept of Biomedical Engineering & Physiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Klaus-Robert Müller
- Google Research, Brain Team, Berlin, Germany
- Machine Learning Group, Department of Computer Science, Berlin Institute of Technology, Berlin, Germany
- Dept of Artificial Intelligence, Korea University, Seoul, Republic of Korea
- Max Planck Institute for Informatics, Saarbrücken, Germany
| | - Gabriela Ojeda Valencia
- Dept of Biomedical Engineering & Physiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Harvey Huang
- Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Nicholas M Gregg
- Dept of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Gregory A Worrell
- Dept of Biomedical Engineering & Physiology, Mayo Clinic, Rochester, Minnesota, United States of America
- Dept of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Dora Hermes
- Dept of Biomedical Engineering & Physiology, Mayo Clinic, Rochester, Minnesota, United States of America
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Li H, Liu X, Wang R, Lu A, Ma Z, Wu S, Lu H, Du Y, Deng K, Wang L, Yuan F. Blood-brain barrier damage and new onset refractory status epilepticus: An exploratory study using dynamic contrast-enhanced magnetic resonance imaging. Epilepsia 2023. [PMID: 36892496 DOI: 10.1111/epi.17576] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE This study was undertaken to characterize the blood-brain barrier (BBB) dysfunction in patients with new onset refractory status epilepticus (NORSE) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). METHODS This study included three groups of adult participants: patients with NORSE, encephalitis patients without status epilepticus (SE), and healthy subjects. These participants were retrospectively included from a prospective DCE-MRI database of neurocritically ill patients and healthy subjects. The BBB permeability (Ktrans) in the hippocampus, basal ganglia, thalamus, claustrum, periventricular white matter, and cerebellum were measured and compared between these three groups. RESULTS A total of seven patients with NORSE, 14 encephalitis patients without SE, and nine healthy subjects were included in this study. Among seven patients with NORSE, only one had a definite etiology (autoimmune encephalitis), and the rest were cryptogenic. Etiology of encephalitis patients without SE included viral (n = 2), bacterial (n = 8), tuberculous (n = 1), cryptococcal (n = 1), and cryptic (n = 2) encephalitis. Of these 14 encephalitis patients without SE, three patients had seizures. Compared to healthy controls, NORSE patients had significantly increased Ktrans values in the hippocampus (.73 vs. .02 × 10-3 /min, p = .001) and basal ganglia (.61 vs. .003 × 10-3 /min, p = .007) and a trend in the thalamus (.24 vs. .08 × 10-3 /min, p = .017). Compared to encephalitis patients without SE, NORSE patients had significantly increased Ktrans values in the thalamus (.24 vs. .01 × 10-3 /min, p = .002) and basal ganglia (.61 vs. .004 × 10-3 /min, p = .013). SIGNIFICANCE This exploratory study demonstrates that BBBs of NORSE patients were impaired diffusely, and BBB dysfunction in the basal ganglia and thalamus plays an important role in the pathophysiology of NORSE.
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Affiliation(s)
- Huiping Li
- Department of Neurocritical Care, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xian Liu
- Department of Imaging, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruihong Wang
- Department of Neurocritical Care, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Aili Lu
- Department of Neurocritical Care, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhaohui Ma
- Department of Neurocritical Care, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shibiao Wu
- Department of Neurocritical Care, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hongji Lu
- Department of Neurocritical Care, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yaming Du
- Department of Neurocritical Care, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kan Deng
- Philips Healthcare, Guangzhou, China
| | - Lixin Wang
- Department of Neurocritical Care, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Chinese Medicine Emergency Research, Guangzhou, China
| | - Fang Yuan
- Department of Neurocritical Care, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Zheng B, Liu DD, Theyel BB, Abdulrazeq H, Kimata AR, Lauro PM, Asaad WF. Thalamic neuromodulation in epilepsy: A primer for emerging circuit-based therapies. Expert Rev Neurother 2023; 23:123-140. [PMID: 36731858 DOI: 10.1080/14737175.2023.2176752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Epilepsy is a common, often debilitating disease of hyperexcitable neural networks. While medically intractable cases may benefit from surgery, there may be no single, well-localized focus for resection or ablation. In such cases, approaching the disease from a network-based perspective may be beneficial. AREAS COVERED Herein, the authors provide a narrative review of normal thalamic anatomy and physiology and propose general strategies for preventing and/or aborting seizures by modulating this structure. Additionally, they make specific recommendations for targeting the thalamus within different contexts, motivated by a more detailed discussion of its distinct nuclei and their respective connectivity. By describing important principles governing thalamic function and its involvement in seizure networks, the authors aim to provide a primer for those now entering this fast-growing field of thalamic neuromodulation for epilepsy. EXPERT OPINION The thalamus is critically involved with the function of many cortical and subcortical areas, suggesting it may serve as a compelling node for preventing or aborting seizures, and so it has increasingly been targeted for the surgical treatment of epilepsy. As various thalamic neuromodulation strategies for seizure control are developed, there is a need to ground such interventions in a mechanistic, circuit-based framework.
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Affiliation(s)
- Bryan Zheng
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - David D Liu
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian B Theyel
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Hael Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Anna R Kimata
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Peter M Lauro
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA.,The Carney Institute for Brain Science, Brown University, Providence, RI, USA.,The Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, USA
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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; 137:1210-1225. [PMID: 35276641 DOI: 10.3171/2022.1.jns212613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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Tang Y, Su TY, Choi JY, Hu S, Wang X, Sakaie K, Murakami H, Alexopoulos A, Griswold M, Jones S, Najm I, Ma D, Wang ZI. Characterizing Thalamic and Basal Ganglia Nuclei in Medically Intractable Focal Epilepsy by MR Fingerprinting. Epilepsia 2022; 63:1998-2010. [PMID: 35661353 DOI: 10.1111/epi.17318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/11/2022] [Accepted: 06/02/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Magnetic resonance fingerprinting (MRF) is a novel, quantitative and noninvasive technique to measure brain tissue properties. We aim to use MRF for characterizing normal-appearing thalamic and basal ganglia nuclei in the epileptic brain. METHODS A 3D MRF protocol (1mm3 isotropic resolution) was acquired from 48 patients with unilateral medically refractory focal epilepsy and 39 healthy controls (HCs). Whole-brain T1 and T2 maps (containing T1 and T2 relaxation times) were reconstructed for each subject. Ten subcortical nuclei in the thalamus and basal ganglia were segmented as regions of interest (ROIs), within which the mean T1 and T2 values, as well as their coefficient of variation (CV) were compared between the patients and HCs at group level. Subgroup and correlation analyses were performed to examine the relationship between significant MRF measures and various clinical characteristics. Using significantly abnormal MRF measures from the group-level analyses, support vector machine (SVM) and logistic regression machine learning models were built and tested with 5-fold and 10-fold cross-validations, to separate patients from HCs, and to separate patients with left-sided and right-sided epilepsy, at individual level. RESULTS MRF revealed increased T1 mean value in the ipsilateral thalamus and nucleus accumbens; increased T1 CV in bilateral thalamus, bilateral pallidum, and ipsilateral caudate; and increased T2 CV in the ipsilateral thalamus in patients compared to HCs (P<0.05, FDR corrected). The SVM classifier produced 78.2% average accuracy to separate individual patients from HCs, with AUC of 0.83. The logistic regression classifier produced 67.4% average accuracy to separate patients with left-sided and right-sided epilepsy, with AUC of 0.72. SIGNIFICANCE MRF revealed bilateral tissue-property changes in the normal-appearing thalamus and basal ganglia, with ipsilateral predominance and thalamic preference, suggesting subcortical involvement/impairment in patients with medically intractable focal epilepsy. The individual-level performance of the MRF-based machine-learning models suggests potential opportunities for predicting lateralization.
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Affiliation(s)
- Yingying Tang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Ting Yu Su
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.,Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Joon Yul Choi
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Siyuan Hu
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Xiaofeng Wang
- Quantitative Health Science, Cleveland Clinic, Cleveland, OH, USA
| | - Ken Sakaie
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Mark Griswold
- Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Stephen Jones
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Imad Najm
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Dan Ma
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Zhong Irene Wang
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
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Richardson RM. Closed-Loop Brain Stimulation and Paradigm Shifts in Epilepsy Surgery. Neurol Clin 2022; 40:355-373. [PMID: 35465880 PMCID: PMC9271409 DOI: 10.1016/j.ncl.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advances in device technology have created greater flexibility in treating seizures as emergent properties of networks that exist on a local to global continuum. All patients with drug-resistant epilepsy are potential surgical candidates, given that intracranial neuromodulation through deep brain stimulation and responsive neurostimulation can reduce seizures and improve quality of life, even in multifocal and generalized epilepsies. To achieve this goal, indications and strategies for diagnostic epilepsy surgery are evolving. This article describes the state-of-the-art in epilepsy surgery and related changes in how we define indications for diagnostic and therapeutic surgical intervention.
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Tung H, Pan SY, Lan TH, Lin YY, Peng SJ. Characterization of Hippocampal-Thalamic-Cortical Morphometric Reorganization in Temporal Lobe Epilepsy. Front Neurol 2022; 12:810186. [PMID: 35222230 PMCID: PMC8866816 DOI: 10.3389/fneur.2021.810186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
IntroductionBrain cortico-subcortical connectivity has been investigated in epilepsy using the functional MRI (MRI). Although structural images cannot demonstrate dynamic changes, they provide higher spatial resolution, which allows exploration of the organization of brain in greater detail.MethodsWe used high-resolution brain MRI to study the hippocampal-thalamic-cortical networks in temporal lobe epilepsy (TLE) using a volume-based morphometric method. We enrolled 22 right-TLE, 33 left-TLE, and 28 age/gender-matched controls retrospectively. FreeSurfer software was used for the thalamus segmentation.ResultsAmong the 50 subfields, ipsilateral anterior, lateral, and parts of the intralaminar and medial nuclei, as well as the contralateral parts of lateral nuclei had significant volume loss in both TLE. The anteroventral nucleus was most vulnerable. Most thalamic subfields were susceptible to seizure burden, especially the left-TLE. SPM12 was used to conduct an analysis of the gray matter density (GMD) maps. Decreased extratemporal GMD occurred bilaterally. Both TLE demonstrated significant GMD loss over the ipsilateral inferior frontal gyrus, precentral gyrus, and medial orbital cortices.SignificanceThalamic subfield atrophy was related to the ipsilateral inferior frontal GMD changes, which presented positively in left-TLE and negatively in right-TLE. These findings suggest prefrontal-thalamo-hippocampal network disruption in TLE.
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Affiliation(s)
- Hsin Tung
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center of Faculty Development, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Epilepsy, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Szu-Yen Pan
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsuo-Hung Lan
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Yang Lin
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Syu-Jyun Peng
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Ictal high-frequency activity in limbic thalamic nuclei varies with electrographic seizure-onset patterns in temporal lobe epilepsy. Clin Neurophysiol 2022; 137:183-192. [DOI: 10.1016/j.clinph.2022.01.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 01/11/2023]
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Chaitanya G, Romeo AK, Ilyas A, Irannejad A, Toth E, Elsayed G, Bentley JN, Riley KO, Pati S. Robot-assisted stereoelectroencephalography exploration of the limbic thalamus in human focal epilepsy: implantation technique and complications in the first 24 patients. Neurosurg Focus 2021; 48:E2. [PMID: 32234983 DOI: 10.3171/2020.1.focus19887] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite numerous imaging studies highlighting the importance of the thalamus in a patient's surgical prognosis, human electrophysiological studies involving the limbic thalamic nuclei are limited. The objective of this study was to evaluate the safety and accuracy of robot-assisted stereotactic electrode placement in the limbic thalamic nuclei of patients with suspected temporal lobe epilepsy (TLE). METHODS After providing informed consent, 24 adults with drug-resistant, suspected TLE undergoing evaluation with stereoelectroencephalography (SEEG) were enrolled in the prospective study. The trajectory of one electrode planned for clinical sampling of the operculoinsular cortex was modified to extend it to the thalamus, thereby preventing the need for additional electrode placement for research. The anterior nucleus of the thalamus (ANT) (n = 13) and the medial group of thalamic nuclei (MED) (n = 11), including the mediodorsal and centromedian nuclei, were targeted. The postimplantation CT scan was coregistered to the preoperative MR image, and Morel's thalamic atlas was used to confirm the accuracy of implantation. RESULTS Ten (77%) of 13 patients in the ANT group and 10 (91%) of 11 patients in the MED group had electrodes accurately placed in the thalamic nuclei. None of the patients had a thalamic hemorrhage. However, trace asymptomatic hemorrhages at the cortical-level entry site were noted in 20.8% of patients, who did not require additional surgical intervention. SEEG data from all the patients were interpretable and analyzable. The trajectories for the ANT implant differed slightly from those of the MED group at the entry point-i.e., the precentral gyrus in the former and the postcentral gyrus in the latter. CONCLUSIONS Using judiciously planned robot-assisted SEEG, the authors demonstrate the safety of electrophysiological sampling from various thalamic nuclei for research recordings, presenting a technique that avoids implanting additional depth electrodes or compromising clinical care. With these results, we propose that if patients are fully informed of the risks involved, there are potential benefits of gaining mechanistic insights to seizure genesis, which may help to develop neuromodulation therapies.
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Affiliation(s)
- Ganne Chaitanya
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
| | - Andrew K Romeo
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Adeel Ilyas
- 2Epilepsy and Cognitive Neurophysiology Laboratory, and.,3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Auriana Irannejad
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
| | - Emilia Toth
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
| | - Galal Elsayed
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - J Nicole Bentley
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Kristen O Riley
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Sandipan Pati
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
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Dolleman-van der Weel MJ, Witter MP. The thalamic midline nucleus reuniens: potential relevance for schizophrenia and epilepsy. Neurosci Biobehav Rev 2020; 119:422-439. [PMID: 33031816 DOI: 10.1016/j.neubiorev.2020.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 09/03/2020] [Accepted: 09/28/2020] [Indexed: 01/08/2023]
Abstract
Anatomical, electrophysiological and behavioral studies in rodents have shown that the thalamic midline nucleus reuniens (RE) is a crucial link in the communication between hippocampal formation (HIP, i.e., CA1, subiculum) and medial prefrontal cortex (mPFC), important structures for cognitive and executive functions. A common feature in neurodevelopmental and neurodegenerative brain diseases is a dysfunctional connectivity/communication between HIP and mPFC, and disturbances in the cognitive domain. Therefore, it is assumed that aberrant functioning of RE may contribute to behavioral/cognitive impairments in brain diseases characterized by cortico-thalamo-hippocampal circuit dysfunctions. In the human brain the connections of RE are largely unknown. Yet, recent studies have found important similarities in the functional connectivity of HIP-mPFC-RE in humans and rodents, making cautious extrapolating experimental findings from animal models to humans justifiable. The focus of this review is on a potential involvement of RE in schizophrenia and epilepsy.
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Affiliation(s)
- M J Dolleman-van der Weel
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, NTNU Norwegian University of Science and Technology, Trondheim NO-7491, Norway.
| | - M P Witter
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, NTNU Norwegian University of Science and Technology, Trondheim NO-7491, Norway.
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