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Lapa S, Schwingshackl A, Frank U, Rosenow F, Mann C, Strzelczyk A. Transient postictal dysphagia in older adults with focal structural epilepsy. Epilepsia 2024; 65:1374-1382. [PMID: 38456606 DOI: 10.1111/epi.17914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/07/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Seizures can cause transient neurological symptoms, such as hemiparesis and aphasia. However, temporary swallowing changes leading to postictal dysphagia have not been previously described. Therefore, this study evaluated the presence of swallowing disorders following seizure. In addition, dysphagia severity and duration of any recovery from dysphagic symptoms were investigated. METHODS The local clinical database of all fiberoptic endoscopic evaluation of swallowing (FEES) examinations performed from 2008 to 2019 was screened for patients diagnosed with seizures, but excluding patients with intensive care unit admission or intubation >24 h. Patient charts were evaluated to identify preexisting dysphagia or potential concurrent medical causes for dysphagia, including hyponatremia, increased intracranial pressure, sepsis, or other encephalopathies associated with infections, or other possible causes at the time of admission. Patients receiving >.5 defined daily doses of benzodiazepines or neuroleptics were also excluded. Age, sex, seizure semiology and etiology, comorbidities, concurrent pneumonia, and dysphagia course during hospitalization were evaluated as predictors of the occurrence of dysphagia or its potential duration. RESULTS We identified 41 patients with dysphagia following a seizure, without evidence of any concurrent cause of swallowing dysfunction. These patients all presented with focal structural epilepsy, they had a mean age of 79 ± 11.3 years (range = 44-95 years), and 21 were women. The mean Elixhauser Comorbidity Score was 4.8. Hospital-acquired pneumonia was detected in 21 patients (51.2%). FEES diagnosed mild and severe dysphagia in 21 (51.2%) and 20 (48.8%) patients, respectively. Dysphagia improved significantly (p = .001) during hospitalization, persisting for an average of 3.9 days (median = 3 days, SD = 2.07 days, range = 1-8 days). SIGNIFICANCE Dysphagia is a potential transient neurological deficit following seizure. Our findings suggest that older patients, with focal structural epilepsy, are at risk for postictal dysphagia. Further studies are needed to ascertain the prevalence, complications, and predictors of postictal dysphagia. Dysphagia screening may improve early detection in patients with relevant risk factors, as well as reduce the occurrence of aspiration pneumonia.
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Affiliation(s)
- Sriramya Lapa
- Goethe University Frankfurt, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Ulrike Frank
- Linguistic Department, Swallowing Research Lab, University of Potsdam, Potsdam, Germany
| | - Felix Rosenow
- Goethe University Frankfurt, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
- Goethe University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Catrin Mann
- Goethe University Frankfurt, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
- Goethe University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Goethe University Frankfurt, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
- Goethe University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Wei KC, Wang TG, Hsiao MY. The Cortical and Subcortical Neural Control of Swallowing: A Narrative Review. Dysphagia 2024; 39:177-197. [PMID: 37603047 DOI: 10.1007/s00455-023-10613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
Swallowing is a sophisticated process involving the precise and timely coordination of the central and peripheral nervous systems, along with the musculatures of the oral cavity, pharynx, and airway. The role of the infratentorial neural structure, including the swallowing central pattern generator and cranial nerve nuclei, has been described in greater detail compared with both the cortical and subcortical neural structures. Nonetheless, accumulated data from analysis of swallowing performance in patients with different neurological diseases and conditions, along with results from neurophysiological studies of normal swallowing have gradually enhanced understanding of the role of cortical and subcortical neural structures in swallowing, potentially leading to the development of treatment modalities for patients suffering from dysphagia. This review article summarizes findings about the role of both cortical and subcortical neural structures in swallowing based on results from neurophysiological studies and studies of various neurological diseases. In sum, cortical regions are mainly in charge of initiation and coordination of swallowing after receiving afferent information, while subcortical structures including basal ganglia and thalamus are responsible for movement control and regulation during swallowing through the cortico-basal ganglia-thalamo-cortical loop. This article also presents how cortical and subcortical neural structures interact with each other to generate the swallowing response. In addition, we provided the updated evidence about the clinical applications and efficacy of neuromodulation techniques, including both non-invasive brain stimulation and deep brain stimulation on dysphagia.
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Affiliation(s)
- Kuo-Chang Wei
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan.
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Toledo D, Meza D, Gómez-martínez DG, Rosales J. Taste perceptual circuit for the generation of autonomous responses in virtual creatures. COGN SYST RES 2022; 76:46-62. [DOI: 10.1016/j.cogsys.2022.09.003] [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: 11/22/2022]
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Cheng I, Takahashi K, Miller A, Hamdy S. Cerebral control of swallowing: An update on neurobehavioral evidence. J Neurol Sci 2022; 442:120434. [PMID: 36170765 DOI: 10.1016/j.jns.2022.120434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/07/2022] [Accepted: 09/18/2022] [Indexed: 01/07/2023]
Abstract
This review aims to update the current knowledge on the cerebral control of swallowing. We review data from both animal and human studies spanning across the fields of neuroanatomy, neurophysiology and neuroimaging to evaluate advancements in our understanding in the brain's role in swallowing. Studies have collectively shown that swallowing is mediated by multiple distinct cortical and subcortical regions and that lesions to these regions can result in dysphagia. These regions are functionally connected in separate groups within and between the two hemispheres. While hemispheric dominance for swallowing has been reported in most human studies, the laterality is inconsistent across individuals. Moreover, there is a shift in activation location and laterality between swallowing preparation and execution, although such activation changes are less well-defined than that for limb motor control. Finally, we discussed recent neurostimulation treatments that may be beneficial for dysphagia after brain injury through promoting the reorganization of the swallowing neural network.
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Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Gastroenterology and Endocrinology, School of Medical Sciences, University of Manchester, UK.
| | - Kazutaka Takahashi
- Department of Organismal Biology and Anatomy, University of Chicago, USA
| | - Arthur Miller
- Division of Orthodontics, Department of Orofacial, Sciences, School of Dentistry, University of California at San Francisco, USA
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Gastroenterology and Endocrinology, School of Medical Sciences, University of Manchester, UK
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Yang CW, Chen RD, Feng MT, Zhang MZ, Liu W, Liu XC, Wang DC. The therapeutic effect of capsaicin on oropharyngeal dysphagia: A systematic review and meta-analysis. Front Aging Neurosci 2022; 14:931016. [PMID: 36425319 PMCID: PMC9679510 DOI: 10.3389/fnagi.2022.931016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/17/2022] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES Capsaicin is a specific agonist of TRPV1 (multimodal sensory receptor), which improves oropharyngeal dysphagia by increasing sensory input from the oropharynx and hypopharynx and by increasing repetitive stimulation of the cerebral cortex. The aim of this systematic review was to evaluate the therapeutic effect of capsaicin on swallowing disorders in stroke patients and the elderly. METHOD We searched Medline, Embase, PubMed, and Cochrane Library databases. We used the Mesh terms search database to screen all clinical trials that complied with the inclusion criteria. Studies were subjected to literature screening, quality assessment, and data extraction to remove studies that did not meet the inclusion criteria. After literature screening, quality assessment, and data extraction, a systematic review and meta-analysis of the included study were performed. RESULTS This systematic review and meta-analysis were prospectively registered on PROSPERO under registration number CRD42022313958. Five high-quality randomized controlled trials were ultimately included. The results of our meta-analysis showed a more significant reduction in swallowing function score change in the capsaicin group compared to the control group [SMD = -1.30, 95% CI: (-2.35, -0.25), P = 0.01] and on the Water swallowing test the improvement was significantly higher in the capsaicin group [RR = 2.46, 95% CI: (1.73, 3.50), P < 0.0001]. CONCLUSIONS Although the results of our meta-analysis showed that capsaicin improved swallowing function, most studies had an unclear bias and included few studies. More studies are needed to support this in the future. SYSTEMATIC REVIEW REGISTRATION www.crd.york.ac.uk/prospero/display_record.php?RecordID=304061, identifier: 304061.
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Affiliation(s)
- Cong-wen Yang
- Department of Neurosurgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Ru-dong Chen
- Department of Spinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Meng-ting Feng
- Department of Pediatrics, Jilin University, Changchun, China
| | | | - Wei Liu
- Department of Neurosurgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xu-chang Liu
- Department of Spinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Da-chuan Wang
- Department of Spinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Xiong H, Chen JJ, Gikaro JM, Wang CG, Lin F. Activation Patterns of Functional Brain Network in Response to Action Observation-Induced and Non-Induced Motor Imagery of Swallowing: A Pilot Study. Brain Sci 2022; 12:brainsci12101420. [PMID: 36291353 PMCID: PMC9599111 DOI: 10.3390/brainsci12101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/09/2022] [Accepted: 10/18/2022] [Indexed: 11/20/2022] Open
Abstract
Action observation (AO) combined with motor imagery (MI) was verified as more effective in improving limb function than AO or MI alone, while the underlying mechanism of swallowing was ambiguous. The study aimed at exploring the efficacy of AO combined with MI in swallowing. In this study, twelve subjects performed the motor imagery of swallowing (MI-SW) during magnetoencephalography (MEG) scanning, and trials were divided into three groups: the non-induced group (control group, CG), male AO-induced group (M-AIG), and female AO-induced group (F-AIG). We used event-related spectral perturbations (ERSPs) and phase locking value (PLV) to assess the degree of activation and connectivity of the brain regions during MI-SW in the three groups. The results showed that compared to CG, F-AIG and M-AIG significantly activated more brain regions in the frontoparietal, attention, visual, and cinguloopercular systems. In addition, M-AIG significantly activated the sensorimotor cortex compared to CG and F-AIG. For the brain network, F-AIG and M-AIG increased the diffusion of non-hub hot spots and cold hubs to the bilateral hemispheres which enhanced interhemispheric functional connectivity and information transmission efficiency in the MI-SW task. This study provided supporting evidence that AO induction could enhance the effect of MI-SW and supported the application of AO-induced MI-SW in clinical rehabilitation.
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Affiliation(s)
- Hao Xiong
- Department of Rehabilitation Medicine, Sir Run Run Hospital Nanjing Medical University, Nanjing 211100, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing 210029, China
| | - Jin-Jin Chen
- Department of Rehabilitation Medicine, Sir Run Run Hospital Nanjing Medical University, Nanjing 211100, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing 210029, China
| | - John M. Gikaro
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing 210029, China
| | - Chen-Guang Wang
- Department of Rehabilitation Medicine, Sir Run Run Hospital Nanjing Medical University, Nanjing 211100, China
| | - Feng Lin
- Department of Rehabilitation Medicine, Sir Run Run Hospital Nanjing Medical University, Nanjing 211100, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Correspondence: ; Tel.: +86-025-87115719
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Hashimoto H, Ming Khoo H, Yanagisawa T, Tani N, Oshino S, Hirata M, Kishima H. Frequency band coupling with high-frequency activities in tonic-clonic seizures shifts from θ to δ band. Clin Neurophysiol 2022; 137:122-131. [DOI: 10.1016/j.clinph.2022.02.015] [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] [Received: 10/07/2021] [Revised: 01/24/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
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Hashimoto H, Khoo HM, Yanagisawa T, Tani N, Oshino S, Kishima H, Hirata M. Phase-amplitude coupling between infraslow and high-frequency activities well discriminates between the preictal and interictal states. Sci Rep 2021; 11:17405. [PMID: 34465798 PMCID: PMC8408139 DOI: 10.1038/s41598-021-96479-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Infraslow activity (ISA) and high-frequency activity (HFA) are key biomarkers for studying epileptic seizures. We aimed to elucidate the relationship between ISA and HFA around seizure onset. We enrolled seven patients with drug-resistant focal epilepsy who underwent intracranial electrode placement. We comparatively analyzed the ISA, HFA, and ISA-HFA phase-amplitude coupling (PAC) in the seizure onset zone (SOZ) or non-SOZ (nSOZ) in the interictal, preictal, and ictal states. We recorded 15 seizures. HFA and ISA were larger in the ictal states than in the interictal or preictal state. During seizures, the HFA and ISA of the SOZ were larger and occurred earlier than those of nSOZ. In the preictal state, the ISA-HFA PAC of the SOZ was larger than that of the interictal state, and it began increasing at approximately 87 s before the seizure onset. The receiver-operating characteristic curve revealed that the ISA-HFA PAC of the SOZ showed the highest discrimination performance in the preictal and interictal states, with an area under the curve of 0.926. This study demonstrated the novel insight that ISA-HFA PAC increases before the onset of seizures. Our findings indicate that ISA-HFA PAC could be a useful biomarker for discriminating between the preictal and interictal states.
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan. .,Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540-0008, Japan.
| | - Hui Ming Khoo
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Naoki Tani
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
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Hashimoto H, Takahashi K, Kameda S, Yoshida F, Maezawa H, Oshino S, Tani N, Khoo HM, Yanagisawa T, Yoshimine T, Kishima H, Hirata M. Motor and sensory cortical processing of neural oscillatory activities revealed by human swallowing using intracranial electrodes. iScience 2021; 24:102786. [PMID: 34308292 PMCID: PMC8283146 DOI: 10.1016/j.isci.2021.102786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/28/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022] Open
Abstract
Swallowing is attributed to the orchestration of motor output and sensory input. We hypothesized that swallowing can illustrate differences between motor and sensory neural processing. Eight epileptic participants fitted with intracranial electrodes over the orofacial cortex were asked to swallow a water bolus. Mouth opening and swallowing were treated as motor tasks, whereas water injection was treated as a sensory task. Phase-amplitude coupling between lower-frequency and high γ (HG) bands (75–150 Hz) was investigated. An α (10–16 Hz)-HG coupling appeared before motor-related HG power increases (burst), and a θ (5–9 Hz)-HG coupling appeared during sensory-related HG bursts. The peaks of motor-related coupling were 0.6–0.7 s earlier than that of HG power. The motor-related HG was modulated at the trough of the α oscillation, and the sensory-related HG amplitude was modulated at the peak of the θ oscillation. These contrasting results can help to elucidate the brain's sensory motor functions. Swallowing has two aspects; sensory input and motor output Phase-amplitude coupling showed differences of motor and sensory neural processing Coupling between the α and high γ band occurred before motor-related high γ activities Coupling between the θ and high γ band occurred during sensory-related high γ activities
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan.,Department of Neurosurgery, Otemae Hospital, Chuo-ku Otemae 1-5-34, Osaka, Osaka 540-0008, Japan.,Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Kazutaka Takahashi
- Department of Organismal Biology and Anatomy, The University of Chicago, 1027 E 57 St, Chicago, IL 60637, USA
| | - Seiji Kameda
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Fumiaki Yoshida
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan.,Department of Anatomy and Physiology, Saga Medical School Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, Saga 849-8501, Japan
| | - Hitoshi Maezawa
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Naoki Tani
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Hui Ming Khoo
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Toshiki Yoshimine
- Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan.,Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
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Hashimoto H, Khoo HM, Yanagisawa T, Tani N, Oshino S, Kishima H, Hirata M. Phase-amplitude coupling of ripple activities during seizure evolution with theta phase. Clin Neurophysiol 2021; 132:1243-1253. [PMID: 33867253 DOI: 10.1016/j.clinph.2021.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/25/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE High-frequency activities (HFAs) and phase-amplitude coupling (PAC) are key neurophysiological biomarkers for studying human epilepsy. We aimed to clarify and visualize how HFAs are modulated by the phase of low-frequency bands during seizures. METHODS We used intracranial electrodes to record seizures of focal epilepsy (12 focal-to-bilateral tonic-clonic seizures and three focal-aware seizures in seven patients). The synchronization index, representing PAC, was used to analyze the coupling between the amplitude of ripples (80-250 Hz) and the phase of lower frequencies. We created a video in which the intracranial electrode contacts were scaled linearly to the power changes of ripple. RESULTS The main low frequency band modulating ictal-ripple activities was the θ band (4-8 Hz), and after completion of ictal-ripple burst, δ (1-4 Hz)-ripple PAC occurred. The ripple power increased simultaneously with rhythmic fluctuations from the seizure onset zone, and spread to other regions. CONCLUSIONS Ripple activities during seizure evolution were modulated by the θ phase. The PAC phenomenon was visualized as rhythmic fluctuations. SIGNIFICANCE Ripple power associated with seizure evolution increased and spread with fluctuations. The θ oscillations related to the fluctuations might represent the common neurophysiological processing involved in seizure generation.
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; Department of Neurosurgery, Otemae Hospital, Osaka 540-0008, Japan; Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Suita 565-0871, Japan.
| | - Hui Ming Khoo
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Naoki Tani
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Suita 565-0871, Japan; Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
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